The new cardiology

The American College of Cardiology 47th Annual Scientific Session Atlanta, GA, USA, 29 March—1 April 1998     

Dietary minerals and modification of cardiovascular risk factors

High serum cholesterol, hypertension and obesity are major risk factors for cardiovascular diseases, and together with insulin resistance form a deadly disorder referred to as the metabolic syndrome. All the aspects of this syndrome are strongly related to dietary and lifestyle factors; therefore, it would be reasonable to look for dietary approaches to their modification. Mineral nutrients, such as calcium, potassium and magnesium, lower blood pressure, and especially calcium has beneficial effects also on serum lipids. Recent evidence suggests that increased intake of calcium may help in weight control as well. This review summarizes previous literature on the effects and use of dietary minerals on serum lipids, blood pressure and obesity, with specific focus on the effects of calcium. Calcium and magnesium as divalent cations can form insoluble soaps with fatty acids in the intestine and thus prevent the absorption of part of the dietary fat. Decreased absorption of saturated fat leads to reduction in serum cholesterol level via decreased production of VLDL and increased intake of LDL in the liver. Dietary calcium may also bind bile acids, which increases the conversion of cholesterol to bile acids in the liver. Furthermore, calcium appears to enhance the cholesterol-lowering effect of plant sterols. Thus, dietary combination of the mineral nutrients and plant sterols provides a promising novel approach to the modification of cardiovascular risk factors.     

The extended pectoralis major myocutaneous flap: uses and indications

The vascular territory of the pectoralis major muscle and overlying skin was studied by selective intraarterial dye injections in fresh cadavers. The area of skin overlying the anterior chest and abdominal wall beyond the limits of the pectoralis major muscle that can be elevated as an extended myocutaneous flap was determined. The cadaver injections were evaluated to determine the size and shape of the skin island used to reconstruct defects of the head, neck, and upper trunk with an extended skin paddle off the pectoralis major muscle. Pectoralis muscle flaps with variously shaped skin paddles, some extending beyond the limits of the muscle, were used in 27 patients to cover large soft-tissue defects of the upper thorax, face, and floor of the mouth and as a skin tube to reconstruct the cervical esophagus. The size of the skin paddle ranged from 5 x 7 cm to 26 x 16 cm. All flaps survived completely, and there were no major donor-site complications.     

The consultation and the therapeutic illusion.

At 45 general-practice surgery sessions 200 patients in whom no definite diagnosis could be made were randomly selected for one of two procedures. Either they were given a symptomatic diagnosis and medications, or they were told that they had no evidence of disease and therefore they required no treatment. No difference in outcome was found between these two methods as judged by the return or not of the patient within one month and his statement that he did or did not get better.     

The SPORTCOR registry: a national databank for sports cardiology

Being physically active is generally regarded as the best buy to prevent (cardiovascular) disease. Although the positive effects of regular exercise prevail, negative aspects of sports activity, particularly sportsrelated injuries, should not be ignored. Sudden cardiac death can be regarded as the most tragic sports-related injury.