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      Long-Term Nitrate Treatment Increases Cardiac Events in Patients With Healed Myocardial Infarction

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          Most cited references 22

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          Estimability and estimation in case-referent studies.

          The concepts that case-referent studies provide for the estimation of "relative risk" only if the illness is "rare", and that the rates and risks themselves are inestimable, are overly superficial and restrictve. The ratio of incidence densities (forces of morbidity)-and thereby the instantaneous risk-ratio-is estimable without any rarity-assumption. Long-term risk-ratio can be computed through the coupling of case-referent data on exposure rates for various age-categories with estimates, possibly from the study itself, or the corresponding age-specific incidence-densities for the exposed and nonexposed combined-but again, no rarity-assumption is involved. Such data also provide for the assessment of exposure-specific absolute incidence-rates and risks. Point estimation of the various parameters can be based on simple relationships among them, and in interval estimation it is sufficient simply to couple the point estimate with the value of the chi square statistic used in significance testing.
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            Catecholamine cardiotoxicity.

             G Rona (1985)
            The morphologic-functional correlative studies that we have carried out in the past 25 years with the various catecholamines have served as an example for analyzing myocardial reaction patterns and the reactions of the cardiac muscle cells to insult. These studies disclosed the unique nature of isoproterenol in producing 'infarct-like' myocardial necrosis. It appears that the pathogenesis of the catecholamine-induced myocardial necrosis is multifactorial. Our early studies suggested the role of relative hypoxia. Later studies by using extracellular fine structural protein tracers demonstrated the importance of microcirculatory effects as well as, in the norepinephrine model, that of early sarcolemmal membrane permeability alteration. The Ca2+ overload theory is supported not only by the experimental observations but also by its successful application in clinical cardiology. A new contribution is the recognition of catecholamine oxidation products in producing myocardial injury. Experimental data indicate that catecholamines play an important role in reperfusion and ischemic myocardial injuries. The sequence of events demonstrated by our studies with catecholamines might represent a common pathway in the evolution of myocardial changes in humans who develop myocardial lesions without narrowing or obstruction of coronary arteries. Investigation in the field of molecular and cellular cardiology has led to a better understanding of current clinical problems and helped to devise procedures for the prevention and management of human myocardial disorders. The isoproterenol-induced myocardial necrosis served as model to Professor A. Fleckenstein to formulate the Ca2+ overload theory of myocardial injury and develop a series of now widely used Ca2+ antagonistic drugs for the management and the prevention of human myocardial diseases.
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              Treatment of myocardial infarction in a coronary care unit

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                Author and article information

                Journal
                Japanese Circulation Journal
                Jpn Circ J
                Japanese Circulation Society
                00471828
                13474839
                1996
                : 60
                : 10
                : 779-788
                Article
                10.1253/jcj.60.779
                03d21ee2-24b9-497d-9f6c-6031f846a1cc
                © 1996

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