Angiology
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Sodium tetradecyl sulfate is a sclerosing agent that has been widely used to treat varicose veins of the legs and digestive tract. Despite the multitude of side-effects of sclerotherapy procedures and sclerosing-drug administration, the medical literature reports only on a few cases of life-threatening hypersensitivity reactions resulting from sodium tetradecyl sulfate therapy. A case is reported of a 49-year-old woman who developed anaphylactoid reaction after the administration of the Fibro-vein for varicose veins in the legs. Attention is drawn to this adverse event and underlines the necessity for potential hypersensitivity assessment before the drug application.
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Alterations in nitric oxide synthase (NOS) are implicated in ischemia and ischemia-reperfusion injury. Changes in the 3 NOS isoforms in human skeletal muscle subjected to acute ischemia and reperfusion were studied. Muscle biopsies were taken from patients undergoing total knee replacement. ⋯ No changes in NOS II/inducible NOS expression or NOS activity occurred. In conclusion, alterations in NOS I and III (neuronal NOS and endothelial NOS) at different levels occurred after acute ischemia and reperfusion in human skeletal muscle; however, this did not result in increased NOS activity. In the development of therapeutic agents based on manipulation of the NO pathway, targeting the appropriate NOS isoenzymes may be important.
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Myocardial injury caused by blunt chest trauma has been recognized with increased frequency over the past 2 decades. Increased awareness by physicians and the increased use of various clinical and laboratory diagnostic modalities have contributed to this recognition. Injuries range from inconsequential to catastrophic and can affect any or all areas of the heart: pericardium, myocardium, coronary arteries and veins, chordae, papillary muscles, valves, and great vessels. ⋯ It is important to assess and classify properly the extent of the trauma and its prognostication as to the possibility of residual sequelae. A proposed classification is presented that has both medical and legal application. The uses of stages 0 (suspect), I (mild), II (moderate), III (severe), and IV (catastrophic) are illustrated in detail.
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To determine the optimal cuff width for measuring toe blood pressure in patients with lower limb ischemia, this experimental prospective study examined 20 patients with symptoms of peripheral arterial disease referred for vascular examination or vascular surgery. Toe blood pressure was measured hydrostatically by the pole test using cuffs of different widths. Pole test reflects the true physiological blood pressure value and was the reference method. ⋯ Using the 1.5-cm and 3.0-cm cuffs, the differences were 27.0 mm Hg (95% CI, 13-43 mm Hg) and -2.0 mm Hg (95% CI, -11 to 8 mm Hg), respectively. The cuff width greatly affects the obtained toe blood pressure value, and larger cuffs correspond better to the hydrostatic pressure. For clinical use and as a reporting standard, we propose that toe blood pressure measurements should be made using a 2.5-cm-wide cuff.
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Comparative Study
Outcome of significant functional tricuspid regurgitation late after mitral valve replacement for predominant rheumatic mitral stenosis.
Significant tricuspid regurgitation (TR) can contribute to increased morbidity and mortality in patients undergoing mitral valve surgery for mitral stenosis. The aim of this study was to evaluate the association between the severity of preoperative functional TR and late adverse outcomes in patients undergoing mitral valve replacement (MVR). The study group comprised 68 patients (54 women, 14 men; mean age 45 +/-10 years) with rheumatic mitral stenosis (MS) who had undergone MVR without tricuspid valve surgery between 4 and 13 years (mean 8.1 +/-2.6 years) before their last clinical examination. ⋯ Freedom from symptomatic heart failure (functional class III or IV) was higher (86% vs 54%) and the need for hospitalization was significantly lower for the mild TR group. Significant preoperative functional TR diagnosed by echocardiography was associated with an adverse outcome. Therefore, further studies are needed to evaluate the effect of concomitant tricuspid valve repair on the late outcome of patients undergoing mitral valve surgery in order to prevent significant late morbidity.