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Biomedical subjects

A Bethencourt

Publications and source records attributed to A Bethencourt.

At least 19 recordsLinked to original sources
PubMed2006

Trypanosomiasis in Venezuelan water buffaloes: association of packed-cell volumes with seroprevalence and current trypanosome infection.

The seroprevalence of trypanosomiasis and the prevalence of current trypanosome infection in water buffaloes from the most important livestock areas of Venezuela were evaluated by IFAT and the microhaematocrit centrifugation technique, respectively. The usefulness of a PCR-based assay for identifying the trypanosome species in the buffaloes was also evaluated. Of the 644 animals investigated, 40 (6.2%) were found infected with trypanosomes by blood centrifugation, and 196 (30.4%) were found positive for anti-trypanosome antibodies, by IFAT. The results of the PCR-based assay indicated that 92.5% of the animals with current infections were infected with Trypanosoma vivax and the rest with T. theileri (the first molecular confirmation of T. theileri in Venezuelan water buffaloes). The national programme to treat and prevent trypanosome infections in the buffaloes does not appear to be meeting with great success, even though it is focused on T. vivax. Although the level of parasitaemia was categorized as low for 28 (70%) of the infections detected (and packed-cell volumes appeared to be unassociated with IFAT result, and uncorrelated, in the infected animals, with level of parasitaemia), the 40 infected buffaloes had a significantly lower mean packed-cell volume than the uninfected animals (P<0.05). Farmers should therefore be made aware of the probability of trypanosome-attributable losses in buffalo productivity.

Animals↗
PubMed2001

[Thallium-201 scintigraphy and dobutamine echocardiography in the assessment of myocardial viability].

BACKGROUND: The possibility of differentiating viable from non-viable tissue among patients with severe coronary artery disease and severe left ventricular impairment entails relevant clinical and therapeutic implications since it may influence the indication of patient revascularization. To evaluate the presence of myocardial viability two techniques are available in the clinical setting: echocardiography with intravenous infusion of dobutamine and scintigraphy with myocardial perfusion with thalliem-201 by means of single-photon emission tomography. OBJECTIVE: To compare prospectively the value of these techniques for detecting viable myocardium. MATERIAL AND METHODS: Thirty-five patients with severe coronary disease and severe left ventricular dysfunction were included in the study. All patients underwent an echocardiogram using incremental doses of dobutamine, from 5 up to 40 micrograms/kg/min in three-minute periods. For thallium-201 scintigraphy the rest redistribution protocol with delayed images at 4 hours was used. The criteria for detecting viability were: a) for thallium-201, the presence of redistribution in delayed images and normal uptake at rest, and b) for dobutamine echocardiography, a sustained improvement in regional motion, biphasic response, and worsening. RESULTS: By considering the segmental improvement post-revascularization as "gold standard" of viability, the statistically significant variables in a logistic regression model and, therefore, predictors of segmental functional recovery were the biphasic response and the sustained response for dobutamine echocardiography and normal uptake at rest and redistribution in the delayed images for thallium-201. Taken together, the result was significant for the biphasic response of dobutamine echocardiography. CONCLUSIONS: The biphasic response with dobutamine echocardiography is the echocardiographic pattern that best predicts the functional recovery of the ischemic myocardium. A normal uptake and redistribution at four hours is the only scintigraphic pattern that can predict functional improvement. Of both patterns, the biphasic response is the best predictor of the functional recovery of the dysfunctional myocardium.

Cardiotonic Agents↗
PubMed2001

[In hospital and mid-term outcome of patients with NIR stent implantation: multicenter ESPORT-NIR registry].

BACKGROUND AND OBJECTIVE: Despite improvements in the results and techniques of catheter-based revascularization, few studies have evaluated the clinical results of the application of new stent designs. We describe the in-hospital and mid-term outcome of patients undergoing a stent NIR implantation. PATIENTS AND METHOD: At least 1 Stent NIR was implanted in 1.004 patients (1.136 lesions) recruited from 50 centers in an international, multicenter, prospective, registry (Spain and Portugal NIR stent registry). Inclusion criteria were objective coronary ischemia related to a severe de novo lesion or first restenosis in native vessels with a reference diameter >= 2.75 mm. The primary end-point was the incidence of major adverse cardiac events within the first 7 months of follow-up. RESULTS: The mean age of the patients was 60 years and 82% were male. Angioplasty was indicated due to unstable angina in 61% of the cases. Stent implantation was successfully achieved in 99.6%. Clinical success (angiographic success without in-hospital major events) was achieved in 98.6% of patients. The rate of angiographic restenosis (> 50% stenosis narrowing) was 16% (CI 95%; 11.7-21.2). The accumulated major cardiac adverse event rate at seven months of follow-up was 8.7%: death (0.9%), acute myocardial infarction (1.2%) and target lesion revascularization (6.6%). CONCLUSION: In the wide setting of the population included in the ESPORT-NIR registry, stent NIR implantation was a highly effective therapy with a good mid-term clinical and angiographic outcome.

Angina, Unstable↗
PubMed2001

[Spontaneous rupture of the papillary muscle with angiographically normal coronary vessels].

Papillary muscle rupture is an unusual pathology, commonly being a mechanical complication of an acute myocardial infarction or a blunt chest trauma. In this case report we describe a patient with a spontaneous complete posteromedial papillary muscle rupture, secondary to an isolated papillary muscle infarction, in the absence of coronary artery disease, resulting in severe mitral regurgitation, cardiogenic shock and uneventful urgent mitral valve replacement. The clinical and histopathologic literature, and mechanisms to explain this kind of rupture, are reviewed.

Aged↗
PubMed2001

[Comparison of dobutamine echocardiography and rest-redistribution 201-thallium SPECT in the assessment of myocardial viability taking PET as gold standard].

BACKGROUND AND AIM: To compare Tl-201 SPECT and dobutamine stress echocardiography for the detection of myocardial viability in patients with severe left ventricular dysfunction using metabolic imaging by positron emission tomography as the standard reference. MATERIAL AND METHODS: We studied 25 consecutive patients with severe coronary artery disease and left ventricular dysfunction that underwent two different diagnostic modalities for evaluating myocardial viability: stress echocardiography with incremental doses of dobutamine from 5 up to 40 g/kg/min in 3 min stages, and 201 Tl SPECT using a rest-redistribution protocol with delayed images obtained at 4 hours. Fluorodeoxyglucose uptake by PET was used as the gold standard. Viability criteria were as follows, for 201Tl SPECT imaging: normal uptake at rest and presence of redistribution in the delayed images, for dobutamine stress echocardiography: sustained improvement and biphasic response. RESULTS: Sensitivity of thallium redistribution was 46%, for normal uptake, plus redistribution 82%, 34% for dobutamine biphasic response and 58% for sustained improvement plus biphasic response. Specificity of biphasic response was 82% and that of redistribution 67%. Stepwise logistic regression indicated that biphasic wall motion response during dobutamine stress echocardiography (2.01 CI 95%; 1.10 to 3.99) and the presence of redistribution plus normal uptake at rest with thallium imaging (2.68 CI 95%; 1.42 to 5.13) were the best predictors of viability. These results were the same when both techniques were analyzed together. CONCLUSIONS: Biphasic wall motion response during dobutamine stress echocardiography and the normal uptake plus presence of redistribution with thallium imaging were the best pre

Cardiotonic Agents↗
PubMed2000

[Heart angiosarcoma: heart magnetic resonance diagnosis].

The case of a young male with a primary cardiac angiosarcoma of the right atrium is reported. The patient presented with a relapsing cardiac tamponade due to hemopericardium, the diagnosis being made by magnetic resonance. The resection of the tumor did not prevent an adverse outcome, as the patient died due to metastatic dissemination.

Adult↗
PubMed2000

[Unstable angina in the elderly: clinical, profile, management and mortality at three months. The PEPA Registry Data].

INTRODUCTION AND OBJECTIVES: Few reports in the literature have studied the characteristics and management of unstable angina in the elderly in Spain. The aim of this study was to analyze the clinical characteristics and the use of diagnostic and therapeutic resources in patients > or = 70 years of age. PATIENTS AND METHODS: A total of 1,551 patients > or = 70 years of age were included out of 4,115 included in the PEPA registry with a follow up of 90 days. These patients were compared with 2,564 < 70 years. RESULTS: In comparison, the elderly (76 +/- 5 years) versus the younger group (58 +/- 8.5 years) included a higher proportion of women (43 vs 27%), diabetics (30 vs 23%)and hypertensive patients (60 vs 49%) with a lower proportion (p < 0.001) of hypercholesterolemia (33 vs 43%), smoking (40 vs 60%) or family history (9 vs 17%). A previous history of angina (49 vs 35%) or infarction (38 vs31%) and comorbidity was found to be significantly more frequent in the elderly, with a worse previous functional class (NYHA > 2 out of 34 vs 15%). The elderly were treated with fewer invasive procedures (25 vs 44%) or catheterization (26 vs 36%) and they were more frequently controlled with medical treatment (86 vs 83%) although with a lower use of beta blockers (45 vs 53%). The mortality at 3 months was greater in the elderly (7.4 vs 3.0%;p < 0.005) with age being an independent predictor of bad prognosis. Cox multivariate analysis showed the age, ST segment depression, diabetes and heart failure on admission to be predictors of bad prognosis in the elderly. CONCLUSIONS: A different pattern is observed in cardiovascular risk factors with a more unfavorable clinical profile in elderly patients with unstable angina. The management of these patients is less aggressive and the mortality is greater. Diabetes, heart failure and ST segment depression on admission are independent predictors of bad prognosis in elderly patients.

Aged↗
PubMed1999

[Early percutaneous revascularization in patients with unstable angina. Current results and comparison with conservative medical treatment].

In patients with ongoing angina, despite optimal medical therapy, the best therapeutic alternative is coronary angiography followed by emergency coronary revascularization with surgery or angioplasty. However, whether or not all patients should have early angiography and revascularization is a matter of debate. This paper reviews the advantages of modern medical therapy in this setting and the problems associated with early coronary revascularization. In particular, it analyses the data from the main clinical trials that have specifically compared an early invasive procedure with a conservative strategy in unstable coronary syndromes. Finally, it assesses the impact of the new antithrombotic agents, such as glycoprotein IIb/IIIa receptor blockers, particularly during coronary percutaneous interventions. The data reviewed suggest that early invasive intervention should be reconsidered, and that patients should be controlled (if possible) under medical treatment until non invasive stratification tests allow the identification of those patients who would benefit most from revascularization.

Angina, Unstable↗
PubMed1998

[Iatrogenic vascular lesions after cardiac catheterization].

INTRODUCTION AND PURPOSE: The increase in vascular complications after cardiac catheterizations is rising due to the increase in the total number of these procedures. The purpose of this report is to determine the incidence of this complication and to identify the variables which are related to the presence of vascular complications which required surgical repair. MATERIAL AND METHODS: Retrospective review of the 3,723 cardiac catheterizations made by the interventional cardiology department during a period between June 1992 to August 1996. RESULTS: Thirty two vascular complications were detected (0.9%), which required surgical reparation. There was no statistical difference in age, sex, presence of vascular risk factors, cardiac indication for catheterization and vascular approach between those patients who had a vascular complication and those who did not. The presence of obesity [RR: 2.5, IC 95% (1.2-5)], use of catheter sheath, superior or equal to 8F [RR: 0.3, IC 95% (0.14-0.62)] and use of systemic anticoagulation [RR: 4.8, IC 95% (2.1-10.8)], increase the risk of vascular complications. Two patients died (6.2%) due to cardiac complications and there were minor complications in 23% after surgical repair. CONCLUSION: Vascular complications after cardiac catheterization continue to be a significant problem. There are several variables which influence the presentation of vascular complications. Continued surveillance of cardiac catheterization complications is necessary to minimize problems and improve results.

Adult↗
PubMed1991

False tendon rupture simulating chordal rupture after percutaneous mitral balloon dilation. A report of two cases.

We describe two cases of ruptured false tendons following percutaneous balloon dilation of the mitral valve in one case, and combined mitral and aortic balloon valvotomy in the other, using in both the retrograde approach. The echocardiographic characteristics of this previously unreported complication of the procedure are presented with special emphasis on the differentiation with true chordal rupture. No short or mid term adverse effects were noted following this complication.

Adult↗
PubMed1991

[Coronary permeability and left ventricular function following thrombolytic therapy].

We study 40 patients, 55 +/- 7 years old with acute myocardial infarction treated early by thrombolytic therapy (20 STK and 20 rt-PA). All patients were angiographically studied in the following conditions: 1) baseline, before initiating therapy. 2) Three hours after treatment. 3) Twenty four hours later. 4) Before discharge. The infarct related artery was patent 24 hours after treatment in 31 patients (78%); five of them were patent before treatment, and we observed an early reperfusion in 20 patients (57%) and late reperfusion in 6 patients (17%). The number of patients with angiographic evidence of intraluminal thrombus decreased progressively through conditions while the grade TIMI of coronary perfusion increased in the absence of reocclusion. Final regional wall motion of infarct related myocardial zones and their degree of recovery were significantly higher in recanalized patients, as compared with non-reperfused patients. Similarly, left ventricular functional recovery was higher in patients with antegrade of collateral flow to the infarct area, as compared with totally occluded patients.

Coronary Angiography↗
PubMed1990

Balloon valvuloplasty for mitral restenosis after previous surgery: a comparative study.

We studied 203 patients with mitral stenosis treated by transarterial valvuloplasty. Forty two (group A) had undergone closed (n = 30) or open n = 12) surgical commissurotomy 15 +/- 5 years before. The remaining 161 had not undergone previous surgery (group B). There were no significant differences between both groups in terms of age, sex, functional class, left atrial size, two-dimensional anatomic features of the valve, incidence of mild basal mitral regurgitation, or ejection fraction. A comparative analysis of both groups showed no significant differences in terms of changes in the mean gradient, mitral valve area, and incidence of severe postvalvuloplasty mitral regurgitation (9.5% versus 5.5%). Echo-Doppler follow-up studies (11 +/- 7 months) showed persistent gradient relief in either group. We conclude that the immediate and short-term results of balloon valvuloplasty in patients who had undergone previous surgery are similar to those observed in patients who had not had commissurotomy.

Catheterization↗
PubMed1990

[Role of percutaneous valvuloplasty in rheumatic mitral valve stenosis. Córdoba-Las Palmas cooperative study].

This article describes our findings on a prospective and cooperative study (Córdoba-Las Palmas) in 203 patients with mitral stenosis who underwent balloon valvuloplasty using a retrograde transarterial technique. We analyzed the immediate and mid-term results, and studied the factors determining an optimal result and those related to the new appearance or worsening of mitral incompetence after the procedure. On the other hand, we analyzed the results of mitral valvuloplasty in patients with previous mitral surgery, mild mitral stenosis and patients dilated while having an acute pulmonary edema. We observed a marked decrease in mean mitral gradient (17 +/- 7 to 6 +/- 3 mmHg; p less than 0.001) as well as a significant increase in mitral valve area (1.02 +/- 0.4 to 2.04 +/- 0.7 cm2; p less than 0.001). Echo-Doppler follow-up did not show significant changes in the residual mitral valve gradient. Multivariate analysis selected, as independent predictors of an optimal result, the presence of a pliable valve and the absence of basal mitral regurgitation. On the other hand, the presence of a lower ejection fraction, an older age and a higher baseline left ventricular endiastolic volume were independent factors determining progression of mitral regurgitation. In patients with previous mitral surgery, the clinical, echo and hemodynamic profiles, as well as the immediate results, were similar to those observed in patients with unoperated mitral stenosis. In the subgroup of mild mitral stenosis, we observed and optimal result in all cases, without major complications. Mitral valvuloplasty was dramatically effective in 8 patients treated during acute pulmonary edema.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Combined percutaneous mitral and aortic balloon valvuloplasty.

Between August 1987 and November 1988, combined mitral and aortic balloon valvuloplasty was performed in 10 patients (mean age 42 +/- 9 years), all of whom had symptomatic mitral and aortic stenosis. The procedure was performed using a transarterial approach with a multiballoon catheter and an exteriorized intracardiac long guidewire circuit. The procedure could be considered successful in 9 patients where significant increases in the mean mitral (0.97 +/- 0.19 to 1.80 +/- 0.26 cm2) and aortic (0.63 +/- 0.18 to 1.15 +/- 0.32 cm2) areas were achieved. Severe mitral regurgitation that required surgery developed in 1 patient in the following 24 hours. Femoral vascular surgery was necessary in 1 patient. Mid-term follow-up was available in 8 patients for a period averaging 8 +/- 3 months. The 9 patients in whom the procedure was successful showed persistent clinical improvement in functional class, Doppler echocardiography showed 2 cases of aortic restenosis and none of mitral restenosis. Combined mitral and aortic balloon valvuloplasty could be a valid alternative treatment in selected patients with both mitral and aortic rheumatic stenosis. Further experience and long-term hemodynamic follow-up are necessary to define the role of this mode of treatment.

Adult↗
PubMed1989

[Coronary transluminal angioplasty and determination of the intracoronary gradient with a new monorail system].

STUDY OBJECTIVE: To evaluate the results obtained in coronary angioplasty using the new very low profile monorail catheter. DESIGN: A retrospective study to define the causes and frequency of successful and unsuccessful coronary angioplasty on proximal and distal lesions located in the three coronary vessels. SETTING: Patients referred to the Hemodynamic Unit for coronary angioplasty. PATIENTS: Coronary angioplasty was performed in 106 patients with cardiac ischemic disease (stable angina, unstable angina and myocardial infarction after thrombolytic therapy). INTERVENTIONS: To perform coronary angioplasty using a monorail system, including dilatation of vessels (angioplasty) and to measure the intracoronary gradient. RESULTS: A high success rate was achieved (92%) independent of vessel dilated or of the position of the stenosis. There was a lower success rate in complex lesions. CONCLUSION: In this study, this newly modified system for coronary angioplasty with balloon catheter and monorail pressure catheter gave a very high performance.

Aged↗
PubMed1989

[Aortic valvuloplasty using the transatrial route in aortic valve stenosis].

We describe a new technique for aortic valvuloplasty in four patients. The balloon catheter was inserted percutaneously from the right femoral vein over a long guidewire introduced into the right femoral vein and advanced transseptally to the left atrium and left ventricle and drawn out of the body through the left femoral artery using an intravascular retriever set. With both ends of the long guidewire under manual control outside the body, the balloon could be easily fixed during inflation. The procedure was easy to perform and caused no complications.

Adolescent↗