PubMed Health⌕ Search

Biomedical subjects

J L Jacob

Publications and source records attributed to J L Jacob.

At least 37 records · Page 2Linked to original sources
PubMed1993

Initial experience with balloon dilatation of supravalvar aortic stenosis.

Primary balloon dilatation of supravalvar aortic stenosis was attempted in three patients: a 20 year old woman, a seven month old boy, and a 12 year old girl. Balloon catheters (Mansfield) with diameters of 25 mm, 8 mm, and 15 mm were used in the three patients respectively. The systolic pressure gradient across the aortic narrowing decreased considerably and the diameter of the constricted area increased significantly. Balloon dilatation was feasible and provided good immediate results and sustained relief of supravalvar aortic stenosis in these three patients. However, a larger study is needed to establish the place of this procedure in treatment.

Adult↗
PubMed1993

High-dose carboplatin and recombinant granulocyte-macrophage colony-stimulating factor in advanced-stage recurrent ovarian cancer.

PURPOSE: We investigated whether carboplatin myelosuppression could be favorably modulated by the administration of recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF) in patients with advanced-stage ovarian cancer. PATIENTS AND METHODS: Thirty-four patients with advanced-stage recurrent ovarian cancer were treated with high-dose carboplatin (800 mg/m2 per 35-day cycle) and rGM-CSF. rGM-CSF was administered as a daily subcutaneous injection starting 72 hours after the carboplatin dose and continuing until 7 days beyond the WBC nadir. rGM-CSF was administered in a phase I fashion. Seven patients were treated at an rGM-CSF dose of 3 micrograms/kg, 11 at 5 micrograms/kg, 10 at 10 micrograms/kg, and six at 20 micrograms/kg. RESULTS: rGM-CSF-related toxicities that were not dose-related included nonneutropenic fever, rib pain, acute hypersensitivity reaction, and pericarditis. At the rGM-CSF dose of 20 micrograms/kg, debilitating malaise was seen in four of six patients and this was the dose-limiting toxicity. Patient tolerance of the 3-micrograms/kg and 5-micrograms/kg doses was good, but tolerance was limited for the 10-micrograms/kg dose. Febrile neutropenia was seen in four of seven patients at 3 micrograms/kg, two of 11 at 5 micrograms/kg, two of 10 at 10 micrograms/kg, and one of six at 20 micrograms/kg. Cumulative carboplatin myelotoxicity was blunted only in respect to WBC count, and not for platelets or RBCs. Gastrointestinal bleeding was seen in seven patients. The administered dose-intensity of carboplatin averaged 134 mg/m2/wk for the cohort, or 670 mg/m2 per 35-day cycle. There were two clinical complete responses and eleven partial responses, for a response rate of 38%. CONCLUSION: rGM-CSF appears to be effective and tolerable at 5 micrograms/kg/d administered subcutaneously, if given with carboplatin doses up to approximately 600 mg/m2 over 35 days. The use of rGM-CSF with high-dose carboplatin is associated with a substantial response rate in poor-prognosis ovarian cancer patients.

Adult↗
PubMed1993

[In-hospital survival predictors in infarction patients undergoing fibrinolytic therapy].

PURPOSE: To analyze the in-hospital predictors of survival in a population of infarcted patients submitted to the same therapeutic protocol that included IV streptokinase (SK) in the dose of 750,000 units. METHODS: Three hundred and thirty two patients (mean age 55.6 +/- 10 years, 82.3% men) with acute myocardial infarction (AMI) were studied within six hours of onset of symptoms in a prospective and consecutive protocol. Using simple and multiple regression analysis, the following variables were selected for correlation with survival: LV ejection fraction by contrast ventriculography > 50%; CK-MB peak < or = 100 UI/1; male sex; invasive treatment (surgery or angioplasty); patent "culprit" coronary on cineangiography; age < or = 65 years; time interval between the onset of pain and the beginning of SK infusion < 3 hours; residual obstruction < 70% at the "culprit" coronary; inferior AMI location on ECG; absence of hypotension per-peri SK infusion, previous AMI, multivessel coronary artery disease and reinfarction. RESULTS: By simple regression analysis, ejection fraction > 50% (p < 0.001), CK-MB peak < or = 100 UI/1 (p = 0.003), and the absence of hypotension (p < 0.001), previous AMI (p = 0.009), multivessel coronary artery disease (p = 0.02) and reinfarction (p = 0.049), correlated significantly with survival. By multiple regression analysis ejection fraction > 50% (p = 0.017) and the absence of hypotension (p < 0.01), multivessel coronary artery disease (p = 0.032) and reinfarction (p = 0.037) correlated independently with survival. CONCLUSION: The data presented strongly support the concept of preventing atherosclerosis and maintaining myocardial viability using either direct measures such as recanalization, or indirect measures such prevention of hypotension and reinfarction.

Age Factors↗
PubMed1993

[Double aortic arch associated with stenosis of left pulmonary artery].

Case report on a 6-year-old patient with vascular ring, due to double aortic arch. The patient was asymptomatic. The barium-filled esophagus showed bilateral indentations and a large posterior indentation. Echocardiographic study in notch suprasternal view revealed features of this pathology. The diagnosis was made by the cineangiocardiographic study that showed double aortic arch with separate carotid and subclavian arteries arising from each arch. The right arch was larger than the left, and the descending aorta was on the left side. There was severe left pulmonary artery stenosis associated. The clinical management was chosen, because the patient was asymptomatic.

Aorta, Thoracic↗
PubMed1992

A pilot trial of chemohormonal therapy for metastatic prostate carcinoma.

Fifteen patients with previously untreated metastatic prostate cancer were treated on a pilot trial with a combination of maximal androgen blockade plus intermittent cytotoxic therapy after androgen priming to stimulate cell division. Androgen blockage was carried out using a gonadotropin-releasing hormone analog (leuprolide) plus a nonsteroidal antiandrogen (flutamide). Carboplatin (CBDCA) (800 mg/m2) was given intravenously every 28 days, preceded for 3 days and followed for 3 days by androgen treatment with fluoxymesterone (5 mg orally twice a day), during which time flutamide was discontinued. Three patients (20%) achieved a complete response (CR), and eight patients (53.3%) achieved a partial response (PR). Four patients (26.7%) had stable disease (SD). The median progression-free survival (PFS) time was 31 months. Nine of 15 patients (60%) remain alive with a median follow-up time of 42+ months (range, 22 to 54 months). Grade 4 thrombocytopenia and Grades 3 or 4 leukopenia were experienced in 87% and 80% of patients, respectively, requiring dose reductions of CBDCA in 85% of the cycles. Six of 15 patients experienced a flare in bone pain with androgen priming. There were no associated spinal cord compressions; however, exclusion of impending spinal cord compression was required before entrance on study.

Adenocarcinoma↗
PubMed1992

Peters' anomaly. The spectrum of associated ocular and systemic malformations.

The cases of Peters' anomaly seen over the past decade, at Hospital Ste-Justine in Montreal, are reviewed. Associated ocular anomalies were observed in 50% of cases while 60% of patients presented with associated systemic defects. It is clear, from these patients and those reported in the literature, that Peters' anomaly can be an isolated condition, or part of distinct syndromes: the Krause-Kivlin syndrome or the Peters'-plus syndrome. The authors emphasize the importance for the ophthalmologist to recognize these possibilities if proper management is to be provided.

Abnormalities, Multiple↗
PubMed1992

[The cholesterol profile in the city of São José do Rio Preto].

PURPOSE: To analyze: a) the cholesterol profile in adults older than 29 years, from São José do Rio Preto (300,000 inhabitants), city located in one of the country's richest regions; b) the variables that correlated with cholesterolemia. METHODS: An specialized firm was hired, and data was obtained through quantitative research, where a survey was done, using a sample stratified by sex and age; the error limits admitted was +/- 4%, for a 95% confidence interval, and Reflotron was utilized for cholesterol measurements. It was studied 672 persons (47% men), with mean age of 47.15 +/- 12.28 years; 35% were between 30 and 39 years, 25% between 40 and 49.22% between 50 and 59, and 18% were 60 or more years old. Thirteen variables were compared with cholesterolemia through simple regression; following, six of them, selected as predictors by stepwise regression, were compared with cholesterol through multiple regression analysis. RESULTS: a) Cholesterol levels: 192.5 +/- 48.9 mg/dl on global average, with 187.6 +/- 53.3 for men and 196.8 +/- 44.2 for women (p = 0.01, 95% CI 2.3 to 17.1); 176.5 +/- 44.7 mg/dl for people > or = 30 < 40 years old, 191.3 +/- 51.7 for those > or = 40 < 50 years (p = 0.002, 95% CI 4.6 to 24.2), 206.8 +/- 44.4 for those > or = 50 < 60 years (p = 0.005, 95% CI 4.6 to 26.4), and 208.5 +/- 47.8 for those > or = 60 years (p = 0.765,95% CI 9.5 to -12.5); 62% of the population showed < or = 200 mg/dl, and 16% > or = 240; b) through simple regression analysis, significant correlations were found between cholesterolemia and: age (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) arterial pressures, diet (any, the great majority hypocaloric, p = 0.001), height (inverse correlation, p = 0.003), and female gender (p = 0.011); under multiple regression analysis, significant correlations were found for age (p < 0.001), educational level (p < 0.001), systolic arterial pressure (p < 0.001), weight (p = 0.004) and height (inverse correlation, p = 0.012). CONCLUSION: In the population older than 29 years, from São José do Rio Preto: a) the mean cholesterolemia is 192.5 +/- 48.9 mg/dl, being significantly higher for women, in relation to men, and showing significant increases between 3rd, 4th and 5th decades of life; b) correlated significantly with cholesterolemia, through simple regression analysis: age, systolic and diastolic arterial pressures, diet, height (inverse), and female gender; under multiple regression analysis: age, educational level, systolic arterial pressure, weight and height (inverse).

Adult↗
PubMed1992

[Transluminal coronary angioplasty combined with cardiomyoplasty in the treatment of coronary disease associated with dilated cardiomyopathy].

A 53-year-old white female candidate to cardiomyoplasty to control heart failure class III (NYHA). Submitted to coronary angioplasty, presented at the coronarography 75% obstruction of the left anterior descending (LAD) artery and at the left ventriculography diffuse and severe hypocontractility ejection fraction (EF) = 17%. After primary success of the coronary dilatation, she was operated on with a good surgical outcome. Six months after the surgery, she did well clinically (class II) and at the coronarography the LAD artery presented free from restenosis or progression of the disease and the left ventriculography showed improvement of the ventricular function (EF = 28%).

Angioplasty, Balloon, Coronary↗
PubMed1991

Serum gastrin and blood glucose levels during halothane-nitrous oxide anaesthesia and strabismus surgery in children.

The purpose of this study was to determine whether serum gastrin levels are increased by reflexogenic stimuli applied to the extrinsic muscles of the eye. Serum gastrin and blood glucose concentrations were measured in ten normal children aged between 5 and 12 yr during general anaesthesia with halothane and nitrous oxide and during strabismus surgery. Fasting basal concentrations of gastrin (33.6 +/- 14.8 pg.ml-1) and of glucose (4.43 +/- 0.72 mmol.L-1) were in the normal range of values for children. Intravenous atropine (0.01 mg.kg-1), general anaesthesia with halothane in nitrous oxide and oxygen by mask for three minutes, tracheal intubation, extraocular muscle stimulation and surgical stress did not cause any variation in the mean serum gastrin concentration. On the contrary, tracheal intubation and surgical stress increased blood glucose concentrations (P less than 0.05). There was no difference in the serum gastrin levels after extraocular muscle stimulation between children with positive or negative oculocardiac reflexes (44.5 +/- 16.7 pg.ml-1 vs 38 +/- 14.7 pg.ml-1, respectively). The incidence of vomiting predischarge was 60 per cent. Serum gastrin levels did not differ between children who vomited and children who did not (44.3 +/- 18.5 pg.ml-1 vs 47.1 +/- 16.9 pg.ml-1, respectively). Vomiting after strabismus surgery cannot be attributed to high gastrin serum levels. Consequently, it is unlikely that vomiting after strabismus surgery is linked to an "oculogastric reflex" with the vagus nerve as the efferent pathway.

Anesthesia, Inhalation↗
PubMed1991

Antiemetic prophylaxis with promethazine or droperidol in paediatric outpatient strabismus surgery.

This randomized, double-blind study evaluated the antiemetic efficacy and the side-effects of promethazine pretreatment (0.5 mg.kg-1 IV + 0.5 mg.kg-1 IM) versus droperidol + placebo pretreatment (droperidol, 0.075 mg.kg-1 IV + physiological saline, 0.02 ml.kg-1 IM). One hundred unpremedicated ASA physical status I children ranging from two to ten years, and undergoing outpatient strabismus surgery were studied. All children received inhalational anaesthesia with halothane, nitrous oxide and oxygen. Neither opioids nor muscle relaxants were used. The incidence of vomiting and/or retching and the incidence of side-effects were determined in the post-anaesthesia recovery room (PARR), in the short-stay surgical unit (SSSU), and after discharge from the hospital (including the journey and the stay at home during the first postoperative day). Promethazine and droperidol were equally effective in reducing the incidence of vomiting before discharge to two and eight per cent respectively. On the contrary, the incidence of vomiting after discharge and overall were significantly less with promethazine (ten and ten per cent) than with droperidol pretreatment (54 and 56 per cent) (P less than 0.0001). Promethazine permitted the time to discharge from the hospital to be reduced to an average of three hours, without increasing the incidence of vomiting postdischarge. Promethazine pretreatment is much less expensive than droperidol pretreatment. The incidence of restlessness was significantly less with droperidol (eight per cent) than with promethazine (36 per cent) (P less than 0.001). Promethazine pretreatment demands the use of an analgesic like acetaminophen in order to reduce the incidence of postoperative pain and restlessness.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Surgical Procedures↗
PubMed1991

[Survival and predictive factors of late mortality in the surgical treatment of aortic stenosis].

PURPOSE: Study of 161 patients submitted to aortic valve replacement due to aortic stenosis to evaluate survival and predictive factors of late mortality. METHODS: The mean age was 45.8 years +/- 13.2 and 122 patients were men. Surgical mortality was 6.8%. The survival actuarial curve showed 59.28% of the patients alive after 16 years. Among the survival 62.3% +/- 10% were event free, including prosthesis thrombosis, thromboembolism, infective endocarditis and reoperation. Symptoms, age, gradient LV/Ao, ejection fraction (EF) and the compliance (CO) were related to prognosis. Sudden death after surgery was studied, with incidence of the 0.8 events/100 patients year. RESULTS: The asymptomatic patients had better evolution than symptomatic (p less than 0.05). The age above 60 years was not predictive of the prognosis in 10 years of follow-up, but no patients survived after 10 years. The gradient LV/Ao was not an important factor in the survival. The group with EF greater than 50% had 66.4% of survival, while the group with EF less than 50% survival was 39%. Normal or decreased compliance was not important in the survival. All patients with EF less than 50% always has decreased CO. Fifteen patients were dead due to heart failure and the most important predictive factor was the left ventricular dysfunction (p = 0.02). CONCLUSION: In aortic stenosis: a) severe ventricular dysfunction does not preclude the surgical treatment; b) the actuarial analysis suggests that EF less than 50% determines worse prognosis and always occurs with decreased CO; c) the excellent evolution of the asymptomatic patients does not generalize the surgical treatment in this phase; d) the incidence of the sudden death was not high after the surgical treatment; e) patients with pre-operative left ventricular dysfunction had greater mortality due to heart failure, than patients with normal left ventricular function; f) despite of the morbid events our results confirm the real benefit of the surgical treatment in the aortic stenosis.

Actuarial Analysis↗
PubMed1991

[Univentricular heart: angiographic features in 31 patients].

PURPOSE: Evaluation of angiographic features of univentricular heart. METHODS: Thirty-one patients were divided into 3 groups according to morphological type of univentricular heart: left ventricle type, right ventricle type and undetermined. They were studied for atrio-ventricular junction, position of rudimentary chamber in relation to principal chamber, ventricle-arterial junction, the position of the two great arteries in relation to each other and whenever possible, the origin of the coronary arteries. RESULTS: There were 16 cases of left ventricle type with A-V junction through 2 valves in 8 and through single valve in 6. The rudimentary chamber position was superior and to the right in 4 cases of dextrocardia and superior and to the left in 8 of levocardia. The ventricle-arterial junction was discordant in 9 patients and concordant in 4, double outlet of rudimentary chamber in 2 and single outlet in 1. The aorta was anterior to the pulmonary artery in 13 patients. Anomalous origin of the coronary arteries occurred in 5 of 9 cases studied. Right ventricle type occurred in 9 patients with absence of one of the A-V junctions in 5. Trabecular pouch was seen in 6 patients, posterior and inferior positioned in all of them. Double outlet from principal chamber occurred in 8 patients. The aorta was anterior in 66.6%. Undetermined type occurred in 6 patients with A-V junction through single valve in 5. In 3 there was double outlet from principal chamber showing pulmonary stenosis and in the remaining 3 there was pulmonary atresia. CONCLUSION: Discordant ventricle-arterial junction is common for left ventricle type; trabecular pouch is frequent in right ventricle type; single A-V valve is common for undetermined type; obstruction of pulmonary flow happens in all 3 types but it is more frequent in undetermined type; the aorta is anterior to the pulmonary artery in most cases; it is common the anomalous origin of the coronary arteries from the aortic sinus.

Adolescent↗
PubMed1991

[Cardiac rhabdomyomas].

Case report of cardiac rhabdomyoma in one two days old infant with important cyanosis and respiratory insufficiency with evolution to death in few hours. The radiologic feature was a great enlargement of the heart and the electrocardiographic study showed left branch block. The two-dimensional echocardiography study showed multiple intracavitary tumours in both ventricles and in the right atrium. These features were confirmed in the post-mortem study. The microscopic study of the tumors showed proliferation of the spider cells, and vacuolation with the presence glycogen. The diagnosis of cardiac rhabdomyoma was confirmed. The brain and the kidney were not studied for the diagnosis of tuberous sclerosis or kidney tumors. It is very important the early diagnosis by echocardiography, due to the possibility of surgical resection of the intracavitary tumors that cause severe obstruction to the blood flow.

Echocardiography↗