Biomedical subjects

E S Thomas

Publications and source records attributed to E S Thomas.

8 recordsLinked to original sources

PubMed1991

Safety and efficacy of a new regimen of intravenous recombinant tissue-type plasminogen activator potentially suitable for either prehospital or in-hospital administration.

The safety and efficacy of a new regimen of intravenous recombinant tissue-type plasminogen activator (rt-PA) potentially suitable for either pre- or in-hospital administration were assessed in 60 patients with acute myocardial infarction in an open label coronary angiographic study. The regimen consisted of a 20-mg bolus dose followed 30 min later by a delayed infusion of 80 mg over 2 h. This regimen was designed to facilitate prehospital administration of rt-PA. Infarct-related artery patency (Thrombolysis in Myocardial Infarction [TIMI] grade 2 or 3 flow) was observed in 40 of 53 patients at 60 min (75.5%, 95% confidence intervals [CI] 61% to 84%) and in 55 of 60 patients at 90 min (91.7%, 95% CI 80% to 95%) after the rt-PA bolus. By 90 min the majority of patients (55%) exhibited TIMI grade 3 flow; infarct artery patency at 120 min was 84.9%. During hospitalization definite recurrent ischemia occurred in nine patients (15%); nonfatal recurrent infarction was noted in one (1.7%). Four patients (6.7%) experienced major bleeding, including one with intracranial bleeding. There were seven deaths (11.7%). Mortality was significantly influenced by the occurrence of cardiogenic shock, which was present in five patients at the time of enrollment. Blood fibrinogen levels were obtained before and during rt-PA infusion. At baseline and 30 and 150 min after the bolus dose, the mean fibrinogen level (+/- SD) was 284.83 +/- 77.39, 237.96 +/- 76.92 and 192.04 +/- 57.82 mg/dl, respectively. Compared with the baseline value, there was a significant (p less than 0.05) decrease in fibrinogen at both 30 and 150 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Doing the right thing.

Explore the source record for details and available documents.

Community-Institutional Relations↗

PubMed1988

Simultaneous double balloon coronary angioplasty through a single guiding catheter for bifurcation lesions.

To enhance the safety, efficacy and expediency of coronary bifurcation lesion angioplasty, we report the use of two dilatation catheters, advanced simultaneously through a single guide catheter in three patients. Successful dilatation was performed in each. The technique involves the use of either two new low-profile dilatation catheters in an 8 French large lumen guide catheter or a single new low-profile dilatation catheter coupled with a conventional over-the-wire catheter within a new large lumen 9 French guide.

Adult↗

PubMed1988

Coronary angioplasty for patients with multivessel coronary artery disease: follow-up clinical status.

To determine the value of percutaneous transluminal coronary angioplasty (PTCA) for patients with multivessel coronary artery disease, we reviewed follow-up data of 92 consecutive multivessel disease patients in whom PCTA had been successful and in whom at least 6 months had elapsed. Clinical outcome of multivessel disease patients was compared to that of 189 patients with single-vessel disease who experienced successful PTCA. Eighty percent of multivessel disease patients noted clinical improvement at follow-up. More single-vessel disease patients, however, were free of angina (77% vs 63%, p = 0.02), were not taking long-acting antianginal medicationS (46% vs 27%, p less than 0.001), and had repeat PTCA less often (5% vs 12%, p = 0.05) than multivessel disease patients. The incidence of late clinical events such as myocardial infarction, coronary artery bypass surgery, and death was low in both single- and multivessel disease patients. To determine whether the degree of revascularization achieved accounted for differences between single- and multivessel disease outcome, PTCA for multivessel disease was classified as either complete or incomplete revascularization. Those patients classified as having incomplete revascularization, although they had multivessel coronary artery disease, had only one significant ischemic zone and this was successfully revascularized by PTCA. There was no significant difference in anginal status or incidence of myocardial infarction, coronary artery bypass surgery, or death between the two multivessel disease subgroups. Thus, PTCA is of clinical value for selected patients with multivessel coronary artery disease, even in those who are incompletely revascularized by design.

Adult↗

PubMed1988

Objective assessment of coronary angioplasty for multivessel disease: results of exercise stress testing.

The efficacy of coronary angioplasty in multivessel coronary artery disease was evaluated in a series of 145 consecutive patients in whom angioplasty had been successful and in whom a follow-up exercise stress test was performed within 2 months. Exercise stress test results of these patients with multivessel disease were compared with those of 177 patients with single vessel disease after successful coronary angioplasty. The postangioplasty exercise test showed ischemia in 13% of patients with single vessel and 29% of those with multivessel disease, although only 7 and 13%, respectively, experienced angina. The mean exercise duration was comparable for patients with multivessel disease (453 +/- 174 s) and single vessel disease (476 +/- 166 s). To assess the impact of the degree of revascularization in patients with multivessel disease on the results of exercise testing, 48 patients with completely revascularized vessels and 97 with incompletely revascularized vessels were evaluated. The mean exercise duration (459 +/- 178 versus 450 +/- 173 s), mean maximal heart rate (132 +/- 31 versus 136 +/- 25 beats/min) and mean systolic blood pressure (174 +/- 25 versus 170 +/- 26 mm Hg) were similar in completely and incompletely revascularized groups. Exercise-induced angina occurred in 13% of both groups. Ischemic ST segments were more common in the incompletely revascularized group (34 versus 19%, p = 0.06). Thus, exercise stress testing provides evidence that successful angioplasty can relieve electrocardiographic manifestations of ischemia as well as anginal symptoms in the majority of patients with either single or multivessel coronary artery disease who are suitable candidates for the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1988

Efficacy of a new angioplasty catheter for severely narrowed coronary lesions.

Conventional over the wire dilation catheters may be unsuccessful in crossing coronary lesions that are severely narrowed. Hence, a new, extremely low profile coronary angioplasty catheter specifically designed to dilate such lesions was investigated. The catheter features a 2.0, 2.5 or 3.0 mm (inflated diameter) balloon mounted on a guide wire. The deflated profile of the 2.0 mm balloon measures 0.020 +/- 0.001 in. (0.51 +/- 0.03 mm). The catheter can be used in conjunction with 7F angiographic or 8F guide catheters. The catheter was used in 61 patients, aged 43 to 86 years, with predominantly Canadian Cardiovascular Society class III-IV angina. Dilation was attempted in 77 lesions. Lesion length averaged 5.7 +/- 3.1 mm (mean +/- 1 SD), minimal diameter 0.51 +/- 0.25 mm and internal vessel diameter 2.27 +/- 0.43 mm. Sixty lesions (78%) were successfully dilated to less than 50% residual stenosis with this catheter alone; nine lesions were further dilated with a larger balloon catheter. The new catheter was unable to cross 13 lesions (17%); only 2 of these lesions were subsequently crossed with a conventional over the wire system. On the other hand, the catheter was used after failure of conventional dilating catheters in 21 lesions and was successful in 16. The new catheter was particularly valuable for distal lesions and those demonstrating 90 to 99% diameter reduction. For all lesions crossed, stenosis decreased from 76 +/- 11 to 29 +/- 12% after 2.9 +/- 2.7 inflations and peak inflation pressure of 8.0 +/- 2.9 bar. Complications were rare; coronary occlusion occurred in two lesions (3%) and dissection in three lesions (4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

The long-term followup results of coronary artery angioplasty.

The long-term efficacy of PTCA for the relief of angina pectoris and myocardial ischemia has been firmly established. Coronary angiography reveals sustained anatomic improvement in the majority, especially if PTCA is repeated in those patients who developed restenosis. Successful PTCA is associated with a low incidence of cardiac events such as myocardial infarction, elective cardiac bypass surgery, or death during late followup. The majority of patients are completely free of angina and demonstrate objective improvement with exercise testing. Patients with multivessel disease, if properly selected, may derive nearly as much long-term benefit from PTCA as patients with single-vessel disease.

Angioplasty, Balloon↗

PubMed1980

The effect of diet on autogenous immunity to mouse mammary tumor virus in C3H/Bi mice.

Antibody levels to mouse mammary tumor virus (MuMTV) in sera of C3H/Bi, C57BL/6 and AKR mice were assayed by an enzyme-linked immunosorbent assay (ELISA). It was found that antibody levels to MuMTV were highest in sera of C3H/Bi females which have a high incidence of breast cancer and low in male C3H/Bi and female C3H/Bi foster-nursed on C57BL/6 females. Sera of C57BL/6 and AKR mice showed very low or undetectable levels of antibody to MuMTV. Reduction of caloric intake sufficient to inhibit mammary tumor formation strikingly inhibited formation of antibody against MuMTV. The lowest levels of antibody were observed in sera of mice fed 10 cal/day of a defined diet. Significantly higher levels developed in the sera of mice fed 16 cal/day of the same defined diet. The highest antibody levels against MuMTV, however, were seen in sera of mice fed lab chow ad libitum but no correlation was evident between levels of antibody and tumor size. These studies indicate that dietary caloric restriction has a profound influence on the development of both mammary adenocarcinoma and antibody responses to MuMTV.

Age Factors↗