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Biomedical subjects

P Battistella

Publications and source records attributed to P Battistella.

18 recordsLinked to original sources
PubMed2006

[Surgery of ventricular tachycardia in post-infarction left ventricular aneurysm].

The treatment of post-infarction ventricular tachycardias with antiarrhythmic drug therapy, implantable automatic defibrillators, radiofrequency ablation, also includes different surgical procedures such as endocardial resection of the infarct scar, encircling endocardial ventriculotomy and endocardial cryoablation or thermoexclusion by laser. These procedures may be extensive or limited, guided or not by preoperative mapping. The aim of this review of the literature is to update our knowledge of these different surgical techniques and to define their indications.

Cryosurgery↗
PubMed2006

Recurrence of postoperative aortic fistulas: is there an ideal method of prevention? A case report.

There are very few cases in English literature of recurrent postoperative aortic fistulas (RPAFs). These are neo-communications between the aortic bloodstream and the lumen of contiguous organs which occur after unpredictable periods from surgical treatment of a previous fistula. The supradiaphragmatic aorta may fistulize into the airways, pulmonary circulation, oesophagus, and cardiac chambers; the infradiaphragmatic aorta into the intestine, stomach, and vena cava. According to the etiology, aortic fistulas are categorized as postoperative (or secondary) and spontaneous (or primary), and RPAF may be considered a subgroup of secondary fistulas. They may recur even more times in the same patient, hence the role of prevention is of the utmost importance. The simultaneous respect of different surgical principles is crucial to make the risk of recurrence less likely. Surgical treatment represents a real challenge due to the emergency conditions and redo nature of operations. Mortality rate is very high. In this article, we describe a case of recurrent aorto-duodenal communication, we discuss the principles of prevention both for the supra and infradiaphragmatic aorta, we introduce some modifications to the classic categorization and we present the first RPAF literature review.

Aorta, Abdominal↗
PubMed2003

[Cardiac surgery in the octogenarian: what risks for what benefits?].

About 1 to 8% of patients referred for cardiac surgery in industrialised countries are octogenarians. Hospital mortality is high and depends on age, type of surgery and other predictors of death which are female gender, left congestive heart failure, history of myocardial infarction, chronic obstructive lung disease, renal insufficiency, carotid and others vascular diseases. Morbidity is also very high. Besides supraventricular arrhythmias, respiratory failure is the main cause (20 to 30%) of morbidity, followed by cerebrovascular accident and renal failure. Due to this high rate of postoperative events, the length of stay is significantly increased. At follow-up however, excellent functional status and survival rate is afforded by the operative procedure. The main problem remains the selection of patients in order to improve results.

Age Factors↗
PubMed1997

Assessment of antihypertensive effect by blood pressure monitoring: applications to bisoprolol and lisinopril in a double-blind study.

The aim of this study was to evaluate the antihypertensive effect of drugs according to the initial ambulatory blood pressure (BP) level. After a 15-day placebo run-in period, 105 patients with moderate essential hypertension (mean age, 52 years) underwent 24-h BP monitoring (spacelabs: 1 measure/15 min). Patients were subdivided into two groups: the "High" group, with 24-h mean values of systolic BP (SBP) > 137 or diastolic BP (DBP) > 87 mm Hg, and the "Low" group, with SBP < or = 137 and DBP < or = 87 mm Hg. All patients received, in a random and double-blind design, either bisoprolol (10 mg q.d.) or lisinopril (20 mg q.d.) for 8 weeks. At the end of this active treatment period, office and ambulatory BP measurements were performed. Casual measurements revealed similar BP decreases in all subgroups receiving bisoprolol and lisinopril; BP monitoring showed that the antihypertensive effect depended on the baseline mean 24-h value; -15/-12 mm Hg for bisoprolol and -18/-13 mm Hg for lisinopril in the High group; -7/-6 mm Hg for bisoprolol and -6/-6 mm Hg for lisinopril in the Low group. This study shows that the antihypertensive effect depended on initial ambulatory BP values, with a lower BP decrease in the Low group. Assessment of the antihypertensive effect on ambulatory BP is useful in clinical trials.

Adrenergic beta-Antagonists↗
PubMed1993

Ambulatory monitoring of blood pressure in normal pregnancy.

The definition of hypertensive disorders in pregnancy is plagued by many difficulties, in part related to the limits of intermittent clinic readings of blood pressure. In order to better define the evolution of arterial blood pressure in normal subjects during normal pregnancy, casual and ambulatory (Spacelabs 90207, n = 22 or Diasys 200, n = 26) measurements of blood pressure were performed at gestational months 3, 6, and 9, in 48 normal women aged 18 to 39, both nulliparas (n = 19) and multiparas (n = 29). Ambulatory blood pressure levels were lowest in the first gestational trimester (24-hour mean: 104 +/- 8/63 +/- 6 mm Hg) and rose by a small increment during the last trimester (109 +/- 8/67 +/- 7 mm Hg at 8 months). Mean daytime ambulatory pressure was almost superimposable to clinic measurements at the three time points. A day-night variation in blood pressure level was detectable in all subjects at each recording. It is concluded that during normal pregnancy, ambulatory blood pressure levels were highest in the day and lowest at night at all gestational ages and increased only minimally before the ninth month. Reference values, as defined by the percentile distribution of daytime and nighttime systolic and diastolic blood pressure, may help define more precisely an alteration in the level and/or the circadian variation of arterial blood pressure during abnormal pregnancies.

Adult↗
PubMed1990

[Ambulatory blood pressure profile during 48 hours in patients treated with chronic hemodialysis].

Hypertension is one of the severest cardiovascular risk factor in subjects affected by end-stage renal disease in chronic hemodialysis. The behavior of blood pressure between the first hemodialysis (day 1) and the next one (day 2) was studied in 24 untreated normotensive hemodialysis patients. Patients were between 34 and 83 years (mean age: 60 +/- 12 yrs) and were hemodialysed 3 x 4 hours a week, between 7 and 12 a.m. ABP was recorded at 15 minutes intervals between 7 and 22 hours, and 30 minutes intervals during the night, during 48 hours with a Spacelabs 90202 or 90207 device. The following results were observed: ABP is greater at day 2 (122/74 mmHg) than at the first (117/70 mmHg, p less than 0.001); that increase is not correlated with gaining weight during interdialytic period; after hemodialysis, blood pressure continues to fall during 2 or 3 hours until a level of 119 mmHg; low values continue during postdialysis and during the first night; the following day, ABP increases progressively during the morning and during the evening; before the second hemodialysis, the increase is suddenly faster; circadian rhythm is lost in 9/24 patients; in 17/24 patients, nocturnal decrease of BP is lower than 5%; age and ancientness of hemodialysis are the most important factor; rest blood pressure measured by physician before HD is continually higher than diurnal ABP (138/74 vs 121/73 mmHg, p less than 0.001), even if ABP is only analysed during one hour before the second hemodialysis (129/77 mmHg).

Adult↗
PubMed1989

[Reference values of ambulatory arterial pressure in activity and during the night. Multicenter study of 394 normotensive subjects at rest].

The blood pressure pattern and variability were assessed in a population of 394 normotensive subjects (OMS) stratified by age (20 to 75 years) and sex. Ambulatory blood pressure measurements were performed with an automatic device (Spacelabs 5200) every 15 min. from 6 a.m. to 12 p.m., and every 30 min. from 0 a.m. to 6 a.m. The analysis was effected during normal daily activities (from 9 a.m. to 7 p.m.) and during night (from 11 p.m. to 7 a.m.). Blood pressure levels were higher in males than females. During daytime and nighttime, diastolic blood pressure rose with age until 59 years while SBP was not affected, except for the females older than 60 years. After this age, diastolic blood pressure decreased. No epidemiological study has provided a measure of the cardiovascular risk related to ambulatory blood pressure, so that we were unable to define true normal values. However, reference population values provided from two statistical methods: limit of the 95th upper confidence interval for the mean of limit of the 90th percentile value for the total data. These blood pressure distributions according to age and sex may allow a better approach to borderline hypertensive patients.

Adult↗
PubMed1988

[Does the blood pressure balance obtained in hospitalized hypertensive patients remain satisfactory a month later at home? (Ambulatory measurement)].

Twenty patients with hypertensive heart disease have been hospitalised for adjustment of their antihypertensive medication. The new treatment was left unchanged during a period of forty days, the survey consisted in three blood pressure measurements at rest every day during the first ten days of hospitalisation and an ambulatory blood pressure measurement the 10th and 40th day. The 10th day, there is no significant correlation between blood pressures measured at rest and ambulatory, even if the average BP levels are not significantly different. The 40th day, the average BP levels are equivalent with a correlation coefficient of 0.5 for the systolic and 0.64 for the diastolic blood pressure (p less than 0.01). Thus, a measurement of the ambulatory BP at the 10th day of hospitalisation seems to be a good indicator of the expected long term therapeutic effect. However, absence of greater increase of the ambulatory BP at one month probably corresponds with the majored action of certain treatments as time goes by.

Adult↗
PubMed1987

Hemodynamic effects of intravenous diltiazem in hypoxic pulmonary hypertension.

The short-term effects of intravenously administered diltiazem on pulmonary and systemic hemodynamics were evaluated in patients with hypoxic pulmonary hypertension. Twelve patients were randomly assigned to two groups in a double-blind fashion. One group (eight patients) received diltiazem, and the other group (four patients) received a placebo. Three increasing doses of diltiazem (0.2, 0.3, and 0.4 mg/kg of body weight) were injected into each patient, followed each time by an infusion (2 micrograms/kg/min, 3 micrograms/kg/min, and 4 micrograms/kg/min). The effects of the drug were also compared with those of oxygen, and the combined effect of high oxygen and diltiazem was tested. The mean plasma concentrations of diltiazem were, successively, 64 +/- 4, 158 +/- 19, and 267 +/- 40 ng/ml with the three increasing doses. There was no significant effect of diltiazem on the pulmonary vascular resistance even when given with oxygen. Diltiazem was well tolerated even at high doses. The arterial oxygen pressure, systemic oxygen supply, and oxygen consumption were unchanged. We conclude that diltiazem does not seem to decrease acutely hypoxic pulmonary vasoconstriction in patients with chronic hypoxia; however, diltiazem may be given safely to these patients for other indications, such as angina pectoris.

Blood Gas Analysis↗
PubMed1987

[Arterial pressure and shift work activities].

Circadian blood pressure (BP) and heart rate (HR) variations are studied during activities and sleep in a group of nine subjects with shiftwork activities (3 X 8 hours with a short rotation of 2 days). BP and HR values are measured in ambulatory (outside the hospital) with and automatic device (Spacelab system 5,200) during 24 hours at 3 times according to the work periods (morning 7-12 AM, afternoon 3-11 PM, night 1-7 AM) on a month. According to BP hour variations, activities and sleep are the main determining factors. For work periods BP mean values are significantly lower during night than during day. The lower BP values are found during the sleep periods, but the values are higher when subjects sleep during the day. There is an adaptation according to work hour changes, but this adaptation is incomplete and during night activities, the circadian rythm is partly altered. These constatations must be taken in account particularly on a therapeutic point of view for hypertensive subjects for which the treatment must be adjusted.

Adaptation, Physiological↗
PubMed1986

[Can ambulatory blood pressure be assessed using 9 self-measurements?].

This study compares the blood pressure (BP) levels, the variability and the circadian BP variation recorded in ambulatory (AM) and self measurement (SM) conditions. The BP is recorded every 15 min on the day time with an automatic device (Space-labs) in a population of 16 normotensive patients; the same day, each patient performs with an half automatic device (SEB) 9 self measurements between 8 am and 8 pm. The SM method provides significantly lower mean values: -3.9 mmHg and -3.1 mmHg for the Systolic and the Diastolic blood pressure (SBP and DBP) than the AM. The heart rate (HR) also is lower in SM than in AM (-6.5 cy/min). The BP variability is lower for the SBP and the HR in SM. The correlation between AM and SM hours means is poor. This study shows that the self measurement method provides a lower BP level and variability than the full ambulatory method and the hourly means variation are not assessed.

Activities of Daily Living↗
PubMed1986

Comparative study of the efficacy of captopril at a single daily dose of 100 mg and at a twice daily dose of 50 mg by measuring ambulatory pressure over 24 hours.

Variations in blood pressure were investigated by an automatic, non-invasive ambulatory method in 9 subjects with essential hypertension. Recordings were made after 6 week periods during which captopril was taken either once or twice daily, in a double-blind cross-over study. Although the effects of captopril administration either once or twice daily were broadly similar, there was a significant decrease in diastolic blood pressure values on the once-daily regimen. These results suggests that treatment once a day can advantageously replace twice-daily treatment.

Adult↗
PubMed1981

Carnitine palmityl transferase deficiency: clinical variability, carrier detection, and autosomal-recessive inheritance.

A 21-year-old man had recurrent myoglobinuria; his 28-year-old sister had symptoms of fatigability. During prolonged fasting, serum free fatty acid rose in both siblings, but only the sister produced ketone bodies and had elevated creatine phosphokinase activity. Carnitine palmityl transferase (CPT) activity was less than 30% of normal in muscle and platelets. Liver biopsy disclosed a low level of the enzyme in the brother. The parents had intermediate levels of the enzyme in platelets. CPT deficiency seems to have an autosomal-recessive pattern of inheritance and a variable phenotypic expression.

Acyltransferases↗
PubMedDate not supplied

Internal thoracic arterial grafts evaluation by multislice CT scan: a preliminary study.

BACKGROUND AND AIM: The internal thoracic artery (ITA) has a better long-term patency than saphenous veins, and anastomosis between ITA and the left anterior descending artery (LAD) represents the "gold-standard" of surgical myocardial revascularization. The aim of this study is to evaluate the multidetector multislice CT Scan (MCTS) as a means of postoperative evaluation of ITA coronary artery bypass grafts. METHODS: Twenty-eight patients having been operated on for coronary artery bypass with ITA during a 6-months period, benefited, 7 days after surgery, from a patency and anastomotic site control of ITA with a MCTS associated with cardiac gating (Light Speed, General Electric, USA). RESULTS: Internal thoracic artery bypasses are visualized perfectly on all their courses, with possibility of 3D reconstructions, showing the relationship between cardiac cavities and the arterial bypasses. The anastomotic site on the LAD was, in selected cases, perfectly visualized. Sequential bypasses with left ITA are well visualized as well as T or Y right-to-left ITA grafts. However, surgical clips create some image artefacts. CONCLUSIONS: The postoperative control of ITAs are possible by MCTS with a satisfactory resolution. This makes it possible to check the patency of ITAs, their course on the heart surface, and the location and quality of anastomosis with a noninvasive reproductive method.

Anastomosis, Surgical↗
PubMedDate not supplied

[Finding of focal heterotopy with magnetic resonance. Description of a case associated with late onset epilepsy].

A case of late onset focal epilepsy in a mentally and neurologically normal girl in which the MRI showed a focal heterotopia is presented. The efficacy of this new procedure in detecting migratory disorders is discussed and the scanty literature reviewed. This case suggests that in the future more cases of epilepsy previously classified as "cryptogenetic" will be demonstrated as secondary to developmental abnormalities.

Brain↗
PubMedDate not supplied

[Effect of artificial ventilation with an end-expiratory plateau on gas exchange amd hemodynamics in chronic respiratory failure].

Previous studies of pulmonary models and with animals have shown that in obstructive disease of the airways, ventilation with an end-expiratory plateau improves ventilation distribution. Paradoxically, there has been no data published on patients with obstructive disease. For this reason, we examined the effects of mechanical ventilation with an end-expiratory plateau on gas exchange and haemodynamics in 12 patients presenting acute exacerbations of chronic respiratory failure. Following a period of conventional controlled ventilation, two plateaux of 0.3 and 0.5 s respectively are successively introduced while the I/E ratio (1/2.5) and then inspiratory flow (respiratory frequency and end-tidal volume remaining the same) are kept constant. PaCO2 decreases by approximately 10% with the addition of each plateau. In spite of a moderate increase in mean airway pressure (+8%), greatest improvement in gas exchange is observed with the longer plateau (0.5 s), maintaining expiration time (I/E constant) : a decrease in PaCO2 and in VD/VT (approximately - 14%), an increase in PaO2 (+7%) and a decrease of venous admixture (shunt + shunt effect : - 18.5%). The plateau tends to reduce ventilation/perfusion mismatch, whereas maintaining prolonged expiration assures "emptying" of slow alveoli. However, no matter which plateau is used, cardiac output decreases by more than 10% in six patients, probably due to a drop in systemic venous return. PaCO2 increase is too slight to hinder a decrease in arterial oxygen transport. The variability of these results accounts for patient diversity and restricts the indication of end-expiratory plateau to patients with severe ventilatory distribution disturbances who can benefit from close cardiorespiratory monitoring.

Aged↗