PPRECIATION OF THE CRUcial role of risk factors in the development of coronary heart disease (CHD) is one of the most significant advances in the understanding of this important disease. Extensive epidemiological research has established cigarette smoking, 1 diabetes, 2 hyperlipidemia, 3 and hypertension 4 as independent risk factors for CHD. In addition, treatment of these risk factors has been convincingly shown to reduce the risk of future cardiac events. 1,5 Because of the strength of evidence supporting their role in the pathogenesis of CHD, these 4 risk factors have often been labeled as "conventional" risk factors. Although the importance of conventional risk factors is well established, it is commonly suggested that more than 50% of patients with CHD lack any of the conventional risk factors. 6-13 This implies that other factors play a significant role in the development of this disease and, furthermore, that there is a substantial void in current understanding of the pathogenesis of CHD. This perceived void has led to considerable research on nontraditional risk factors and genetic causes of heart disease. Yet, data to support this "50%" belief are limited, and some have suggested that conventional risk factors play a much more significant role. 14,15 Determining the validity of this idea is important for scientific accuracy and to guide the practice of clinical medicine, public health policies, and prioritization of research efforts. In addition, patients and physicians can better understand the impact of preventing or modifying these specific risk factors on the risk of future CHD. We therefore sought to determine the prevalence of the 4 conventional risk
Background-Consensus guidelines and hospital quality-of-care programs recommend that ST-elevation myocardial infarction patients achieve a door-to-balloon time of Յ90 minutes. However, there are limited prospective data on specific measures to significantly reduce door-to-balloon time. Methods and Results-We prospectively determined the impact on median door-to-balloon time of a protocol mandating(1) emergency department physician activation of the catheterization laboratory and (2)
NCREASINGLY SOPHISTICATED LABOratory studies and diagnostic testing have led to diminished attention to the importance of the physical examination of patients. This is evidenced by a decreased emphasis on the physical examination in training programs and also by decreased proficiency among trainees in basic physical examination skills, such as cardiac and pulmonary auscultation. 1,2 An important reason for this diminished interest is that studies have documented limitations of physical examination when compared with more sophisticated methods. 3 These studies have given credence to a widespread belief that information obtained by physical examination is of limited value. 4-6 Yet increasing evidence suggests that assessment for the presence and severity of heart failure by physical examination provides significant independent prognostic information. For example, in chronic heart failure, the presence of an S 3 gallop, elevated jugular venous pressure, or both has been found to independently predict longterm mortality. 7 In ST-elevation myo
The Thermal Diffusion Probe (TDP) System allows continuous real-time measurement of tissue perfusion in flaps. The authors used a TDP with two thermistors, one active, the other passive, embedded in a 0.9-mm diameter catheter to measure continuous tissue perfusion in rabbit epigastric flaps. The distal thermistor is heated to 2 degrees C above the tissue baseline temperature. The power required to maintain this temperature difference is mathematically related to the tissue perfusion in the volume surrounding the probe tip. Central and peripheral TDPs were placed. The TDP effectiveness in detecting and measuring daily tissue perfusion in buried epigastric flaps was tested. Contralateral epigastric pedicles were transposed into the flaps prior to ligation of the original pedicle. Flaps with transposed pedicles showed a progressive and significant increase in tissue perfusion during the initial 3 weeks of the experiment, compared to flaps without the pedicle transfer. The TDP System is a useful experimental method for the continuous and real-time quantification of flap perfusion and may be helpful in making clinical decisions about prefabricated flap transfer.
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