bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal ultrasound diagnosis and management of body stalk anomaly: analysis of nine singleton and two multiple pregnancies
Authors: Smrcek J. M. , Germer U. , Krokowski M. , Berg C. , Krapp M. , Geipel A. , Gembruch U. 
Published: April 2003

AbstractObjectiveTo determine prenatal ultrasonographic features and management of fetuses with body stalk syndrome in singleton and multiple gestations.MethodsIn a retrospective chart analysis we reviewed all cases with body stalk anomaly diagnosed in our prenatal unit between 1994 and 2001. During this time period we adopted a uniform approach to the investigation of cases of body stalk anomaly, including amniocentesis or chorionic villus sampling (CVS) for fetal karyotyping. A general schematic sonographic examination was performed to search for fetal abnormalities and was followed by detailed two‐dimensional and color‐coded Doppler echocardiography. Nuchal translucency (NT) measurements were performed before 14 weeks of gestation. Postmortem examinations of fetuses were performed following termination by induction with prostaglandin.ResultsEleven fetuses with body stalk anomaly were diagnosed, including two multiple pregnancies complicated by discordant body stalk anomaly. The typical ultrasonographic features were a major abdominal wall defect, severe kyphoscoliosis, limb abnormalities, neural tube defects, and a malformed, short umbilical cord with a single artery. None of the fetuses demonstrated craniofacial defects. All placentae that were examined showed evidence of persistence of the extra‐embryonic celomic cavity. NT measurements were abnormal in all cases. Fetal karyotyping was normal in ten cases. In one case CVS showed a mosaic trisomy 2 (46,XX/47,XX,+ 2). Selective fetocide was performed in one trichorionic–triamniotic triplet pregnancy in early gestation, which was followed by normal development of the remaining healthy dichorionic–diamniotic twins. In a monochorionic–diamniotic twin pregnancy with one affected fetus ultrasound surveillance showed the normal development of the unaffected twin.ConclusionsWe present a large series of body stalk anomaly, including multiple gestations, with thoraco‐ and/or abdominoplacental attachment and without craniofacial defects. This specific phenotype may be explained by embryonic maldevelopment. The typical features of body stalk anomaly can be detected by ultrasound by the end of the first trimester, which is important for patient management. Consequently, this anomaly should be distinguished from other fetal abdominal wall defects. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
What is osteoporosis?
Authors: Christodoulou C , Cooper C 
Published: April 2003

Abstract
Osteoporosis is a very common disorder, which results in an increase in fracture risk. The annual cost attributable to hip, vertebral, and wrist fractures in England and Wales is £1.7 billion. Significant mortality and morbidity are associated with osteoporotic fractures. The method that is most widely used for the diagnosis of osteoporosis is dual energy x-ray absorptiometry. The aim of prevention and treatment of osteoporosis is to prevent the occurrence of future fractures. Lifestyle changes should be encouraged in high risk patients. Pharmacological treatments include the bisphosphonates, hormone replacement therapy, selective oestrogen receptor modulators, calcitonin, the 1–34 fragment of parathyroid hormone, calcium and vitamin D supplements, and calcitriol.
Antihypertensive Treatment in Postmenopausal Women: Results from a Prospective, Randomized, Double-Blind, Controlled Study Comparing an ACE Inhibitor (Moexipril) with a Diuretic (Hydrochlorothiazide)
Authors: Stimpel Michael , Koch Brigitte , Oparil Suzanne 
Published: April 2003

The present study was designed to compare the safety and efficacy of the new angiotensin-converting enzyme inhibitor moexipril with that of hydrochlorothiazide (HCTZ) in postmenopausal women with mild-to-moderate hypertension. After a 4-week single-blind placebo period, 97 postmenopausal hypertensive women (42–74 years of age) with a sitting diastolic blood pressure (SDBP) of 95–114 mm Hg were randomized to receive either once daily moexipril 15 mg or HCTZ 25 mg for a 12-week double-blind treatment period. At study endpoint, HCTZ caused significantly greater increases from baseline in serum uric acid levels than did moexipril (0.8 ± 0.1 vs. 0.1 ± 0.1 mg/dl, p < 0.01). Furthermore, 12-week treatment with HCTZ resulted in significant increases in glucose (+11.0 ± 4.1 mg/dl) and total cholesterol/HDL ratio (+0.3±0.1 mg/dl) and a significant decrease in HDL (–3.2±0.7 mg/dl). In contrast, moexipril treatment was not associated with significant changes in any metabolic parameter. Both drugs efficiently lowered SDBP with reductions of –10.0 ± 1.3 and –11.8 ± 1.1 mm Hg in the moexipril and HCTZ group, respectively. Clinical adverse events were reported by a greater percentage of HCTZ patients (53%) than moexipril patients (40%), with headache and rhinitis as the most frequent events. The results indicate that moexipril was better tolerated than HCTZ in postmenopausal women and did not adversely affect metabolic parameters. Both drugs were effective in lowering blood pressure.
Decreased Levels of β-Endorphin in Circulating Mononuclear Leukocytes from Patients with Acute Myocardial Infarction
Authors: Buratti Thomas , Schratzberger Peter , Dunzendorfer Stefan , Manfreda Susanne E. , Pechlaner Christoph , Joannidis Michael , Sacerdote Paula , Panerai Alberto E. , Wiedermann Christian J. 
Published: April 2003

Lymphocytes can be activated to produce and release opioid peptides. We investigated the levels of immunoreactive β-endorphin in peripheral blood mononuclear cells from 11 patients with acute myocardial infarction. The concentrations of β-endorphin in mononuclear leukocytes of 30.2 ± 6.9 pg/10<sup>6</sup> cells on admission were in the normal range of 20–40 pg/10<sup>6</sup> cells and decreased significantly to 6.9 ± 1.9 pg/10<sup>6</sup> cells after 48 h (p < 0.05). Decreased levels of mononuclear leukocyte-associated β-endorphin in acute myocardial infarction may be due to the release of endogenous opioid after stimulation by stress and acute-phase reactants and play a role in inflammation and pain.
Directional Coronary Atherectomy in Acute Myocardial Infarction
Authors: Dangas George , Mehran Roxana , Duvvuri Srinivas , Vidhun Raghuraman , Ambrose John A. , Sharma Samin K. 
Published: April 2003

Balloon angioplasty (percutaneous transluminal coronary angioplasty, PTCA) is an established common strategy in the treatment of acute myocardial infarction (MI) with high success rates but a 5–10% incidence of reclosure/reinfarction due to thrombus and/or intimal flaps. Directional coronary atherectomy (DCA) by removing plaque/thrombus and achieving larger postprocedural luminal diameter may further decrease the incidence of reclosure/reinfarction, with a resultant better in-hospital outcome in this setting. We analyzed the clinical, procedural and in-hospital outcome of patients who underwent DCA or PTCA within 48 h of MI. Long lesions (>20 mm), large angiographic intracoronary thrombus, lesions in a bend, heavy calcification, and vessel diameter <3.0 mm were excluded from the study. Although slow flow occurred more frequently during DCA (17 vs. 9% during PTCA, p = 0.04), procedural success (<50% final diameter stenosis with TIMI-3 flow) was achieved in 96% of DCA and 92% of PTCA group (nonsignificant). Acute closure occurred in 9% of the PTCA group versus 2% of the DCA (p = 0.05), and the composite endpoint of in-hospital reinfarction, reintervention, bypass surgery or death was present in 9% of PTCA cases versus none of DCA cases (p = 0.03). There were no major peripheral vascular complications requiring surgery in either group. Therefore, DCA appears safe and effective in selected patients with recent MI, and is associated with a low incidence of major clinical complications.
Transmyocardial Revascularization with Holmium Laser
Authors: García Corrales Francisco , García-Rubira Juan C. , Font J. Ignacio , Berjillos Mariano , de la Mata Manuel , Clavero Javier , Cruz José M. , Infantes Carlos A. 
Published: April 2003

Sixteen patients with angina refractory to medical therapy who were not considered suitable for standard revascularization underwent transmyocardial revascularization with holmium laser. The average age of the patients was 63.2 ± 10.5 years. All of them had angina class 3 or 4, and 9 (56%) had previously undergone an aortocoronary bypass grafting. Four patients died during the 6-month follow-up period (25%). Among the survivors, anginal class decreased to class 2 or 1 at the 6th month (p = 0.002). Ejection fraction did not change. The ischemic burden by Holter decreased from 85.3 ± 656 to 5.5 ± 9.7 min (p = 0.046). Myocardial perfusion with <sup>201</sup>Tl single photon emission computed tomography (SPECT) images at rest and after dipyridamole showed a significant improvement among the ischemic treated segments (p = 0.015). Baseline ejection fraction was somehow lower in nonresponsive than in responsive patients (33 ± 13 vs. 49 ± 10, p = 0.052). We conclude that transmyocardial laser revascularization with holmium laser is effective in treatment in ischemic patients not amenable to surgery or percutaneous procedures, as previously reported with CO<sub>2</sub> laser. Further investigation is needed to determine which clinical profiles identify the patients for whom this therapy is suitable.
Impact of Early Risk Stratification on the Length of Hospitalization in Patients with Acute Q-Wave Myocardial Infarction
Authors: Schuster Stefan , Koch Armin , Schiele Rudolf , Burczyk Udo , Wagner Stefan , Zahn Ralf , Rustige Jörg , Limbourg Peter , Gülker Hartmut , Senges Jochen 
Published: April 2003

An assessment of individual risk factors may identify a subgroup of postinfarction patients at low risk, i.e. patients appropriate for early discharge. Using a large unselected population of the national registry, ‘The 60-Minutes Myocardial Infarction Project’, we (1) attempted to provide a retrospective analysis of clinical factors and in-hospital mortality in a population living on the 6th hospital day following admission to define a low-risk patient group with a residual in-hospital mortality of less than 1% eligible for early discharge, and (2) to analyze the current impact of risk stratification based on these clinical factors on the length of hospitalization. The study group consisted of 12,045 survivors on the 6th day after admission out of 14,980 patients of the registry with proven Q-wave myocardial infarction. Risk modeling was performed with multiple logistic regression. <b>Results:</b> A total of 873 patients (7.3%) died after day 6 in hospital. The most important prognostic factors were cardiopulmonary resuscitation prior to admission (odds ratio, OR: 7.2, confidence interval, CI: 5.11–10.22), thrombolysis complicated by severe bleedings (OR: 6.2, CI: 1.2–31.2) and age >70 years (OR 4.7, CI 3.51–6.39). The other more significant independent predictors of increased mortality were end-stage renal disease, age between 56 and 70 years, systolic blood pressure <95 mm Hg on admission, history of trauma ≤2 months, cancer and left-bundle-branch block. Summarizing these nine groups of patients with the strongest association to in-hospital mortality, we defined a high-risk group comprising 79% of the AMI patients with a residual in-hospital mortality of 8.8%. On the other hand, by excluding these nine high-risk patient groups, a low-risk group of 21% of all AMI patients seems to be appropriate for early discharge (residual in-hospital mortality = 1.07%). However, in the current practice, there was no difference regarding the median length of hospital stay between the two risk groups. The low-risk patients were hospitalized 20 days compared to 22 days in the high-risk patients. <b>Conclusion:</b> Using a simple logistic regression model, which considers clinical factors of the early hospital phase, one fifth of the infarction patients can be stratified to be at low risk, and might be eligible for early hospital discharge. Currently, an individual risk stratification has no impact on the length of hospital stay in Germany.
Apolipoprotein A1 Gene Polymorphisms and Risk of Early Coronary Disease
Authors: Reguero Julián R. , Cubero Gustavo Iglesias , Batalla Alberto , Alvarez Victoria , Hevia Sergio , Cortina Arturo , Coto Eliecer 
Published: April 2003

Genetic studies have identified polymorphisms at the apolipoprotein (Apo) A1 gene associated with HDL cholesterol and apolipoprotein levels, and a relationship between the severity of coronary artery disease and polymorphisms at the 5′-end of Apo A1 has been also reported. This study was designed to examine the relationship between polymorphism at the Apo A1 gene and the risk of early coronary artery disease. Furthermore, the association of the polymorphism with the classical risk factors was analyzed. A total of 176 male patients (mean age 43 ± 5 years) diagnosed as having unstable angina (53 cases) or myocardial infarction (123 cases) were prospectively evaluated. Data referring to hypertension, diabetes and tobacco consumption were recorded. The levels of total cholesterol, HDL cholesterol, Apo A1 and B and triglycerides were determined. DNA was obtained from the 176 patients and from 200 controls. In order to determine the Apo A1 genotypes at two polymorphic sites (G/A at –75 bp, and C/T at +83 bp), DNA was PCR amplified and digested with <i>Msp</i>I. The frequency of carriers of the rare allele at the –75 bp site (M1–) was 0.34 in cases and 0.24 in controls (p < 0.05). The frequencies of the M1– allele among patients with angina and myocardial infarction were 0.43 (p = 0.009, angina vs. controls) and 0.30, respectively. No significant association between this polymorphism and other cardiovascular risk factors was found. No difference in the frequencies for carriers of the rare allele at the +83-bp polymorphism (M2) was observed among patients with angina (0.08 vs. 0.07) or myocardial infarction (0.04 vs. 0.07), and no association between this polymorphism and tobacco, hypertension and diabetes was noted. Patients carrying the rare M2– allele had a lower concentration of total cholesterol compared to those without this allele (183 ± 29 vs. 223 ± 54, p < 0.04) and HDL cholesterol was also lower among patients carrying the M2– (26 ± 4 vs. 33 ± 9, p < 0.02). In our community male patients with a diagnosis of coronary artery disease and age less than 50 years showed a higher frequency of the M1– allele at the –75-bp site of the Apo A1 gene. There was a significant increase in the frequency of the M1– allele in patients with unstable angina and no association with risk factors. In the +83-bp polymorphism there was no difference in the allelelic frequencies or the risk factors, except for the HDL cholesterol and total cholesterol where the patients with the allele M2– had lower levels than those homozygous for the M2+.
Effect of Isosorbide-5-Mononitrate on Exercise Performance and Clinical Status in Patients with Congestive Heart Failure
Authors: Lewis Basil S. , Rabinowitz Babeth , Schlesinger Zwi , Caspi Abraham , Markiewicz Walter , Rosenfeld Tiberio , Sclarovsky Samuel , Ermer Wolfgang 
Published: April 2003

<i>Background and Aims:</i> Nitrate therapy improves hemodynamics in patients with heart failure, but the chronic effects of oral nitrates on exercise performance and clinical status have not been well studied. <i>Methods:</i> Oral isosorbide-5-mononitrate (ISMN) (50 mg once daily) or placebo was administered to 136 patients (NYHA Class 2–3) treated for heart failure, all receiving captopril and most also furosemide. Endpoints were treadmill exercise time at 12 weeks by modified Naughton protocol (primary), with an additional 12-week follow-up period. Secondary endpoints included left ventricular dimensions, ejection fraction, cardiothoracic ratio, functional class, quality of life, hospitalizations and plasma norepinephrine and atrial natriuretic peptide in a four-center substudy. <i>Results:</i> Intention-to-treat analysis showed that mean change in treadmill exercise duration tended to be greater in patients receiving ISMN than placebo (treatment difference +42 s, 95% CI –5, +90 s at 12 weeks and +21 s, 95% CI –25, +74 s after 24 weeks) (NS). Treatment difference was greater in the prespecified subgroup with ejection fraction 31–40% (+55 s, 95% CI –11, +136 s at 12 weeks and +65 s, 95% CI +3, +147 s) (p = 0.035) at 24 weeks. No deleterious effects (i.e. hypotension) were observed with ISMN, although headache was reported in 19% of the active treatment group (p = 0.0001). <i>Conclusions:</i> ISMN added to captopril increased treadmill exercise time in patients with heart failure and a lesser reduction in baseline ejection fraction, although for the group as a whole, the increase in treadmill time was not significant.
Fixed Subaortic Stenosis Revisited
Authors: Tentolouris Konstantinos , Kontozoglou Theodosios , Trikas Athanasios , Brilli Styliani , Chlapoutakis Emanouel , Exadactylos Nikolaos , Pitsavos Christos , Toutouzas Pavlos 
Published: April 2003

Seventy-two patients aged 2–65 years (mean 20.2) with fixed subaortic stenosis (FSS) are reported. All patients underwent echocardiography and angiography prior to surgical intervention. Sixty-four (89%) had discrete subaortic stenosis (DSS) and 8 (11%) tunnel type stenosis (TSS). Patients with DSS aged 2–65 years (mean 29) while patients with TSS aged 10–34 years (mean 19) and had a distinct female preponderance (7:1). Twenty-five patients (39%) with DSS had other congenital abnormalities of which aortic stenosis associated with bicuspid aortic valve was slightly more common than ventricular septal defect (7:6). Five patients with TSS had a small aortic annulus and hypoplastic aorta. Our data and those in the literature indicate that TSS although related to DSS has certain features that may set it apart as a distinct entity. In addition DSS appears to be associated with aortic stenosis and bicuspid aortic valve as frequently as with ventricular septal defect.
Prognostic Value of Ischemia Monitoring with On-Line Vectorcardiography in Patients with Unstable Coronary Artery Disease
Authors: Lundin Peter , Jensen Jens , Lindahl Bertil , Wallentin Lars , Eriksson Sven V. 
Published: April 2003

<i>Aim:</i> The aim of this study was to determine whether on-line vectorcardiography (VCG) gives independent prognostic information, regarding death, myocardial infarction (MI), and revascularization in patients with unstable coronary artery disease, i.e. unstable angina or non-Q-wave MI. <i>Methods and Results:</i> One hundred and fifty patients (mean age 69 ± 10), participating in a randomized study of low-molecular-weight heparin in unstable coronary artery disease, were studied with on-line VCG recordings for 24 h. During a 5–6-month follow-up, 11 patients died, 14 suffered a nonfatal MI and 31 were revascularized. Univariate predictors of death were diabetes mellitus (p < 0.01), maximum ST vector magnitude (ST-VM; p < 0.001), maximum ST change vector magnitude (STC-VM; p < 0.001), number of ST-VM (p < 0.01) and STC-VM episodes (p < 0.001). In multivariate analysis, the number of STC-VM episodes (p < 0.01) and diabetes mellitus (p < 0.02) each gave independent prognostic information regarding death. When all cardiovascular events were combined, the inhability to perform an exercise test (p < 0.05), maximum value of ST-VM (p < 0.01) and STC-VM (p < 0.001), the number of episodes of STC-VM (p < 0.001) and ST-VM (p < 0.001) all gave prognostic information. In multivariate analysis, the inability to perform an exercise test and the number of STC-VM episodes were independent predictors. <i>Conclusion:</i> VCG monitoring during the first 24 h of hospitalization for unstable coronary artery disease gives independent prognostic information.
The Utility of Four Biochemical Markers in the Triage of Chest Pain Patients
Authors: Ellestad Myrvin H. , Startt-Selvester Ronald , Stanton Eric , VanNatta Bruce , Ahmad Javed , Gawad Yehia , Swiger Florence 
Published: April 2003

Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.
Isolated Left Ventricular Abnormal Trabeculation Is a Cardiac Manifestation of Neuromuscular Disorders
Authors: Stöllberger Claudia , Finsterer Josef , Blazek Gerhard 
Published: April 2003

<i>Objectives:</i> Isolated left ventricular abnormal trabeculation (ILVAT) is defined as >3 coarse trabeculations of the left ventricular wall, apically to the papillary muscles, in hearts without congenital malformations. The aims of the study were to assess by echocardiography the prevalence of ILVAT, look for cardiac findings in ILVAT and find out if ILVAT is associated with neuromuscular disorders. <i>Design and Results:</i> In the course of 3 years, ILVAT was found in 15/17, 648 patients (0.08%). Twelve patients had heart failure, all had ECG abnormalities. All patients had neuromuscular disorders. A definite diagnosis could be established in 10 patients (metabolic myopathy, n = 9; Becker’s muscular dystrophy, n = 1). The remaining 5 patients refused further neurological investigations. <i>Conclusions:</i> ILVAT is a rare disorder associated with ECG abnormalities, heart failure and neuromuscular disorders, which is a reason why both cardiologists and neurologists should be involved.