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Roberts CS, Hassan MH, Hasson L, Guileyardo JM, Roberts WC. Fatal Acute Myocardial Infarction With Normal Epicardial Coronary Arteries Shortly Following COVID-19 Vaccination. Am J Cardiol 2024; 218:68-71. [PMID: 38428710 DOI: 10.1016/j.amjcard.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/26/2024] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
Myocarditis and acute myocardial infarction (AMI) have been reported after COVID-19 messenger ribonucleic acid vaccination. Nearly all reported patients with myocarditis or AMI after COVID-19 vaccination have survived and become asymptomatic. Described herein is a previously healthy man who developed severe heart decompensation shortly after receiving a COVID-19 vaccination and died approximately 40 hours later. An autopsy disclosed massive AMI.
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Affiliation(s)
- Charles S Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Murad H Hassan
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Lena Hasson
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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2
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Biancari F, Dell'Aquila AM, Onorati F, Rossetti C, Demal T, Rukosujew A, Peterss S, Buech J, Fiore A, Folliguet T, Perrotti A, Hervé A, Nappi F, Conradi L, Pinto AG, Lega JR, Pol M, Kacer P, Wisniewski K, Mazzaro E, Gatti G, Vendramin I, Piani D, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Acharya M, Mariscalco G, Field M, Kuduvalli M, Pettinari M, Rosato S, Mustonen C, Kiviniemi T, Roberts CS, Mäkikallio T, Juvonen T. Classification of the Urgency of the Procedure and Outcome of Acute Type A Aortic Dissection. Am J Cardiol 2024; 217:59-67. [PMID: 38401652 DOI: 10.1016/j.amjcard.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
Surgery for type A aortic dissection (TAAD) is associated with a high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study. Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD). The rates of in-hospital mortality of 3,902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure 10.0%, emergency procedure grade 1 13.3%, emergency procedure grade 2 22.1%, salvage procedure grade 1 45.6%, and salvage procedure grade 2 57.1% (p <0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model and the integrated discrimination indexes and the net reclassification indexes. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades. In conclusion, the urgency of surgical repair of acute TAAD, which seems to have a significant impact on the risk of in-hospital mortality, may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of the patients may survive to discharge.
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Affiliation(s)
- Fausto Biancari
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Cecilia Rossetti
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Andreas Rukosujew
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Amélie Hervé
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Angel G Pinto
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Rodriguez Lega
- Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marek Pol
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital, Udine, Italy
| | - Luisa Ferrante
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona Spain
| | - Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona Spain
| | - Sebastien Gerelli
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Dario Di Perna
- Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Metesh Acharya
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matteo Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Stefano Rosato
- National Center for Global Health, Istituto Superiore di Sanitá, Rome, Italy
| | - Caius Mustonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
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Jeong M, Bonilla A, Roberts WC, Roberts CS, Banerjee S. Causes of Malfunction of Bioprostheses Inserted Percutaneously in the Aortic Valve Position in Patients Whose Native Aortic Valve Was Congenitally Bicuspid and Stenotic. Am J Cardiol 2023; 209:24-28. [PMID: 37848171 DOI: 10.1016/j.amjcard.2023.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has brought in recent years relief of cardiac-induced symptoms to a large number of patients with aortic stenosis. Whether it is better to use TAVI for the treatment of aortic valve stenosis superimposed on a congenitally bicuspid valve has been debated in contrast to its proved usefulness in aortic valve stenosis involving a tricuspid aortic valve. From January 2020 to March 2023, surgical aortic valve replacement of TAVI valve and native aortic valve was done in 6 patients. The clinical findings of the patients and morphologic findings from the surgical specimens submitted to the cardiac pathology department were subsequently examined. All the 6 native aortic valves had bicuspid configuration. The TAVI valve in each patient was excised from 9 to 88 months (mean 36 months) after it had been implanted because of paravalvular leak in 4, severe stenosis of the prosthetic valve in 1, and bioprosthetic cuspal degeneration in 1. Prosthetic valve endocarditis was clinically suspected in 2 patients, but the specimen culture was negative. Before surgical aortic valve replacement, 3 patients experienced stroke after TAVI. All 6 patients had low hemoglobin levels (mean 9.5 mg/100 ml) and low hematocrit levels (mean 29.5%). Reticulocyte count was available in 4 patients and was increased in all (mean 3.5%). When the stenotic native aortic valve configuration is bicuspid, the raphe tends to be calcified first and located perpendicular to the flow of the blood and may prevent the ring of the caged bioprosthesis from being transferred to the aortic wall, which is a requirement for full opening of the lumen of the bioprosthesis. Thus, thorough consideration needs to be made before performing TAVI in patients whose native aortic valve is stenotic and bicuspid.
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Affiliation(s)
- Minseob Jeong
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Arantza Bonilla
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; University of Texas at Dallas, Dallas, Texas
| | - William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Subhash Banerjee
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Division of Cardiology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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Roberts WC, Salam YM, Roberts CS. Examination of Non-Infected Operatively-Excised Bioprostheses in the Aortic Valve Position to Determine the Reason for their Dysfunction. Am J Cardiol 2023; 189:137-147. [PMID: 36642461 DOI: 10.1016/j.amjcard.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 01/15/2023]
Abstract
Described herein are findings in 55 non-infected bioprostheses that had been in the aortic valve position from 2 to 276 months (mean 107). The major purpose of this study was to illustrate the variable causes prompting excision of the bioprostheses. Fifty-three (96%) patients survived ≥ 30 days following the bioprosthetic excision and 50 (91%) patients lived ≥1 year postoperatively. The techniques used to explant the bioprostheses appear to vary considerably among the operating surgeons.
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Affiliation(s)
- William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Yusuf M Salam
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Charles S Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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Roberts WC, Roberts CS, Meyer DM. Acute Dissection of Epicardial Coronary Arteries Shortly Following Full Term Delivery Resulting in Acute Myocardial Infarction and Leading to Orthotopic Heart Transplantation. Am J Cardiol 2022; 185:129-131. [DOI: 10.1016/j.amjcard.2022.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
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Roberts CS, Roberts WC. Circumferential Fibrosis of the Ascending Aorta After COVID Infection. Am J Cardiol 2022; 184:154-156. [PMID: 36184351 PMCID: PMC9595303 DOI: 10.1016/j.amjcard.2022.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022]
Abstract
After recovering from severe COVID-19 infection, 2 women presented with chest pain. Computed tomographic angiography suggested acute ascending aortic dissection. At operation in both patients, the ascending aorta was encased in dense fibrous tissue, within which were focal collections of mononuclear cells, including many plasma cells. There was no entry tear or dissection. Such findings we have not encountered previously, and PubMed search of “periaortic fibrosis and COVID-19” yielded no similar cases or possible relation.
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7
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Roberts CS, Roberts WC. Diagnosing aortic syphilis. Proc (Bayl Univ Med Cent) 2022; 35:822-823. [DOI: 10.1080/08998280.2022.2104528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Charles S. Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas
| | - William C. Roberts
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
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8
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Roberts CS, Roberts CC, Roberts WC. Cardiac Findings at Necropsy in Acute Type A Aortic Dissection. Am J Cardiol 2022; 170:155-159. [PMID: 35400482 DOI: 10.1016/j.amjcard.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/01/2022]
Abstract
Described herein are necropsy findings in 97 patients aged 22 to 82 years (mean 55), 37 women, 60 men, studied at necropsy with acute aortic dissection (AD) with the intimal-medial tear in the ascending aorta. The cases were studied from 1966 to 1989, a period when echocardiography and computed tomography were relatively infrequently available for diagnosis of AD. Arteriography was the method for diagnosis in most cases. Of the 97 cases, 30(31%) had operative intervention and 67 did not. Most appeared to have had systemic hypertension before the acute AD; only 4 had previous heart failure; only 8 had considerable atherosclerotic coronary disease; only 4 had a left ventricular (LV) scar and in each it was small; most (96%) had a normal-sized LV cavity (suggesting normal cardiac indices in them), and the other 4 had only a mildly dilated cavity; the heart weight in all 97 patients was increased; the quantity of subepicardial adipose tissue was increased in most patients, and the frequency of a congenitally malformed aortic valve was much higher than in the general population (6% - vs- 1%), but still uncommon. Thus, in > 90% of patients with acute Type A AD, coronary atherosclerosis was insignificant, myocardial fibrosis is absent, and the aortic valve has 3 cusps without stenosis.
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Abstract
The occurrence of acute aortic dissection with the initiating tear in the ascending aorta superimposed on cardiovascular syphilis is an exceedingly rare occurrence. Such was the case, however, in a recently seen patient who presented with typical features of acute dissection (type A). Operative repair yielded the entire ascending aorta to examine both grossly and histologically and classic features of both conditions were observed.
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Affiliation(s)
- William C Roberts
- Baylor Scott & White Heart and Vascular Institute, the Departments of; Internal Medicine,; Pathology,.
| | - Charles S Roberts
- Baylor Scott & White Heart and Vascular Institute, the Departments of; Cardiac and Thoracic Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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10
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Baginski BN, Roberts CS. Education in the operating room. Proc AMIA Symp 2022; 35:397. [DOI: 10.1080/08998280.2022.2030176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Charles S. Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas
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11
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Roberts CS. The Physician Legacy of Stewart R. Roberts, MD (1878-1941), "The Osler of the South". Am J Cardiol 2022; 162:191-196. [PMID: 34903341 DOI: 10.1016/j.amjcard.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas.
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12
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Roberts WC, Salam YM, Roberts CS. Morphologic Findings in Native Mitral Valves Replaced for Isolated Acute Infective Endocarditis. Am J Cardiol 2022; 162:136-142. [PMID: 34903338 DOI: 10.1016/j.amjcard.2021.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/31/2021] [Indexed: 11/01/2022]
Abstract
Described here are some clinical and morphological observations in 37 adults having mitral valve replacement for active infective endocarditis limited to the mitral valve. The operatively-excised mitral valves are illustrated in 11 of the 37 patients, and photographs in them show that mitral valve repair in them would have been fruitless. Of the 37 patients, 32 (86%) survived the early operative period (30 days) and 31 (84%) were alive one year after the mitral operation. Of the 37 patients, 34 (92%) appeared to have had anatomically normal mitral valves before the infective endocarditis appeared.
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Roberts WC, Siddiqiquiz S, Roberts CS. Total 12-lead QRS voltage in patients with spontaneous acute aortic dissection with an initiating tear in the ascending aorta. Proc (Bayl Univ Med Cent) 2021; 34:446-450. [PMID: 34219923 DOI: 10.1080/08998280.2021.1896060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Because nearly all patients with acute aortic dissection have systemic hypertension, we examined electrocardiograms (ECGs) in 21 patients with spontaneous acute type A aortic dissection. An earlier study had shown that total 12-lead QRS voltage was the best criterion for determining left ventricular hypertrophy from the ECG. We measured total 12-lead QRS voltage in 21 patients with spontaneous (no previous cardiac or aortic operation) acute type A aortic dissection and operative repair. Using >175 mm as evidence of left ventricular hypertrophy, only 8 patients (38%) had hearts of increased mass. Total 12-lead QRS voltage corresponded slightly with age but not with body mass index. In conclusion, total 12-lead QRS voltage is not useful for diagnostic purposes in patients with acute type A aortic dissection undergoing operative repair.
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Affiliation(s)
- William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.,Division of Cardiology, Department of Medicine, Baylor University Medical Center, Dallas, Texas
| | - Shaffin Siddiqiquiz
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.,Princeton University, Princeton, New Jersey
| | - Charles S Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.,Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas
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Abstract
Coronavirus disease 2019 (COVID-19) initiates a hypercoagulable state and causes thrombotic complications. A presentation of multiple thromboembolic events without an underlying source should raise suspicion for COVID-19 hypercoagulability. We describe a patient with an ascending aortic thrombus resulting in multiple emboli treated by multiple modalities.
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Affiliation(s)
- Portia Schmidt
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Javier Vasquez
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Bryce Gagliano
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Alastair J Moore
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas
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15
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Raju B, Roberts CS, Sathyamoorthy M, Schiffman R, Swift C, McCullough PA. Ventricular Septal Myectomy for the Treatment of Left Ventricular Outflow Tract Obstruction Due to Fabry Disease. Am J Cardiol 2020; 132:160-164. [PMID: 32773220 DOI: 10.1016/j.amjcard.2020.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Fabry cardiomyopathy can cause symptomatic left ventricular outflow tract obstruction. We review a case of Fabry cardiomyopathy mimicking hypertrophic cardiomyopathy on echocardiography with severe left ventricular outflow tract obstruction treated with ventricular septal myectomy.
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16
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Hamman BL, Henry AC, Hebeler RF, Rafael AE, Gonzalez-Stawinski GV, Enter DH, Mercado-Reza A, Leeper B, Roberts CS. High-quality cardiac surgery through teamwork. Proc (Bayl Univ Med Cent) 2020; 34:215-220. [PMID: 33456201 DOI: 10.1080/08998280.2020.1811057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The high-quality cardiothoracic surgery program is primed for mindful effective surgery. The challenge lies in attaining mindful skills and efficiency. Herein is one journey toward high departmental quality over two decades.
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Affiliation(s)
- Baron L Hamman
- Department of Cardiothoracic Surgery, Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, Texas
| | - A Carl Henry
- Department of Cardiothoracic Surgery, Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, Texas
| | - Robert F Hebeler
- Department of Cardiothoracic Surgery, Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, Texas
| | - Aldo E Rafael
- Department of Cardiothoracic Surgery, Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, Texas
| | - Gonzalo V Gonzalez-Stawinski
- Department of Cardiothoracic Surgery, Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, Texas
| | - Daniel H Enter
- Department of Cardiothoracic Surgery, Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, Texas
| | - Aaron Mercado-Reza
- Department of Cardiothoracic Surgery, Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, Texas
| | - Bobbi Leeper
- Department of Cardiothoracic Surgery, Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, Texas
| | - Charles S Roberts
- Department of Cardiothoracic Surgery, Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, Texas
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17
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Selbst MA, Roberts CS, Schussler JM. Hanging by a thread-urgent coronary artery bypass grafting for ST elevation myocardial infarction in a patient with isolated left main coronary artery disease. Proc (Bayl Univ Med Cent) 2020; 33:457-459. [PMID: 32675987 DOI: 10.1080/08998280.2020.1759338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022] Open
Abstract
A 78-year-old man presented with a left main stenosis as the culprit lesion in an acute myocardial infarction. He had no significant narrowing in any other coronary territory. This case describes findings in an isolated left main myocardial infarction and discusses appropriate treatment strategies.
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Affiliation(s)
| | - Charles S Roberts
- The Baylor Scott & White Heart and Vascular HospitalDallasTexas.,Division of Cardiothoracic Surgery, Baylor University Medical CenterDallasTexas
| | - Jeffrey M Schussler
- The Baylor Scott & White Heart and Vascular HospitalDallasTexas.,Division of Cardiology, Baylor University Medical CenterDallasTexas
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Chalkley RA, Roberts WC, Patlolla S, Schussler JM, Snyder RW, Smith RL, Roberts CS, Meyer DM. Giant Right Coronary Artery Aneurysms. Am J Cardiol 2020; 125:1599-1601. [PMID: 32245634 DOI: 10.1016/j.amjcard.2020.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/25/2022]
Abstract
Described herein are 2 adults with right coronary artery aneurysms measuring ≥4.0 cm in maximal diameter. Each aneurysm contained huge intra-aneurysm thrombus and each coronary artery contained atherosclerotic plaques diffusely. Each aneurysm was resected without complication and each patient has resumed preoperative level of activities without limitations.
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Roberts CS, Stoler RC, Roberts WC. The Case for Primary Prevention of Atherosclerotic Events from Study of a Single Patient. Am J Cardiol 2020; 125:1443-1445. [PMID: 32005440 DOI: 10.1016/j.amjcard.2019.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
This report describes a 64-year-old woman who presented with unstable angina pectoris, her first atherosclerotic event, and who underwent coronary bypass including endarterectomy of the entire right coronary artery which was diffusely and severely narrowed by atherosclerotic plaque. Preoperatively, she fulfilled none of the present-day criteria for lipid-lowering drug therapy. The report demonstrates the deficiency of present-day lipid-lowering drug guidelines and emphasizes the need to switch emphasis from decreasing risk of an atherosclerotic event to the prevention of arterial plaques, a goal which will require a much lower threshold of low-density lipoprotein cholesterol to initiate drug therapy.
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20
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Roberts CS, Roberts WC. The Layer Where the Coronary Arterial "Endarterectomy" Specimen Separates from the Underlying Artery. Am J Cardiol 2020; 125:999-1000. [PMID: 31980140 DOI: 10.1016/j.amjcard.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
Described herein is a patient who had a coronary endarterectomy at the time of coronary artery bypass grafting. Histologic study of cross-sections of the endarterectomy specimen disclosed that the layer of separation of the endarterectomy specimen from the underlying native artery was in the media. This layer or plane of excision is virtually always the media irrespective of the artery having the endarterectomy. The procedure might better be called "endomediaectomy?"
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas.
| | - William C Roberts
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas; Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
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21
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Hansen SK, Vasquez J, Roberts CS. Direct access of ascending aorta for endograft delivery in the descending thoracic aorta. J Vasc Surg Cases Innov Tech 2020; 6:63-66. [PMID: 32072091 PMCID: PMC7016351 DOI: 10.1016/j.jvscit.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022]
Abstract
First-line therapy for aneurysm, dissection, or rupture of the descending thoracic aorta is now by the endovascular approach. Retrograde insertion of the endograft, through access from the femoral arteries, is the preferred approach. This case presents a new, innovative technique for delivery of an endoprosthesis into the descending thoracic aorta when hostile anatomy prevents delivery from the femoral arteries, iliac arteries, or infrarenal abdominal aorta in a patient not suitable for open repair.
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Affiliation(s)
- Spencer K Hansen
- Department of Vascular Surgery, Baylor Scott & White Heart and Vascular Hospital, Dallas, Tex
| | - Javier Vasquez
- Department of Vascular Surgery, Baylor Scott & White Heart and Vascular Hospital, Dallas, Tex
| | - Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, Tex
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Roberts WC, Kale I, Roberts CS. Perforation of a Stenotic Congenitally Bicuspid Aortic Valve Cusp by Heavy Calcium in the Other Cusp. Am J Cardiol 2020; 125:299-301. [PMID: 31847960 DOI: 10.1016/j.amjcard.2019.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/24/2019] [Indexed: 11/25/2022]
Abstract
On occasion in patients with stenotic congenitally bicuspid aortic valves (BAVs), the quantity of calcium in one of the cusps is considerably greater than in the other cusp. We examined operatively excised stenotic congenitally BAVs in 630 patients having isolated aortic valve replacement (No other cardiac valve was replaced, and none had had infective endocarditis.) Of the 630 valves, 3 contained a perforation in the mildly calcified cusp due to a large calcific "spur" extending across the orifice from a heavily calcified cusp. In conclusion, heavy calcific deposits in 1 of 2 BAVs may extend across the orifice causing a perforation in the noncalcified portion of the opposing cusp.
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Roberts WC, Siddiquiz S, Rafael-Yarihuaman AE, Roberts CS. Management of Adults With Normally Functioning Congenitally Bicuspid Aortic Valves and Dilated Ascending Aortas. Am J Cardiol 2020; 125:157-160. [PMID: 31718787 DOI: 10.1016/j.amjcard.2019.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
We describe herein a 65-year-old woman who underwent resection of a dilated (5.1 cm) ascending aorta associated with a normally functioning congenitally bicuspid aortic valve. The patient provided the framework to discuss proper management-operative versus nonoperative-of the dilated ascending aorta associated with a normally functioning bicuspid aortic valve. Unfortunately, there is inadequate data to provide an unequivocal answer to this dilemma. Operative intervention requires that the short-term risk of the prophylactic procedure be considerably lower than the long-term risk of aortic dissection/rupture without operative intervention. Because there is no proof that operative intervention provides less morbidity and lower mortality, nonoperative management at this time seems to be the better approach.
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Roberts CS, Salam YM, Moore AJ, Roberts WC. Pseudoaneurysm of the Ascending Aorta at the Cannulation Site Diagnosed More Than Four Decades After Repair of Ventricular Septal Defect. Am J Cardiol 2019; 124:1962-1965. [PMID: 31699357 DOI: 10.1016/j.amjcard.2019.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022]
Abstract
Described herein is a 69-year-old woman who developed a large saccular aortic aneurysm at a previous cannulation site for repair of a ventricular septal defect at age 25 years. The aneurysm was resected and proved histologically to be a false one. The long interval between operations (44 years) exceeds those reported previously.
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Yusuf M Salam
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Alastair J Moore
- Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Radiology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - William C Roberts
- Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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25
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Roberts WC, Moore AJ, Roberts CS. Syphilitic aortitis: still a current common cause of aneurysm of the tubular portion of ascending aorta. Cardiovasc Pathol 2019; 46:107175. [PMID: 31951962 DOI: 10.1016/j.carpath.2019.107175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022] Open
Abstract
Aortic syphilis today is infrequently diagnosed clinically. Described herein are findings in 5 women who had resection of a fusiform aneurysm of the tubular portion of ascending aorta, and examination of the wall of the aneurysm disclosed classic features of aortic syphilis. The 5 patients were among 36 who had ascending aortic operations at Baylor University Medical Center in Dallas in 2018 and early 2019. Syphilitic aneurysm in each spared the sinus portion and involved diffusely the tubular portion of ascending aorta, beginning at the sinotubular junction. The aneurysmal wall was thicker than normal because of thickening of both intima and adventitia. The latter contained foci of lymphocytes and plasmacytes and thickened and narrowed vasa vasora. The media was disrupted by fibrous scars, which weakened the integrity of the aorta. Aortitis of the tubular portion of ascending aorta in syphilis is a diffuse process, but often is mistakenly called "atherosclerosis" which, when present in this portion of aorta, can be extensive but is focal. Aortic syphilis is important to diagnose so that patients can receive antibiotic therapy to delay, prevent, or treat neurosyphilis, a common accompaniment of aortic syphilis.
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Affiliation(s)
- William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA; Department of Internal Medicine (Cardiology Division) and Pathology, Baylor University Medical Center, Dallas, TX, USA.
| | - Alastair J Moore
- Department of Radiology Baylor University Medical Center, Dallas, TX, USA
| | - Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, TX, USA
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Roberts CS, Dunn MA. Postpartum inferior vena cava thrombosis treated by endovascular suction thrombectomy utilizing veno-venous extracorporeal circulation. Proc (Bayl Univ Med Cent) 2019; 32:554-556. [PMID: 31656417 DOI: 10.1080/08998280.2019.1629206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022] Open
Abstract
Vena cava thrombosis arising from ovarian vein thrombosis in the postpartum period is a challenging clinical problem with limited treatment options. We describe the first reported use of veno-venous extracorporeal circulation and endovascular suction thrombectomy to treat inferior vena cava thrombosis in a postpartum patient.
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical CenterDallasTexas
| | - Matthew A Dunn
- Department of Radiology, Trident Medical CenterCharlestonSouth Carolina
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Roberts CS, Milligan GP, Stoler RC, Grayburn PA, Roberts WC. Mitral stenosis produced by infective endocarditis involving a previously anatomically normal valve. Proc (Bayl Univ Med Cent) 2019; 32:387-389. [PMID: 31384194 DOI: 10.1080/08998280.2019.1617011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022] Open
Abstract
Described herein is a 63-year-old man who developed methicillin-sensitive Staphylococcus aureus endocarditis on a previously anatomically normal mitral valve. The resulting vegetations were so large that severe mitral stenosis resulted. The development of valve stenosis due exclusively to infective endocarditis is extremely rare.
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
| | - Gregory P Milligan
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
| | - Robert C Stoler
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
| | - Paul A Grayburn
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
| | - William C Roberts
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
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Roberts WC, Lee AY, Lander SR, Roberts CS, Hamman BL. Libman-Sacks Endocarditis Involving a Bioprosthesis in the Aortic Valve Position in Systemic Lupus Erythematosus. Am J Cardiol 2019; 124:316-318. [PMID: 31133276 DOI: 10.1016/j.amjcard.2019.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 11/16/2022]
Abstract
Described herein is a 39-year-old man with systemic lupus erythematosus not receiving corticosteroid therapy who developed Libman-Sacks endocarditis causing stenosis of a bioprosthesis in the aortic valve position.
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Affiliation(s)
- William C Roberts
- Baylor Scott and White Heart and Vascular Institute, Departments of Internal Medicine and Heart Surgery, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas; Departments of Internal Medicine (Division of Cardiology) and Cardiac Surgery, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas.
| | - Andy Y Lee
- Departments of Internal Medicine (Division of Cardiology) and Cardiac Surgery, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Stuart R Lander
- Departments of Internal Medicine (Division of Cardiology) and Cardiac Surgery, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Charles S Roberts
- Cardiothoracic Surgery, Department of Cardiology, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Baron L Hamman
- Cardiothoracic Surgery, Department of Cardiology, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
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29
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Roberts CS, Carry MM, Choi JW, Grayburn PA, Roberts WC. Papillary fibroelastoma in the left atrium. Proc (Bayl Univ Med Cent) 2019; 32:247-248. [PMID: 31191142 DOI: 10.1080/08998280.2018.1553439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022] Open
Abstract
Described herein is a 71-year-old woman with previous angina pectoris who suddenly developed slurred speech and right-arm weakness. She was found to have significant coronary narrowing, a small mass in the left atrium attached to the endocardium near the orifice of the appendage, and multifocal punctate cerebral lesions in the distribution of the left middle cerebral artery. The left atrial mass was excised and confirmed to be a papillary fibroelastoma. Coronary bypass was also performed. It is believed that fibrin thrombus developed within the fronds of the fibroelastoma and embolized to the brain. Such lesions in the left atrium are exceedingly uncommon. She had no further emboli events.
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac and Thoracic Surgery, Baylor University Medical CenterDallasTexas.,Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
| | - Melissa M Carry
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
| | - James W Choi
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
| | - Paul A Grayburn
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas.,Baylor Scott & White Heart and Vascular Institute, Baylor University Medical CenterDallasTexas
| | - William C Roberts
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical CenterDallasTexas.,Baylor Scott & White Heart and Vascular Institute, Baylor University Medical CenterDallasTexas
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Roberts WC, Jameson LC, Bahmani A, Roberts CS, Rafael AE, Hall SA. Morphological and Functional Characteristics of the Right Ventricle Functioning as a Systemic Ventricle for Decades After an Atrial Switch Procedure for Complete Transposition of the Great Arteries. Am J Cardiol 2019; 123:1863-1867. [PMID: 30955865 DOI: 10.1016/j.amjcard.2019.02.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Abstract
Described herein are certain clinical and cardiac morphologic findings in 4 adults with complete transposition of the great arteries who underwent the Mustard procedure in the newborn period or in childhood and each lived >30 years thereafter before either having orthotopic heart transplantation (3 patients) or dying while awaiting orthotopic heart transplantation. Compared with the wall of the left ventricle, the wall of the right ventricle (the systemic one) was much thicker, the myofibers much larger, and either grossly-visible or microscopic-sized scars were present in its wall. Additionally, some intramural coronary arteries in the right ventricular wall were numerous, large, had thick walls, and often narrowed lumens. That the Mustard operation provided the necessary time for the right ventricle (the systemic one) to develop to its fullest is a tribute to this procedure.
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Clancy AJ, Anthony DB, Fisher SJ, Leese HS, Roberts CS, Shaffer MSP. Reductive dissolution of supergrowth carbon nanotubes for tougher nanocomposites by reactive coagulation spinning. Nanoscale 2017; 9:8764-8773. [PMID: 28620663 DOI: 10.1039/c7nr00734e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Long single-walled carbon nanotubes, with lengths >10 μm, can be spontaneously dissolved by stirring in a sodium naphthalide N,N-dimethylacetamide solution, yielding solutions of individualised nanotubide ions at concentrations up to 0.74 mg mL-1. This process was directly compared to ultrasonication and found to be less damaging while maintaining greater intrinsic length, with increased individualisation, yield, and concentration. Nanotubide solutions were spun into fibres using a new reactive coagulation process, which covalently grafts a poly(vinyl chloride) matrix to the nanotubes directly at the point of fibre formation. The grafting process insulated the nanotubes electrically, significantly enhancing the dielectric constant to 340% of the bulk polymer. For comparison, samples were prepared using both Supergrowth nanotubes and conventional shorter commercial single-walled carbon nanotubes. The resulting nanocomposites showed similar, high loadings (ca. 20 wt%), but the fibres formed with Supergrowth nanotubes showed significantly greater failure strain (up to ∼25%), and hence more than double the toughness (30.8 MJ m-3), compared to composites containing typical ∼1 μm SWCNTs.
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Affiliation(s)
- A J Clancy
- Imperial College London, Department of Chemistry, Frankland Road, London, SW7 2AZ, UK.
| | - D B Anthony
- Imperial College London, Department of Chemistry, Frankland Road, London, SW7 2AZ, UK.
| | - S J Fisher
- Imperial College London, Department of Chemistry, Frankland Road, London, SW7 2AZ, UK.
| | - H S Leese
- Imperial College London, Department of Chemistry, Frankland Road, London, SW7 2AZ, UK.
| | - C S Roberts
- Imperial College London, Department of Chemistry, Frankland Road, London, SW7 2AZ, UK.
| | - M S P Shaffer
- Imperial College London, Department of Chemistry, Frankland Road, London, SW7 2AZ, UK.
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Zigmond J, Pecen L, Tichopad A, Roberts CS, Jomaa I. Modeled Outcomes and Overall Costs of the 13-Valent Pneumococcal Conjugate Vaccine in the Tunisian National Vaccination Program. Value Health 2014; 17:A607-A608. [PMID: 27202107 DOI: 10.1016/j.jval.2014.08.2122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Zigmond
- CEEOR s. r. o., Prague, Czech Republic
| | - L Pecen
- CEEOR s. r. o., Prague, Czech Republic
| | | | | | - I Jomaa
- Pfizer Pharmaceuticals Tunisia, Tunis, Tunisia
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Samyshkin Y, Roberts CS, Koroleva N, Rodionov A. The Cost Burden of Community-Acquired Pneumonia in Russia in Adults of 50 and Older: A Regional Study and National Estimates. Value Health 2014; 17:A593. [PMID: 27202028 DOI: 10.1016/j.jval.2014.08.2038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - N Koroleva
- Sechenov Moscow Medical University, Moscow, Russia
| | - A Rodionov
- Tver State Medical Academy, Tver, Russia
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Tichopad A, Pecen L, Roberts CS, Uglesic L, Tesovic G, Rogier K. Cost-Effectiveness of 13-Valent Versus 10-Valent Pneumococcal Conjugate Vaccine Use in Croatia National Vaccination Program. Value Health 2014; 17:A608-A609. [PMID: 27202116 DOI: 10.1016/j.jval.2014.08.2127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - L Pecen
- CEEOR s. r. o., Prague, Czech Republic
| | | | - L Uglesic
- Pfizer Croatia d. o. o., Zagreb, Croatia
| | - G Tesovic
- University of Zagreb Medical School, Zagreb, Croatia
| | - K Rogier
- Pfizer bv, Capelle a/d IJssel, The Netherlands
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Harvey-Kelly KF, Kanakaris NK, Obakponovwe O, West R, Roberts CS, Giannoudis PV. The impact of traumatic pelvic fractures on sporting activity and quality of life. J R Nav Med Serv 2014; 100:73-80. [PMID: 24881432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Pelvic fractures (PFX) reflect high-energy trauma with high mortality and morbidity. AIM We attempted to determine: whether there is a decrease in levels of sporting and physical activity in patients with operatively-treated PFX; risk factors for decreased sporting activity; any correlation between sporting activity and quality of life in this group. METHODS Retrospective demographics on mechanism of injury, fracture type, associated injury and injury severity score, as well as prospective documentation of the level and frequency of sporting activity, were collected from adult patients treated operatively for a PFX between 2007 and 2010, using a specifically designed questionnaire. Quality of life before and after injury was also recorded using the EuroQol-5D health-outcome tool. RESULTS 80 patients without pre-existing musculoskeletal disability were enrolled. The mean age was 44.9 years (18-65). The mean follow-up was 30.5 months (12-39). A decrease in level and frequency of sporting activity was observed. It was associated with lower-extremity associated injuries, but not with injury severity score, PFX severity, PFX type, age, or timing of follow-up. Sporting activity before injury predicted higher levels of sporting participation after injury. Decreased sporting activity after injury was associated with decreased EuroQol-SD score. CONCLUSIONS Patients should be counselled on the likelihood of a reduction in sporting activities after surgically treated PFX. A larger multi-centre study is needed to further expand on the evidence of the true impact of PFX and its associated injuries on sporting activity.
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Roberts CS. On the relationship between the unidirectional and omnidirectional flux of trapped particles on a magnetic line of force. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/jz070i011p02517] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Roberts CS. Coordinates for the study of particles trapped in the Earth's magnetic field: A method of converting fromB, LtoR,λ coordinates. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/jz069i023p05089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Chapman RH, Ferrufino CP, Kowal SL, Classi P, Roberts CS. The cost and effectiveness of adherence-improving interventions for antihypertensive and lipid-lowering drugs*. Int J Clin Pract 2010; 64:169-81. [PMID: 20089007 DOI: 10.1111/j.1742-1241.2009.02196.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS Adherence to cardiovascular medications is poor. Accordingly, interventions have been proposed to improve adherence. However, as intervention-associated costs are rarely considered in full, we sought to review the effectiveness and costs associated with different adherence-improving interventions for cardiovascular disease therapies. METHODS We reviewed MEDLINE to update a prior review of interventions to improve adherence with antihypertensive and/or lipid-lowering therapy covering January 1972 to June 2002, to add studies published from July 2002 to October 2007. Eligible studies evaluated > or = 1 intervention compared with a control, used measures other than self-report, reported significant improvement in adherence and followed patients for > or = 6 months. Effectiveness was measured as relative improvement (RI), the ratio of adherence in the intervention group to the control group. Costs were calculated based on those reported in the analysis, if available or estimated based on resource use described. All costs were truncated to 6 months and adjusted to 2007 US$. RESULTS Of 755 new articles, five met all eligibility criteria. Combining with the prior review gave 23 interventions from 18 studies. RI in adherence ranged from 1.11 to 4.65. Six-month intervention costs ranged from $10 to $142 per patient. Reminders had the lowest effectiveness (RI: 1.11-1.14), but were least costly ($10/6 months). Case management was most effective (RI: 1.23-4.65), but the most costly ($90-$130/6 months). CONCLUSIONS Generally, we found a positive association between intervention costs and effectiveness. Therefore, consideration of intervention costs, along with the benefits afforded to adherence, may help guide the design and implementation of adherence-improving programs.
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Affiliation(s)
- R H Chapman
- US Health Economics and Outcomes Research, IMS Health, Falls Church, VA 22046, USA.
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Wingard JR, Herbrecht R, Mauskopf J, Schlamm HT, Marciniak A, Roberts CS. Resource use and cost of treatment with voriconazole or conventional amphotericin B for invasive aspergillosis. Transpl Infect Dis 2007; 9:182-8. [PMID: 17605747 DOI: 10.1111/j.1399-3062.2007.00210.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Voriconazole, a broad-spectrum triazole, has demonstrated significantly improved survival compared with conventional amphotericin B (CAB) as initial therapy for invasive aspergillosis (IA). OBJECTIVE To compare health care resource use and cost at 12 weeks following first-line treatment with voriconazole compared with CAB for IA using resource use data collected during a clinical trial. METHODS Days of hospitalization, intensive care, antifungal drug use, and outpatient care were collected during a large randomized, controlled trial of patients with IA receiving initial treatment with voriconazole or CAB. Unit costs based on published data sources were applied to healthcare use to estimate 12-week costs following initiation of therapy. Resource use and costs were compared for each treatment arm overall and by survival. The sensitivity of total costs to changes in healthcare use and unit costs was examined. RESULTS Total hospital days and intensive care unit (ICU) days were similar for voriconazole and CAB (total: 27.8 vs. 27.7, P=0.97 and ICU: 5.6 vs. 8.1, P=0.11). Among survivors, voriconazole was associated with similar numbers of total hospital days (29.8 vs. 32.0 days, P=0.54) to CAB, but fewer ICU days (3.9 vs. 8.2, P=0.03). For non-survivors, those treated with voriconazole had a similar number of total hospital days (23.0 vs. 21.8, P=0.73) and ICU days (9.8 vs. 7.9, P=0.44). Patients treated with voriconazole had significantly more days alive and out of the hospital than with CAB at 12 weeks (40.3 vs. 28.4 days, P<0.001). Total costs were similar with voriconazole compared with CAB ($78,860 vs. $83,857, P=0.51). Differences in cost were not sensitive to changes in the input parameter values. CONCLUSIONS Using voriconazole first-line for treatment of IA resulted in significantly fewer deaths and similar treatment costs. Hospital-free survival was significantly greater for patients initially treated with voriconazole.
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Affiliation(s)
- J R Wingard
- University of Florida, Gainesville, Florida, USA.
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Abstract
With the development of systems of trauma care the management of pelvic disruption has evolved and has become increasingly refined. The goal is to achieve an anatomical reduction and stable fixation of the fracture. This requires adequate visualisation for reduction of the fracture and the placement of fixation. Despite the advances in surgical approach and technique, the functional outcomes do not always produce the desired result. New methods of percutaneous treatment in conjunction with innovative computer-based imaging have evolved in an attempt to overcome the existing difficulties. This paper presents an overview of the technical aspects of percutaneous surgery of the pelvis and acetabulum.
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Affiliation(s)
- P V Giannoudis
- Department of Orthopaedic and Trauma Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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Roberts CS. Three French Writers on the Art of Conversation. Proc (Bayl Univ Med Cent) 2006. [DOI: 10.1080/08998280.2006.11928219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hann DM, Baker F, Roberts CS, Witt C, McDonald J, Livingston M, Ruiterman J, Ampela R, Crammer C, Kaw O. Use of complementary therapies among breast and prostate cancer patients during treatment: a multisite study. Integr Cancer Ther 2006; 4:294-300. [PMID: 16282506 DOI: 10.1177/1534735405282109] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the use of complementary therapies (CT) among breast and prostate cancer patients during active cancer treatment. The authors compared use and beliefs about the role of CT in cancer recovery. METHODS A self-report survey was completed by 126 breast cancer patients and 82 prostate cancer patients as part of a multisite research project. The self-report questionnaire inquired about the use of various CTs, sources of information about CT, reasons for using CT, beliefs about the benefits and risks of CT, demographic characteristics, and cancer treatment history. RESULTS Most of the respondents were older than 50 years, Caucasian, married, had attended or completed college, and were less than 1 year post-diagnosis. Prostate cancer patients were significantly older than the breast cancer patients (P < .001). Several differences emerged between the groups. Compared to the prostate cancer patients, significantly more of the breast cancer patients reported using CT because they wanted to reduce the risk of recurrence (P < .01), play a more active role in recovery (P < .01), help manage stress (P < .01), take a more holistic approach (P < .01), or boost the immune system (P < .01). More of the prostate cancer patients reported using CT to have more control of their recovery (P < .05). The 2 groups also differed significantly (P < .01) on several beliefs about the potential benefits and risks of using CT. CONCLUSIONS Most of the patients in this study had used some form of CT since the time of their diagnosis. Differences among breast and prostate cancer patients with regard to their use of CT during cancer treatment should be considered by oncology professionals who are discussing this topic with their patients.
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Affiliation(s)
- D M Hann
- American Cancer Society Behavioral Research Center, Atlanta, Georgia 30329, USA.
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Abstract
This study was designed to determine if nicotine treatment alters the constrictor and/or dilator function of the vessels which regulate blood flow to intact bone. Nicotine (1.7 mg/kg/day) or nicotine-free, phosphate-buffered saline was administered subcutaneously to mature male rats for 2 weeks via osmotic mini-pumps. On the 14th day, the rats were anesthetized and in vivo experiments were performed to quantitate the changes in arterial blood pressure and perfusion of the intact tibia (measured by laser Doppler flowmetry) in response to two constrictor agonists (norepinephrine, NE and arginine vasopressin, AVP) and two vasodilator agents (acetylcholine, ACh and sodium nitroprusside, SNP). Dose-response curves were generated by plotting the change in the bone vascular resistance index (mmHg/bone perfusion units) evoked by each dose of agonist. In addition, bone arteriolar expression of endothelial nitric oxide synthase protein was quantitated by Western blot analysis. Nicotine treatment significantly enhanced the constriction of the bone vasculature in response to NE, but not to AVP. Vascular dilation in response to ACh and SNP was not changed by nicotine. These results indicate that nicotine selectively accentuates the constrictor response of the bone vasculature to exogenous NE. This enhanced constriction to NE is not due to impaired endothelial cell release of nitric oxide or diminished smooth muscle response to nitric oxide. Since NE and AVP activate similar cell signaling mechanisms to induce constriction, the selective enhancement of NE-induced constriction suggests that nicotine alters a mechanism unique to NE signaling; possibly the number or binding affinity of alpha adrenergic receptors. Since endogenous NE regulates basal blood flow to bone, the effect of nicotine to augment NE-induced constriction could lead to a chronic reduction in blood flow to bone.
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Affiliation(s)
- J B A Feitelson
- Department of Physiology and Biophysics, 1115A, Health Sciences Center, University of Louisville, KY 40292, USA
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McKee SA, Roberts CS, Deliargyris EN. Definitive repair of double-outlet right ventricle with subaortic ventricular septal defect and pulmonary atresia in adulthood. Am J Cardiol 2003; 91:380-2. [PMID: 12565108 DOI: 10.1016/s0002-9149(02)03179-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Scott A McKee
- Cardiology Section, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Donovan KD, Roberts CS. Establishment of a secondary prevention program for coronary bypass patients. Prog Cardiovasc Nurs 2002; 16:161-2. [PMID: 11684907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
To treat atherosclerosis systemically in the surgical patient, proper drug therapy and risk factor modification are necessary. A secondary prevention program for coronary bypass patients was established at the University of North Carolina School of Medicine for that purpose. Modifiable risk factors, such as hypercholesterolemia and hypertension, are identified preoperatively, and therapy is initiated postoperatively, with follow-up in the Risk Reduction Clinic at 3 and 6 months. Treatment is designed to achieve defined goals in secondary prevention.
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Affiliation(s)
- K D Donovan
- Division of Cardiothoracic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7065, USA
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Abstract
We report the clinical use of "medulloscopy" for the visualization and irrigation of sepsis or nonunion of the tibia and femur in 7 cases. Included were 2 cases of aseptic femoral nonunion, 1 infected femoral nonunion with chronic osteomyelitis, 2 cases of healed tibia fracture with chronic osteomyelitis, 1 aseptic nonunion of the tibia, and 1 case of tibial osteomyelitis secondary to intravenous drug use. Visualization of the nonunion site or pathologic lesion was achieved in 86% of cases (6 of 7) and additional diagnostic information was obtained by medulloscopy in 86% of cases (6 of 7). A representative case is presented. Medulloscopy appears to be clinically useful for the treatment of sepsis or nonunion of the tibia and femur when access to the intramedullary canal is necessary.
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Affiliation(s)
- C S Roberts
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA.
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Abstract
A 72-year-old woman had rupture of a coronary artery during angioplasty in the setting of abciximab therapy. Prolonged reinflation of the balloon failed to produce closure of the perforated site. Emergency coronary ligation and bypass after abciximab administration was associated with excessive postoperative bleeding.
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Affiliation(s)
- C S Roberts
- Division of Cardiothoracic Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7065, USA.
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Roberts CS, Walker JA, Seligson D. Diagnostic capabilities of shoulder ultrasonography in the detection of complete and partial rotator cuff tears. Am J Orthop (Belle Mead NJ) 2001; 30:159-62. [PMID: 11234944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Our study assessed the accuracy of shoulder ultrasonography in detecting complete and partial rotator cuff tears. We performed a prospective study in 24 patients scheduled for shoulder arthroscopy for impingement, partial-thickness or full-thickness (complete) rotator cuff tears, adhesive capsulitis, or arthritis. Before surgery, all patients underwent diagnostic shoulder ultrasonography followed by a shoulder arthroscopy with examination of the rotator cuff. The arthroscopic findings of rotator cuff integrity were compared with the diagnoses made from ultrasonography. The ultrasonographer was not blinded to the history and examination findings, and the surgeon was not blinded to the results of the ultrasonography. Ultrasound had sensitivity and specificity rates of 80% and 100%, respectively (positive and negative predictive rates of 100% and 88%), in the diagnosis of full-thickness rotator cuff tears and sensitivity and specificity rates of 71% and 100%, respectively (positive and negative predictive values of 100% and 88%), for partial-thickness tears. Although the potential for bias exists in this study, the results suggest that diagnostic ultrasound is effective in the diagnosis of rotator cuff tears.
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Affiliation(s)
- C S Roberts
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, Kentucky, USA
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