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Biomedical subjects

E Alegría

Publications and source records attributed to E Alegría.

At least 19 recordsLinked to original sources
PubMed2000

[Guidelines of the Spanish Society of Cardiology for clinical practice in exercise testing].

Most exercise testing is performed in adults with known or suspected ischemic heart disease. In the last few years cardiac imaging techniques have been applied in this field, improving the information obtained with the procedure. However, the exceptions to this rule are emerging rapidly not only in healthy people (asymptomatic individuals, athletes, handicapped people) but also in cardiac patients (advanced congestive heart failure, hypertension, rhythm disorders, congenital heart disease, etc.). All the-se issues justify the need for a multidisciplinary consensus document in Spain. This paper reviews and updates the methodological aspects of the stress test, including those related to oxygen consumption measurements. The main aim of this review was to determine the role of exercise testing in the evaluation of ischemic heart disease as well as the applications of imaging stress testing. The usefulness of this test in other non-ischemic cardiac disorders and in selected subsets of healthy people is also reviewed.

Adult↗
PubMed1999

Implantation of 500 consecutive cardiac pacemakers in the electrophysiology laboratory.

OBJECTIVE: The purpose of this study was to examine the practice of cardiac bradycardia pacing in an electrophysiology laboratory and to evaluate the safety and efficacy of pacemaker implantation by cardiologists in this setting. METHODS AND RESULTS: We evaluated a consecutive series of the first 500 permanent pacemakers (mean age of patients: 74 +/- 14 years) implanted entirely in the electrophysiology laboratory at our institution. All procedures were performed by two cardiologists. Three-hundred and four patients (60.8%) received a dual-chamber device. After 3 months of follow-up, procedure-related complications occurred in 19 patients (3.8%). The most frequent complication was lead dislodgement (1.4%). There were 2 postoperative infections (0.4%). The mean time to hospital discharge after the implant was 2.9 +/- 1.6 days. CONCLUSIONS: These results show that permanent pacemaker implantation may be successfully carried out by cardiologists in the electrophysiology laboratory with a low complication rate. Atrial lead dislodgement seems to be the most frequent complication in centres with a high proportion of dual-chamber pacemaker implantations.

Adolescent↗
PubMed1998

Magnetic resonance imaging in a patient with a dual-chamber pacemaker.

The presence of an implanted cardiac pacemaker has been considered an absolute contraindication for magnetic resonance imaging due to the interactions between the pulse generators and the magnetic and radiofrequency fields generated by the magnetic resonance unit. We describe the case of a patient with a dual-chamber pacemaker who underwent two magnetic resonance imaging examinations of the head without any sequelae. Both procedures were performed with a 1 Tesla unit, with the pacemaker programmed to the AOO mode. The only interference observed was activation of the reed switch -probably due to the static magnetic field- resulting in asynchronous atrial pacing at the magnet rate. Although the general policy of never exposing a patient with a pacemaker to magnetic resonance imaging should not be revised, we think that if the testing is considered essential, it could be safely used in certain carefully selected patients.

Adenoma↗
PubMed1997

[Pericardial hematoma 2 years after coronary surgery].

Cardiac tamponade is a life-threatening complication after cardiac surgery which may develop in the early or late postoperative period. The latest have been defined arbitrarily as the ones occurring after the 7th postoperative day. They are less common than the early ones and most of the cases have been reported up to six months after the operation. They usually determine diagnostic difficulties that can negatively influence the prognosis. Because of its atypical late appearance, a case of a 65 year old man is presented who developed a postpericardiotomy syndrome and subsequently a pericardial clot nearly two years after aortocoronary bypass grafting.

Aged↗
PubMed1996

Effect of hypercholesterolaemia on platelet growth factors.

Evidence from several sources suggests that important interactions occur between platelets and low-density lipoproteins. This study was undertaken to find out if diet-induced hypercholesterolaemia affects the growth factor content in circulating platelets. Minipigs were fed either normal diet supplemented with 2% cholesterol (n = 12) or normal diet alone (n = 12). After 4 months, mean platelet volume was significantly lower (P < 0.05) and monocyte count was significantly higher (P < 0.05) in the cholesterol group. Serum and intraplatelet levels of platelet-derived growth factor (BB homodimer) and transforming growth factor beta 1 were statistically unchanged after diet. Hypercholesterolaemia did not affect the proliferative effect of either serum or platelet lysates on porcine vascular smooth muscle cells and Swiss-3T3 cells in culture. A significant positive correlation between Swiss-3T3 and smooth muscle cell proliferation was present in both groups. These results suggest that the atherosclerosis-promoting effect of hypercholesterolaemia cannot be explained by its direct effect on smooth muscle cell proliferation or by changes in serum or intraplatelet concentrations of growth factors.

3T3 Cells↗
PubMed1996

Verapamil deleterious effects in chronic renal failure.

Three hypertensive patients with chronic renal failure treated with slow-release verapamil at the recommended doses for high blood pressure experienced acute deleterious effects shortly after treatment (6 h to 3 days). Patients developed slow cardiac rhythms (junctional bradycardia or atrial fibrillation), hypotension and hyperkalemia. Consequently they also had oliguria and worsening of the renal function. Inotropic support, fluid therapy and potassium-lowering measures were able to restore the renal function and sinus rhythm after 10-12 h. Only 7 similar cases have been described so far. It is suggested that slow-release formulations of verapamil must be used with caution in hypertensive patients with impaired renal function.

Aged↗
PubMed1996

[Growth factors and mitogenic activity in experimental hypercholesterolemia].

INTRODUCTION: Hypercholesterolemia is associated with increased platelet reactivity and changes in megakaryopoiesis, which might influence the synthesis of growth factors in the megakaryocyte. MATERIAL AND METHODS: 20 miniature pigs were randomly assigned to received 18 weeks of either regular pig chow feed (control group, n = 10) or a high cholesterol diet (cholesterol group, n = 10). Platelet count, mean platelet volume, platelet distribution width and bleeding time were determined in both groups. Intraplatelet and serum mitogenic activity was quantified by Swiss 3T3 and vascular smooth muscle cells proliferation assays. Insulin-like growth factor I and platelet-derived growth factor (BB isoform) levels were quantified in platelet lysates and in serum in both groups. RESULTS: Hypercholesterolemia was associated to a significant decrease in mean platelet volume and bleeding time, but it did not affect the proliferative effect of serum and platelet lysates nor its growth factor content. CONCLUSIONS: Taken together, our results suggest that although hypercholesterolemia affects platelet reactivity, its atherosclerosis-promoting effects cannot be explained by a direct effect on vascular smooth muscle cell proliferation or by changes in serum or intraplatelet growth factor content.

3T3 Cells↗
PubMed1994

[Quantification of myocardial tomography with thallium in coronary disease. Evaluation of the Cedars-Sinai technique].

OBJECTIVE: The aim of this study is to evaluate the contribution of the Cedars-Sinai quantification tomographic method (CS) in the diagnosis and localization of ischemic areas in coronary artery disease (CAD) and to optimize the threshold values proposed by CS. PATIENTS AND METHODS: Fifty patients with clinical suspicion of CAD performed a maximal stress test by cycloergometer; thallium myocardial tomographic images were obtained; applying the CS program afterwards. The sensitivity and specificity variations obtained by changing the criteria for extent of myocardial hypoperfusion (range 1% to 100%) were used to calculate the new thresholds (CS-I), using the results of coronariographic studies as a reference. The data determined by qualitative analysis were compared with that obtained by quantitative analysis by means of CS and CS-I using coronary angiography as the standard of reference. RESULTS: The coronary angiography showed coronary disease in 37 patients. The sensitivity for the diagnosis of CAD was superior using CS (97%) at the expense of low specificity (15%) which nevertheless improved with CS-I (54%). For the location of CAD, the visual analysis was statistically significant (p < 0.05) in the left anterior descending and right coronary arteries, CS being superior in the diagnosis of 3 vessel disease. CONCLUSIONS: The quantification of tomographic studies with thallium by means of CS needs a readjustment of the thresholds. The tested values (CS-I) improved the CS results, although they require prospective validation. Quantitative study permits the confirmation of visual findings, being a complementary method that can be rapidly and easily interpreted, although it is not recommended as a single technique for the diagnosis of coronary disease.

Adult↗
PubMed1994

[Clonidine in the treatment of tobacco withdrawal. A comparison with nicotine chewing gum].

The objective of our work was to carry out a prospective study on the effectiveness of clonidine and nicotine gum in the treatment of tobacco withdrawal. Sixty smokers were randomly distributed in two groups and were included in a tobacco withdrawal program. One group received oral clonidine treatment while the other group was given nicotine gum. Adjuvant therapy such as group therapy or psychotherapy was not performed. At the end of one year there were no significant differences between the two groups with regards to the number of subjects who have continued to stop smoking. There were also no significant differences between the two groups with regards to the symptoms of tobacco abstinence. When we studied the relation between treatment fulfillment and tobacco withdrawal we observed that the clonidine treated group had a significantly greater number of success compared to the nicotine group (p < 0.01).

Adult↗
PubMed1994

[Dynamic cardiomyoplasty. Preliminary experience].

INTRODUCTION AND OBJECTIVES: The purpose of this study is to show our experience in clinical dynamic cardiomyoplasty. PATIENTS, MATERIALS AND METHODS: Six patients with end-stage heart failure and 2 patients with left ventricular aneurysm underwent dynamic cardiomyoplasty using the latissimus dorsi muscle. The latissimus dorsi was electrically conditioned before the procedure through a lead placed under local anesthesia and connected to an external cardiac pace-maker. Surgical technique--including dissection of the latissimus dorsi and encircling of the ventricles with the muscle flap--was performed in general terms as described at the Broussais Hospital. In the first 3 patients a bipolar lead connected to a single impulse generator was used. In the other 5 patients a train of impulses cardiomyostimulator was used. Changes in systolic function were studied through Doppler-echocardiography and radionuclide studies. Changes in diastolic function were evaluated through E wave velocity and deceleration time. RESULTS: Mean follow up was 9 +/- 5.7 months. No early deaths were recorded. One patient underwent emergency surgery, one week after the procedure, because of a tear of the patch used to close the wall defect after left ventricular aneurysm resection. In 2 patients a subcutaneous serous collection secondary to muscle dissection was evacuated. One patient died due to a stroke 4 months after the procedure. Another patient died after an unsuccessful coronary transluminal percutaneous angioplasty 11 months after the procedure. An improved functional class was observed in all patients. No changes in systolic function were observed after surgery when the cardiomyoestimulator was turned-off either with echocardiography (26.7 +/- 8.6 vs 24.8 +/- 5.8% [NS]) or radionuclides (24.5 +/- 9.5 vs 20.2 +/- 8.3% [NS]). When the cardiomyostimulator was turned-on a statistically significant increase of the left ventricular ejection fraction was observed either with echocardiography (24.8 +/- 5.8 vs 37 +/- 10.3%; p < 0.05) or radionuclides (20.2 +/- 8.3 vs 33.3 +/- 12.2%; p < 0.05). This significant increase of the ejection fraction has been observed in subsequent studies. Nevertheless the differences when the cardiomyostimulator is turned-on and turned-off have decreased several months after the procedure. A significant increase of the left ventricular outflow velocity (cm/seg) was observed when the generator was turned-on (57.7 +/- 20.4 vs 75.1 +/- 17.8%; p < 0.01). A significant increase of the dP/dt (mmHg/seg) was observed when the generator was turned-on (706.3 +/- 291.5 vs 592.6 +/- 181.6%; [NS]). No significant changes were observed on E wave velocity. A significant decrease of the deceleration time was observed several months after the procedure (p < 0.05). CONCLUSIONS: We believe that dynamic cardiomyoplasty is a safe and valid surgical procedure for some patients with end stage cardiomyopathies as well as in association with Jatene's technique for the management of left ventricular aneurysms. An improvement in functional class is present and a significant increase of the left ventricular systolic function. Nevertheless it is necessary to find new systolic parameters, independent of volumetric calculations, to evaluate the mechanical support of the muscle as well as to determine the long-term pattern of electrical stimulation.

Adult↗
PubMed1993

Protective effect of triflusal against acute myocardial infarction in patients with unstable angina: results of a Spanish multicenter trial. Grupo de Estudio del Triflusal en la Angina Inestable.

A multicenter, double-blind, placebo-controlled study was carried out to evaluate the effect of a new antiplatelet agent, triflusal (2-acetoxy-4-trifluoromethyl benzoic acid), in the prevention of nonfatal myocardial infarction and cardiac or vascular death (principal end-points) in patients with unstable angina. 281 patients were randomly assigned to triflusal (300 mg t.i.d.; n = 143) or placebo (n = 138). After 6 months of treatment, the incidence of nonfatal acute myocardial infarction was significantly lower in the triflusal than in the placebo group: 6 patients (4.2%) versus 17 (12.3%), p = 0.013. The low number of deaths (2/143 triflusal versus 0/138 placebo recipients) hampered statistical analysis of mortality rates. The need for revascularization was similar in the two groups: 24 patients (16.8%) in the triflusal group and 28 (20.3%) in the placebo group, p = 0.449. In conclusion, the results show that treatment with triflusal can reduce the incidence of myocardial infarction in patients with unstable angina.

Administration, Oral↗
PubMed1993

[Aerobic capacity. Differences between smokers and non-smokers. Effects of withdrawal].

The purpose of this study is to determine the aerobic capacity in a group of smokers and to carry out a prospective study of the changes in cardiorespiratory and metabolic response to exercise after smoking withdrawal. An aerobic capacity test was performed in 90 smokers and 30 non-smokers. Afterwards, the smokers were included in a smoking withdrawal program. One year later, the aerobic capacity test was repeated in those individuals who were able to stop smoking. The initial study of the aerobic capacity during exercise showed that smokers had significantly lower values of maximal oxygen uptake per kg body weight (VO2 max./kg) (28.7 +/- 8 vs. 35.1 +/- 7 ml/kg/min) (p < 0.001), work time (5.8 +/- 2.6 vs. 7.5 +/- 3.1 min) (p < 0.01) and work load (1.1 +/- 0.3 vs. 1.4 +/- 0.3 W/kg) (p < 0.001) under aerobic conditions. Aerobic capacity test performed one year after smoking withdrawal in those who were able to stop smoking showed a significant increase in VO2 max./kg (35.5 +/- 6.1 vs. 31.1 +/- 5.5) (p < 0.05), work time (8.1 +/- 3.2 vs. 5.8 +/- 3.2 min) (p < 0.05) and work load (1.5 +/- 0.4 vs. 1.1 +/- 0.4 W/kg) (p < 0.01) under aerobic conditions. No differences were observed in the aerobic capacity test performed on the ten subjects who did not stop smoking. From these data we suggest that tobacco consumption produces impairment of the aerobic capacity that can be reverted, at least in part, after smoking withdrawal.

Adult↗
PubMed1993

[Acute non-lethal complete occlusion of the left main coronary artery].

Myocardial infarction secondary to total obstruction of the left main coronary artery is an infrequent finding in clinical practice. Even though this disease usually results in high mortality rates, various cases have been described documenting survival after complete occlusion of the left main trunk. We present a patient who survived after a massive myocardial infarction due to total obstruction of the left main coronary artery. Orthotopic cardiac transplantation was subsequently performed with good results.

Acute Disease↗
PubMed1993

[Respiratory function tests. Differences between smokers and non-smokers. Effects of withdrawal].

The purpose of this study is to determine the characteristics of spirometric performance in a group of smokers and to carry out a prospective study of the changes in ventilatory lung function after smoking withdrawal. The ventilatory lung function was studied in 90 smokers and 30 non-smokers. Afterwards the smokers were included in smoking withdrawal program. One year later, the ventilatory function tests were repeated in those individuals who were able to stop smoking. Respiratory function tests were likewise repeated in 10 subjects chosen randomly among those who were not able to stop smoking. The initial study of the ventilatory lung function showed that smokers had significantly lower values of FVC (p < 0.001), FEV1 (p < 0.001), FEVC1/FVC (p < 0.001), FEF25-75 (p < 0.01 and PEF (p < 0.01) compared to non-smokers. Likewise smokers also had a statistically significant higher prevalence rate of obstructive pulmonary disease (p < 0.001). Ventilatory function studies performed one year after smoking withdrawal on those who were able to stop smoking showed a significant improvement of respiratory function parameters compared to studies done one year before. There was also a significant decrease in the prevalence and severity of obstructive pulmonary disease. No differences were observed in the ventilatory function tests performed on the ten subjects who did not stop smoking. From these data we suggest that tobacco consumption produces obstruction of the airways that can be reverted, at least in part, after smoking withdrawal.

Adult↗
PubMed1992

Dynamic cardiomyoplasty in a patient with end-stage cardiomyopathy.

Dynamic cardiomyoplasty is a relatively new surgical procedure by which a transformed fatigue-resistant skeletal muscle wrapped around the heart is stimulated to contract in synchrony with it, thereby augmenting the ventricular functions of a failing heart. We performed a cardiomyoplasty with latissimus dorsii (LD) in a patient who was refused the heart transplant programme because of pulmonary hypertension and psychosocial contraindications. The patient was 34 years old, functional class grade IV of the New York Heart Association (NYHA), with a three-month history, due to ischemic cardiomyopathy with multiple vessels affected, 10% ejection fraction, arteriolar pulmonary resistance of 7.5 U Wood. Cardiomyoplasty was performed after training the LD muscle for four weeks. One week later the pacemaker was programmed in a DDD mode: amplitude 3.75 V, pulse duration 0.50 ms, AV delay 175 ms. The patient reached functional class grade I-II (NYHA). Inotrope support was discontinued and great clinical improvement was noted. The ejection fraction rose from 10% to 30%. Echocardiographic left ventricular outflow tract velocity increased from 0.33 m/s to 0.60 m/s. These values were compared with radionuclide angiocardiography and echocardiography evaluations. The great clinical improvement and positive changes in left ventricular parameters suggest that cardiomyoplasty is useful in the treatment of some cases of dilated or ischemic cardiomyopathy as an alternative to heart transplantation. Long term follow-up is necessary to evaluate this procedure.

Adult↗