Current therapy of coronary heart disease. Conservative measures

BACKGROUND: Intraperitoneal spillage of dermoid cyst content, if not followed immediately by abundant peritoneal lavage, can cause a chemical peritonitis with subsequent adhesion formation. STUDY DESIGN: We performed an open clinical study in a university hospital. Forty-four consecutive ovarian dermoid cysts were removed intact from 40 premenopausal women operated on between October 1993 and December 1997. The laparoscopic technique included: 1) creation of a cleavage plane between the cyst and the ovary; 2) dissection of the cyst by a combination of water, scissors, and gravity without direct traction on the cyst; and 3) extraction of the cyst after its placement inside a laparoscopic bag. RESULTS: The mean cyst diameter was 6.5 cm (range 3 to 12 cm). Mean operating time was 125 minutes (range 50 to 180 minutes). All patients were discharged within 48 hours. The cysts were dissected completely intact and were extracted without spillage in the abdominal cavity in all cases. Operative followup was available in 15 of the 40 patients; mild adhesions were found on the treated ovary in 3 (20%). CONCLUSIONS: It is always possible to prevent rupture and spillage of dermoid cysts during laparoscopic operations, but this approach is time consuming and needs expert surgical technique.     

Antihypertensive drug therapy and coronary heart disease risk

Coronary heart disease (CHD) is the major cause of death in the United States. Major modifiable risk factors for CHD are hypertension, hypercholesterolemia, and cigarette smoking, with concomitant risk factors, especially left ventricular hypertrophy, that act synergistically to significantly increase overall risk. Antihypertensive therapy, while reducing the incidence of stroke, has not consistently reduced the incidence of CHD. This may be a result, in part, of adverse effects on the metabolic profile, especially on blood lipids, which are induced by diuretics and certain beta-blockers. Other antihypertensive agents appear to be either lipid neutral, such as calcium channel blockers and angiotensin-converting enzyme inhibitors, or lipid positive, such as selective alpha 1-blockers. The choice of initial antihypertensive therapy should be made with all of a patient's risk factors in mind. In addition to the drugs recommended in the 1988 Guidelines of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, selective alpha 1-blockers should also be considered since they improve the lipid profile as well as reduce blood pressure.     

Behavioural aspects of coronary heart disease.

Reviews research that has implicated behavior in the development of coronary heart disease. The interface between epidemiological and psychological orientations is argued to be mutually beneficial for both professions. Epidemiology has put greater emphasis on the genesis and statistical incidence of disease, whereas psychology has tended to put greater emphasis on a closer-grained analysis of behavioral processes that impact on health (e.g., Type A [coronary prone] behavior, life-event stresses, psychophysiological reactivity). It is concluded that given the progress that the interdisciplinary efforts have met with in the last decade, the prospect for continued collaborative efforts is promising. (French abstract) (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic heart failure in the United States: a manifestation of coronary artery disease

BACKGROUND: Hyperhomocysteinemia occurs in renal failure and may increase the risk for cardiovascular disease, possibly by damaging the endothelium. Folic acid and betaine are required in two separate homocysteine conversion pathways and may therefore lower plasma homocysteine. OBJECTIVE: To study the therapeutic role of betaine and the effect on endothelial function of long-term homocysteine-lowering therapy with folic acid, in peritoneal dialysis (PD) patients. PATIENTS AND DESIGN: Thirty PD patients were randomized to a 12-week treatment with 5 mg folic acid and 4 g betaine daily, or to 5 mg folic acid alone daily. They were then rerandomized to treatment with 1 or 5 mg folic acid daily for 40 weeks. MEASUREMENTS: At baseline and after 52 weeks, endothelial function was assessed by determination of endothelium-dependent vasodilatation and biochemical markers. RESULTS: Plasma total homocysteine (tHcy) was elevated at baseline: 42.6 (5.8) micromol/L. Only 1 patient (3%) had a normal plasma homocysteine (i.e., < or = 15 micromol/L) before therapy. Normalization of plasma homocysteine occurred in 39% of the patients at 12 weeks. Betaine had no additional homocysteine-lowering effect. Plasma tHcy levels were similar during treatment with 1 or 5 mg folic acid daily. Endothelial function was impaired at baseline and had not improved after 52 weeks of treatment. CONCLUSIONS: Peritoneal dialysis patients have hyperhomocysteinemia, which can be normalized with folic acid alone in about 40% of patients. Betaine does not further lower plasma homocysteine. A maintenance dose of 1 or 5 mg folic acid daily results in equivalent plasma homocysteine levels. Long-term reduction in plasma homocysteine did not result in improvement of endothelial function as assessed by our methods.     

Percentage change rather than plasma level of LDL-cholesterol determines therapeutic response in coronary heart disease

PATIENT: A 35-year-old female patient with Marfan's syndrome presented with fast progressive reduction of visual acuity (hand movements) of her right eye and lens-related glaucoma on both eyes. On examination, subluxation of the lens and nuclear cataract were seen on both eyes. Diurnal pressure curve showed great fluctuations in pressure with normal IOP in the morning and elevated pressure in the evening. Pressure measurement revealed great fluctuations depending on positioning. Because of cataractous lens in the right eye blocking the visual axis and uncontrollable, phacogenic glaucoma removal of the lens by cryoextraction was necessary. Visual acuity increased to 0.5 and IOP was normal after three weeks. To improve safety of topical medication of lens-related glaucoma in Marfan's syndrome regular measurement of IOP at different times of the day is especially important. Measurement of IOP at different positions seems to be an effective provocation test in cases of phacogenic glaucoma in Marfan's syndrome. Examination of all members of a family with Marfan's syndrome should include regular measurement of IOP at different times of the day. In suspected cases, measurement of IOP at different positions that may provoce IOP-increase could be useful in the early detection of lens-related glaucoma.     

Chronotherapy for coronary heart disease

Traditionally the therapy for coronary heart disease has been focused on the "how-to" problem. However, the clustering of cardiovascular events around the specific time of the day has been clarified. To solve the problems of the clustering would give us the clue to treat the coronary heart disease timely and in time. Therefore, the research has been stressed to solve "when-to" problem. The circadian variabilities in coronary heart disease has been clarified to be the function of the biologic time. Therefore, three problems were discussed in this paper. 1) The circadian variabilities in biology should be assessed based on the biologic zero hour rather than the mid-night of the mechanical clock. Our concept of the biologic zero hours has been proposed to answer this problem. 2) Daily health care with circadian order and harmony for the prevention of the coronary risk factors should be recommended as the prevention of the acute coronary risk factors as the trigger mechanism of the cardiovascular events. 3) The chronotherapy to chronic coronary risk factors such as hypertension was discussed, In hypertension the anti-hypertensive therapy should be customized individually adjusting the circadian variability of blood pressure with the proper selection of agents and time of the administration.     

Diet, lipids, and coronary heart disease.

Contends that R. M. Kaplan (see record 1985-12441-001) presented a one-sided debate on the diet/heart controversy. It is suggested, based on studies cited, that preventive efforts recognizing dietary cholesterol's primary contribution to death and disability must be implemented. Answers to 5 questions about cholesterol presented to a National Institutes of Health panel are appended. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking, stress, and coronary heart disease.

Smoking is a major coronary heart disease risk factor that has proven to be very resistant to treatment efforts. For many smokers, environmental stressors, which have also been related to coronary heart disease risk, appear to be strong determinants of smoking behavior and of relapse after cessation. This review focuses on the interrelation between stressors and smoking and on the potential impact of this interrelation on coronary heart disease risk beyond that which is due to stressors or to smoking alone. First, evidence supporting the interrelation between stress and smoking and its relevance to the risk of heart disease is reviewed. Second, mechanisms that may explain why smokers smoke more during stress and why stress may cause relapse are discussed. Finally, new directions in the development of individualized methods to assess, understand, and treat stress-related smoking and relapse are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)