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Biomedical subjects

M Khalilullah

Publications and source records attributed to M Khalilullah.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Electrophysiologic effects of oral propafenone in Wolff-Parkinson-White syndrome studied by programmed electrical stimulation.

We studied the electrophysiologic effects of oral propafenone on induction of supraventricular tachycardia (SVT) in 10 patients with Wolff-Parkinson-White syndrome (5 manifest and 5 concealed accessory pathways). Nine patients had orthodromic SVT and one patient had atrial fibrillation with preexcited QRS (shortest RR 220 msec). Electrophysiologic studies were performed during control and 48 hours after oral propafenone administered in a dose of 300 mg every eight hours. Propafenone caused complete anterograde accessory pathway conduction block in 4 of 5 patients with manifest delta waves. Retrograde conduction through the accessory pathway was abolished in 6 of 9 patients in whom it was present during control. Sustained SVT was inducible in all 9 patients during control. Propafenone prevented induction of SVT in 8 of 9 patients (88.9%) and slowed the rate of induced SVT in one patient. In the patient with atrial fibrillation (AF) the accessory pathway was blocked and AF was not inducible. There was a significant increase in the effective refractory period (ERP) of the atrium (208 +/- 40 msec to 257 +/- 25 msec, p less than 0.01), atrioventricular (AV) node (less than or equal to 256 +/- 34 msec to greater than or equal to 324 +/- 35 msec, p less than 0.001) and ventricle (204 +/- 14 msec to 262 +/- 51 msec, p less than 0.01). The atrial paced cycle length at AV nodal block also increased from 288 +/- 51 msec to 389 +/- 51 msec (p less than 0.01) after the drug. Thus propafenone has potent inhibitory effects on accessory pathways and has additional significant effects on atrial, AV nodal and ventricular refractoriness.

Administration, Oral↗
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Randomised two way crossover comparison of the effects of six weeks propranolol and acebutolol therapy on plasma lipid profiles in patients with hypertension or ischaemic heart disease.

The effect of propranolol and acebutolol therapy on serum lipoproteins was studied in thirty patients (mean age 43.9 +/- 8.7 years) with essential hypertension and/or stable myocardial ischaemia. Patients received six weeks therapy with propranolol (80-160 mg per day) and acebutolol (400-800 mg per day) each in random order and were changed over from one to the other beta-blocker after 6 weeks therapy. On propranolol treatment there was no significant effect on total cholesterol and LDL-cholesterol but the concentration of serum triglycerides (94.2 +/- 37.7 to 129.1 +/- 41.2 mg/dl) and VLDL cholesterol (18.9 +/- 7.8 to 26.1 +/- 8.1 mg/dl) significantly increased, concentration of HDL cholesterol (49.5 +/- 9.4 to 42.4 +/- 8.7 mg/dl) significantly decreased (p less than 0.01). Atherogenic index also worsened from 4.17 +/- 0.48 to 5.15 +/- 0.54 (p less than 0.05) on propranolol therapy. Acebutolol therapy, on the other hand, produced no significant change in the concentration of total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol and VLDL cholesterol.

Acebutolol↗
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Evaluation of lesions suitable for percutaneous transluminal coronary angioplasty after thrombolytic therapy of acute myocardial infarction.

Forty-two patients of acute myocardial infarction (AMI) and clinically successful thrombolysis underwent coronary angiography 7.6 +/- 3.6 days after the AMI. The infarct related artery was patent in 33 of 42 (78.5%) patients, and 27 of these 33 (82%) had residual diameter stenosis of 70 per cent or more. Arteries showing more than 70 per cent luminal diameter narrowing were considered suitable for percutaneous transluminal coronary angioplasty (PTCA) if the lesion was less than 1 cm in length and there was no significant left main or distal lesion. Based on the above criteria, 22 of the 33 patients (66%) with recanalised infarct-related artery were found to have lesions suitable for PTCA. Thus, after successful thrombolysis, significant proportion of patients of acute myocardial infarction have residual lesions that are suitable for PTCA.

Adult↗
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Non-surgical mitral valvuloplasty for rheumatic mitral stenosis.

One hundred and twenty-six patients of rheumatic mitral stenosis (MS), aged 10-30 (mean 19.5 +/- 5.9) years underwent balloon mitral valvuloplasty (BMV). All valvuloplasties were done by the anterograde transvenous, transatrial route. The procedure was successful in 120 (95%) cases. Single balloon was used in 10 patients early in the series and double balloon was used in the other 110 patients. BMV resulted in a significant increase in the mitral valve area (MVA) from 0.96 +/- 0.35 to 2.3 +/- 0.8 cm2 (p less than 0.0001) and a significant fall in the transmitral pressure gradient (TMG) from 28.2 +/- 3.2 to 7.4 +/- 4.8 mmHg (p less than 0.001). The MVA achieved by BMV was found to have a significant positive correlation with the balloon diameter to body surface area ratio (BD/BSA) (r = 0.69, p less than 0.001). New mitral regurgitation (MR) developed in 15 patients--trivial in 11, 2+ in 2 and 3+ in 2. One patient required emergency mitral valve replacement. Procedure induced MR did not have a significant relation to the balloon size, degree of mitral sub-valvular pathology or the severity of mitral stenosis. Iatrogenic atrial septal defect was detected by oximetry in none, by angiography in one patient, and by Doppler color flow imaging in 5 patients. Cardiac tamponade was the most frequent serious complication, occurring in 6 patients, 4 of whom died following emergency surgery. Sixty-five patients have been followed up for at least 6 months (range 6-30, mean 16.3 +/- 6.3 months) following BMV.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Long term performance of dual chamber pacemakers.

Records of 98 patients who had dual chamber pacemakers implanted at our institution and had a follow up for at least 6 months (range 6-90 months, mean 47.8 months) were analysed for long term performance of the pacemakers. There were 78 males and 20 females in the age range of 14 to 81 (mean 51.1 +/- 13.6) years. The mode of pacing was VDD in 12, DVI in 9 and DDD in 77 patients. Atrial malsensing was seen in 15 (16.7%) cases and generally occurred within the first week of implantation. Atrial lead dislodgement occurred in 4 cases (4.1%). Most of the problems related to atrial lead could be managed conservatively and re-operation was performed in only 4 cases. Other problems encountered on follow up included cross talk in one, endless loop tachycardia in 4, and pulse generator pocket erosion or infection in 4 (4.1%) patients. There were two instances of ventricular undersensing and one instance of insulation failure in the ventricular lead. A total of 16 patients underwent elective replacement of pulse generator 53-84 months (mean 66.3) following the initial implants. It is concluded that the incidence of pacemaker malfunction and other problems with dual chamber pacemaker implantation are not high; and most cases can be managed by conservative measures such as reprogramming.

Adolescent↗
PubMedDate not supplied

Short term hypolipidemic effects of oral lactobacillus sporogenes therapy in patients with primary dyslipidemias.

Short term hypolipidemic effects of oral Lactobacillus sporogenes (360 million spores/day) were studied in 17 patients (mean age 45.6 years; males 15, females 2) with type II hyperlipidemia in an open label fixed dose trial. Over a period of 3 months, significant reductions were observed in total cholesterol (330 +/- 55 mg% to 226 +/- 46 mg%, p less than 0.001) and LDL-cholesterol (267 +/- 58 mg% to 173 +/- 54 mg%, p less than 0.001). The HDL-cholesterol was marginally increased (43.6 +/- 7 mg% to 46.8 +/- 8.9 mg%, p less than 0.05). There was no change in serum triglyceride concentration. Total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios were significantly reduced after treatment (p less than 0.001). No adverse effect was noted. While the change in serum lipid levels on treatment was consistent with regard to total and LDL-cholesterol, it was not so in case of serum triglycerides and HDL-cholesterol. Oral Lactobacillus sporogenes therapy may prove to be an important hypolipidemic therapy after confirmation in larger trials.

Adult↗
PubMedDate not supplied

Clinical and haemodynamic effects of oral metoprolol therapy in dilated cardiomyopathy.

The clinical and haemodynamic effects of oral metoprolol therapy were assessed in thirty patients of dilated cardiomyopathy, aged 14-58 (33 +/- 10.9) years. After baseline haemodynamic study, metoprolol was administered in a dose of 25-100 mg/day (mean 87.0 +/- 25.1 mg/day). Before start of therapy, 13 patients were in NYHA symptom class IV, 14 were in NYHA class III and 3 were in NYHA class II. Symptomatic improvement was seen on oral metoprolol therapy in all patients except one. Six months after therapy 13 patients were asymptomatic, 16 were in NYHA class II, while 1 patient continued to be in NYHA class III. Repeat haemodynamic study in 15 patients done at a mean of 5.7 months showed a significant fall in the right ventricular end diastolic pressure (from 9.1 +/- 4.4 to 5.7 +/- 2.9 mm Hg, p less than 0.01), mean pulmonary artery pressure (from 32.3 +/- 13 to 24.5 +/- 10.3 mmHg, P less than 0.01) and mean pulmonary capillary pressure (from 23.3 +/- 10.3 mmHg to 14.7 +/- 7.4 mmHg, P less than 0.01). The left ventricular ejection fraction increased from 18.8 +/- 6.3 to 24.0 +/- 7.3 per cent, (P less than 0.05), while no significant change was observed in the cardiac index (2.43 +/- 0.47 to 2.66 +/- 0.83 L/min/m2, p = NS). These data suggest improvement in diastolic and systolic left ventricular function after metoprolol therapy.

Administration, Oral↗
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Percutaneous transluminal angioplasty for ischaemic arterial disease of the lower extremities.

We attempted percutaneous transluminal angioplasty (PTA) in 43 patients with limb-threatening ischaemia (rest pain, nonhealing ulcer or gangrene) or lifestyle-limiting claudication. Of the 51 lesions dilated, 31 were in iliac, 12 in femoral, 6 in popliteal and 2 in tibial arteries. Overall primary success rate was 90.2 percent (46/51); 96.8 percent (30/31) in iliac, 83.3 percent (10/12) femoral, 66.7 percent (4/6) popliteal and 100 percent (2/2) in tibial arteries. Marked relief of ischaemic symptoms and increase in ankle-arm pressure index from 0.45 +/- 0.14 to 0.94 +/- 0.23 (P less than 0.005) were seen in the 39 patients with initial technical success. Three (6.9%) patients had minor complications. On 1-33 (mean 13.4 +/- 7.5) months follow up, 89.5 percent patients showed continued clinical improvement as well as improvement in noninvasive parameters of lower limb perfusion. We conclude that angioplasty of iliac, femoral, popliteal and tibial arteries is a highly effective and safe procedure to revascularize the ischaemic lower extremity.

Adult↗
PubMedDate not supplied

Comparison of atrial and VVI pacing modes in symptomatic sinus node dysfunction without associated tachyarrhythmias.

The natural course of patients with symptomatic sinus node dysfunction who did not have associated tachyarrhythmias before pacemaker implantation was compared after VVI and atrial pacemaker implantation. Between April 1981 and June 1989, forty-seven such patients (mean age 52 + 13 years) received VVI pacemakers and forty patients (mean age 54 + 13 years) received AAI or DDD pacemakers. Baseline clinical characteristics and severity of sinus node dysfunction were comparable in the two groups. Over a follow up of 10 to 96 months (mean 49.2 + 26 months), 11 (23.4%) VVI patients were in functional class II or more compared to 2 (5%) atrially paced patients (p less than 0.01). Other complication rates were also higher in the VVI group as compared to AAI group viz. atrial fibrillation (21.2% vs 2.5% p less than 0.01) and stroke (10.6% vs 2.5%) though the number of deaths (14.9% vs 10%) was not significantly different in the two groups. Two patients in atrial paced group and one patient in VVI group developed first degree heart block. There was no incidence of second or third degree heart block. Transient loss of atrial sensing occurred in 3 patients and atrial lead displacement in 2 cases, but overall incidence of lead related problems was low and comparable in both groups. Thus atrial pacing is superior to ventricular pacing in sinus node dysfunction and risk of developing high grade atrioventricular block on follow up is low.

Adult↗
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Determinants of left ventricular function in isolated rheumatic mitral stenosis.

Left ventricular end-diastolic volume (preload), peak systolic wall stress (afterload), instant Emax (contractility index = peak systolic left ventricular pressure/end-systolic volume), left ventricular mass, left ventricular ejection fraction (LVEF) alone and normalised for mass index, were studied in 30 patients with isolated rheumatic mitral stenosis (group 1) and compared with 24 normal individuals (group II) who served as control. Preload was not different in the two groups (p = NS), afterload was increased in group I (p = 0.01), while LVEF, Emax, left ventricular mass and mass normalised LVEF were reduced in mitral stenosis as compared to normal control (p less than 0.01- less than 0.001). Comparison of patients with reduced ejection performance (LVEF less than 50%, n = 9, group IA) with those having normal LVEF (n = 21 group IB) revealed increased left ventricular end-diastolic volume and reduced left ventricular mass, mass normalised ejection fraction and Emax (in IA p less than 0.05). Peak systolic wall stress was comparable in these two subgroups. This study shows that the major determinant of left ventricular dysfunction in isolated rheumatic mitral stenosis is impaired contractility and not the loading factors.

Adolescent↗
PubMedDate not supplied

Totally occluded coronary arteries with normal LV function: clinical and angiographic profile.

The clinical and coronary angiographic profile of 50 patients (Group I) with total occlusion of one or more major coronary arteries in the absence of electrocardiographic findings of myocardial infarction and normal segmental and global left ventricular (LV) functions were analysed to identify any variables responsible for this observation. Twenty five age and sex matched patients (Group II), who had 100% occlusion of at least one major coronary artery with significant wall motion abnormalities on LV angiograms, served as controls. The mean duration of angina before angiography or the occurrence of acute coronary event was significantly longer in Group I (2.8 +/- 2.2 yrs) compared to Group II (1.2 +/- 1.2 yrs; p less than .05) patients. RCA was found totally occluded more often in Group I as compared to Group II (60% vs 32%; p less than .05) patients, whereas complete occlusion of LAD occurred more frequently in Group II than in Group I (70% vs 32%; p less than .05). Significant stenoses in other arteries was found in 88% of Group I, compared to 48% of Group II patients (p less than .001). Although there was no significant difference in the frequency of collaterals feeding the totally occluded arteries in the two groups, 80% of patients in Group I had grade 3 collaterals compared to only 30% in Group II patients (p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Evaluation of aortic aneurysms and dissection of aorta by intravenous digital subtraction angiography.

Intravenous (IV) digital subtraction angiography (DSA) was performed in 12 patients with suspected aortic aneurysm/dissection. Bolus injection of 30-40 ml of contrast in mid right atrium/main pulmonary artery at a flow rate of 18-20 ml/sec. during DSA accurately localised the site and extent in all 7 patients of aortic aneurysm and in 4 patients of aortic dissection. In one patient, radiological opacity was unrelated to aorta. There were no complications. IV-DSA should be the preferred mode of evaluation for aortic aneurysm and dissection of aorta.

Adult↗
PubMedDate not supplied

Prevalence and clinical significance of coronary artery ectasia (an angiographic study).

Coronary cine-angiograms of 1,042 patients were reviewed for the presence of ectasia of major coronary arteries. Ectasia or irregular dilatation of the coronary artery was defined as 1.5 times diffuse or segmental dilatation as compared to segment of normal caliber coronary artery. Forty-one (3.9%) patients were found to have diffuse or localised coronary artery dilatations with segments of normal caliber throughout the length of major vessels. Mean age of the patients was 52 years, and majority were males (39, 95%). Right coronary artery (RCA) and left circumflex (Cx) were involved in 23 (56%) each, left anterior descending (LAD) in 15 (37%), obtuse marginal in 4 (10%) and left main in 2 (5%). Multiple vessel involvement was present in 21 (51%). Evidence of myocardial infarction was present in 21 (51%). Major risk factors were not different from the patients with coronary artery disease without ectasia.

Cineangiography↗
PubMedDate not supplied

Follow-up of balloon aortic valvuloplasty in young adults--a combined hemodynamic and Doppler echocardiographic study.

Percutaneous Balloon Valvuloplasty was performed in 25 patients with severe aortic stenosis (Aortic valve area index: 0.23 to 0.70, mean 0.36 +/- 0.11 cm2/m2). The mean age was 23 +/- 15 (range 6-66) years, and majority (n = 18) had noncalcific valves. Valve morphology was bicuspid in 14, tricuspid in 6 and indeterminate in 5. Valvuloplasty resulted in a fall of peak systolic gradient (PSG) from 112 +/- 35 to 34 +/- 16 mmHg (p less than 0.001), and an increase in aortic valve area (index) (AVAI) from 0.36 +/- 0.11 to 0.82 +/- 0.43 cm2/m2 (p less than 0.001). Follow-up data at 16 +/- 6 months were available for 18 patients, 80 per cent of whom registered symptomatic improvement. Repeat catheterization, performed in 12 cases, showed increase of PSG to 53 +/- 22 mmHg and a fall in AVA (1) to 0.62 +/- 0.24 cm2/m2, as compared to the results immediately following the procedure. In addition, 3 patients had their valve areas estimated by doppler echocardiography. Forty-six per cent of these 15 patients (n = 7) showed evidence of restenosis. Four out of these 7 cases had calcific valves, whereas none of the patients who had sustained improvement had calcification. Tricuspid morphology was present in 50 per cent of the group with sustained improvement, as compared to 20 per cent of the group that restenosed. Our preliminary data shows sustained hemodynamic improvement after balloon dilatation in young patients with severe aortic stenosis with noncalcific and tricuspid aortic valve.

Adolescent↗
PubMedDate not supplied

Detection of multivessel coronary artery disease by early exercise testing after first myocardial infarction.

The ability of a symptom limited treadmill exercise test (TMT) to predict the presence of multivessel coronary artery disease (MVD) three weeks after a first myocardial infarction was assessed in 76 male patients aged 25-65 (mean 40.9 +/- 10.1) years. There were 6 patients with normal coronaries, 36 with single vessel disease (SVD), 20 with double vessel disease (DVD), and 14 with three vessel disease (TVD). TMT was positive in 20/34 (58.8%) patients with MVD, and 4/42 (9%) patients with SVD or normal coronaries. The predictive accuracy of a positive TMT in detecting MVD was 83.3%, and the predictive accuracy of a negative TMT in excluding MVD was 73.1%. It is concluded that TMT is useful test for predicting the presence or absence of MVD in survivors of a first transmural myocardial infarction.

Adult↗
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An arteriographic assessment of renal vasculature in young patients with essential hypertension.

Twenty-five patients below the age of 40 years with Uncomplicated hypertension underwent selective renal arteriography to assess the involvement of interlobar and arcuate arteries. Renal vasculature was abnormal in all 25 patients. Patients with severe hypertension had markedly abnormal renal vasculature. None of the patients with mild hypertension had severe vascular involvement. Functional significance of these arteriographic abnormalities is discussed.

Adolescent↗