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Biomedical subjects

P Hekali

Publications and source records attributed to P Hekali.

At least 19 recordsLinked to original sources
PubMed1991

Coronary collateral circulation.

The occurrence and influence of coronary collateral circulation and obstruction of the supplying coronary arteries on left ventricular contractility, prevalence of myocardial infarction, and bicycle exercise ergometer test were studied in a random sample of 286 patients with angiographically documented coronary artery disease. Collaterals appeared increasingly in all three main coronary arteries with grade of obstruction. The highest prevalence of collaterals occurred in stenosis of the right coronary artery (60%), followed by the left descending artery (45%); they occurred least in the left circumflex artery (21%) (p less than 0.001). The frequency of intra-arterial collateral circulation was 42%, 11%, and 12%, respectively (p less than 0.001). With total occlusion of the left anterior descending coronary artery, 22% of the patients had normokinetic anterior and apical left ventricular wall when collaterals were present. More often, the inferior wall showed normal contraction with total occlusion of the right coronary artery and collaterals [52%, p less than 0.001 compared with left anterior descending artery (LAD)]. The prevalence of inferior myocardial infarction was 39%, with collateral circulation to the totally occluded right coronary artery. The respective prevalence of anterior infarction and total occlusion in the left coronary artery was 58% (p less than 0.02). The presence or absence of collaterals had no obvious influence on ST-segment response during bicycle ergometer test. In triple-vessel disease, peak work capacity was better when collaterals to LAD were not jeopardized (427 kpm) than when jeopardized (321 kpm) (p less than 0.02).

Analysis of Variance↗
PubMed1991

Iohexol, ioxaglate and iopamidol in coronary angiography. A double-blind comparative study of 300 patients.

A randomized, double-blind study was carried out in 300 consecutive coronary angiography examinations to investigate the clinical safety of three low osmolar contrast media, iohexol 300, ioxaglate 320 and iopamidol 300, and the electrocardiographic changes that occurred with them. The ECG from electrode V5/V6 or AVF and intra-arterial pressure were monitored continuously, and recorded before and after the first contrast injections into the left and right coronary arteries. Of the variables tested, no statistically significant changes occurred in systolic arterial pressure, PR interval or ventricular extrasystole. The QT interval increased in the ioxaglate group (p = 0.001). Heart rate decreased in all groups, but slightly less in the ioxaglate group than in the iopamidol group (p = 0.02). The ST segment depression (mean 0.67m) was more marked in the ioxaglate group than in the other treatment groups (p = 0.0001) during right coronary angiography. The same characteristics, but less marked, were observed during left coronary angiography, the ioxaglate group (mean 0.251mm) differing from the iopamidol group (mean 0.050mm) (p = 0.04). No significant difference in severe adverse reactions were detected between these groups (ioxaglate 1, iopamidol 1). Ioxaglate produced mild side effects (nausea, vomitus, urticaria) in 16% of the patients, the other two contrast agents producing side effects in 1%.

Coronary Angiography↗
PubMed1991

Diagnostic significance of angiographically observed visceral aneurysms with regard to polyarteritis nodosa.

During a 10-year period, intraparenchymal aneurysms were found in 38 of 748 patients at selective abdominal angiography with magnification technique. According to strict criteria, 17 patients were classified as suffering from necrotizing vasculitis of the polyarteritis nodosa group (PAN), 7 from severe arterial hypertension, and 3 from rheumatoid arthritis. The diagnoses of 5 patients remained to be confirmed, and each of the remaining 6 patients suffered from various other diseases. PAN was diagnosed histopathologically in 2 patients without angiographic aneurysms. Based on the 156 patients in whom the indication for angiography was suspicion of arteritis, the angiographic diagnosis of PAN had a sensitivity of 89 percent and a specificity of 90 percent, a positive predictive value of 55 percent and a negative predictive value of 98 percent. The mean number of both renal and hepatic aneurysms was higher in patients with PAN than in the other patients (p less than 0.01 and p less than 0.05, respectively). Five PAN patients had numerous and large aneurysms, whereas the aneurysms of the other 12 PAN patients did not differ from those of patients with other diseases. Patients with PAN had renal infarcts more often than the other patients (p less than 0.05). Our findings suggest that visceral angiography is useful in establishing the diagnosis of PAN, but the angiographic finding of aneurysms is not pathognomonic.

Adult↗
PubMed1990

Cardiac involvement in bone marrow transplantation: serial changes in left ventricular size, mass and performance.

Forty-five consecutive adult patients with haematological malignancies were studied prospectively to evaluate cardiac involvement in bone marrow transplantation (BMT). Echocardiography and measurement of systolic time intervals were performed before conditioning with cyclophosphamide (CY) (120 mg kg-1) and total body irradiation (10-12 Gy), and repeated 1 month and 1 year after BMT. The left ventricular (LV) changes at the 1-month study included increases in mass index (85.1 +/- 4.0 g m-2 vs: 76.1 +/- 3.3 g m-2, mean +/- SE; P less than 0.001) and in the pre-ejection period/ejection time ratio (0.46 +/- 0.01 vs. 0.36 +/- 0.01, P less than 0.001), and decreases in fractional shortening (24.9 +/- 1.0% vs. 27.9 +/- 0.8%, P less than 0.01) and in the peak normalized diameter lengthening rate (2.2 +/- 0.1 s-1 vs. 2.6 +/- 0.1 s-1, P less than 0.01). Four patients developed congestive heart failure. Twenty-four patients were alive and relapse-free 1 year after BMT. The LV measurements were then no longer different from the pre-transplant readings. Thus BMT that is preceded by conditioning with CY and total body irradiation results in increased LV mass and impaired systolic and diastolic LV function. These changes are mostly subclinical, and are also reversible if the recipient survives the initial months after transplantation.

Adult↗
PubMed1990

Cardiac involvement in bone marrow transplantation: electrocardiographic changes, arrhythmias, heart failure and autopsy findings.

In order to evaluate cardiac involvement in bone marrow transplantation (BMT) we reviewed serial electrocardiograms, chest X-rays and cardiac pathology at autopsy in 45 consecutive adult patients undergoing BMT for hematologic malignancies at our institution. All patients were pretreated with cyclophosphamide (CY, 120 mg/kg) and total body irradiation (TBI, 10-12 Gy). A total of 15 patients developed electrocardiographic ST-segment or T-wave changes and/or arrhythmias post-BMT; four of them also suffered from congestive heart failure. The arrhythmias included frequent ventricular extrasystoles (two patients), paroxysmal atrial fibrillation (one patient), repeated supraventricular tachycardia (one patient) and QT-prolongation with ventricular tachyarrhythmias (one patient). Twelve patients showed an early drop of the total QRS voltage sum exceeding 15% of the pretransplant reading. In a subgroup of five patients the voltage drop was associated with ST-segment or T-wave changes; three of them developed congestive heart failure. At autopsy in 15 patients, the heart weight was on the average 113% of predicted. Myocardial edema, fibrosis and cellular hypertrophy were the most common microscopic findings. Two patients had marantic endocarditis of the aortic valve. Thus, in our experience clinically significant heart involvement affects 5-10% of patients undergoing BMT after pretreatment with CY and TBI. While cardiac complications are generally not a major problem of BMT, they may have serious consequences for individual patients and should therefore be carefully watched for in the treatment of BMT recipients.

Adolescent↗
PubMed1986

Treatment of Takayasu's arteritis: an analysis of 29 operated patients.

Over a 25-year period 29 patients underwent 49 vascular procedures due to arterial insufficiency or vascular complications caused by Takayasu's arteritis. In bypass operations 36 grafts were inserted. The 5-year patency rates were 53% when grafts were used for patients with the active disease stage and 88% during the inactive disease stage (p = 0.059). The material of the graft, or postoperative warfarin or platelet-inhibitor drug treatment administered for at least 3 postoperative months had less bearing on graft patency. Ten out of the 11 graft occlusions occurred within the first 2 postoperative years. In operations due to lesions of the brachiocephalic arteries (20 patients), bypass procedures appeared to be superior to thromboendarterectomies; 67% (20/30) of the grafts and 17% (1/6) of the thromboendarterectomies remained patent. Five hypertensive patients underwent surgery because of renal artery stenosis. Hypertension was cured in one patient and in another the antihypertensive regimens could be reduced. There were 2 operative deaths, one due to myocardial infarction after aortic valve replacement and the other due to cerebral hemorrhage, probably because of excessive blood flow resulting from the insertion of an aorto-bicarotid bifurcation bypass graft. Four of the 7 late deaths occurring nine months to 15.7 years postoperatively were considered to be related to Takayasu's arteritis.

Adolescent↗
PubMed1986

Radiology of aortic dissection: pitfalls in diagnosis.

The diagnosis of aortic dissection can be made with certainty when computed tomography or aortography reveals two lumina and a intimal flap between them. If the false lumen is thrombosed, the differential diagnosis between dissection and aneurysm with intraluminal thrombus is difficult. High resolution computed tomography with dynamic scanning seems more effective in differentiating these two entities than aortography. Two illustrative cases are presented.

Aged↗
PubMed1985

Narrowing of coronary artery: thresholds for the occurrence of angina pectoris.

The degree of narrowing of coronary artery that caused angina pectoris, was estimated in female and male patients with single vessel coronary artery disease, with the aid of quantitative measurements of a single stenosis in arteriograms. In female patients, the onset of mild angina pectoris (NYHA, functional class I-II) occurred when the coronary artery diameter was reduced by an average of 41 per cent, whereas it could not be estimated reliably in male patients because they nearly all had well developed collaterals bypassing the stenosis. For severe angina pectoris (NYHA, functional class III-IV) the mean stenosis was 72 per cent in female and 78 per cent in male patients.

Angina Pectoris↗
PubMed1985

Isolated renal artery and combined aortic and renal artery reconstruction for renovascular hypertension. Late results of surgical treatment.

Fifty consecutive patients with renal artery occlusive disease underwent surgery for renovascular hypertension. The etiology was arteriosclerosis; only three patients had fibromuscular hyperplasia. Isolated renal artery stenosis was operated on in 22 patients while 28 patients underwent combined renal and aortoiliac/femoral procedures. Four of the patients required re-operation because of unsuccessful primary results. There was no operative mortality. Renin was determined in 29 patients and postoperative angiography was carried out in 22 cases. The patency rate of the aorto-renal grafts was 94%; 2 aneurysmal vein graft dilatations occurred. Preoperative renin assays were positive in 90% of the patients with isolated renal artery stenosis but in only 45% of those having renal and aortoiliac/femoral arteriosclerosis. Postoperatively, the renin values had returned to normal limits in 95% of the patients. Long-term (2-11 years) successful treatment of hypertension was achieved in 79% of the cases with isolated stenosis and in 59% of the cases with aorto-iliac/femoral arteriosclerosis. The patients having a preoperative ipsilateral/contralateral renin ratio greater than or equal to 1.5 showed a success rate of 69%. Normal levels of renin were found in 85% of the successful cases.

Adult↗
PubMed1982

The effect of sequential versus single vein aortocoronary bypass surgery on resting left ventricular function.

To study the effectiveness of sequential vein grafts in coronary bypass surgery, left ventricular (LV) function was serially estimated in 28 patients with sequential grafts and compared with that in 24 patients with multiple single vein grafts. Early patency of sequential grafts was 98% vs. 94% for single veins. Late patency (mean 28 months after operation) of sequential veins was 97% vs. 85% for single vein grafts (mean 32 months after operation). Various parameters of resting LV function (pressure, volumes, ejection fraction, regional contraction score, mean velocity of fiber shortening) showed only slight and non-significant changes during the angiographic follow-up in the sequential vein graft group, with the exception of LVEDP, which was significantly lower at the late follow-up (p less than 0.05). There was an apparently spurious highly significant decline in fiber shortening velocity in the sequential graft group (p less than 0.001). Division of the series into subgroups of complete or incomplete revascularization did not improve the predictive power of resting LV function. The data reveal that sequential vein grafts are comparable to multiple single vein grafts as far as the influence on LV function at rest is concerned.

Adult↗
PubMed1982

Patency of sequential versus single vein grafts in coronary bypass surgery.

The patency and graft flow of sequential (seq. SVBG) and single saphenous vein bypass grafts (single SVBG) in coronary bypass surgery were compared angiographically (mean follow-up 26 months) in 76 patients with 36 seq. SVBG (75 distal anastomoses) and 85 single SVBGs. The late patency of all seq. SVBGs anastomoses (94.7%) was higher than that of single SVBGs (80.0%). No early or late graft occlusions were seen in the side-to-side (SSA) anastomoses of the seq. SVBGs. The cine-angiographically determined mean volume flow in the proximal segments of the seq. SVBGs was significantly higher (p less than 0.001) than that in the distal segments of the seq. SVBGs or in the single SVBGs at both early and late follow-up. Despite the higher late patency rate (88.9% vs 80.0%) in the end-to-side anastomoses (ESA) of the seq SVBGs, the mean graft flow was significantly lower in the distal segments of seq SVBGs than in the single SVBGs (71 ml/min vs. 109 ml/min, p less than 0.05).

Adult↗
PubMed1982

Chronic unilateral hyperlucent lung. A consecutive series of 40 patients.

A clinical series of 40 consecutive patients with chronic unilateral hyperlucent lung was analysed. Swyer-James (MacLeod) syndrome turned out to be the most common diagnosis (18 patients, 45%). Other causes were localized emphysema (8 patients, 20%), congenital hypoplastic pulmonary artery (4 patients, 10%), previous massive pulmonary embolism (4 patients, 10%), bronchial carcinoma (3 patients, 7.5%), sequelae of radiation therapy (2 patients, 5%) and benign intrabronchial neoplasm (1 patient, 2.5%). The reduction of pulmonary vasculature was scored (0-9). The most extensive reduction was found in patients with Swyer-James syndrome (mean 5.8), whereas patients with bronchial cancer had the smallest changes (mean 3.0).

Adenoma↗