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Biomedical subjects

J Angel

Publications and source records attributed to J Angel.

At least 55 records · Page 3Linked to original sources
PubMed1991

Percutaneous right brachial artery approach with 5F catheters for studying coronary artery disease.

We prospectively studied 60 ischemic patients with 5F catheters (Pigtail and Amplatz) using the percutaneous right brachial artery approach (group I), in order to compare this technique with two groups of 100 patients each randomly studied by the femoral route with either 5F (group II) or 8F (group III) catheters (Pigtail and Judkins). The following parameters were analyzed: need to change the initially elected catheter diameter or/and artery approach; technical difficulty for obtaining LV, LCA, and RCA angiograms; total time of X-ray exposure; quality image of LV, LCA, and RCA angiograms; incidence of arterial puncture related hematomas or total arterial occlusion; and duration of local compression after sheath removal. There were no differences between 5F brachial and femoral approaches except for the arterial compression time (p less than 0.01) and the X-ray exposure time (p = 0.03) which were longer with the brachial approach. Whatever the route used, 5F showed a mild increase difficulty (brachial p = 0.001; femoral p = 0.01) and a mild decreased quality image for LCA (branchial p = 0.006; femoral p less than 0.05). Mild hematomas were more frequent with 8F catheters (p less than 0.05). The procedure could be completed by the elected first artery and type of catheter (5F or 8F) in 57/60 patients in group I, in 95/100 in group II, and in 96/100 in group III (nonsignificant differences). Thus, the percutaneous right brachial artery approach using 5F catheters is similar to the femoral artery approach with the same catheters. Although both of them showed a mild increased technical difficulty and a mild decreased quality image compared to 8F, mainly for LCA angiograms, they allowed complete and reliable angiograms reading and analysis.

Angiography↗
PubMed1991

Effect of drugs on a noninvasive index of arterial compliance in healthy and heart failure patients.

Ten healthy (aged 28 to 39) and ten heart failure NYHA II (aged 19 to 49) male subjects were prospectively studied under no drugs, under furosemide (40 mg/day), under captopril (150 mg/day) and under their association. Arterial compliance (ml/mmHg) was measured in all subjects at rest and supine. Heart failure etiology was dilated cardiomyopathy or ischemic heart disease without significant regurgitation. Arterial compliance was significantly higher in healthy than in heart failure patients in all studied conditions (p less than 0.001) (healthy = 2.2 + 0.29 vs. heart failure = 0.79 + 0.14). Neither single drug nor their association induced any change in healthy subjects. Arterial compliance progressively increased in heart failure with furosemide, captopril, and their association (no drug = 0.79 + 0.14; furosemide = 0.87 + 0.15; captopril = 0.94 + 0.15 and furosemide + captopril = 0.99 + 0.14). Captopril induced a higher increment than furosemide (p less than 0.001) and their association even a higher increment (p less than 0.001) than any single drug. Thus captopril and/or furosemide increased arterial compliance in heart failure but not in healthy subjects, possibly through changes in arterial wall edema and smooth muscle contraction.

Adult↗
PubMed1991

An Analysis of the Predictability of Hypoxemia Following Vertical Banded Gastroplasty.

Postoperative (post-op) hypoxemia is unpredictable, often undetected by physical examination, sometimes fatal. We studied 45 morbidly obese patients with an average age of 37, including 16 smokers, having vertical banded gastroplasty (VBG) for useful preoperative (preop) predictor(s) of post-op hypoxemia during the first five days following VBG. Patient blood gases (arterial blood oxygen, P&infa;O&inf2; in mmHg), pre-op and five post-op days (POD), after 30 min in room air were: pre-op, 85 +/- 9; POD1, 63 +/- 9*; POD2, 61 +/- 9*; POD3, 63 +/- 10*; POD4, 63 +/- 9* POD5, 64 +/- 1 * (* p < 0.05, Student's t-test compared with pre-op). Linear regression showed no practical, predictive value for P.02 for age, Body Mass Index (BMI), pulmonary function tests (PFTs), smokers or preop P&infa;O&inf2;. Post-op atelectasis occurred in 84% of patients, mostly the posterior basilar regions on chest X-ray. No patient developed clinically diagnostic pneumonia. VBG patients experienced profound hypoxemia post-op, the lowest on POD2. There is no reliable method to predict which patient may develop severe hypoxemia. It is, therefore, extremely helpful to uniformly monitor P&infa;O&inf2; post-op in morbidly obese patients.

Journal Article↗
PubMed1990

Ten-year follow-up of worksite hypertension control programs.

We have analyzed the control of hypertension and the demographics of 898 actively treated (AT) (visits within past 12 months) and inactive patients (IAT) (no visit for at least 12 months) in six worksite hypertension programs established in 1977. Results were analyzed using Student's t test and correlation coefficients. Patients are treated at the worksites by a nurse-physician team using a stepped-care protocol. In the AT group (n = 436), the mean age was 52 +/- 0.5 years, initial blood pressure (BP) was 152 +/- 1/97 +/- 0.5 mm Hg, and current BP was 136 +/- 0.7/86 +/- 0.04 mm Hg (p less than 0.001). Of the 436 patients, 194 were men and 242 were women (217 Caucasian and 156 black). In the IAT group (n = 462) mean age was 51 +/- 0.5 years, initial BP was 154 +/- 1/99 +/- 0.5 mm Hg, and last BP was 138/88 +/- 0.4 mm Hg (p less than 0.001). Of these, 171 were men and 291 were women (238 Caucasian and 171 black). No differences in initial and current BP were noted when comparing the AT with the IAT group. The percent of Caucasian (43%) and blacks (36%) men in the AT group was similar to those in the IAT group (37%). Control of hypertension at worksites where blacks predominate was similar to sites where Caucasians predominate. We conclude that worksite control of hypertension over a 10-year period maintains approximately 50% of the initial population under treatment. Control rates greater than 80% to less than 90 mm Hg diastolic are present despite heterogeneity in demographics.

Black People↗
PubMed1989

[Evaluation of small branch occlusion and myocardial damage related to angioplasty. Usefulness of determining serum CK-MB].

In 65 consecutive cases of PTCA we prospectively looked for the appearance of myocardial necrosis during PTCA and for the presence of occlusion of collateral branches arising from the inflation area. Premedication was oral in 44 and intramuscular in 21 cases. CK-MB was abnormally increased in 6 cases: 3 with total occlusion of the dilated artery, 1 with transient coronary occlusion, and 1 with occlusion of a collateral branch greater than 1 mm diameter; in the sixth case the increased CK-MB peak was attributed to repeated defibrillations. Only 1 collateral branch less than 1 mm was occluded during PTCA though myocardial necrosis was not detected. Only collateral branches arising from the dilated stenosis were affected (occlusion and/or appearance of new stenosis) by PTCA (4/24 vs 0/162; p less than 0.01). There were no significant differences in CK-MB peak between both types of premedication. Thus we conclude that: 1) in PTCA myocardial necrosis is only induced by occlusion of coronary arteries greater than 1 mm diameter; 2) only collateral branches arising from the dilated stenosis are at risk of occlusion; 3) estimation of CK-MB pre-PTCA and 8 hours post-PTCA are sufficient for detection of myocardial necrosis.

Adult↗
PubMed1989

[Coronarography using high-flow 5F catheters. Percutaneous technic using the femoral and brachial routes].

In order to validate 5F catheters for assessing ischemic heart disease either by the femoral and the right brachial approaches, we prospectively studied with these catheters 125 patients by means of left ventriculogram and coronary artery angiograms. Twenty-five patients were studied with pigtail and Amplatz catheters using the right brachial approach (group I) and 100 patients were studied by the femoral route with pigtail and Judkins catheters (group II). Results were compared to those obtained in a control group of 100 patients prospectively studied by the femoral route with 8F catheters (group III). The following parameters were analyzed: need to change the initially elected catheter diameter or/and artery approach; technical difficulty for obtaining left ventriculogram, left coronary artery, and right coronary artery angiograms; total time of X-ray exposure; quality image of left ventriculograms; incidence of arterial puncture related hematomas or total arterial occlusion; and duration of local compression after sheath removal. There were no differences between groups I and II except for the arterial compression time (p less than 0.0001), and the X-ray exposure time (p = 0.02); both were longer in patients studied by the brachial approach (group I). Whatever the route used, 5F showed a mild increased difficulty (brachial p = 0.001; femoral p = 0.01), and a mild decreased quality image for left coronary artery (brachial p = 0.006; femoral p less than 0.05). Among patients studied by the femoral route a reduction in mild hematomas (p less than 0.05) and in the arterial compression time (p less than 0.0001) were observed in those studied with 5F catheters.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1989

[Intravenous streptokinase in acute myocardial infarction. Reduction of early in-hospital mortality].

A randomized study of the effects of intravenous streptokinase was performed in 214 patients with an acute myocardial infarction of less than 4 hours of whom 110 were included in the therapeutic group (SK) and 104 in the control group (C). Incidence of angiographic recanalization was higher in SK group (71 vs 28%, p less than 0.001) as that of non-significant residual coronary artery stenosis (less than 70%, 16% vs 3%, p less than 0.005), particularly in young patients (less than 45 years; 42% vs 8%, p less than 0.05). However, SK group presented a higher incidence of severe residual stenosis (90-99%) (SK, 42% vs C, 22%, p less than 0.01). Ejection fraction was higher among recanalized patients in both groups. Peak CPK-MB occurred earlier in SK group (13 vs 19 hours, p less than 0.001) and also among the recanalized patients of each group (SK, 12 vs 16 hours, p less than 0.001; C, 15 vs 21 hours, 0.002). The course of ST segment was similar in the 2 groups. The occurrence of ventricular arrhythmias within the first hour was greater in SK group (40% vs 20%, p less than 0.002), whereas the incidence of pericarditis (14% vs 35%, p less than 0.001) and of early mortality (less than 5 days, 2% vs 10%, p less than 0.02) was lower in SK group. The incidence of cardiac rupture, confirmed at necropsy in each of the 5 cases studied, was also lower in SK group (1 vs 8).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Five French versus eight French catheters and the Judkins technique. Advantages and limitations for studying coronary artery disease.

In order to compare 5 French versus 8 French catheters for assessing ischemic heart disease, we prospectively studied 2 groups of 100 patients each, one with 5 French (group I) and the other with 8 French (group II) catheters by the Judkins technique. Significant differences were found in the greater easiness to catheterize LV (p less than 0.05) and LCA (p = 0.01) in group II and in better quality image for LCA in group II (p less than 0.05), although all patients in both groups had acceptable image quality. Pressure curves quality was better in group II (p less than 0.01); X-ray exposure time was longer in group I (p less than 0.001) and arterial compression time in group II (p less than 0.0001). Group I showed 3 and group II 10 mild hematomas (p less than 0.05). The procedure could be completed by the elected first artery and type of catheter in 95 patients in group I and in 96 in group II. Thus, the Judkins technique with 5 French catheters is as valid as with 8 French for assessing ischemic patients, reducing arterial morbidity, although mildly increasing technical difficulty and mildly decreasing quality image.

Adult↗
PubMed1988

Differences of postextrasystolic behavior of left ventricular and aortic pressures between fixed and dynamic left ventricular outflow tract stenosis.

The dynamic behavior of fixed LV outflow tract stenosis partly resembles that of OCM. To analyze their differences we studied basal and postextrasystolic (post-PVC) peak-to-peak LV aortic gradients, aortic systolic pressure, and pulse pressure in 14 OCM and in 36 pure VAS without two-dimensional echocardiographic findings of OCM. Fifteen mild VAS had basal gradients similar to those of OCM (39 +/- 17 mm Hg vs 24 +/- 16 mm Hg). Patients with OCM show a post-PVC gradient (109 +/- 41 mm Hg) similar to that of VAS (110 +/- 50 mm Hg). However, the latter were departing from much higher gradients (VAS 72 +/- 30 mm Hg vs OCM 24 +/- 16 mm Hg). Decrement of post-PVC aortic systolic pressure and pulse pressure were frequent in both groups, but decrement of pulse pressure greater than 5 mm Hg were more frequent in OCM. We concluded that (1) post-PVC increased aortic gradients and decreased aortic systolic pressure occurred in both VAS and OCM; (2) post-PVC decreased aortic pulse pressure might occur in VAS; and (3) association of post-PVC gradient increment greater than 75 percent and pulse pressure decrement greater than 5 mm Hg are strongly suggestive of OCM.

Aortic Valve Stenosis↗
PubMed1988

[Function of the right ventricle in interauricular communication in adults].

This study was designed prospectively to analyze the influence of age and operation on right ventricular function in atrial septal defect; 17 patients were studied by means of radionuclide studies performed immediately before and approximately 6 months (5,8 +/- 2,3) after surgery. The pulmonary/systemic flow ratio (Qp/Qs) was determined by first pass technique, and right ventricular ejection fraction and peak filling rate were determined by equilibrium ventriculography. In addition, all patients had preoperative catheterization. According to age, patients were divided in group I (less than 35 years) and group II (greater than or equal to 35 years). Preoperatively, patients in group I, in comparison to group II, had better ejection fraction (48 +/- 8 vs 36 +/- 7; p less than 0.01), and better peak filling rate (3.7 +/- 0.9 vs 2.6 +/- 0.7; p less than 0.01), while Qp/Qs were not significantly different (2.5 +/- 0.8 vs 3.0 +/- 1.6) and pulmonary vascular resistances were less elevated (69 +/- 32 vs157 +/- 95 dynes/sec/cm-5; p less than 0.01). After surgery, right ventricular function did not significatively change in relation to preoperative data in both groups (ejection fraction: 44 +/- 13 and 34 +/- 5, respectively; peak filling rate: 3.3 +/- 1.4 and 2.1 +/- 0.6). We conclude that in atrial septal defect indexes of systolic and diastolic right ventricular function deteriorate with age, these changes being associated with a slight increase in pulmonary vascular resistance without changes of Qp/Qs; right ventricular dysfunction does not tend to improve postoperatively.

Adolescent↗
PubMed1987

Transient cardiac constriction: an unrecognized pattern of evolution in effusive acute idiopathic pericarditis.

In 16 of 177 patients with effusive acute idiopathic pericarditis (10 men, 6 women, mean age 38 years), features of cardiac constriction were detected (by physical examination in 6 patients and by noninvasive recordings in all) between 5 and 30 days after an echocardiogram had shown pericardial effusion, at a time when signs of activity had abated and effusion was already minimal or had altogether disappeared. Cardiac catheterization was performed in 5 patients, showing either overt (3 patients) or occult (2 patients) cardiac constriction. Two patients had clinical signs of cardiac failure. After a mean of 2.7 months, the features of constriction had spontaneously disappeared in all patients in the clinical examination and noninvasive recordings, and remained so in subsequent control studies (mean follow-up 31 months). Repeat cardiac catheterization in the 5 patients in whom it had been previously performed showed normal features both in the basal state and after fluid overload. The results of the present study show that some patients may go through a transient phase of cardiac constriction at the end of the effusive period of acute idiopathic pericarditis. Features of constriction are, in most cases, subtle and can go unrecognized if not specifically sought. However, they may have clinical relevance in some patients. These findings provide insight into the resolution phase of effusive acute idiopathic pericarditis, and an unnecessary pericardiectomy may be avoided.

Acute Disease↗
PubMed1986

Risk of myocardium adjacent to infarcted myocardium: electrocardiographic, metabolic and scintigraphic evidence within the first week of acute myocardial infarction.

Atrial pacing was carried out within 5 days of an uncomplicated acute myocardial infarction (AMI) in 28 patients to detect the existence of a menaced area. A positive pacing response (at least 1.0 mm of ST-segment shift) was observed in 23 patients (82%, group I), whereas pacing results were negative in 5 (18%, group II). Pacing-induced electrocardiographic changes involved the leads affected by AMI in patients with transmural necrosis. A well-defined thallium-201 redistribution, mostly localized near or within the AMI site, was present in 10 patients from group I (43%), in 1 from group II (20%), and in 1 of 12 comparable patients (8%) in whom pacing was not performed. During pacing, abnormal lactate metabolism was observed in 11 of 17 patients from group I (65%) and in 0 of 5 from group II (0%). A 90% or greater coronary stenosis of at least 1 artery was found in 19 of 23 patients from group I (83%) and in 1 of 5 from group II (20%); 2- to 3-vessel disease (more than 70% diameter stenosis) was present in 14 patients from group I (61%) and 1 from group II (20%). During a 15-month follow-up (range 9 to 25), effort angina developed in 9 patients from group I (39%) and in none from group II. No deaths or reinfarctions occurred in either group. Thus, very early after a first AMI, most patients have a jeopardized periinfarction area that is usually associated with a critical coronary stenosis and that heralds effort angina in a significant proportion of them.

Adult↗
PubMed1986

Recurrent anaphylactic shock as a manifestation of echinococcosis. Report of a case.

Hydatid disease, caused by the cestode Echinococcus granulosus, is common in Mediterranean regions, being highly endemic in Greece. Depending on its size, an intact hydatid cyst may be "silent" or may cause symptoms from compression of adjacent organs. Rupture of a hydatid cyst commonly gives to allergic phenomena, which can include anaphylactic shock. A case is presented in which there was a two-year history of recurrent anaphylactic shock due to small, incomplete ruptures of hydatid cyst. The case emphasizes the potentially life-saving importance of early diagnosis of hydatid cyst.

Adult↗
PubMed1985

Hemodynamic evaluation of stenotic cardiac valves: I. Effect of ventriculography and atropine on mitral stenosis.

Mitral area is the parameter used for quantitating mitral stenosis (MS) severity. When mitral gradient (MG) is low and reduction of mitral valve area (MVA) might be critical, interventions presumably increasing mitral valve flow (MVF), such as stress or atrial pacing, have been carried out. The purpose of this study was to analyze in 28 patients the combined effect of left ventriculography (LVG) and intravenous atropine (ATR) in the hemodynamic evaluation of MS. The rationale for combining these two interventions is to add up the ATR-positive chronotropic effect to the LVG potentiation of cardiac output. The LVG plus ATR markedly accelerated heart rate (from 80 +/- 14 to 104 +/- 18 bts/min, P less than 0.001), mildly increased cardiac index (from 2.6 +/- 0.6 to 2.9 +/- 0.6 1/min/m2, P less than 0.05), and importantly increased MVF (from 136 +/- 30 to 172 +/- 46 ml/bt, P less than 0.001). Pulmonary wedge pressure increased (from 14 +/- 5 to 21 +/- 5 mmHg, P less than 0.001) because of an important increment of MG (from 12 +/- 6 to 18 +/- 7 mmHg, P less than 0.001). None of six cases with mild MS (MVA greater than 1.5 cm2) and nine of ten cases with severe MS (MVA less than or equal to 1.0 cm2) had MG after LVG plus ATR greater than 12 mmHg. The remaining case with severe MS and the two cases (out of 12) with moderate MS having MG after LVG plus ATR less than or equal to 12 mmHg had, at surgical evaluation, noncritically reduced MVA. This study shows that LVG plus ATR is a valid and easy intervention for increasing MVF during cardiac catheterization. It also allows the reclassification of patients with low baseline MG and reduced MVA into two subgroups: Cases with critically reduced MVA at surgery achieve a postintervention MG greater than 12 mmHg and those cases with noncritically reduced MVA achieve a postintervention MG less than or equal to 12 mmHg.

Adult↗
PubMed1985

Hemodynamic evaluation of stenotic cardiac valves: II. Modification of the simplified valve formula for mitral and aortic valve area calculation.

Since the introduction by Gorlin and Gorlin of the hydraulic formulae for calculating valve area, it has become the best parameter for quantitating valve stenosis. Recently Hakki et al proposed a simplified formula for valve area calculation that does not take into account either heart rate (HR) or left ventricular filling or ejection time. The purpose of this study was to analyze the validity of Hakki's formulae under different physiological conditions and to propose an easy correction to improve its accuracy. Our study suggests: (1) that an easy correction for heart rate in certain cases, dividing by 1.35 when HR less than 75 beats per min in mitral stenosis and when HR greater than 90 beats per min in aortic stenosis, significantly improves the accuracy and validity of Hakki's formulae (p less than 0.02 and p less than 0.05); (2) the instantaneous valve gradients (peak gradient for aortic stenosis and average of instantaneous early, middle, and late diastolic gradients for mitral stenosis) are as valid as mean planimetric gradients for valve area calculation. Thus the simplified formulae proposed in this study allow mitral and aortic valve area calculations by means of instantaneous gradients, cardiac output, and heart rate.

Adolescent↗