Background:  Peri-operative myocardial infarction (PMI) may be under- and/or mis-diagnosed because WHO criteria are often not met and creatinine kinase (CK/CK-MB) ratios can be difficult to interpret.  Cardiac troponin (cTn) I is the most sensitive and specific marker of myocardial cell necrosis but is not yet widely available. Aims: 1.  To examine the use of pre-operative risk indices, including ASA score, POSSUM score and Goldman’s cardiac risk index and compare these with peri-operative cTnI rise. 2.  To compare cTnI levels with CK/CK-MB levels peri-operatively in the diagnosis of MI. 3.  To explore the role of the fibrinolytic system in patients undergoing emergency surgery for ruptured aneurysm and relate this to cTnI levels. 4.  To examine the use of the polymerase chain reaction (PCR) in the identification of bacteraemia and to relate this to systemic endotoxin levels and septic episodes. Methods:  Prospective observational study of 67 patients undergoing aortic surgery (29 elective AAA, 31 emergency AAA, 7 aorto-occlusive).  cTnI and endotoxin were measured pre-operatively and at 6, 24, 48, 72 and 96 hours post­operatively.  Blood for PCR was also collected at these time points.  CK and CK-­MB were measured where cTnI was detectable.  Fibrinolytic markers were measured up to 24 hours post operatively.  Clinical, septic, ECG and cardiac events were prospectively documented. Results:  ASA score was correlated with perioperative cTnI rise.  Over 50%<i> </i>of patients undergoing emergency, and more than a quarter undergoing elective, aortic surgery will suffer myocardial injury as determined by cTnI rise.  This is accompanied by CK/ CK-MB ratio in less than a fifth of cases.  eTnI rise is associated with inhibition of fibrinolysis with emergency AAA repair.  No relationships were observed with the presence of bacterial DNA, endotoxin response and sepsis.

No description available.

No description available.

Myocardial infarction is the most common cause of heart failure and remains one of the leading causes of morbidity and mortality in humans. Stem cells are important in the maintenance and repair of adult tissues. Hoechst effluxing cells, termed side population cells are a rare subset of cells found in adult tissues that are highly enriched for stem and progenitor cell activity. Recent studies have suggested that Sca-1+/CD31- cardiac side population cells are capable of differentiation into cardiomyocytes in vitro. However, the response of cardiac side population cells to myocardial injury remains unknown in vivo. In this study, we directly transplanted Sca-1+/CD31- cardiac side population cells into an acutely infarcted mouse heart. After two weeks, the transplanted cells were found to express cardiomyocyte or endothelial cell markers. Importantly, when these cells were transplanted into a remote nonischemic part of the heart after MI, they were able to migrate to the damaged myocardium. Consistent with these cells homing property, we found that SDF-1α, a chemotactic chemokine and its receptor, CXCR4 were up-regulated in the damaged myocardium and on Sca-1+/CD31- cardiac SP cells respectively following an acute myocardial infarction. We further showed that SDF-1α was able to induce migration of Sca-1+/CD31- cardiac side population cells in vitro. Our results have therefore suggested that Sca-1+/CD31- cardiac side population cells are able to migrate to damaged myocardium from non-ischemic myocardium and differentiate into cardiomyocytes as well as endothelial cells in the acutely infarcted mouse heart. We postulate that the SDF-1α/CXCR4 interaction may play an important role in the migration of these cells. Understanding and enhancing these processes may hold enormous potential possibilities for therapeutic myocardial regeneration for the treatment of cardiovascular disease.

Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

Thesis (PH.D.) -- University of Adelaide, Dept. of Surgery, 1975.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Göteborg : Univ. , 2006. / Härtill 4 uppsatser.

Thesis (Th. M.)--Calvin Theological Seminary, 1994. / Abstract. Includes bibliographical references (leaves [60-61]).

Thesis (M.S.)--Rochester Institute of Technology, 1981. / Typescript. Includes bibliographical references (leaves 83-84).