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Biomedical subjects

M Olona

Publications and source records attributed to M Olona.

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

Heart failure after aortic valve replacement for aortic regurgitation: prospective 20-year study.

BACKGROUND: The objective of this study was to assess the probability of development of heart failure during a long-term follow-up in patients submitted for aortic valve replacement for aortic regurgitation on the basis of preoperative findings. METHODS AND RESULTS: Eighty-seven consecutive patients with pure aortic regurgitation and normal coronary arteries were submitted for aortic valve replacement and prospectively followed up. Clinical examination, echocardiography, and radionuclide ejection fraction were performed before surgery and at 1, 2, 5, and 10 years after surgery. Operative mortality rate was 2.2% (2 patients). The follow-up period was 1 to 12 years (mean 6 years). Overall survival rate was 87% at 5 years and 81% at 10 years. During follow-up, 19 patients had heart failure develop, and there were 14 deaths (6 caused by heart failure). Probability of heart failure was 16% at 5 years and 24% at 10 years. Age was the single independent preoperative predictor of both death and heart failure. Age >50 years (relative risk [RR] 10.4), preoperative ejection fraction <40% (RR 10.6), and end-systolic diameter >50 mm (RR 74) were independently related to the postoperative development of heart failure. CONCLUSIONS: Aortic valve replacement can be performed safely in patients with severe aortic regurgitation by following current recommendations. Age >50, end-systolic diameter >50 mm, and radionuclide ejection fraction <40% were independent preoperative predictors of postoperative heart failure. The only independent predictor of both postoperative death and heart failure was age >50 years.

Adult↗
PubMed1997

[Influence of ergometric parameters on the results of myocardial perfusion tomographic scintigraphy].

BACKGROUND: The percentage of peak predicted heart rate that is accepted to consider as sufficient a given exercise test is 85%. However, the optimal value of such rate and other exercise parameters for the purposes of myocardial single-photon emission tomography is not well established. PATIENTS AND METHODS: With the aim of establishing the minimal levels of maximal heart rate, product heart rate x systolic blood pressure and ventilatory oxygen uptake to obtain an adequate diagnostic efficacy of myocardial perfusion scintigraphy, 159 patients with coronary artery disease or suspicion of this without previous myocardial infarction were studied with stress test single photon emission tomography with 99mTc-methoxi-isobutil-isonitrile. All the patients were coronary angiography tested. RESULTS: Sensitivity and negative predictive value were significantly higher at levels of heart rate > 80% (93 vs 78%; p = 0.002 and 94 vs 56%; p = 0.0004), product heart rate x systolic blood pressure > 18,000 (88 vs 78%; p = 0.04 and 84 vs 52%; p = 0.004) and > 5 METs (85 vs 77%; p = 0.002 and 74 vs 69%; p = 0.03). CONCLUSIONS: Sensitivity and negative predictive value of stress test single photon emission tomography with 99mTc-methoxi-isobutil-isonitrile are low if levels higher than 80% of heart rate, 18,000 of product of heart rate x systolic blood pressure and 5 METs have not been achieved.

Aged↗
PubMed1997

Simultaneous dipyridamole/maximal subjective exercise with 99mTc-MIBI SPECT: improved diagnostic yield in coronary artery disease.

OBJECTIVES: We attempted to demonstrate that simultaneous dipyridamole administration and maximal subjective exercise in patients who are unable to achieve a good exercise level can improve the diagnostic efficacy of technetium-99m methoxy isobutyl isonitrile (99mTc-MIBI) myocardial single-photon emission computed tomography (SPECT). BACKGROUND: The results of myocardial perfusion scintigraphy are unsatisfactory if the level of exercise achieved by the patient is insufficient. The use of dipyridamole with maximal subjective stress testing has been shown to improve the quality of the thallium-201 myocardial perfusion images, but there are no studies demonstrating that this combination improves the diagnostic accuracy of myocardial perfusion SPECT. METHODS: Two hundred thirty-one consecutive patients, without a previous myocardial infarction, were classified into three groups: group 1, 91 patients with an adequate exercise test; group 2, 68 patients with an inadequate exercise test; group 3, 72 patients with an inadequate exercise test who then received intravenous dipyridamole (0.56 mg/kg body weight over 4 min) simultaneously with exercise. RESULTS: Results for sensitivity (89%) and negative predictive value (83%) in group 3 were significantly better than those in group 2 (71% [p = 0.03] and 56% [p = 0.002], respectively) and not significantly different from those in group 1. The polar maps of 20 patients studied with an without dipyridamole at the same exercise level revealed a significantly greater extent of ischemia in each territory and in a global assessment (19 + 20% vs. 8 + 11%, p < 0.0001) when dipyridamole was administered during physical exercise. CONCLUSIONS: Intravenous dipyridamole administration during exercise testing is advisable in all patients who are unable to achieve an adequate exercise level. This approach permits physicians to avoid missing ergometric information while optimizing myocardial SPECT results.

Cardiac Catheterization↗
PubMed1997

[Stress myocardial gammatomography in the diagnosis of multivessel coronary disease].

OBJECTIVE: The aim of the study was to evaluate the diagnostic yield of 99m-Technetium-methoxy-isobutyl-isonitrile (MIBI) SPET for identification of individual coronary artery disease and in the prediction of multivessel involvement. METHODS: Stress/rest myocardial SPET and coronary arteriography were evaluated in 231 consecutive patients (age 58 +/- 10 years, 26% women) without prior myocardial infarction. 149 patients had coronary narrowing > 50%: 104 with multivessel disease and 45 with one vessel disease. Tomographic stress defect score was obtained by semiquantitative analysis (maximal score 65). Univariate and multivariate analysis was performed to identify discriminant parameters between one vessel and multivessel patients. RESULTS: The sensitivity and specificity for the identification of individual artery disease was 74% and 85% for left anterior descending artery, 79% and 85% for right coronary and 45% and 96% for circumflex artery. In the prediction of multivessel involvement the sensitivity was 65%, specificity 87%, positive predictive value 81% and negative predictive value 76%. In the bivariate analysis, four parameters differed significantly between one vessel and multivessel disease patients: ST downslope > 1 mm (p = 0.01), ST downslope/heart rate corrected (p = 0.005), reversible defects in two or more regions (p = 0.009) and SPET score (p = 0.002). In the multivariate analysis the probability of multivessel disease was 90% when ST depression > 1 mm and SPET score > 20 were associated and the probability was lowered to 16% when these criteria were not present. CONCLUSION: Myocardial SPET with MIBI offers an accurate localization of individual coronary artery disease, mainly in left anterior descending artery and right coronary artery lesions. Combined evaluation of ST depression and extension of myocardial stress defects improved prediction of multivessel involvement.

Coronary Disease↗
PubMed1997

Clinical and magnetic resonance imaging correlation in acute spinal cord injury.

The aim of this study was to correlate traumatic spinal cord injury (SCI) patient's outcome with magnetic resonance imaging (MRI) performed within the first 15 days following trauma. We retrospectively analyzed 55 SCI patients. Upon admission, 28 were diagnosed as having a complete SCI (51%), versus 27 with an incomplete SCI (49%). All of the patients with a normal pattern on MRI (four cases), had an incomplete SCI, whereas all patients (15 cases) presenting with a hemorrhage pattern (Type 1) had a complete SCI (P = 0.0001). Fourteen of the 15 individuals (93.4%) with the edema pattern (Type II) had an incomplete SCI (P = 0.001), while the other patient had neurological deterioration, and a syrinx was noted 2 years later (6.6%). Among the 10 individuals showing a contusion pattern (Type III), seven were admitted with an incomplete SCI (70%) and three with a complete SCI (30%). The compression pattern tends to be associated with a complete SCI in 77.8% (seven of nine patients). All patients with a transection pattern on MRI (two cases) were clinically diagnosed as having a complete SCI. Early functional prognosis may be established on the basis of clinical presentation of SCI and associated MRI. Cord hemorrhage and transection are irreversible, while edema has a potential for neurological recovery. Cord contusion tends to be associated with an incomplete SCI, unlike the compression pattern, in which the prognosis depends on the degree of the initial neurological damage.

Adolescent↗
PubMed1997

Clinical outcome and long-term prognosis of late prosthetic valve endocarditis: a 20-year experience.

A prospective study of the clinical characteristics and evolutionary patterns of 59 cases of late prosthetic valve endocarditis (LPVE) that occurred between January 1975 and December 1994 was performed. Of these 59 cases of LPVE, 48 involved mechanical valves and 11 involved biological valves. Etiologies were as follows: streptococci, 41% of cases; staphylococci, 25%; enterococci, 13%; and miscellaneous, 21%. Echocardiography documented vegetations in 21 patients, paravalvular abscesses in 10, and prosthetic leaks in 34. Emboli occurred in 22 patients, and heart failure in 19 patients. Forty-two patients received medical treatment alone, and 17 received medical treatment and underwent valve replacement surgery. The in-hospital mortality rate was 25%; staphylococcal infection caused 67% of deaths, streptococcal infection caused 5%, and other etiologies caused 23% (P = .0004). After adjustment for age and type of prosthesis, multiple logistic regression revealed an odds ratio for death due to nonstreptococcal infections of 9.67. The overall survival rate was 59% at 5 years and 52% at 10 years. During follow-up, 17 patients needed new valves. At the end of follow-up, only 13 patients remained alive and had the same prosthesis that they had at the time of the diagnosis of LPVE.

Adolescent↗
PubMed1996

[Cost-effectiveness analysis of serum ferritin screening in periodic physical examinations of women at the fertile age].

BACKGROUND: Fertile-aged women are a population group at special risk for developing ferropenia. In the periodic health care examinations, hemogram, among other tests, are included to detect the most advanced state of iron deficity, ferropenic anemia. Likewise, preanemic ferropenia presents a certain morbidity. The aim of this study was to analyze the cost-effectiveness of screening serum ferritin determination in health care examinations of fertile-aged women. SUBJECTS AND METHODS: An observational transversal study was carried out in 322 women in whom hemogram and serum ferritin were determined. The effects of serum ferritin determination were simulated in a hypothetical cohort of 20-year old women annually examined up to the age of 50 years (mean age of menopause). RESULTS: The prevalence of preanemic ferropenia (serum ferritin < or = ng/ml) was 44.1% and that of ferropenic anemica (Hb < 120 g/l and serum ferritin < or = 25 ng/ml) was 3.4%. Hemogram sensitivity for detection of ferropenia was 7.2% (3.6-12.5). By means of the screening program with serum ferritin avoiding of one year with ferropenia costs 2,428 pesetas. Prolonging the program to longer than 35 years largely increases the marginal cost. Cost-effectiveness analysis is specially sensitive to the cost of the diagnostic tests and disease prevalence. CONCLUSIONS: Ferropenia in fertile-aged women is a frequent disorder. Avoiding ferropenia by early diagnosis may be performed at a relatively low cost.

Adult↗
PubMed1996

[Prevalence of iron deficiency in the female working population in the reproductive age].

INTRODUCTION: Iron deficiency is particularly common among women in child-bearing age. The early detection and institution of an appropriate therapy can prevent the development of anemia. OBJECTIVE: To study the prevalence of iron deficiency among women in child-bearing age (in the setting of periodic health visits) and the associated risk factors. SAMPLE AND METHODS: A cross-sectional observational study was undertaken with 322 women in child-bearing age. An hemogram and serum ferritin levels were obtained on the same day when an interview was carried out to obtain data on general personal details, gynecological-obstetrical antecedents, diet, sports, and blood donations. Iron deficiency was defined as a serum ferritin concentration lower than 25 ng/ml. RESULTS: The prevalence of iron deficiency was 47.5%. In the multivariate analysis, factors significantly influencing on prevalence were: a copious menstruation blood loss (OR = 4.64, CI 2.22-9.68), a body mass index higher than 25 (OR = 0.49; CI 0.27-0.89) and maternity (OR = 2.08; CI 1.12-3.84). The likelihood associated with chi square goodness-of-fit was 0.08. DISCUSSION: The prevalence of iron deficiency detected is high; although there are clear associated risk factors, the goodness-of-fit was poor; therefore, for predictive purposes it is not possible to delineate a group in a special risk for iron deficiency.

Adolescent↗
PubMed1995

[Diagnosis of coronary disease by means of stress gamma-tomography with 99m-technetium-isonitriles].

BACKGROUND: To assess the yield of exercise myocardial stress tomogammagraphy (SPET) with methoxy-isobutyl-isonitrile-technetium-99m (99mTc-MIBI) in the diagnosis of coronary artery disease. METHODS: Seventy-two consecutive patients, without previous myocardial infarction and with coronary angiography, were investigated. All underwent a symptom-limited exercise test with intravenous infection of 15 mCi of 99mTc-MIBI 30-60 seconds before the end of exercise. Detection of tomographic images was performed after one hour. Rest images were detected 24 hours later. Images with exercise perfusion defects which became normal at rest were considered as positive. RESULTS: Sensitivity (84%), specificity (93%), global value (87%), positive predictive value (95%), and negative predictive value (79%) of 99mTc-MIBI were significantly higher than those of conventional exercise electrocardiogram (46%, 69%, 55%, 69% and 46%, respectively). These values were lower when exercise test was insufficient (peak heart rate below 80% in the absence of angina). The sensitivity values were similar for the diagnosis of one (81%), two (76%), and three (93%) vessel disease. The application of Bayes' theorem disclosed that the highest yield of MIBI was achieved with prevalences ranging between 30% and 70%. CONCLUSION: The efficacy of 99mTc-MIBI SPET for the diagnosis of coronary artery disease was satisfactory, particularly when exercise was sufficient and with a prevalence of coronary artery disease ranging between 30% and 70%.

Coronary Disease↗
PubMed1995

Strategies for prognostic assessment of uncomplicated first myocardial infarction: 5-year follow-up study.

OBJECTIVES: Our aim was to use noninvasive studies early after infarction to assess medium-term prognosis in patients with a first uncomplicated myocardial infarction. BACKGROUND: Although the use of early postinfarction assessment to gauge short-term prognosis in myocardial infarction is well established, there have been few comprehensive evaluations of noninvasive methods for assessing medium- and long-term prognosis. METHODS: We prospectively studied 115 consecutive patients < 65 years old with a first acute uncomplicated myocardial infarction to evaluate the prognostic role of predischarge cardiac studies. These included submaximal exercise testing, thallium-201 scintigraphy, radionuclide exercise ventriculography, two-dimensional echocardiography, ambulatory electrocardiographic (Holter) monitoring and cardiac catheterization. All patients without complications were followed up > or = 5 years. RESULTS: During the follow-up period, 78 patients (68%) developed complications, which were severe in 37 (32%). Exercise thallium-201 scintigraphy yielded the highest percentage (77%) for correctly classified patients. It also had the highest predictive value for complications (97%) and severe complications (92%) when it was used in association with exercise testing and radionuclide ventriculography. The addition of cardiac catheterization did not improve on the predictive power of noninvasive studies. Four decision trees (exercise testing + echocardiography, exercise testing + radionuclide ventriculography, thallium-201 + echocardiography, thallium-201 + radionuclide ventriculography) allowed stratification of all patients in a high, intermediate or low risk category. The combination of thallium-201 scintigraphy and radionuclide ventriculography yielded the best results (90% predictive value for complications if the outcome of both tests was positive), but there were no significant differences with the other models. CONCLUSIONS: Any combination of a test detecting residual ischemia or functional capacity, or both (exercise testing or thallium-201 scintigraphy), and a test assessing ventricular function (echocardiography or radionuclide ventriculography) results in useful prognostic information in patients with an uncomplicated first acute myocardial infarction.

Adult↗
PubMed1995

Clinical outcome of severe asymptomatic chronic aortic regurgitation: a long-term prospective follow-up study.

One hundred one patients with asymptomatic chronic severe aortic regurgitation and normal ejection fraction were monitored for up to 10 years (mean 55.4 +/- 33.5 months). Predefined surgical indications were the development of cardiac symptoms or the documentation of impaired basal left ventricular function. During the follow-up period there were no cardiac deaths; 14 patients needed surgery, 8 because of development of symptoms and 6 because of left ventricular impairment. The risk of surgery was 12% at 5 years and 24% at 10 years. Baseline end-systolic diameter > 50 mm and radionuclide ejection fraction < 60% were independent predictors or either cardiac symptoms or left ventricular dysfunction. In patients needing surgery, a pattern of progressive left ventricular dilatation was demonstrated. There were no deaths during surgery, and echocardiographic and radionuclide parameters normalized in the first year of follow-up. Our data confirm that the prognosis of severe aortic regurgitation in patients with no symptoms is good and that the occurrence of asymptomatic left ventricular dysfunction is an uncommon event. Surgery can be safely postponed until the appearance of cardiac symptoms or the documentation of left ventricular dysfunction at rest.

Adult↗
PubMed1995

Is the clinical spectrum and prognosis of native valve infective endocarditis in non-addicts changing?

One hundred and ninety-four episodes of endocarditis on native valves in non-addict patients were diagnosed from 1975 to 1992 and were divided into groups A (78 patients, 1975-1983) and B (116 patients 1984-1992). Both groups had the same gender distribution, similar valvular involvement and microbiological characteristics. In group B patients, median age was older (46 vs 54 years, P = 0.0002), the number of patients without previous heart disease was higher (46% vs 22%, P = 0.02) and the median time of symptoms before diagnosis was shorter (30 vs 50 days, P = 0.038). Both groups had similar incidence of heart failure (32% vs 36%), surgical treatment (30% vs 33%) and embolic episodes (26% vs 34%). Surgical mortality decreased from 43% to 18% (P = 0.03). Overall mortality decreased non-significantly from 19% in group A to 12% in group B. Predictors of death in group A were heart failure (odds ratio 9.6, 95% confidence interval 3-36) and surgical treatment (odds ratio 5, 95% confidence interval 1.3-19). Predictors of death in group B were age (odds ratio 4.98, 95% confidence interval 1.4-19), female sex (odds ratio 5.3, 95% confidence interval 1.3-20), staphylococcal infection (odds ratio 4.9, 95% confidence interval 1.1-22) and heart failure (odds ratio 5.2, 95% confidence interval 1.3-20). Although in recent years infective endocarditis occurs in older patients and is more common in patients with previously unknown heart disease a substantial change in major clinical and prognostic variables is not apparent in our population. Overall in-hospital mortality has decreased from 19% to 12% mainly due to better surgical results.

Adolescent↗
PubMed1994

[Pneumonia in patients undergoing heart surgery].

OBJECTIVE: We performed a follow-up study of 104 consecutive patients who underwent cardiac surgery to ascertain the following: 1) the incidence of nosocomial pneumonia (NP) in this patient population; 2) the differences in the incidence of NP between patients who underwent coronary artery bypass grafting (CABG) vs. valvular replacement (VR), and 3) the identification of risk factors which predispose patients to the development of NP. RESULTS: The study included 104 patients of which 49 underwent VR, 43 CABG and 12 who had both procedures performed simultaneously. Six of the 104 patients developed NP (5.7%). Five of these patients had undergone VR where as opposed to only one in the CABG group. Pulmonary hypertension preoperatively was a risk factor for the development of NP. Of the 49 patients in the VR group, 46 had pulmonary artery pressures (PAP) recorded, and from their 23 (50%) had pulmonary hypertension. However, 4 of the 5 (80%) patients who developed NP had elevated PAP. The mortality among patients with NP was high. Sixty six percent of patients (4/6) with NP died in comparison to the 10 deaths (10.2%) among 92 patients without NP (p = 0.002). CONCLUSIONS: A trend in the development of NP was observed in patients who underwent valve replacement as opposed to CABG. Because of the small number of patients who developed pneumonia in the study population statistical significance cannot be reached. Pulmonary hypertension in the post operative period is a risk factor for the development of NP. Mortality among patients who develop NP is significantly high (p = 0.002).

Adult↗
PubMed1994

[An evolutionary study at 5 years of left ventricular systolic function in patients with an uncomplicated infarct].

INTRODUCTION AND OBJECTIVES: The aim of the present study was to compare the left ventricular ejection fraction in a first uncomplicated acute myocardial infarction before hospital discharge (initial ejection fraction) and 5 years later (late ejection fraction) and to evaluate the factors that may influence their possible changes. PATIENTS AND METHODS: Eighty-three patients (mean age: 52.2 +/- 7.5, range: 35-65 years) who had a first uncomplicated infarction were evaluated. Between 10 and 15 days after the acute episode, thallium perfusion scintigraphy, radionuclide ventriculography and coronary arteriography were carried out. The ventricular function was reevaluated after 5 years with radionuclide ventriculography. The population was classified according to the localization of infarction (anterior or inferior) and to the initial ejection fraction (< 30%, 30-50% and > 50%). The factors derived from predischarge exercise test, perfusion scintigraphy, radionuclide ventriculography and coronary arteriography that might have had an influence on ejection fraction changes were evaluated with bivariate and multivariate analysis. RESULTS: 1) left ventricular ejection fraction of anterior infarctions was lower than in inferior infarctions, both during the subacute phase (35.1 +/- 12.9 vs 48.1 +/- 12.1; p < 0.001) and after 5 years (41.3 +/- 15.1 vs 47.6 +/- 12.8; p = 0.006); 2) a significant increase in ejection fraction after 5 years was found in patients with anterior infarction (35.1 +/- 12.9 vs 41.3 +/- 15.1; p < 0.001), particularly in those with initial ejection fraction between 30-50% (38.8 +/- 5.9 vs 44.8 +/- 11.2; p < 0.001), and 3) no variable, either clinical or derived from exercise test, perfusion scintigraphy, radionuclide ventriculography or coronary arteriography, discriminated between the patients in whom ejection fraction decreased by more than 5% during follow-up nor those with anterior infarction and initial ejection fraction between 30-50% in whom ventricular function was improved after 5 years. CONCLUSIONS: Left ventricular ejection fraction of anterior infarctions shows a significant improvement after 5 years, particularly in the subgroups with initial ejection fraction between 30-50%. Predictive factors of such improvement have not been identified.

Adult↗
PubMed1993

[A cost-effectiveness analysis of prognostic studies in acute uncomplicated myocardial infarct].

INTRODUCTION AND OBJECTIVES: The prognostic assessment of the acute myocardial infarction may be obtained through clinical criteria, particularly in patients who are symptomatic during admission, or with several studies in patients without complications. The "effectiveness" of such investigations has been long studied, but not so their "efficiency", which analyses the relationships between costs and outcomes. The goal of the present study is to report the results of a cost-effectiveness analysis of various combinations of diagnostic tests. METHODS: One hundred and fifteen patients (age < 65) with uncomplicated first acute myocardial infarction were evaluated. In all patients exercise test, two-dimensional echocardiogram thallium-201 scintigraphy, radionuclide ventriculography, Holter monitoring and cardiac catheterization were performed. The effectiveness was calculated as the "global value" (rate of correctly diagnosed patients: complications prediction during the first year follow-up) of every of such tests combinations. We have used the direct differential costs estimated following the "Colegio Oficial de Médicos de Barcelona" standards. The index used in the cost-effectiveness analysis was the medium cost person/global value. The lowest index corresponded to the most efficient test combination. RESULTS: The highest effectiveness was found for the exercise test plus bidimensional echocardiography combination (global value = 0.64). At the same time it was the less expensive combination (medium cost = 14.444 ptas); therefore, its index was the lowest (21.724 ptas/patient). CONCLUSIONS: In patients with a first uncomplicated myocardial infarction, the performance of exercise test and echocardiogram is the less costly and most effective combination of studies for one year prognosis. In these patients, routine cardiac catheterization does not improve the results.

Chi-Square Distribution↗
PubMed1992

[Predictive factors of mortality in severe craniocerebral trauma].

BACKGROUND: The prediction of mortality in severe head injury is of interest for the evaluation of patient prognosis and to also permit therapeutic measures to be considered and improve knowledge of this problem. METHODS: A multiple logistic regression model was developed and validated from the data obtained from a series of 231 patients hospitalized for the above mentioned condition. Seventy-five percent of the patients were used to define the model with the remaining 25% validating the same. RESULTS: The variables included in the model were: intraventricular hemorrhage, odds ratio = 20.4 (confidence interval 95%: 3.56-116); compression of basal cistern and/or of the III ventricle, odds ratio = 11.5 (4.43-29.8); mydriatic pupils in both eyes, odds ratio = 5.71 (1.32-24.6); age, odds ratio = 1.03 (1.01-1.05) and Glasgow scale upon admission, odds ratio = 0.57 (0.43-0.75). The maximum global value of the model (84.9%) corresponded to a sensitivity of 84.5% and specificity of 85.2%. The cut-off point of probability of death was found to be 0.475. In the validation of the model the highest global value (84.2%) was also observed at the cut-off point of 0.475 with a sensitivity of 84.2% and specificity of 84.4%. CONCLUSIONS: The predictive factors of mortality in severe head injury are the evidence of hemorrhage in the cerebral ventricles, mydriasis and a low score on the Glasgow scale. The model presented is useful and valid for carrying out the prediction of mortality at the time of admission and is also easy to apply since the variables used are obtained in the initial examination of the patients with severe head injury.

Adult↗
PubMed1992

Long-term complications of native valve infective endocarditis in non-addicts. A 15-year follow-up study.

OBJECTIVE: To describe the incidence and clinical manifestations of long-term cardiac complications of endocarditis. DESIGN: Cohort study. SETTING: University-affiliated tertiary medical center. PATIENTS: One hundred twelve consecutive patients, survivors from a series of 140 non-addicted patients with a first episode of infective endocarditis on native valves hospitalized from 1975 to 1990. Thirty-two patients had had valve replacement during the active phase of the infection, and the remaining 80 patients received medical treatment alone. MEASUREMENTS: Relapse, recurrence, need for late cardiac surgery, and cardiac mortality. RESULTS: Relapses occurred in three patients (2.7%) and recurrences in five patients (4.5%, incidence density at 15 years, 0.0030 per patient-year). Late cardiac surgery was needed by 47% of the patients treated medically during the active phase, and most had surgery in the first 2 years of follow-up (incidence density, 0.25 per patient-year at 2 years). Aortic valve involvement (relative risk, 2.66; 95% CI, 1.15 to 6.17) and end-diastolic diameter greater than 60 mm (relative risk, 1.04; 95% CI, 1.03 to 2.43) were associated with the need for late surgery in univariate analysis. Multiple logistic regression analysis showed aortic valve involvement to be an independent predictor of the need for late surgery (relative risk, 3.04; CI, 1.23 to 7.54). Only 2 of the 32 patients who had surgery during the active infection needed a second operation during follow-up. At the end of follow-up, the number of patients who had surgery after the onset of the infection was 86 (60% of the whole series). Cardiac death occurred in 16 patients; most deaths were sudden or postoperative and occurred in the first 2 years of follow-up (incidence density, 0.047 per patient-year at 2 years). Independent predictors of death were not found. Survival was 90% at 2 years, 88% at 5 years, 81% at 10 years, and 61% at 15 years. CONCLUSIONS: Survival after infective endocarditis is fair (81% probability of survival at 10 years), and the most common types of cardiac death are sudden and postoperative. Aortic valve involvement is an independent predictor of the need for late cardiac surgery. The rate of recurrences is not negligible (incidence density at 15 years, 0.0030 per patient-year).

Adult↗