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Biomedical subjects

J Primo

Publications and source records attributed to J Primo.

At least 37 records · Page 2Linked to original sources
PubMed1998

Early benefit of implantable cardioverter defibrillator therapy in patients waiting for cardiac transplantation.

The ICD can effectively recognize and treat ventricular arrhythmias that can lead to sudden death. Sudden death is a major problem in patients awaiting heart transplantation. We reviewed our experience with the ICD in patients with malignant ventricular arrhythmias waiting for cardiac transplantation. Nineteen patients were included. Seventeen were men, mean age was 54 +/- 11 years (range 17-66) and the left ventricular ejection fraction was 22% +/- 10% (range 9%-46%). After a mean follow-up of 6 +/- 5 months (range 1-20 months), 17 patients reached heart transplantation. One patient died and the other is waiting for a transplant. Before transplantation 71% of patients received an appropriate discharge. The mean time to the first appropriate discharge was 2 +/- 2 months (range < 1-6 months), which was significantly shorter than the mean time to first discharge in the other patients (n = 182) receiving a defibrillator in our center (11 +/- 10 months; range 1-58 months) (P < 0.0004). In conclusion, cardiac transplantation candidates with life-threatening ventricular arrhythmias can effectively be protected against sudden arrhythmic death by ICD. These patients have a high incidence of appropriate shocks occurring very early after implantation.

Adolescent↗
PubMed1998

Long-term follow-up in patients with the permanent form of junctional reciprocating tachycardia treated with radiofrequency ablation.

This study sought to determine the long-term follow-up, safety, and efficacy of radiofrequency catheter ablation of patients with the permanent form of junctional reciprocating tachycardia (PJRT). We assessed the reversibility of tachycardia induced LV dysfunction and we detailed the location and electrophysiological characteristics of these retrograde atrioventricular decremental pathways. PJRT is an infrequent form of reciprocating tachycardia, commonly incessant, and usually drug refractory. The ECG hallmarks include an RP interval > PR with inverted P waves in leads II, III, a VF, and V3-V6. During tachycardia, retrograde VA conduction occurs over an accessory pathway with slow and decremental conduction properties, located predominantly in the posteroseptal zone. It is known that long-lasting and incessant tachycardia may result in tachycardia induced severe ventricular dysfunction. We included 36 patients (13 men, 23 women, mean +/- SD, aged 44 +/- 22 years) with the diagnosis of PJRT. Seven patients had tachycardia induced left ventricular dysfunction. Radiofrequency energy was delivered at the site of earliest retrograde atrial activation during ventricular pacing or during reciprocating tachycardia. All patients were followed at the outpatient clinic and serial echocardiograms were performed in those who presented with depressed LV function. Radiofrequency ablation was performed in 36 decremental accessory pathways. Earliest retrograde atrial activation was right posteroseptal in 32 patients (88%), right mid-septal in 2 (6%), right posterolateral in 1 (3%), and left anterolateral in 1 (3%). Thirty-five accessory pathways were successfully ablated with a mean of 5 +/- 3 applications. A mid-septal accessory pathway could not be ablated. After a mean follow-up of 21 +/- 16 months (range 1-64) 34 patients are asymptomatic. There were recurrences in 8 patients after the initial successful ablation (mean of 1.2 months), 5 were ablated in a second ablation procedure, 2 patients required a third procedure, and 1 patient required four ablation sessions. All patients with LV dysfunction experienced a remarkable improvement after ablation. Mean preablation LV ejection fraction in patients with tachycardiomyopathy was 28% +/- 6% and rose to 51% +/- 16% after ablation (P < 0.02). Our study supports the concept that radiofrequency catheter ablation is a safe and effective treatment for patients with PJRT. Radiofrequency ablation should be the treatment of choice in these patients because this arrhythmia is usually drug refractory. The majority of accessory pathways are located in the posteroseptal zone. Cessation of the arrhythmia after successful ablation results in recovery of LV dysfunction.

Adolescent↗
PubMed1998

Neck pounding during sinus rhythm: a new clinical manifestation of dual atrioventricular nodal pathways.

OBJECTIVE: To determine the clinical and electrophysiological characteristics of patients with paroxysmal palpitations and neck pounding during sinus rhythm. METHODS: Clinical, electrocardiographic, and electrophysiological characteristics of six patients with paroxysmal palpitations and neck pounding during sinus rhythm were studied in basal conditions and when symptomatic. Response to treatment was observed. RESULTS: Baseline ECGs were normal (four patients) or had first degree atrioventricular block with intermittent PR shortening. During symptoms, narrow QRS rhythms were seen without visible P waves (three patients) or with P waves partially hidden in the QRS complex (three patients). Dual atrioventricular nodal pathways were found in all five patients who had electrophysiological studies. In these patients the slow pathway conduction time was long enough (mean (SD), 425 (121) ms) for ventricular activation after slow pathway conduction during sinus rhythm to coincide with the next atrial depolarisation, causing neck pounding during exercise (four patients) or at rest (two patients). Tachycardia was not induced in any patient. Medical treatment aggravated symptoms in three patients. A pacemaker was successfully used in two. CONCLUSIONS: Neck pounding during sinus rhythm is a clinical manifestation of dual atrioventricular nodal pathways. Medical treatment may aggravate symptoms but a pacemaker may offer definitive relief.

Adult↗
PubMed1998

[Acute hepatocellular lesion induced by amoxicillin-clavulanic acid].

Since first description in 1988, numerous cases of amoxycillin-clavulanic acid hepatotoxicity have been reported. Most of them are cholestatic hepatitis. A case of acute hepatocellular injury by amoxycillin-clavulanic acid is reported in a 23-years-old male, with a favourable outcome after 18 weeks.

Acute Disease↗
PubMed1997

CD3 antibody-induced dominant self tolerance in overtly diabetic NOD mice.

Low doses of the CD3 mAb 145 2C11 restored self tolerance to beta cell Ags in adult overtly diabetic NOD mice. Within 2 to 4 wk after treatment, complete and permanent remission of diabetes was observed. Autoreactive T cells were not deleted in CD3 Ab-protected animals as evidenced first, by the persistence of peripheral insulitis and, second, by the capacity of spleen cells from CD3 Ab-treated mice to transfer diabetes to adult irradiated syngeneic recipients. Moreover, the conferred tolerance was reproducibly reversed by a single injection of cyclophosphamide. For 5 to 7 wk after treatment, IFN-gamma production by stimulated spleen cells was significantly decreased in treated animals. One unique feature was that the CD3 Ab-induced tolerance ensued only from treatment of overtly diabetic NOD mice. Durable protection was exclusively observed when treating mice with recent onset disease (14-20 wk old). At variance with this finding, treatment of 4- and 8-wk-old mice was without effect, and complete but transient protection followed the treatment of 12-wk-old NOD mice. The tolerogenic properties of 145 2C11 did not depend on its mitogenic capacity, since nonmitogenic F(ab')2 fragments also appeared potent at inducing durable remission in overtly diabetic NOD, although nonmitogenic CD3 F(ab')2 fragments could mediate T cell signaling, as evidenced by cytokine gene transcription (IL-2, IFN-gamma, IL-4, and IL-10) assessed by PCR on splenocytes from treated mice. A concomitant cyclosporine treatment abrogated the CD3 mAb-induced protection, further pointing to the crucial role of T cell signaling in the effect observed.

Adoptive Transfer↗
PubMed1997

Experience with implantable cardioverter defibrillator therapy in elderly patients.

AIM: Concern exists about the benefit of implantable defibrillator therapy in elderly patients. We assessed the utility of implantable defibrillator therapy and its effect on mortality in patients 70 years and older and compared results in this group to those in younger patients. METHODS AND RESULTS: Thirty-two out of 200 consecutive patients (16%) were 70 years or older at the time of implantation of a defibrillator. When comparing elderly to younger patients no significant differences were noted with respect to presenting arrhythmia, left ventricular ejection fraction or presence of an old myocardial infarction. Elderly patients had a higher prevalence of ischaemic heart disease, while in the younger group more patients had idiopathic ventricular tachycardia. Cumulative survival curves (Kaplan-Meier method) for all-cause mortality, sudden cardiac death and non-sudden cardiac death were constructed for elderly and younger patients. No significant differences for cumulative survival from all-cause mortality (75 vs 74%), sudden cardiac death (0 vs 4%) and non-sudden cardiac death (97 vs 93%) were found. The incidence of appropriate shocks during follow-up was comparable (65 vs 72%). CONCLUSION: Implantable defibrillator therapy was effective in preventing sudden cardiac death in the elderly. Total mortality was similar to younger patients at a follow-up of 19 +/- 14 and 25 +/- 19 months, respectively. Age itself should be no contraindication to implantable cardioverter defibrillator therapy.

Aged↗
PubMed1997

[Right bundle-branch block, the elevation of the ST segment in V1 to V3 and sudden death: the diagnostic and therapeutic approach].

In 1992, Brugada and Brugada described the "syndrome of right bundle branch block, persistent ST segment elevation and sudden death". This clinical and electrocardiographic entity, which occurs in patients with a structurally normal heart, has drawn the attention of many investigators. Nowadays, the occurrence of sudden death in otherwise asymptomatic patients with a typical ECG, and the transient normalization of the ECG in symptomatic patients, support the existence of asymptomatic and intermittent forms of this disease. The knowledge of these new forms and the modulation of the ECG pattern by administration of antiarrhythmic and autonomic drugs suggest that a functional abnormality of the electrical activity of the heart is responsible for this syndrome. The role of "M cells" in ventricular repolarization and in the occurrence of polymorphic ventricular arrhythmia suggests that these cells are the substrate for that electrical abnormality. Further studies are required to determine the appropriate therapeutic strategy for these patients. Until new information is available, the implantable cardioverter defibrillator is indicated in all symptomatic patients.

Bundle-Branch Block↗
PubMed1997

[Dysfunction of a TIPS (transjugular intrahepatic porto-systemic shunt) and chylous ascites].

We reported a 66 year old woman diagnosed of cirrhosis secondary to VHC. A TIPS (transjugular intrahepatic portosystemic shunt) placement was used for the treatment of recurrent variceal hemorrhage and, a chyloperitoneum with hepatorenal syndrome developed after shunt occlusion. We discuss the pathological processes that might be responsible and the poor prognosis of this no reported complication.

Aged↗
PubMed1997

[Acute myocardial infarct--the hospital phase and follow-up: sex-related differences].

OBJECTIVES: The aim of this study was to evaluate the differences between male and female patients, during hospitalization and follow-up, after acute myocardial infarction. PATIENTS: The clinical data and follow-up files of 504 previously hospitalized patients were studied. The patients were divided in two groups: Group A (male, n = 434) with a mean age of 56.4 +/- 11.7 years, and Group B (female, n = 70) with a mean age of 64.1 +/- 9.2 years. METHODS: The following parameters were studied: vascular risk factors; clinical, functional and anatomic aspects during hospitalization; therapeutic orientation and events; and mortality during follow-up. RESULTS: Hypertension, diabetes, obesity, anterior infarction and lower ejection fraction were more common in Group B. Coronary angiography and thrombolytic therapy were performed more frequently in Group A; severe coronary disease was more common in this group (60.8% vs 38.9%, p < 0.05). During the follow-up we observed a worse prognosis in the Group B, with a higher incidence of events, morbidity and mortality. Therapeutic approach was more aggressive in the male group. CONCLUSION: We observed a worse prognosis in the female patients after myocardial infarction, this fact may be attributed to a later age and higher previous morbidity; the therapeutic and diagnostic procedures are generally less aggressive in females, who are consequently referred for revascularization with more advanced stages of disease, and therefore with higher morbidity and mortality, in the short and long term, even though multivessel coronary disease is more common in males. Thrombolytic therapy was administered and coronary angiography was performed more often in Group A, who had more severe coronary disease.

Aged↗
PubMed1995

[Efficacy of 6-mercaptopurine in the treatment of inflammatory bowel disease].

OBJECTIVE: To assess the efficacy of 6-mercaptopurine in I.B.D. treatment. PATIENTS: 21 patients with chronic active disease (8 patients with ulcerative colitis and 13 with Crohn's disease) and mean follow-up 5 years for both diseases (range ulcerative colitis 1-11 and Crohn's disease 1-14 years, respectively). The indications of inmunosuppressor treatment were: corticosteroid dependence (3 ulcerative colitis; 6 Crohn's disease), refractory disease (5 ulcerative colitis; 4 Crohn's disease), fistulae (5 Crohn's disease) and perianal disease (4 Crohn's disease). All patients received a mean dose of 30 mg/day of prednisone. Complete, partial and clinical remission, of failure of treatment are defined. RESULTS: The mean dose of 6-mercaptopurine was 90 mg/day with a response mean time of 3.4 months and 12 months of duration (range 1-36). Complete or partial clinical remission was achieved in 77.7% of all the patients (steroid dependent 88.8%, refractory disease 77.7%, fistulae 40%, perianal disease 100% of all the patients (steroid dependent 88.8%, refractory disease 77.7%, fistulae 40%, perianal disease 100%), in 87% of ulcerative colitis patients (steroid dependent 100%, refractory 80%) and in 61.5% of Crohn's disease patients (steroid dependent 83.7%, refractory disease 75%). Secondary effects were observed in two patients. CONCLUSIONS: Our results suggest that 6-mercaptopurine is an effective and safe drug in the treatment of patients with ulcerative colitis and Crohn's disease in corticosteroid dependent, refractory and perianal disease, its efficacy being less in fistulae.

Adrenal Cortex Hormones↗
PubMed1994

Anti-CD3 antibody induces long-term remission of overt autoimmunity in nonobese diabetic mice.

Anti-CD3 monoclonal antibodies suppress immune responses by transient T-cell depletion and antigenic modulation of the CD3/T-cell receptor complex. Anti-CD3 treatment of adult nonobese diabetic (NOD) mice, a spontaneous model of T-cell-mediated autoimmune insulin-dependent diabetes mellitus, significantly inhibits the autoimmune process. Short-term low-dose anti-CD3 treatment (5 micrograms/day i.v. for 5 consecutive days) prevented the occurrence of an accelerated form of the disease induced by cyclophosphamide. More unexpectedly, when applied to adult NOD females within 7 days of the onset of full-blown diabetes, the same anti-CD3 regimen induced a complete remission of overt disease (i.e., a return to permanent normoglycemia) in 64-80% of mice. This remission was durable (> 4 months) and was not associated with the disappearance of insulitis (mononuclear cell infiltration of the islets). The immunosuppression was apparently specific for beta-cell-associated antigens, since mice showing anti-CD3-induced remission rejected histoincompatible skin grafts normally, whereas they did not destroy syngeneic islet grafts, unlike control untreated overtly diabetic NOD females. These results open major therapeutic perspectives. They strongly suggest that self-tolerance can be restored in adult mice once autoimmunity is fully established and confirm that this effect can be obtained by transient targeting of the CD3/T-cell receptor without massive T-cell debulking.

Animals↗
PubMed1994

Fecal excretion of alpha 1-antitrypsin in patients with Crohn's disease. A comparison of nephelometry and radial immunodiffusion.

A comparison is made of two methods for quantifying fecal alpha 1-antitrypsin (A1ATF): nephelometry (NPL) (the method habitually employed in our laboratory), and radial immunodiffusion (RID). A method is also described for extracting A1ATF from single 24-hr stool samples. The normal A1ATF values were initially established in 25 healthy controls, followed by quantification of the protein in 30 patients with Crohn's disease, with the aim of evaluating the sensitivity and specificity of the test in assaying A1ATF and alpha 1-antitrypsin fecal clearance (CLAT). The precision of the measurement method and its applicability to the A1ATF extraction process are also evaluated. The ranges of normal A1ATF and CLAT values were found to be 0-42.2 mg/24 hr and 0-12.6 ml/24 hr, respectively; sensitivity was in turn 83% and 80% for A1ATF and CLAT, respectively, with a specificity of 100% in both cases. A good correlation was observed between the A1ATF quantifications afforded by RID and NPL in both the controls and patients with Crohn's disease (r = 0.917 and 0.997, respectively). We consider that A1ATF quantification is a rapid, safe, and reproducible method that is well tolerated by the patient.

Adolescent↗