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Biomedical subjects

E Oram

Publications and source records attributed to E Oram.

18 recordsLinked to original sources
PubMed1997

Percutaneous balloon valvuloplasty for severe mitral stenosis in pregnancy. Four case reports.

Four pregnant women with mitral stenosis who did not respond to medical therapy underwent successful percutaneous balloon valvuloplasty with complete resolution of their symptoms. Their clinical features and echocardial and hemodynamic data are presented. The procedures and the remainder of their pregnancy were uncomplicated. Percutaneous balloon valvuloplasty of the mitral valve is a safe and effective alternative to surgical therapy if medical management is unsuccessful.

Adult↗
PubMed1996

Silent myocardial ischemia in Behçet's disease.

OBJECTIVE: Behçet's disease (BD) is a multisystemic disorder usually described as a triple symptom complex consisting of aphthous stomatitis, genital ulcerations, and uveitis. Vasculitis is a key feature of the disease, which may lead to functional disturbances in highly vascularized organs. However, cardiac involvement is seldom recognized. We investigated the prevalence of silent myocardial ischemia (SMI) in BD as the clinical presentation of microvascular disease. METHODS: Ambulatory cardiac monitoring (Holter) was used in 36 patients with BD to detect silent myocardial ischemia. 201Thallium myocardial perfusion scintigraphy and radionuclide ventriculography were also performed. All patients fulfilled International Study Group for Behçet's Disease criteria and 11 of them had major vascular involvement. The same method was also performed on 38 control subjects for comparison of SMI positivity in patients with BD. RESULTS: Ambulatory cardiac monitoring was performed for 9.2 +/- 0.9 h, mean heart rate was 82 +/- 9 bpm, and no serious rhythm disturbance was recorded. SMI was described in 9 of 36 patients (25%) (median age 38 years, range 30-46) as ST segment depression of 3.00 +/- 0.42 mm with a duration of 4.01 +/- 0.9 min. One SMI positivity only was recorded in the control group in a 52-year-old man with a stenotic lesion in the left anterior descending coronary artery (p < 0.001). Eight of 9 patients with SMI showed a partially reversible myocardial perfusion defect after exertion, and 7 demonstrated some degree of left ventricular wall motion abnormality by radionuclide ventriculography. Coronary angiography was normal in 7 of 9 patients with SMI. Additionally, 7 of 9 patients with SMI had major vascular involvement, while only 4 of 27 without SMI had major vascular disease (p = 0.0022). CONCLUSION: SMI incidence is significantly higher in BD compared to the control group. Impaired endothelial cell function may be the underlying cause in the pathogenesis of BD or of its vascular complications such as SMI.

Adult↗
PubMed1993

Scintigraphic evaluation of the short- and long-term renal effects of oral felodipine using technetium-99m-mercaptoacetyl triglycine.

The short- and long-term effect of felodipine on renal perfusion and tubular function was investigated using a new renal tubular imaging agent, 99mTc-mercaptoacetyl triglycine (99mTc-MAG3). Twelve patients with essential hypertension (mean age = 49 +/- 8 years) were studied. Renal scintigraphies with 180 MBq 99mTc-MAG3 were performed at baseline, at the 2nd hour following oral administration of 5 mg felodipine and 4 weeks later on 5-10 mg daily felodipine therapy. The time-activity curves of each kidney were obtained following background subtraction. The 99mTc-MAG3 clearance value was measured for each kidney. In addition, perfusion index (PI), reno index, time to maximum, half-maximum and two thirds of maximum activity values of each kidney were calculated. Systolic and diastolic blood pressures were significantly lowered with long-term administration of felodipine (from 159 +/- 12/105 +/- 5 to 141 +/- 11/87 +/- 7 mm Hg, p = 0.01 and p = 0.002, respectively). Heart rate did not change significantly. Initially, a decrease in PI indicating an increase in renal blood flow (from 246 +/- 96 to 194 +/- 54, p = 0.01) was observed, whereas no change was noted during the chronic administration (to 230 +/- 69, p = NS). Total clearance of 99mTc-MAG3 was decreased nonsignificantly following the initial dose of felodipine (from 361 +/- 93 to 351 +/- 91 ml/min, p = NS). During long-term therapy, felodipine did not alter the perfusion and tubular function of the kidneys. Our results indicated that felodipine causes a significant increase in renal blood flow initially, even with a nonsignificant change in systemic blood pressure.

Administration, Oral↗
PubMed1993

Late percutaneous extraction of an intracardiac catheter fragment.

A patient was found to have a mobile catheter fragment in the right atrium incidentally during echocardiography. On further investigation, it was learned that the catheter had been inserted 9 years earlier during surgery and had probably been broken during removal. The patient did not experience any symptoms during this period. The catheter was removed percutaneously without any complications using a system similar to the loopsnare catheter.

Catheterization, Central Venous↗
PubMed1991

Levels of IgE in the serum of patients with coronary arterial disease.

Because previous studies have shown that mast cells can be activated by IgE-mediated mechanisms to release potent mediators which affect coronary blood flow, we measured serum IgE levels in 156 patients with coronary arterial disease and in 53 healthy controls (27 men, 26 women, mean 54 years). Patients were classified into 3 groups according to well established criteria as having stable angina pectoris (28 men, 15 women, mean 58 years), unstable angina pectoris (37 men, 15 women, mean 57 years), and acute myocardial infarction (52 men, 9 women, mean 58 years). In every subject, serum IgE measurement, eosinophil count, and stool examination for parasites were performed. Every subject was interviewed concerning history of allergy, smoking habits and the other risk factors for coronary arterial disease. In a model including the factors that may affect the serum levels of IgE (namely, age, sex, cigarette smoking, parasites, and family and personal history of allergy), IgE levels were found to be significantly higher in the patients with unstable angina and acute myocardial infarction compared to the patients with stable angina pectoris and controls. These data indicate that IgE may play a role in the pathogenesis of unstable angina pectoris and acute myocardial infarction.

Adult↗
PubMed1991

Quality of life in patients with rate responsive pacemakers: a randomized, cross-over study.

Eleven patients with rate responsive pacemakers (7 men, 4 women, mean age 41 years with a range of 23-60) were randomly assigned to a cross-over study in order to assess their overall exercise capacity and quality-of-life (QOL) scores. All of the pacemakers were implanted for complete AV block or sick sinus syndrome. The pacemakers were randomly programmed into VVI or rate responsive (VVIR) pacing modes for 3-week study periods in each mode. At the end of each period, an exercise test was performed and the QOL was evaluated by the "Hacettepe Quality-of-Life Questionnaire". All patients exercised longer in the VVIR mode (mean 10.54 +/- 0.73 min) than in the VVI mode (mean 7.81 +/- 0.62 min) (P less than 0.05). QOL scores were also found to be significantly higher in the VVIR mode (mean 173.81 +/- 16.22 points) compared to the VVI mode (mean 156.27 +/- 21.22 points) (P less than 0.01). In conclusion, our results suggest that VVIR pacing offers a better QOL in addition to an improved exercise capacity, compared to the single chamber nonrate modulated pacing (VVI).

Adult↗
PubMed1991

Cardiac electrophysiologic study in children. Preliminary report from Turkey.

Eighteen children (10 females, 8 males; age range 5.5 to 17 years, median: 10 years) who suffered from recurrent syncope, drug refractory supraventricular tachycardia and atrioventricular block or bradycardia were evaluated by cardiac electrophysiologic study between August 1988-April 1990. During the study, basal intervals were measured and the conduction system and sinus node functions were investigated. In some patients the mechanism of the tachycardia was investigated and drug-electrophysiologic studies also performed. Two of 6 cases with recurrent syncope had positive electrophysiologic findings and adequate treatment resolved the symptoms. The others have been followed. The mechanism of the tachycardia was determined in 5 cases with drug refractory supraventricular tachycardia and drug-electrophysiologic studies were done in all of them. The site of block was determined in 7 patients with atrioventricular block and pacemaker implantation was done in 5 patients. The results emphasized the usefulness of cardiac electrophysiologic study in childhood arrhythmias.

Adolescent↗
PubMed1991

Left ventricular dysfunction and blood glycohemoglobin levels in young diabetics.

Left ventricular function including regional wall motion (RWM) was evaluated by 99mTc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart disease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection/cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels.

Adolescent↗
PubMed1990

Comparison of sublingual captopril and sublingual nifedipine in hypertensive emergencies.

Hypertensive crises require immediate therapy, usually by parenteral drug administration. Sublingual nifedipine has been shown to be highly effective. However, the blood pressure fall following nifedipine is frequently associated with side-effects. The use of sublingual captopril has recently been indicated in hypertensive crisis, assuming that by this route, there would be a faster absorption and thus a more rapid effect on blood pressure than with the oral route. To verify this hypothesis, we have compared the hypotensive effects of sublingual nifedipine and sublingual captopril in 52 patients with hypertensive emergencies: 25-mg captopril and 10-mg nifedipine were administered sublingually to 28 and 24 patients, respectively. Blood pressures and heart rates were continuously measured up to 240 min postdose. A significant (P less than 0.001) hypotensive effect of both sublingual captopril and nifedipine therapy occurred at 5 min and persisted for 240 min. Heart rates increased with nifedipine, but decreased with captopril. We observed no side-effects in the captopril group, but flushing, tachycardia and headache were observed in 6 patients in the nifedipine group. We conclude that sublingual captopril is effective in patients with hypertensive emergencies and that captopril may be an excellent alternative to sublingual nifedipine in the urgent treatment of hypertensive crisis.

Administration, Sublingual↗
PubMed1988

Effects of oral prazosin on total plasma digoxin levels.

Prazosin and digoxin are frequently coadministered in clinical practice. To determine the effects of oral prazosin treatment on steady-state digoxin levels, 20 patients receiving a constant maintenance dose of digoxin, who had normal renal and liver functions and were not receiving any other treatment, were given 5 mg of prazosin for 3 days. Plasma digoxin levels were measured before, on days 1 and 3 of prazosin treatment, and after prazosin had been discontinued. It was found that prazosin significantly increased plasma digoxin levels. On discontinuation of prazosin digoxin levels returned to their previous values.

Administration, Oral↗
PubMed1987

Supravalvular and valvular aortic stenosis in homozygous familial hypercholesterolemia.

Premature atherosclerosis with a particular predilection to the coronary arteries is a well-known complication of homozygous familial hypercholesterolemia. However, well documented involvement of the aortic root and valve with aortic stenosis has not been recognized frequently antemortem. Clinical, echocardiographic, hemodynamic and angiographic features of a case with valvular and supravalvular aortic stenosis secondary to homozygous familial hypercholesterolemia are described. Surgical relief of the left ventricular outflow obstruction was not attempted because of the patient's refusal.

Adult↗
PubMed1986

The determination of serum estradiol, testosterone and progesterone in acute myocardial infarction.

The levels of serum estradiol, testosterone and progesterone were determined in 13 cases of acute myocardial infarction. Thirteen intensive care patients without coronary, hepatic or renal disease, 13 cases of unstable angina and 15 normal subjects. The patients were males ranging from 24 to 56 years of age, the average being 40.4 years. The levels of serum estradiol in the acute myocardial infarction and unstable angina groups were significantly higher than in the normal group, and no difference was found between the normal and intensive care patient. The testosterone levels were significantly lower in the acute myocardial infarction and unstable angina groups than in the normal group. Progesterone levels increased in acute myocardial infarction patients. The estradiol: testosterone ratio was considerably elevated in the acute phase of myocardial infarction, and in unstable angina patients. No difference was found between the intensive care patient and normal groups.

Adult↗
PubMedDate not supplied

Exercise-induced ventricular tachycardia in children.

Two children with exercise-induced tachycardia, one with idiopathic long-QT syndrome, are presented. The patients were evaluated by exercise testing and electrophysiologic study. From the onset of treatment with the beta-blocking agent, pindolol, the patients have been symptom-free. These findings emphasize that children with syncope must be evaluated by ECG, exercise testing, 24-h Holter-monitoring, and finally, electrophysiological study.

Adolescent↗