Pulmonary embolism is the third most common cardiovascular disease. For prevention of pulmonary e... more Pulmonary embolism is the third most common cardiovascular disease. For prevention of pulmonary embolism, vena caval filters are extensively used in the United States. Of the reported complications of vena caval filters, strut fracture of the filter is the least common. We present a rare case of pericardial tamponade from fractured filter strut/leg embolization. We also discuss a possible hypothesis for the filter fracture along with its complications.
Congenital heart disease (CHD) is a major public health problem that is largely underrecognized. ... more Congenital heart disease (CHD) is a major public health problem that is largely underrecognized. Surgical and medical advances over the past decades have dramatically improved the once bleak prognosis of patients with CHD. Eighty-five percent of infants born with ...
Case Report.—A 49-year-old athletic male presented with a 3-year history of unrelenting left lowe... more Case Report.—A 49-year-old athletic male presented with a 3-year history of unrelenting left lower-extremity edema after a motor vehicle accident. He underwent a venous duplex ultrasound, which revealed distal left superficial femoral and popliteal deep venous thrombosis and multiple venous collaterals with arterial Doppler signals within the thrombus and vein wall at the level of the popliteal fossa. Doppler waveforms were highly suspicious for an arteriovenous fistula (AVF). Direct auscultation of the popliteal fossa revealed a continuous bruit. Magnetic resonance arteriography revealed early venous filling of the left femoral vein with multiple dilated veins in the region of the popliteal artery, consistent with AVF. The patient underwent surgical interruption of the AVF with significant resolution of the lower extremity edema.Conclusion.—In our experience, unusual Doppler waveform characteristics and multiple collateral vessels should alert the sonographer to the possibility of ...
American journal of physiology. Gastrointestinal and liver physiology, 2002
The protein activator of RNA-activated protein kinase (PKR) is a proapoptotic protein called PACT... more The protein activator of RNA-activated protein kinase (PKR) is a proapoptotic protein called PACT. PKR is an interferon (IFN)-induced serine-threonine protein kinase that plays a central role in IFN's antiviral and antiproliferative activities. PKR activation in cells leads to phosphorylation of the alpha-subunit of the eukaryotic protein synthesis initiation factor (eIF)2alpha, inhibition of protein synthesis, and apoptosis. In the absence of viral infections, PKR is activated by its activator PACT, especially in response to diverse stress signals. Overexpression of PACT in cells causes enhanced sensitivity to stress-induced apoptosis. We examined PACT expression in different mouse tissues and evaluated its possible role in regulating apoptosis. PACT is expressed at high levels in colonic epithelial cells, especially as they exit the cell cycle and enter an apoptotic program. PACT expression also coincides with the presence of active PKR and phosphorylated eIF2alpha. These resu...
This study was designed to compare the rates of subacute stent thrombosis (SAT) among patients re... more This study was designed to compare the rates of subacute stent thrombosis (SAT) among patients receiving heparin-coated stents to patients receiving bare-metal stents in real world, contemporary coronary interventions. Controlled trials with heparin-coated coronary stents have shown a trend toward decreased rates of SAT. The data in this study were collected from a single, large cardiac center over a period of 9 months. All patients who underwent coronary stent implantation during this 9-month period were included in the study (1,288 patients; 1,366 procedures; 2,231 stents). All patients were treated with aspirin and clopidogrel (or ticlopidine) after stenting. Primary thrombotic outcome was defined as angiographically documented SAT and/or sudden unexplained cardiac death (SCD) within 30 days of the procedure. Follow-up data (1,264/1,276 patients) were obtained in 99% of patients. A total of 337 patients received 543 heparin-coated stents (BX Velocity Hepacoat) and 939 patients re...
Endogenous lipoid pneumonia (ELP) is a rare clinical entity associated with malignant neoplasms, ... more Endogenous lipoid pneumonia (ELP) is a rare clinical entity associated with malignant neoplasms, connective tissue disease, benign bronchial tumors and rarely infections. We present to you the first case report of ELP associated with tuberculosis.
The seeding of endocarditis directly to the non-valvular areas of the heart is extremely rare. We... more The seeding of endocarditis directly to the non-valvular areas of the heart is extremely rare. We report a case of a 36-year-old woman presenting with sudden-onset lower-extremity pain and swelling, who was found to have mitral valve endocarditis with pulmonary vein vegetation. Echocardiography showed a large linear mitral valve mass coming into contact with the base of the left inferior pulmonary vein with each ventricular contraction. Spread into the atrium from mitral valve endocarditis is generally thought to be caused by jet lesions, whereas direct seeding as in this case is not well described. The location in the pulmonary vein is also unique, with no case reports being found in the literature, although the significance remains to be ascertained.
Pulmonary embolism is the third most common cardiovascular disease. For prevention of pulmonary e... more Pulmonary embolism is the third most common cardiovascular disease. For prevention of pulmonary embolism, vena caval filters are extensively used in the United States. Of the reported complications of vena caval filters, strut fracture of the filter is the least common. We present a rare case of pericardial tamponade from fractured filter strut/leg embolization. We also discuss a possible hypothesis for the filter fracture along with its complications.
Congenital heart disease (CHD) is a major public health problem that is largely underrecognized. ... more Congenital heart disease (CHD) is a major public health problem that is largely underrecognized. Surgical and medical advances over the past decades have dramatically improved the once bleak prognosis of patients with CHD. Eighty-five percent of infants born with ...
Case Report.—A 49-year-old athletic male presented with a 3-year history of unrelenting left lowe... more Case Report.—A 49-year-old athletic male presented with a 3-year history of unrelenting left lower-extremity edema after a motor vehicle accident. He underwent a venous duplex ultrasound, which revealed distal left superficial femoral and popliteal deep venous thrombosis and multiple venous collaterals with arterial Doppler signals within the thrombus and vein wall at the level of the popliteal fossa. Doppler waveforms were highly suspicious for an arteriovenous fistula (AVF). Direct auscultation of the popliteal fossa revealed a continuous bruit. Magnetic resonance arteriography revealed early venous filling of the left femoral vein with multiple dilated veins in the region of the popliteal artery, consistent with AVF. The patient underwent surgical interruption of the AVF with significant resolution of the lower extremity edema.Conclusion.—In our experience, unusual Doppler waveform characteristics and multiple collateral vessels should alert the sonographer to the possibility of ...
American journal of physiology. Gastrointestinal and liver physiology, 2002
The protein activator of RNA-activated protein kinase (PKR) is a proapoptotic protein called PACT... more The protein activator of RNA-activated protein kinase (PKR) is a proapoptotic protein called PACT. PKR is an interferon (IFN)-induced serine-threonine protein kinase that plays a central role in IFN's antiviral and antiproliferative activities. PKR activation in cells leads to phosphorylation of the alpha-subunit of the eukaryotic protein synthesis initiation factor (eIF)2alpha, inhibition of protein synthesis, and apoptosis. In the absence of viral infections, PKR is activated by its activator PACT, especially in response to diverse stress signals. Overexpression of PACT in cells causes enhanced sensitivity to stress-induced apoptosis. We examined PACT expression in different mouse tissues and evaluated its possible role in regulating apoptosis. PACT is expressed at high levels in colonic epithelial cells, especially as they exit the cell cycle and enter an apoptotic program. PACT expression also coincides with the presence of active PKR and phosphorylated eIF2alpha. These resu...
This study was designed to compare the rates of subacute stent thrombosis (SAT) among patients re... more This study was designed to compare the rates of subacute stent thrombosis (SAT) among patients receiving heparin-coated stents to patients receiving bare-metal stents in real world, contemporary coronary interventions. Controlled trials with heparin-coated coronary stents have shown a trend toward decreased rates of SAT. The data in this study were collected from a single, large cardiac center over a period of 9 months. All patients who underwent coronary stent implantation during this 9-month period were included in the study (1,288 patients; 1,366 procedures; 2,231 stents). All patients were treated with aspirin and clopidogrel (or ticlopidine) after stenting. Primary thrombotic outcome was defined as angiographically documented SAT and/or sudden unexplained cardiac death (SCD) within 30 days of the procedure. Follow-up data (1,264/1,276 patients) were obtained in 99% of patients. A total of 337 patients received 543 heparin-coated stents (BX Velocity Hepacoat) and 939 patients re...
Endogenous lipoid pneumonia (ELP) is a rare clinical entity associated with malignant neoplasms, ... more Endogenous lipoid pneumonia (ELP) is a rare clinical entity associated with malignant neoplasms, connective tissue disease, benign bronchial tumors and rarely infections. We present to you the first case report of ELP associated with tuberculosis.
The seeding of endocarditis directly to the non-valvular areas of the heart is extremely rare. We... more The seeding of endocarditis directly to the non-valvular areas of the heart is extremely rare. We report a case of a 36-year-old woman presenting with sudden-onset lower-extremity pain and swelling, who was found to have mitral valve endocarditis with pulmonary vein vegetation. Echocardiography showed a large linear mitral valve mass coming into contact with the base of the left inferior pulmonary vein with each ventricular contraction. Spread into the atrium from mitral valve endocarditis is generally thought to be caused by jet lesions, whereas direct seeding as in this case is not well described. The location in the pulmonary vein is also unique, with no case reports being found in the literature, although the significance remains to be ascertained.
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Papers by Vishal Gupta