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Biomedical subjects

G Steg

Publications and source records attributed to G Steg.

At least 37 records · Page 2Linked to original sources
PubMed1994

Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction.

BACKGROUND: When used in the setting of acute myocardial infarction, intravenous thrombolytic agents fail to achieve early infarct artery patency in 15% to 50% of patients. We tested the hypothesis that immediate balloon angioplasty applied to patients with failed early reperfusion would improve left ventricular function and clinical outcome at 30 days compared with conservative management alone. METHODS AND RESULTS: One hundred fifty-one patients with first anterior wall infarction treated with any accepted intravenous thrombolytic regimen and angiographically demonstrated to have an occluded infarct vessel within 8 hours of chest pain onset were randomized to aspirin, heparin, and coronary vasodilators (conservative therapy) or to this therapy and balloon angioplasty supplemented by further thrombolytic therapy as needed. Left ventricular function was assessed using multiple-gated equilibrium radionuclide technique to determine ejection fraction, and adverse clinical outcome was assessed evaluating death, ventricular tachycardia, and class III or IV heart failure at 30 days. Seventy-three patients were randomized to conservative therapy and 78 to angioplasty. The two groups were well balanced for patient age (59 +/- 11 years), sex (82% were male), and time to randomization (4.5 +/- 1.9 hours). Angioplasty was technically successful in 72 of 78 randomized patients (92%). Two patients randomized to conservative therapy crossed over to angioplasty within 72 hours. Resting 30-day ejection fraction was 40 +/- 11% in the angioplasty group and 39 +/- 12% in the conservative group (P = .49), but ejection fraction with exercise was 43 +/- 15% and 38 +/- 13% for the angioplasty and conservatively treated groups, respectively (P = .04). Adverse clinical outcomes included death in 5% and 10% (P = .18), severe heart failure in 1% and 7% (P = .11), and either death or severe heart failure in 6% and 17% (P = .05) of the angioplasty and conservatively managed groups, respectively. CONCLUSIONS: When applied to patients with first anterior infarction, rescue angioplasty appears to be useful in the prevention of death or severe heart failure, with improvement in exercise, but not resting, ejection fraction. This strategy deserves further study and highlights the potential advantage of early mechanical restoration of infarct vessel patency when thrombolytic therapy has failed.

Aged↗
PubMed1993

Single-dose L-dopa response in early Parkinson's disease: measurements with optoelectronic recording technique.

Twenty-five patients with suspected Parkinson's disease were submitted to optoelectronic movement analysis with the Posturo-Locomotor-Manual (PLM) test before and 60 min after a single dose of L-Dopa. They were then examined clinically for diagnosis. Two patients were excluded due to L-Dopa intolerance. Seventeen of the remaining patients were classified as having Parkinson's disease. The movement time (MT) in the PLM test was increased for all these patients, and they improved their performance after L-Dopa. The degree of improvement was roughly proportional to the pretreatment augmentation of MT in comparison to healthy subjects of the same age. The PLM phase analysis showed a specific disability profile for each individual. Six patients were given diagnoses other than PD. Some improvement was found in one patient with suspected olivopontocerebellar atrophy and one patient with multiple brain injury. Two patients with progressive supranuclear palsy, one with suspected striatonigral degeneration, and one with functional disturbance deteriorated after L-Dopa. In conclusion, truly objective and fully reproducible evaluation of the motor performance before and after a single L-Dopa dose is easily accomplished with computer-assisted modern optoelectronic recording equipment. The technique is a valuable tool for the quantitative measurement of treatment effects and contributes to the differential diagnosis.

Adult↗
PubMed1991

Optoelectronic movement analysis in Parkinson's disease: effect of selegiline on the disability in de novo parkinsonian patients--a pilot study.

New opto-electronic camera systems permit easy quantification of the motor performance during natural acts in freely moving humans. We used a simple test movement (PLM test) to quantify the disturbance in the postural (P), locomotor (L) and manual (M) part of the body movement and the coordination of the different movement phases into a smooth motor act. The test movement time was used to quantify the overall performance. With this technique we have measured the effects of selegiline on the degree of parkinsonism in a double-blind, placebo-controlled pilot study of 5 de novo patients with Parkinson's disease. There was a clear trend that selegiline was superior to placebo in reducing the test movement time.

Aged↗
PubMed1989

Human fetal dopamine neurons grafted into the striatum in two patients with severe Parkinson's disease. A detailed account of methodology and a 6-month follow-up.

By using stereotaxic surgical techniques, ventral mesencephalic tissues from aborted human fetuses of 8 to 10 weeks' gestational age were implanted unilaterally into the striata in two patients with advanced Parkinson's disease. The patients were treated with a cyclosporine, azathioprine, and steroid regimen to minimize the risk for graft rejection. They were examined for 6 months preoperatively and 6 months postoperatively and continued to receive the same doses of antiparkinsonian medication. There were no significant postoperative complications. No major therapeutic effect from the operation was observed. However, in the clinical tests, both patients showed small but significant increases of movement speed for repeated pronation-supination, fist clenching, and foot lifting. The rate of walking also increased in the one patient tested. For both patients, there was an initial worsening postoperatively, followed by improvement vs preoperative performance at 1 to 3 months. Both patients also showed significant improvement in the magnitude of response to a single dose of levodopa (L-dopa), but there was no increase in the duration of drug action. The motor readiness potential increased in both patients postoperatively, primarily over the operated hemisphere. Neurophysiological measurements also showed a more rapid performance of simple and complex arm and hand movements on the side contralateral to transplantation in one patient at 5 months postoperatively. Positron emission tomography demonstrated no increased uptake of 6-L-(18F)-fluorodopa in the transplanted striatum at 5 and 6 months. Taken together, these results suggest that the fetal nigral implants may have provided a modest improvement in motor function, consistent with the presence of small surviving grafts. Although our results support further scientific experimentation with transplantation in Parkinson's disease, widespread clinical trials with this procedure are probably not warranted at this time.

Contingent Negative Variation↗
PubMed1989

Objective measurement of motor disability in Parkinson's disease.

A kinesiological analysis of complex movement performance was carried out in patients with Parkinson's disease, and in healthy subjects of different ages, with a computer-assisted optoelectronic camera system. A lifting movement entailing simultaneous coordination of rising, walking some steps and a goal-directed manual movement, the PLM test, was used. Speed reduction through normal aging was greatest at higher ages, where the coordination deficits were also most prominent. The increased movement time in parkinsonian patients was due both to deficient simultaneous coordination of postural, locomotor and manual movement phases, and to varying increases in phase durations. It was possible to determine postural, locomotor and manual disability profiles quantitatively, in terms of the relative phase time values. The presented documentation of parkinsonian disability and single-dose effects of l-dopa indicates that the technique is applicable in the objective assessment of disability and pharmacotherapeutic efficacy.

Adult↗
PubMed1989

Disability profiles and objective quantitative assessment in Parkinson's disease.

A new technique for quick objective and quantitative determination of important aspects of the motor handicap in movement disorders is presented. A compound, but natural, test movement was used to find out if the degree of dysfunction in postural, locomotor and manual motor functions differed among the patients and if medication influenced these functions differently. After 12 h without medication, 16 patients with Parkinson's disease showed a movement time between 1.5 and 13.6 times that of an age-matched normal subject and a greater performance variability on repeated examination. In some patients the increase of test movement time was caused mainly by the locomotion component while in others the time for the postural or manual part of the movement was more markedly augmented. Thus, a specific motor disability profile was found for each patient and expressed in quantitative terms. The effects of l-dopa treatment were quantified in each patient.

Adult↗
PubMed1989

[Immediate postoperative results following conservative surgery of rheumatic mitral valve insufficiency in children].

The immediate post-operative results of conservative surgery were evaluated objectively in 31 children aged under 13 years referred to us for surgical correction of severe rheumatic mitral valve regurgitation. 16 patients had pure mitral regurgitation. In the others, lesions which required additional surgery were aortic regurgitation in 7 cases, tricuspid of the mitral valve and left ventricle was studied by two-dimensional TM-mode echocardiography. This examination was combined with a pulsed doppler study in search of a possible residual mitral regurgitation signal, with special attention to the depth at which it was recorded in the left atrium -- a semi-quantitative indication of the severity of residual leakage. Two mitral valve replacements were performed, and two early reoperations were needed for residual regurgitation developed between the 5th and 8th post-operative days. Three deaths occurred due to supra-systemic pulmonary arterial hypertension. The post-operative evaluation of mitral valvuloplasty results therefore involved 25 patients. In the absence of significant residual mitral regurgitation, two-dimensional echocardiography was inconclusive since the images obtained varied considerably according to the surgical procedures performed. There was a distinct reduction of end-diastolic diameters (43.5 +/- 5.9 versus 62.1 +/- 8.7 mm pre-operatively), reflecting the disappearance or marked decrease of the pre-operative ventricular volume overload consecutive to mitral regurgitation. The reduction of end-systolic diameters was also significant (31.2 +/- 6.7 mm versus 39.2 +/- 7.1 mm pre-operatively), though less pronounced than that of end-diastolic diameters, which explains the diminution observed in the percentage of fibre shortening, although the figures remained within normal limits (28.7 +/- 9.7 p. 100 versus 37.0 +/- 6.8 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1988

Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation.

The authors studied the hemodynamic effects of rapidly weaning from mechanical ventilation (MV) 15 patients with severe chronic obstructive pulmonary disease (COPD) and cardiovascular disease who were recovering from acute cardiopulmonary decompensation. In each patient, 10 min of spontaneous ventilation (SV) with supplemental oxygen resulted in reducing the mean esophageal pressure (X +/- SD, + 5 +/- 3 to -2 +/- 2.5 mmHg, P less than .01) and increasing cardiac index (CI) 3.2 +/- 0.9 to 4.3 +/- 1.3 1/min/M2, P less than .001), systemic blood pressure (BP 77 +/- 12 to 90 +/- 11 mmHg, P less than .001), heart rate (HR 97 +/- 12 to 112 +/- 16 beats/min, P less than .001), and, most importantly, transmural pulmonary artery occlusion pressure markedly increased (PAOPtm 8 +/- 5 to 25 +/- 13 mmHg, P less than .001), mandating a reinstitution of MV. In four patients with left ventricular (LV) catheters, the PAOP correlated with the LV end-diastolic pressure during both MV and SV. Gated blood pool imaging showed SV increased the LV end-diastolic volume index (65 +/- 24 to 83 +/- 32/M2, P less than .002) with LV ejection fraction unchanged. Patients were treated for a mean of 10 days with diuretics, resulting in a reduction of blood volume (4.55 +/- 0.9 1 to 3.56 +/- 0.55 1) and body weight (-5 kg, P less than .001). Subsequently, nine of the 15 patients were weaned successfully from mechanical ventilation with unchanged PAOP.

Adult↗
PubMed1988

[Serum sickness after fibrinolysis using intravenous streptokinase in myocardial infarction].

A case of serum sickness was observed 7 days after administration of intravenous streptokinase in the acute phase of myocardial infarction. The clinical presentation was the sudden development of fever, a papuloerythematous skin rash, myalgia and polyarthritis accompanied by a severe biological inflammatory syndrome without any signs of bacterial or viral infection. Spontaneous regression was observed within 72 hours. Although this complication of streptokinase fibrinolysis seems to be rare, clinicians should be aware of it and not confuse the allergic reaction with that of another drug, the withdrawal of which could be prejudicial for the patient.

Humans↗
PubMed1987

[Hydatid cyst of the right heart and post-embolic pulmonary hypertension].

A 22-year old man with hydatid cyst of the right ventricle presented, for about 10 years, with clinical signs of post-embolic pulmonary hypertension. Despite tumoral resection, the patient died post-operatively of his pulmonary hypertension. Post-mortem examination showed a hydatid cyst on the main pulmonary artery and fixed post-embolic pulmonary hypertension, but we were unable to determine whether we were dealing with old migrated cysts or blood clot emboli developed in contact with the cardiac tumour.

Adult↗
PubMed1984

Is parkinsonian gait caused by a regression to an immature walking pattern?

The gait of 6 patients with Parkinson's disease was analyzed by movement, EMG, and force recordings. In certain important details, a regression towards a more immature walking pattern was seen. It is suggested that the characteristic parkinsonian gait in addition to hypokinesia is caused by deficits in the neural circuits controlling plantigrade locomotion.

Adult↗
PubMed1984

An asanguineous reperfusion solution. An effective adjunct to cardioplegic protection in high-risk valve operations.

The protection afforded by cardioplegia during elective ischemic arrest can be partly compromised by a reperfusion injury, which may impede the recovery of cardiac function. We previously showed experimentally that this postischemic damage could be largely avoided by an appropriate crystalloid reperfusate. The present study was thus undertaken to assess the effects of this "reperfusion solution" clinically. One hundred twelve patients undergoing valve replacement with the aid of hypothermic cardioplegia (K+ 12 mEq, Mg2+ 26 mEq) were prospectively divided in two groups: Group I (n = 49) received an unmodified blood reperfusate. In Group II (n = 63), 1 L of the reperfusion solution was delivered just prior to removal of the aortic clamp. The formulation of the reperfusion solution adhered to the following principles: (1) maintenance of cardioplegia (K+ = 15 mEq), (2) replenishment of Ca2+ stores (Ca2+ = 2.5 mEq), (3) substrate provision (glutamate = 2,942 gm), (4) buffering (pH = 7.70 at 28 degrees C), and (5) hyperosmolarity (370 mOsm). The two groups were matched for preoperative data except for a higher incidence of isolated aortic valve replacement (p = 0.01) in Group II. Also, the cross-clamp time (mean +/- standard error of the mean) was longer in Group II (94 +/- 4 minutes versus 63 +/- 4 minutes, p less than 10(-6]. The reperfusion solution was found to increase both the rate and extent of postischemic functional recovery, as evidenced by (1) a lower proportion of catecholamine-supported patients 48 hours after operation (9/63 [14.28%] versus 16/49 [32.6%] in the control group [p less than 0.03]) and (2) a lower amount (gamma/kg/min) of dobutamine required to achieve stable hemodynamics (11 +/- 1 versus 26 +/- 6 in the control group [p less than 0.03]). A similar recovery pattern was noted in the high-risk subgroup of patients with mitral valve disease. Further, serial postoperative hemodynamic measurements were performed in 31 randomly selected patients (10 control and 21 reperfused). Although the reperfused patients were found to be at higher risk because of lower preoperative cardiac indices and longer cross-clamp times, they consistently achieved better postoperative hemodynamics with a lower incidence of catecholamine support. This hemodynamic improvement was particularly reflected by a higher left ventricular stroke work index throughout the postoperative course, the difference being significant 6 hours and 12 hours postoperatively.(ABSTRACT TRUNCATED AT 400 WORDS)

Catecholamines↗
PubMed1982

A mechanographic method for measurement of muscle tone in the conscious rat. The calf muscle stretch response in reserpine-induced rigidity.

A simple mechanographic method for the measurement of muscle tone in awake rats is presented. It utilizes principles corresponding to those in clinical assessment of tone and it has been applied to an animal model of Parkinson's disease: the reserpine-treated rat. The rat was restrained by a plastic cylinder and by metal cuffs at the ankles. The hind feet were repeatedly dorsiflexed by an electromechanical manipulator and the resulting calf muscle tension was indirectly measured with a strain-gauge system. The relative contributions to the stretch response from the different muscle groups acting on the ankle joint in the awake and untreated rat and during reserpine-induced rigidity are described. Very little active tension was found in the untreated rat. After treatment with reserpine, continuous activation of the muscle was found in EMG recordings and there was a sharp increase in the tension recorded during stretch. The static response to the increased isometric stretch was augmented. An additional, tonic response to ramp stretch was elicited at all stretch velocities. There was no evidence for phasic responses to rapid stretch in reserpine-induced rigidity. The amplitude of the myomechanogram was thus found to be independent of the ramp stretch velocity. Subsequent injection of apomorphine abolished the increased stretch response. It is demonstrated that changes in muscle tone could be followed during drug treatment and that the method can be used in investigations of the pathophysiological mechanisms behind the disorders of muscle tone.

Animals↗