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Biomedical subjects

A Usal

Publications and source records attributed to A Usal.

9 recordsLinked to original sources
PubMed1997

Effects of trimetazidine on heart rate variability and left ventricular systolic performance in patients with coronary artery disease after percutaneous transluminal angioplasty.

Fifty-one patients (mean age 51.6 +/- 7.1 years) with angiographically proven coronary artery disease (CAD) entered the study. In 26 patients (Group I), trimetazidine treatment started twenty-four hours after percutaneous transluminal coronary angioplasty (PTCA). Another 25 patients (Group II) without trimetazidine treatment were kept as controls. The groups were comparable by age, gender, risk factors of CAD, coronary anatomy, left ventricular performance, and heart rate variability indices at baseline state. Power spectral analysis of heart rate variability and two-dimensional and Doppler echocardiographic examinations were performed before PTCA, and twenty-four hours, ten days, thirty days, and three months after PTCA. A statistically significant improvement of left ventricular systolic performance (P < 0.001), augmentation of the parasympathetic band of heart rate variability (P < 0.001), and decline of P1/P2 ratio (P < 0.01) were evident in patients treated with trimetazidine, while no apparent changes were observed in controls. The intergroup analysis also showed marked difference between groups as recorded on the day 30 and month 3 of observation (P < 0.001). During follow-up period recurrences of angina pectoris and ischemia were registered in Group II, while no evidence of ischemia was discerned in Group I patients. In conclusion, trimetazidine modulates the autonomic control of heart rate, ie, reduces sympathetic overactivity and augments vagal influences, improves left ventricular contractility, and diminishes the clinical manifestations of ischemia in patients with CAD after PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1997

Thromboembolism risk in patients with mitral stenosis.

A total of 168 consecutive patients with predominant rheumatic mitral stenosis were evaluated by transthoracic (TTE) and transesophageal echocardiography (TEE). Of the 168 patients, 35 had previous embolic events (group I) and 133 had no emboli (group II). A total of 77 (45.8%) patients had atrial fibrillation. The frequency of atrial fibrillation was higher in group I than group II (68.6% vs 39.8%, p < 0.001). The incidence of left atrial enlargement was greater in group I (p < 0.001). Mitral valve area was found to be smaller in group I compared to group II (p < 0.001). In group I 83.3% and 29.2% of the patients with atrial fibrillation had left atrial spontaneous echo contrast (SEC) and left atrial thrombus, respectively, and 72.7% of the patients with sinus rhythm had left atrial SEC. In group II 79.2% and 20.8% of the patients with atrial fibrillation had left atrial SEC and left atrial thrombus whereas 28.6% and 2.6% of the patients with sinus rhythm had left atrial SEC and left atrial thrombus, respectively. The incidence of left atrial thrombus was significantly different in those patients with compared to those without embolic events (20% vs 9.7%, p < 0.01). In groups I and II, 28 of 35 (80%) and 64 of 133 (48.1%) patients had left atrial SEC (p < 0.01). Patients with left atrial SEC had a greater left atrial size (p < 0.01) and smaller mitral valve area (p < 0.01). Left atrial size was normal in 2 patients with left atrial SEC and SEC was not found in 55 patients with enlarged left atrium. Multiple logistic regression analysis showed that atrial fibrillation, mitral valve area and left atrial enlargement were independent predictors of the SEC (p < 0.001) and left atrial SEC was the principal determinant of thromboembolism. These data suggest that regardless of rhythm and atrial size, left atrial SEC is a principal determinant of thromboembolic risk in mitral stenosis. TEE may be able to detect those patients with mitral stenosis at risk for emboli and guide appropriate therapy.

Adolescent↗
PubMed1996

A serious complication of percutaneous mitral valvuloplasty: systemic embolism. How can we decrease it? Case history.

Systemic embolism is a potential and severe complication of percutaneous balloon mitral valvuloplasty (PBMV). The incidence of systemic embolism during PBMV has been reported to be less than 5% and only 0.6% with the Inoue technique. This is less than that reported in closed commissurotomy series and about the same as in open commissurotomy. In the authors' series of 50 cases, the incidence of systemic embolism was 2% (1 case). The patient had mitral restenosis (after closed commissurotomy) with mild to moderate valvular and subvalvular calcification, and cerebral embolism occurred during the procedure. To prevent systemic embolism, the authors' standard policy was to perform transesophageal echocardiography (TEE), computed tomography, and magnetic resonance imaging before the procedure and to give heparin during the procedure and two months preceding it in cases with atrial fibrillation or with a history of previous embolism and to limit manipulation of the catheter in the left atrium. The authors believe that a close scrutiny in the selection of patients, improved technology of the dilating system, good experience with PBMV, and adequate heparinization are also of great importance in the prevention of thromboembolic complications.

Anticoagulants↗
PubMed1996

Hydatid disease presenting as cardiac tamponade. A case history.

Although hydatid disease has been reported in almost all human tissues, cardiac involvement is uncommon. The authors report a case of cardiac hydatid disease presenting with cardiac tamponade. The diagnostic value of transthoracic and transesophageal echocardiography, computed tomography, and angiography in hydatid heart disease is also discussed.

Adult↗
PubMed1996

Decreased glutathione levels in acute myocardial infarction.

Although experimental studies have demonstrated that reduced glutathione (GSH) is involved in cellular protection from deleterious effects of oxygen free radicals (OFRs) in ischemia and reperfusion, there are controversial data on the correlation between the levels of erythrocyte GSH and the ischemic process. To clarify, we determined the erythrocyte GSH levels in 21 patients with acute myocardial infarction (AMI), aged 39-70, who were not given thrombolytic therapy and 21 age- and sex- matched healthy controls. Samples of blood were taken on days 1, 3, 5 and 7 from AMI patients and on the same days from the controls. The GSH levels of patients with AMI were significantly depressed by 11.5% as compared to the controls on the second day after infarction (7.44 +/- 1.71 vs 8.41 +/- 1.54 U/gHb p < 0.05). Although the total mean of GSH levels for all days was lower (3.8%) in patients than in the controls, this finding did not reach statistical significance (7.41 +/- 1.71 vs 7.71 +/- 1.27 U/gHb, ns). There was no correlation between the erythrocyte GSH levels and cardiac enzyme concentrations, infarct localization, hemodynamic status according to Killip classification and the frequency of ventricular arrhythmias. This preliminary work suggests that depressed GSH levels may be associated with an enhanced protective mechanism to oxidative stress in AMI. Measurements of erythrocyte GSH can be helpful in the estimation of oxidative stress in the course of AMI. However, further research must be done to determine the primary scavenger in AMI by analyzing all the enzymes and substrates involved in the endogeneous system that controls the effects of OFRs.

Case-Control Studies↗
PubMed1994

AA-amyloidosis presenting with chronic diarrhea and cardiac manifestations.

In secondary amyloidosis (AA type), clinically significant cardiac and gastrointestinal involvement are uncommon, in contrast to the primary type. We report a case presenting with chronic diarrhea and cardiac manifestations who was diagnosed as having AA-amyloidosis with unknown predisposing illness based on endomyocardial, rectal and subcutaneous fat tissue biopsies.

Aged↗
PubMed1990

A case of infiltrating lipomatosis with diffuse, symmetrical distribution.

Infiltrating lipomatosis represents a distinct clinicopathological entity characterised by collections of non-encapsulated, mature lipocytes that infiltrate local tissues. The lesions are usually first observed during the first three decades of life, but congenital types exist. Although a predilection for the lower extremity exists in approximately 80% of patients, they can affect a multitude of anatomic sites. Infiltrating lipomatosis of the face, head and neck, upper and lower extremities, trunk and abdominal cavity and pelvis have all been reported. The patient presented here had symmetrical, diffuse infiltrating lipomatosis involving almost the whole body, sparing only the head, neck, fingers and toes.

Adipose Tissue↗