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Biomedical subjects

J C Dillon

Publications and source records attributed to J C Dillon.

At least 37 records · Page 2Linked to original sources
PubMed1990

Improvement in rest and exercise-induced wall motion abnormalities after coronary angioplasty: an exercise echocardiographic study.

Exercise echocardiography was performed in 36 patients to evaluate functional improvement after coronary angioplasty. Thirty-one patients (86%) had provokable ischemia before angioplasty including 22 with an abnormal exercise electrocardiographic test (angina or ST depression), 25 with an abnormal exercise echocardiogram (exercise-induced wall motion abnormalities) and 16 with both tests abnormal. Nineteen patients had no induced ischemia after angioplasty. Seventeen (47%) continued to have ischemia that was limited in 12 to exercise-induced wall motion abnormalities, which were less severe compared with those of preangioplasty studies. Fifteen (65%) of 23 patients had improvement in rest wall motion abnormalities after angioplasty. The rest to immediate postexercise change in global wall motion score was significantly improved after angioplasty. The change in regional wall motion score was significantly improved after angioplasty in patients with single vessel right or left circumflex coronary artery disease and approached significant improvement (p = 0.06) in those with single vessel disease of the left anterior descending coronary artery. Exercise echocardiography improves the sensitivity of functional testing for ischemia, aids in localizing the ischemic zone and documents improvement in regional function after coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1990

Peripheral cardiopulmonary support during high-risk angioplasty.

We report the safety and feasibility of the first three patients using cardiopulmonary bypass support at the Indiana University Medical Center during PTCA. All patients had severe left ventricular dysfunction. Cannulation was performed using 18- or 20-French cannulae of the femoral vessels, either surgically or percutaneously. After heparinization with an activated clotting time of greater than 450 seconds, cardiopulmonary bypass was instituted using the Bard CPS system. Flows ranged from 3.0 to 4.3 L/min. Normasol was used to prime the pump. Blood was retransfused back into the patient at the end of the procedure. Bleeding was a problem in case 1 at the arterial cannulation site and subsequently was corrected for cases 2 and 3. Coronary angioplasties were deemed technically successful. We conclude that high-risk angioplasty can be performed in patients with poor left ventricular function using cardiopulmonary bypass support in the cardiac catheterization laboratory. Further study is indicated.

Aged↗
PubMed1989

Early recovery of regional left ventricular function after reperfusion in acute myocardial infarction assessed by serial two-dimensional echocardiography.

Although global and regional left ventricular (LV) function has been demonstrated to improve after reperfusion in acute myocardial infarction (AMI), the timing of these changes has not been well established. In this study, serial 2-dimensional echocardiography was used to assess regional LV function in 23 patients with AMI in whom reperfusion was accomplished by thrombolysis alone, by coronary angioplasty alone or by both interventions within 6 hours after onset of chest pain. Echocardiograms were performed before or within 6 hours after reperfusion (n = 23) and at 1 (n = 19), 3 (n = 21) and 7 (n = 20) days after reperfusion. Wall motion index and percentage of normally functioning muscle were calculated using a 16-segment scoring system analyzed in blinded fashion without knowledge of patient identity, therapy or time of study. The mean wall motion index improved from 1.78 +/- 0.48 to 1.56 +/- 0.38 at 1 day (n = 19, p less than 0.01), and to 1.48 +/- 0.37 at 3-7 days (p less than 0.01), with no significant difference between 3 days (1.49 +/- 0.39) and 7 days (1.42 +/- 0.30). There was a corresponding improvement in the percentage of normally functioning muscle, from 53 +/- 24% at 6 hours to 62 +/- 20% at 1 day (p less than 0.05) and to 67 +/- 18% at 3-7 days (p less than 0.01), again with no significant difference between 3 days (67 +/- 21) and 7 days (70 +/- 20).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Improvement in regional wall motion after percutaneous transluminal coronary angioplasty during acute myocardial infarction: utility of two-dimensional echocardiography.

In the setting of acute myocardial infarction, 16 patients undergoing successful coronary angioplasty (PTCA) within 6 hours of presentation (group I) and eight patients receiving conventional medical therapy (group II) were studied by serial two-dimensional (2D) echocardiography to assess the functional recovery of myocardium. All patients underwent 2D echocardiograms within 24 hours of presentation and at a minimum of 6 days after admission. Wall motion analysis was quantified with a wall motion score index based on 16 left ventricular wall segments. Wall motion score index improved significantly from early to late echocardiographic study in the patients undergoing PTCA (1.65 +/- 0.29 to 1.40 +/- 0.30; p less than 0.001), whereas the index did not improve in the conventionally treated group (1.54 +/- 0.26 to 1.58 +/- 0.25; p = NS). One patient in group II had a greater than or equal to 10% improvement in wall motion score index compared to 11 of 16 in group I (p less than 0.01). In all cases improvement in wall motion score index was due to improvement in regional wall motion in the area of infarction. In group I, 40 of 77 (52%) infarct zone segments showed improvement of at least one grade, versus 4 of 28 (14%) segments in group II (p less than 0.001). These data indicate that regional myocardial function improves in the majority of patients undergoing successful PTCA as emergency therapy for acute myocardial infarction and that serial 2D echocardiography is an excellent means to quantify this improvement.

Adult↗
PubMed1987

Digital two-dimensional echocardiographic imaging of the proximal left anterior descending coronary artery.

The use of 2-dimensional echocardiography to evaluate coronary artery anatomy noninvasively and directly has been primarily limited to the evaluation of the left main coronary artery. To determine the feasibility of visualization of the proximal left anterior descending coronary artery (LAD) and assessment for atherosclerotic disease in this location, 128 consecutive patients undergoing coronary arteriography were evaluated with digital 2-dimensional echocardiography. Visualization of the proximal LAD was possible in 90 (70%) of the 128 patients. Of 45 patients with proximal LAD narrowing by angiography, digital echocardiography correctly identified 44 (98% sensitivity). In 27 patients with angiographically normal coronary arteries, digital echocardiography was normal in 18 (67% specificity). In the 18 patients with an angiographically normal proximal LAD but narrowing elsewhere in the coronary system, digital echocardiographic evaluation of the proximal LAD was abnormal in 15. This initial study suggests that 2-dimensional echocardiography is a feasible technique to image the proximal LAD noninvasively in patients undergoing coronary arteriography.

Adult↗
PubMed1986

Failure of fluosol DA to enhance the ultrasonic image of infarcted myocardium.

The perfluorocarbon Fluosol DA has been reported to increase the subjective echogenicity of infarcted myocardium. To investigate this phenomenon, two-dimensional echocardiograms were recorded in 20 closed-chest dogs before and 24,48,72, and 96 h following permanent coronary artery occlusion. Low-dose Fluosol, 10 ml/kg (LDF) (four dogs), high-dose Fluosol, 25 ml/kg (HDF) (eight dogs), or lactated Ringers 25 ml/kg (LR) (eight dogs) was administered 48 h after occlusion. Left ventricular sections corresponding to the short-axis echocardiographic examination plane were stained with nitroblue tetrazolium 48 h after Fluosol administration. Short-axis echocardiographic studies were evaluated by two blinded observers who found no consistent increase in the echogenicity of the infarcted area in any group. Videodensitometry of the infarcted area, normalized to the average value of two remote areas, confirmed mean post-Fluosol increases of 66% in LR dogs, 65% in LDF dogs, and 107% in HDF animals (p less than 0.001 for all dogs; all intergroup comparisons NS). The increase in videodensity observed in all groups may have occurred as a consequence of volume administration, although changes in infarct intensity occurring over time cannot be excluded.

Animals↗
PubMed1986

Quantitative two-dimensional echocardiographic assessment of patients undergoing left ventricular aneurysmectomy.

To evaluate the role of quantitative two-dimensional echocardiography (2DE) in the preoperative assessment of patients undergoing left ventricular (LV) aneurysmectomy, we identified 37 patients who were studied with 2DE 1 to 56 (mean 12.6) days prior to surgery. Diastolic (Dd) and systolic (Ds) minor-axis dimensions at the base were measured and fractional shortening (FS) was calculated. Global and basilar half ejection fraction (EF) as measured from right anterior oblique left ventriculograms. At follow-up (mean 17.9 months), 27 patients were alive and clinically improved (group A) and 10 patients either died or were symptomatically unimproved (group B). Basilar half EF was significantly greater among patients in group A (0.50 +/- 0.09) than in group B (0.37 +/- 0.10) (p less than 0.001). Echocardiographic FS provided the best separation between groups. Mean FS was 0.25 +/- 0.06 in group A and 0.15 +/- 0.04 in group B (p less than 0.001). All seven patients with FS less than 0.17 were in group B while 25 of 27 patients with FS greater than 0.17 were in group A (p less than 0.001). Considering all patients, basilar half EF and FS were highly correlated (r = 0.84).

Adult↗
PubMed1986

Doppler echocardiographic evaluation of patients with porcine mitral valves.

The application of Doppler echocardiography to the study of valvular function has recently been extended to include prosthetic valves. We have used Doppler echocardiography to evaluate 40 patients with porcine mitral valves (PMV) implanted 0.5 to 99 months prior to examination. Three parameters of PMV flow were assessed: maximum diastolic left ventricular inflow velocity (Vmax), pressure half-time (P1/2t), and presence or absence of mitral regurgitation (MR). Normally functioning PMV (n = 29) were characterized by Vmax less than or equal to 180 cm/sec and P1/2t less than or equal to 160 msec. Within this group, P1/2t was not correlated significantly with the age of the patient nor with prosthesis size. Doppler correctly identified all 10 patients with MR. Among these 10 patients, Vmax was 206 +/- 53 cm/sec, significantly higher than the mean observed in normally functioning prostheses (136 +/- 24 cm/sec, p less than 0.001). In eight patients with stenosis of the PMV, mean P1/2t was 220 +/- 63 msec, and in seven of eight, it was greater than or equal to 180 msec (p less than 0.001 compared to normals). We conclude that: (1) Vmax less than or equal to 180 cm/sec, P1/2t less than or equal to 160 msec, and absence of systolic turbulence in the left atrium characterize normally functioning PMV; (2) P1/2t greater than or equal to 180 msec identifies patients with stenosis of the PMV; and (3) Doppler echocardiography can detect MR and separate mitral from tricuspid regurgitation.

Adult↗
PubMed1986

[Elimination kinetics of organochlorine compounds in the 1st week of breast feeding].

The elimination kinetics of organochlorine compounds (DDE, lindane, aldrin, heptachlor epoxide and heptachlor) from day 2 to day 10 of breast feeding was studied in 39 volunteers who had a baby in the Maternity Department in Nancy. If there was any contamination of the mothers' milk with DDT, the levels were below the level of detection. In contrast, contamination with DDE was high (112.6 ng/g fat content) on day 2, although it decreased rapidly, to 38.6 ng/g by day 3. On day 2, contamination with lindane, aldrin, heptachlor epoxide and heptachlor averaged 43.8, 23.5, 25.4 and 7.4 ng/g fat, respectively, and the levels showed a linear decrease on subsequent days in all cases except that of heptachlor, for which no significant negative correlation with time could be demonstrated. A breast-fed infant thus absorbs measurable quantities of pesticides but not in excess of the acceptable daily doses. Levels of contamination of human milk in France are lower than those reported in Canadian and Italian studies but are higher than the levels in formulated milk.

Aldrin↗
PubMed1986

[Influence of glucose on the conversion of galactose into galactitol in the young adult].

The levels of galactose and galactitol in the sera of 6 young adults after ingestion of 0.25 g/kg of galactose alone or with the same quantity of glucose were studied. The results showed that: glucose decreased significantly the galactosemia and galactitolemia observed after ingestion of galactose alone; repeated consumption on 4 consecutive days of galactose alone induced an increase in galactosemia, and more significantly in galactitolemia. The addition of glucose to galactose in the same conditions abolished these effects.

Adult↗
PubMed1986

Complementary value of two-dimensional exercise echocardiography to routine treadmill exercise testing.

Two-dimensional echocardiograms were done during rest and after exercise in 95 patients who subsequently had coronary arteriography. Prior myocardial infarction was present in 36 patients, 35 of whom had wall motion abnormalities. There was no evidence of prior infarction in 59 patients, 44 of whom had coronary disease. In these 44 patients, the exercise electrocardiogram showed ischemia in 19, was normal in 13, and was nondiagnostic in 12. Exercise echocardiograms were abnormal in 35 of these 44 patients. In 15 patients without coronary disease, the treadmill response was nondiagnostic in 6, ischemic in 1, and normal in 8. Exercise echocardiograms were normal in 13 of these 15 patients. We conclude that exercise echocardiography is a valuable addition to routine treadmill testing. It may be of special value in patients with an abnormal resting electrocardiogram or a nondiagnostic response to treadmill testing or when a false-negative treadmill test is suspected.

Adult↗
PubMed1985

Quantitative evaluation of inflammation in biopsy specimens from idiopathically failing or irritable hearts: experience in 80 pediatric and adult patients.

The histologic criteria for the diagnosis of myocarditis on an endomyocardial biopsy specimen are troubled by varying institutional criteria and interobserver differences. A comprehensive approach to tissue evaluation including quantitative assessment of mononuclear cell populations enhances the accuracy and the specificity of the morphologic diagnosis. Future efforts to characterize the infiltrating cell lines in inflammatory conditions of the heart will aid in the ultimate refinement of therapeutic efficacy.

Adult↗
PubMed1985

Prediction of survival in progressive systemic sclerosis by multivariate analysis of clinical features.

The records of 64 patients with progressive systemic sclerosis (PSS) were reviewed. More than 100 items from the patient's history, physical examination, and laboratory tests were encoded. A two-tailed Gehan's test was used to evaluate the effect of each variable on patient survival. Variables significant at the 0.05 level were then analyzed simultaneously, using the Cox regression model, in order to determine which clinical features are most predictive of survival in PSS. By Cox regression, the presence of an S3 gallop and advanced age at onset of PSS related negatively to survival. The relative risk of death for a patient with an S3 gallop was 5.44 (ratio of risk) times that for a patient without an S3 gallop, and the risk of death for a 70-year-old patient at disease onset was 20 times that of a 20-year-old patient at disease onset. In addition, when patient selection was taken into account, corticosteroid administration had a significant effect, and seemed to actually shorten survival. Although one of the factors, age at onset, is not modifiable, the presence of either variable should alert the clinician to the patient being at high risk for short survival. The application of this technique should also prove helpful in analyzing the efficacy of various proposed therapies.

Adolescent↗
PubMed1985

An echocardiographic index for separation of right ventricular volume and pressure overload.

Abnormal motion of the interventricular septum has been described as an echocardiographic feature of both right ventricular volume and pressure overload. To determine if two-dimensional echocardiography can separate these two entities and distinguish them from normal, geometry and motion of the interventricular septum in short-axis views of the left ventricle were evaluated in 12 normal subjects and 35 patients undergoing cardiac catheterization. Thirteen of the 35 patients had uncomplicated atrial septal defect with associated right ventricular volume overload, but no elevation in pulmonary artery pressure. The 22 remaining patients had a pulmonary artery systolic pressure greater than 40 mm Hg and, thus, constituted the group with right ventricular pressure overload. An eccentricity index, defined as the ratio of the length of two perpendicular minor-axis diameters, one of which bisected and was perpendicular to the interventricular septum, was obtained at end-systole and end-diastole. In all normal subjects, the eccentricity index at both end-systole and end-diastole was essentially 1.0, as would be expected if the left ventricular cavity was circular in the short-axis view. In patients with right ventricular volume overload, the eccentricity index was approximately 1.0 at end-systole, but was significantly increased at end-diastole (mean eccentricity index = 1.26 +/- 0.12) (p less than 0.001). In patients with right ventricular pressure overload, the eccentricity index was significantly greater than 1.0 at both end-systole and end-diastole (1.44 +/- 0.16 and 1.26 +/- 0.11, respectively) (p less than 0.001). These results suggest that an index of eccentric left ventricular shape which reflects abnormal motion of the interventricular septum can be defined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Myeloperoxidase activity of polymorphonuclear leukocytes in iron deficiency anemia and anemia of chronic disorders.

Myeloperoxidase (MPO) activity was studied in adults with iron deficiency anemia (IDA) or anemia of chronic disorders (ACD). MPO activity (biochemical quantitation) was found to be decreased in IDA when compared to the control group (p less than 0.05); ACD subjects also had lower values although the difference was not significant (p less than 0.05). MPO scores (MPO staining) were significantly lower in IDA and ACD subjects than in the healthy control group (p less than 0.05). A significant positive correlation was noted between ferritin (R = 0.40) and percent transferrin saturation (R = 0.37) and MPO activity (p less than 0.001) in IDA and for the healthy controls.

Adult↗