Foreign acquisition and internal organization

NIPE WP 05/2016

Chylothorax after myocardial revascularization with the left internal thoracic artery

A 38-year-old male underwent coronary artery bypass grafting (CABG). A saphenous vein graft was attached to the left marginal branch. The left internal thoracic artery was anastomosed to the left anterior descending artery (LAD). The early recovery was uneventful and the patient was discharged on the 5th postoperative day. After three months, he came back to the hospital complaining of weight loss, weakness, and dyspnea on mild exertion. Chest X-rays showed left pleural effusion. On physical examination, a decreased vesicular murmur was detected. After six days, the diagnosis of chylothorax was made after a milky fluid was detected in the plural cavity and total pulmonary expansion did not occur. On the next day, both anterior and posterior pleural drainage were performed by videothoracoscopy, and prolonged parenteral nutrition (PPN) was instituted for ten days. After seven days the patient was put on a low-fat diet for 8 days. The fluid accumulation ceased, the drains were removed and the patient was discharged with normal pulmonary expansion.

Application of receptive music therapy in internal medicine and cardiology

OBJECTIVE: To investigate the effects of receptive music therapy in clinical practice. METHODS: Receptive music therapy was individually applied via musical auditions, including five stages: musical stimulation, sensation, situation, reflection, and behavioral alteration. Following anamnesis and obtainment of consent, patients answered a first questionnaire on health risk evaluation (Q1), and after participating in 16 weekly music therapy sessions, answered a second one (Q2). RESULTS: Two men and 8 women, aged above 18 years, referred to us due to symptoms of stress, emotional suffering, and the need to change lifestyles (health risk behavior) were studied between August 1998 and December 1999. Comparison between answers to Q1 and Q2, showed a trend (P=0.059) for reduction of ingestion of cholesterol-rich foods and for increased prospects in life with a tendency towards improvement, and also of increased intake of fiber-rich food (55.6%), increased levels of personal satisfaction (44.5%), and decreased levels of stress (66.7%). CONCLUSION: The study demonstrated decreased stress levels and increased personal satisfaction, higher consumption of fiber-rich food, lower cholesterol intake, and a better perspective on life, suggesting that receptive music therapy may be applied in clinical practice as an auxiliary therapeutic intervention for the treatment of behavioral health risks.

Cardiovascular assessment of patients with Ullrich-Turner's Syndrome on Doppler echocardiography and magnetic resonance imaging

OBJECTIVE: To assess the cardiovascular features of Ullrich-Turner's syndrome using echocardiography and magnetic resonance imaging, and to correlate them with the phenotype and karyotype of the patients. The diagnostic concordance between the 2 methods was also assessed. METHODS: Fifteen patients with the syndrome were assessed by echocardiography and magnetic resonance imaging (cardiac chambers, valves, and aorta). Their ages ranged from 10 to 28 (mean of 16.7) years. The karyotype was analyzed in 11 or 25 metaphases of peripheral blood lymphocytes, or both. RESULTS: The most common phenotypic changes were short stature and spontaneous absence of puberal development (100%); 1 patient had a cardiac murmur. The karyotypes detected were as follows: 45,X (n=7), mosaics (n=5), and deletions (n=3). No echocardiographic changes were observed. In regard to magnetic resonance imaging, coarctation and dilation of the aorta were found in 1 patient, and isolated dilation of the aorta was found in 4 patients. CONCLUSION: The frequencies of coarctation and dilation of the aorta detected on magnetic resonance imaging were similar to those reported in the literature (5.5% to 20%, and 6.3% to 29%, respectively). This confirmed the adjuvant role of magnetic resonance imaging to Doppler echocardiography for diagnosing cardiovascular alterations in patients with Ullrich-Turner's syndrome.

Internal Mammary to Pulmonary Artery Fistula Presenting as Early Recurrent Angina after Coronary Bypass

A 50-year-old man developed recurrent angina 1 year after coronary artery bypass surgery. The patient was found to have a large fistula involving branches of the internal mammary artery graft and the left pulmonary artery. In the absence of another clear cause for the patient's symptoms, we speculated that our patient's angina and abnormal stress nuclear study were due to coronary steal. In patients with a history of coronary bypass grafting, fistula formation between graft and native vessels should be considered as a possible cause of early recurrent angina.

Resonancia Magnética Nuclear aplicada al estudio de nuevos sistemas farmacéuticos y biológicos, complejos poliméricos y conjuntos de espines modelo. Nuclear Magnetic Resonance applied to the study of new pharmaceutical and biological systems, polymeric complexes and model spin clusters.

El presente proyecto plantea utilizar integralmente la técnica de Resonancia Magnética Nuclear en sólidos como un medio experimental que permite entender fenómenos de la física fundamental, como así también realizar aplicaciones de interés en el campo de la química, los desarrollos farmacéuticos y la biología. Novedosas técnicas experimentales serán empleadas, en conjunción con otras más tradicionales, en la caracterización de nuevas estructuras poliméricas acomplejadas a metales, membranas biológicas y compuestos de interés farmacéutico en vías de desarrollo, los cuales presentan el fenómeno de polimorfismo . Esto se llevará a cabo complementando los resultados de RMN en sólidos con técnicas tanto espectroscópicas como analíticas (Infrarrojo, Difracción de Rayos X, Calorimetría, RMN en solución) y trabajo interdisciplinario. Paralelamente al desarrollo de estos temas, profundizaremos mediante investigación básica, en la compresión de la dinámica cuántica y el surgimiento de la irreversibilidad en sistemas de espines nucleares. Observaremos en particular la generación, evolución y control de las coherencias cuánticas múltiples en sistemas cuánticos abiertos, lo cual nos da información sobre tamaño de clusters de espines. Esto permitirá la correcta implementación de secuencias de pulsos sofisticadas, como así también desarrollar nuevos métodos de medición aplicados a la caracterización estructural y a la dinámica molecular de sólidos complejos. Debemos resaltar que este proyecto está conectado con aspectos tanto básicos como aplicados de la RMN en sólidos como técnica experimental, la cual se desarrolla en el país únicamente en FaMAF-UNC. Se nutre además de trabajo multidisciplinario promoviendo la colaboración con investigadores y becarios de distintas áreas (física, química, farmacia, biología) provenientes de distintos puntos del país. Finalmente podemos afirmar que este plan impulsa la aplicación de la física básica proyectada a diferentes áreas del conocimiento, en el ámbito de la provincia de Córdoba. The aim of the present proyect is to use Nuclear Magnetic Resonance (NMR) as a complete techique that allows the understanding of fundamental physics phenomena and, at the same time, it leads to important applications in the fields of chemistry, pharmaceutical developments and biology. New experiments will be used together with traditional ones, in the characterization of new metal-polymer complexes, biological membranes and pharmaceutical compounds, some of them presenting polymorfism. NMR experiments will be complemented with diverse spectroscopic and analytical techniques: Infrared, X ray Diffraction, Thermal Analysis, solution NMR, as well as multidisciplinary investigation. Additionally, the present proyect plans to study in depth several aspects of quantum dynamics phenomena and decoherence in nuclear spin systems. The present proyect is connected with basic and applied aspects of the solid state NMR technique, developed in our country, only at FaMAF-UNC. It is is composed by multidisciplinary work and it promotes the collaboration with researchers and students coming from different fields (physics, chemistry, pharmaceutical developments, biology) and different points of our country.

Assessment of Myocardial Infarction by Cardiac Magnetic Resonance Imaging and Long-Term Mortality

Background: Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. Objective: To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. Methods: A total of 1959 reports of “infarct size” were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors – left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named “MET-AMI”. The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. Results: The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003). Conclusion: The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long-term mortality, especially for ischemic heart disease death.

Analysis of functional magnetic resonance imaging time series by independent component analysis

Independent Component Analysis, Time Series Analysis, Functional Magnetic Resonance Imaging

Non-linear model reduction and control of molten carbonate fuel cell systems with internal reforming fuel cell systems with internal reforming

Magdeburg, Univ., Diss, 2007

Prognostic Value of Pulmonary Vascular Resistance by Magnetic Resonance in Systolic Heart Failure

Abstract Background: Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. Objective: We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). Methods: Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVRwere calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. Results: 105 patients (average LVEF 26.0 ±7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). Conclusions: In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.