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Biomedical subjects

J J Rams

Publications and source records attributed to J J Rams.

At least 19 recordsLinked to original sources
PubMed1993

Detection of microemboli in patients with artificial heart valves using transcranial Doppler: preliminary observations.

Embolic events, particularly involving the central nervous system, represent one of the important hazards associated with the implantation of mechanical valves. The use of the transcranial Doppler to insonate the middle cerebral artery has allowed us to detect microembolic events in some of these patients. Patients with long term implantation and frequent microemboli appear to be more prone to transient ischemic attacks or stroke. Evaluation of 26 patients with mechanical valves revealed 14 with detectable microemboli, four of whom experienced central nervous system symptoms. Modifications in the medical or anticoagulant regimes have not been successful in decreasing or eliminating these microemboli. As the transcranial Doppler is a non-invasive means of quantifying these microemboli, it may become a useful tool in identifying those patients in need of a new type of antithrombotic regimen, or even a valve replacement. Transcranial Doppler could thus provide advance warning before a catastrophic cerebral embolism occurs.

Aortic Valve↗
PubMed1986

Should coronary artery bypass be delayed following successful direct coronary artery streptokinase thrombolysis during evolving myocardial infarction?

The effect of deferring immediate coronary artery bypass was evaluated in two groups of similar patients having successful direct coronary artery thrombolysis with streptokinase in the treatment of evolving myocardial infarction. Within 6 hours of onset of myocardial infarction, 140 patients underwent immediate cardiac catheterization and infusion of intracoronary streptokinase up to 500,000 units. Of those patients having restoration of orthograde coronary blood flow coupled with immediate evidence of myocardial salvage, 31 patients (group I) had immediate coronary artery bypass and 34 patients (group II) had coronary artery bypass deferred. Group I had no hemorrhagic, hemodynamic, or new cardiac complications. There were no deaths, reinfarction, recurrence of angina, or loss of salvaged myocardium at restudy. In group II, 11 of 34 patients had early reinfarction (p less than 0.01 vs. group I), 16 of 34 patients had recurrent angina (p less than 0.01 vs. group I) and two deaths occurred from cardiac causes. Subsequent coronary bypass was needed in 16 patients. All restudied reinfarction patients lost restored myocardium. We concluded that immediate coronary artery bypass is safe after acute myocardial infarction and coronary artery thrombolysis with streptokinase, delay of coronary artery bypass leads to an unacceptable incidence of reinfarction and recurrent severe angina, and early coronary artery bypass is needed to ensure success of thrombolysis.

Coronary Artery Bypass↗