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Biomedical subjects

L C Pelletier

Publications and source records attributed to L C Pelletier.

133 records · Page 8Linked to original sources
PubMedDate not supplied

Left ventricular aneurysm complicated by congestive heart failure: an analysis of long-term results and risk factors of surgical treatment.

The results of surgical treatment of post-infarction left ventricular aneurysms in 49 patients with congestive heart failure preoperatively were analyzed. Average patient age was 55 years. Preoperative total ejection fraction averaged 30.5 +/- 1.5% (mean +/- SEM), contractile segment ejection fraction was 42.5 +/- 1.1% and end-diastolic volume of aneurysm was 81.4 +/- 10.4 ml. Seventy eight percent of patients underwent coronary artery bypass grafting concomitantly with aneurysmectomy. Mean follow-up after operation was 41.5 +/- 3.5 months. Hospital mortality was 8.2%, the 5 year survival rate was 70 +/- 7% and the 5 year complication free rate was 52 +/- 8%. Mean functional class of dyspnea improved significantly from 2.9 +/- 0.1 preoperatively to 1.6 +/- 0.1 at late follow-up (p less than 0.001). Likewise, isotopic ejection fraction at rest increased from 13.7 +/- 1.3% preoperatively to 30.9 +/- 3.0% postoperatively (p less than 0.0001). Logistic regression analysis isolated two factors which influenced postoperative survival independently: contractile segment ejection fraction (p = 0.045) and myocardial score of left anterior descending coronary artery (p = 0.035). Combining these two risk factors, it was possible to identify a low risk group of patients with a 5 year survival probability of 93 +/- 6%, contrasting with a high risk group of patients having a 5 year survival of 57 +/- 9% (p less than 0.02). Thus, resection of left ventricular aneurysms complicated by congestive heart failure provides improvement in left ventricular function and clinical status.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Complications of circulatory assistance with intra-aortic balloon pumping: a comparison of surgical and percutaneous techniques.

One hundred and two consecutive patients who underwent circulatory support with intra-aortic balloon pumping were reviewed. All patients underwent surgery for coronary bypass, resection of ventricular aneurysm, or valve replacement. Circulatory assistance was initiated preoperatively in 21 patients and postoperatively in 81 patients. Insertion of the balloon catheter was attempted randomly by the surgical technique or by the percutaneous method in 47 patients each. The surgical insertion failed in five patients (10.6%), and the percutaneous method was a failure in four patients (8.5%). All failures with both techniques occurred when catheter insertion was attempted postoperatively. Among 85 patients studied for complications, there were 17 vascular and 3 wound complications (23.5%). The complication rate with the surgical technique was 11.4% and that of the percutaneous insertion 30.6%, a difference that is significant. The mean duration of circulatory support was significantly longer in patients who developed vascular complications (123 hours vs 78 hours). Vascular complications resulted in the loss of limb in two patients, one in each group. There were two deaths directly related to the use of circulatory assistance, one from perforation of the iliac artery and one from acute renal failure following revascularization of a severely ischemic limb, both in the percutaneous group. Thus, percutaneous balloon insertion has a failure rate similar to surgical insertion but a higher rate of complications, partly caused by percutaneous removal of the catheter. Practical recommendations are made in regard to the use and management of the technique.

Acute Kidney Injury↗
PubMedDate not supplied

Enhancing staff skill. Developing critical pathways at a community hospital.

Clinical pathways are an essential tool in implementing case management. The authors, in this article, describe how one institution developed and implemented critical pathways. The result was enhanced staff skill in physical assessment, patient/family teaching, and communication with physicians.

Clinical Competence↗
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Cardiac troponin T and creatine kinase MB isoenzyme as biochemical markers of ischemia after heart preservation and transplantation.

An ischemic preservation period of less than 4 to 6 hours for the donor heart is considered safe in heart transplantation. To determine the severity of myocardial cell damage, we measured serum creatine kinase MB isoenzyme activity, creatine kinase MB isoenzyme mass concentration, and troponin T release in 14 patients during the first 48 hours after heart transplantation. All donors had normal cardiac function at echocardiographic evaluation. The heart was arrested with cold crystalloid cardioplegic solution and preserved in a hypothermic solution. All patients survived the first week after transplantation. Total ischemic time averaged 126 +/- 33 minutes (range 88 to 195 minutes). Maximal creatine kinase MB isoenzyme activity, creatine kinase MB isoenzyme mass concentration, and troponin T serum values after transplantation averaged 130 +/- 44 IU/L, 140 +/- 121 ng/ml, and 3.3 +/- 1.4 ng/ml, respectively. No significant correlation was found between ischemic time and peak levels of creatine kinase MB isoenzyme activity (r = 0.22), creatine kinase MB isoenzyme mass (r = 0.37) and troponin T (r = 0.12). A moderate correlation between ischemic time and the initial slope of time-activity curve of creatine kinase MB isoenzyme mass (r = 0.66, p = 0.01) and of troponin T release (r = 0.55, p = 0.03) was observed. Ischemic time and donor age were significantly related to creatine kinase MB isoenzyme mass (R2 = 0.61) and to troponin T (R2 = 0.47) initial release slopes. In conclusion, during a short period of ischemic preservation, myocardial cell damage appears to be mild and best reflected by the elevation and the time-activity curves of release of cardiac troponin T and creatine kinase MB isoenzyme mass.

Adult↗
PubMedDate not supplied

Role of thromboxane and angiotensin in cyclosporine-induced renal vasoconstriction in the dog.

Cyclosporine is associated with renal insufficiency characterized by a reduction in glomerular filtration rate that may result from renal vasoconstriction. Injection of cyclosporine in the isolated renal artery perfused at a constant flow induces a potent dose-dependent vasoconstriction of renal arterial vessels in the dog. The present study was designed to investigate the role of thromboxane A2, angiotensin, and endothelial-dependent vasodilation in the cyclosporine-induced renal vasoconstriction. A specific thromboxane A2-receptor antagonist (pinane-thromboxane A2), administered at a dose of 150 micrograms, significantly decreased the renal vasoconstriction response to cyclosporine from 103 +/- 26 mm Hg to 45 +/- 11 mm Hg (p < 0.05), with cyclosporine serum levels at the end of injection averaging 382 +/- 105 and 421 +/- 150 nmol/L before and after injection of the antagonist. In contrast, pharmacologic blockade of angiotensin receptors by saralasin had no effect on the cyclosporine arterial vasoconstriction in the kidney. The endothelium-dependent vasodilation to acetylcholine was not modified during cyclosporine injection. Thus cyclosporine renal vasoconstriction appears independent of the renin-angiotensin system and of endothelium-dependent vasodilation. It is at least partly mediated by thromboxane A2. Prevention of cyclosporine vasoconstriction by thromboxane A2-receptor antagonist may likely be possible, with more potent agents having more affinity to thromboxane A2 renal receptors.

Acetylcholine↗
PubMedDate not supplied

Risk factors of venous aortocoronary bypass graft disease noted at late symptom-directed angiographic study.

One hundred and nineteen consecutive patients who had undergone venous aortocoronary bypass surgery 95.1 +/- 46.0 months earlier and in whom symptom-directed late graft angiography was performed were studied. Patients were designated 'controls' if their graft(s) appeared intact or revealed only minimal irregularities; they were designated 'cases' if one or several grafts showed at least 25% stenosis or complete occlusion. Controls and cases did not reveal significant differences in the frequency of classic nonlipoprotein risk factors or medication, including the use of acetylsalicylic acid. In multivariate analysis, significant graft narrowing or occlusion was most strongly related to elevated serum apolipoprotein B and lipoprotein(a) levels, as well as to the age of the grafts.

Apolipoproteins B↗