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Biomedical subjects

J Sagristá-Sauleda

Publications and source records attributed to J Sagristá-Sauleda.

5 recordsLinked to original sources

Primary acute pericardial disease: a prospective series of 231 consecutive patients.

A series of 231 patients with "primary" acute pericardial disease (acute pericarditis or tamponade presenting without an apparent cause) were studied according to the following protocol: general clinical and laboratory studies (stage I), pericardiocentesis (stage II), pericardial biopsy (stage III) and blind antituberculous therapy (stage IV). In 32 patients (14%) a specific etiologic diagnosis was obtained (13 with neoplasia, 9 with tuberculosis, 4 with collagen vascular disease, 2 with toxoplasmosis, 2 with purulent pericarditis and 2 with viral pericarditis). "Diagnostic" pericardiocentesis (32 patients) was performed when clinical activity and effusion persisted for longer than 1 week or when purulent pericarditis was suspected, whereas "therapeutic" pericardiocentesis (44 patients) was performed to treat tamponade; their diagnostic yield was 6% and 29%, respectively. "Diagnostic" biopsy (20 patients) was carried out when illness persisted for longer than 3 weeks, whereas "therapeutic" biopsy was performed whenever pericardiocentesis failed to relieve tamponade; their diagnostic yield was 5% and 54%, respectively. The diagnostic yield difference between "diagnostic" and "therapeutic" procedures was significant (p less than 0.001); in contrast, the global diagnostic yield of pericardiocentesis (19%) and biopsy (22%) was similar. At the end of follow-up (1 to 76 months, mean 31 +/- 20), no patient in whom a diagnosis of idiopathic pericarditis had been made showed signs of pericardial disease. It is concluded that a "diagnostic" procedure is not warranted as a routine method, a choice between "therapeutic" pericardiocentesis and biopsy is circumstantial and must be individualized, and only through a systematic approach can a substantial diagnostic yield be reached in primary acute pericardial disease.

Acute Disease↗

Electroversion after verapamil administration.

Forty-nine consecutive patients (44 with atrial fibrillation and five with atrial flutter) received 10 mg of verapamil five to seven minutes before elective electroversion, to evaluate the feasibility of the latter while verapamil effects were present. Excluded were patients with moderate-to-severe heart failure, acute myocardial infarction, mean ventricular rate lower than 70 beats/minute, those receiving any antiarrhythmic drug other than digoxin, and those in whom sinus node dysfunction was suspected. In six patients, eight complications took place: four instances of hypotension (systolic blood pressure below 80 mm Hg), two instances of junctional escape rhythm (47 and 63 beats/minute) and two instances of junctional tachycardia. In all four instances of hypotension, return to normal values of blood pressure was spontaneous (within five minutes in three patients). Rhythm disturbances were transient, without clinical relevance. This study suggests that electroversion can be safely carried out during clinical action of verapamil in properly selected patients, and that occasional, self-limited hypotension is the only complication of clinical significance to be expected.

Adolescent↗

Huge chronic pericardial effusion caused by Toxoplasma gondii.

Two patients who had a huge pericardial effusion of at least 9 and 14 years' duration caused by cardiac toxoplasmosis are reported. Toxoplasma gondii were seen in the pericardial fluid, and serologic evidence also demonstrated the activity of the infection. These cases illustrate both the need to exclude toxoplasmosis in chronic pericardial effusion of unknown cause and the possibility of seeing toxoplasma in the pericardial fluid of patients with active toxoplasmic pericarditis. Moreover, in endemic areas, cardiac toxoplasmosis may not be an exceptional cause of chronic pericardial effusion.

Adult↗

Effect of verapamil in infants with paroxysmal supraventricular tachycardia.

Twenty-nine consecutive spontaneous attacks of paroxysmal supraventricular tachycardia (PSVT) in 14 infants (mean age 4.4 months) were treated with verapamil. No infant had associated heart disease. Verapamil 1-2 mg i.v was administered over 30 seconds. The dosage varied according to the weight of the infant. Within 60 seconds sinus rhythm was obtained in 28 instances (96.5%). No significant complications were observed. The high effectiveness, rapid action and lack of undesirable side effects observed in this series suggest that verapamil is the drug of choice in the treatment of PSVT in infants without underlying heart disease.

Drug Evaluation↗