Biomedical subjects
Publications and source records attributed to P Lisanti.
We report a case of a 47-year-old woman with a previous myocardial infarction, in whom coronary angiography showed a right-type single coronary artery (arising from a single ostium in the right sinus of Valsalva) without associated obstructive lesions. We have demonstrated that the transesophageal echocardiogram was complementary to angiography in the assessment of retroaortic course of the anomalous left main coronary artery.
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We report the case of a 16-year-old boy with Marfan syndrome who presented in severe congestive heart failure secondary to rupture of an aneurysm of the sinus of Valsalva into the right atrium, a condition that was aggravated by coarctation of the aorta. The patient also had a large aneurysm of the ascending aorta with the characteristics of annuloaortic ectasia. The patient underwent successful surgical correction and is asymptomatic 3 years after the repair.
A patient admitted to your unit this morning presents a dauntingly complex clinical picture. Maria DeJesus, 34 years old, has HIV infection, which progressed to AIDS last year with an episode of Pneumocystis carinii pneumonia. She's also experienced recurrent vaginal and esophageal candidiasis and cryptococcal meningitis, and her more recent history includes peripheral neuropathy, causing pain and numbness, as well as cognitive and motor function problems. Her admission was prompted by diarrhea that has persisted despite outpatient treatment. To provide the best care for patients like Ms. DeJesus, you need to understand HIV infection and the diseases associated with it. Yet that's a challenging task, given that the possible manifestations of advanced infection are so many and varied. Though your approach to care is holistic, you may find it helpful to consider the numerous facets of the patient's illness individually. In the following pages, we'll examine how HIV enters the body, infects immune cells, and eventually cripples the immune system. We'll look at some of the more common opportunistic infections preying on people with HIV. And we'll explore the less well-charted territory of complications attributed to HIV infection of the central and peripheral nervous systems.
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STUDY OBJECTIVE: To assess blood pressure (BP) response to continuous maximal arm ergometry in patients with spinal cord injury (SCI). DESIGN: Cross-sectional analysis of data collected for a prospective study of functional electrical stimulation in patients with SCI. SETTING: Short-term rehabilitation hospital. PARTICIPANTS: Twenty individuals with SCI; 4 cervical (C6 to C8), 10 high thoracic (T1 to T6), and 6 low thoracic (T7 to T12). MEASUREMENTS AND RESULTS: Each subject performed continuous maximal arm ergometry with expired gas analysis. Blood pressure was measured using a technician-assisted protocol. The BP at maximal exercise was compared with the highest submaximal BP reached during the test (delta BP = final BP minus highest submaximal BP). All 20 subjects had a negative delta BP (mean +/- SD; -22.8 +/- 12.1 mm Hg) for mean BP and 19 of 20 had a negative delta BP (-25.8 +/- 14.4 mm Hg) for systolic BP. The delta BP was not significantly related to maximum exercise parameters, resting BP, or level of lesion. Four able-bodied subjects and six wheelchair-bound individuals without SCI showed no exertional hypotension. Repeated testing on the four able-bodied subjects showed excellent reproducibility for mean BP (coefficient of variation [CV] = 3.6 percent; r = 0.98; p < 0.01) and systolic BP (CV = 2.2 percent; r = 0.99; p < 0.01) using this protocol. CONCLUSIONS: These data describe, for the first time to our knowledge, that exertional hypotension is present in all individuals with SCI during continuous arm ergometry. Further studies are needed to clarify the mechanisms responsible for this phenomenon and to evaluate the long-term consequences for individuals with SCI.
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The organizational strategy used in a high risk Coronary Angioplasty procedure is discussed. The attempted vessel was a severely stenosed Right Coronary Artery in a patient who had undergone triple graft, with residual obstruction of Left Main Artery and only one patent venous graft on a marginal branch of the Circumflex artery. The procedure was performed using a Stack type autoperfusion balloon angioplasty catheter, with a Cardiopulmonary Support System held in standby.
The authors describe a case of coronary angioplasty on a distal Left Main coronary lesion. The left coronary tree was protected by the left internal mammary connected to left anterior descending artery. The procedure was performed using the "kissing balloon" technique, with a single guiding catheter. Immediate angiographic result and one-year follow-up have been excellent.
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One thousand one hundred and thirty-two percutaneous transluminal coronary angioplasties have been performed at Centro Cuore Columbus in Milan between January 1987 and September 1989. The whole population was divided into two groups: Group A (90 patients with ejection fraction less than or equal to 0.40); Group B (678 patients with ejection fraction greater than 0.40. Mean ejection fraction in Group A (0.35) was significantly lower (p less than 0.0001) than in Group B (0.56). In each group three subsets were identified: subgroup 1: total obstruction of two major epicardial vessels plus severe stenosis of the patent one; subgroup 2: total obstruction of one vessel plus severe stenosis on a different remote one; subgroup 3: all patent vessels with one or more severe stenoses on one or all. We attempted percutaneous transluminal coronary angioplasties on 923 stenosed and 161 totally obstructed vessels, with a primary success of 95 and 56% respectively. We experienced 36 major complications (7 deaths, 10 acute myocardial infarctions, 19 emergency aortocoronary bypasses in 21 patients (2.7% of the whole population). Subgroup A1 (7 patients with ejection fraction less than or equal to 0.40 and attempted percutaneous transluminal coronary angioplasties on the sole patent vessel) showed the lowest success rate (44%) and the highest complication rate: 3 deaths (42.8%); 1 acute myocardial infarction (14.2%); 3 emergency aorto-coronary by-pass (42.8%). The 83 patients in group A2 and A3, with reduced ejection fraction, did not have significantly higher complication rate than all group B patients, with normal ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)
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The authors describe a case report on the rupture of the distal left anterior descending artery during PTCA. This complication gave rise to a fistula between the ruptured distal anterior descending and the right ventricular cavity. The patient was asymptomatic and was treated conservatively. The coronary arteriogram at six months follow-up showed the closure of the fistula with patency of the vessel up to that segment.
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The angiographic definition of "Myocardial Bridge" universally applies to signify systolic narrowing of a coronary segment by strips of myocardial tissue. The Authors report the clinical history of two patients suffering from effort angina and transient myocardial ischemia, in whom coronary angiography showed no atherosclerotic lesions, but wide systolic kinking of the left anterior descending (LAD) artery, without systolic luminal obstruction. The definition of "Intramural LAD Pathway" has been put off in place of "Myocardial Bridge", making a distinction not simply semantic but between two different angiographic and pathologic pictures. It is very likely indeed that coronary flow impairment, solely systolic in myocardial bridge, takes places mainly during diastole in Intramural LAD Pathway.
A 50 year-old man had a history of crescendo exertional angina. Echocardiographic and electrocardiographic findings were typical of apical hypertrophic cardiomyopathy. Selective coronary angiography showed no atherosclerotic lesions, but there was a stream of dye into the left ventricle, via a tiny plexus of intramural vessels, from the distal third of the anterior descending coronary artery. The origin of myocardial ischemia has been related to a "steal" phenomenon, while this vascular anomaly could represent a disorder of the thebesian system, possibly due to the "disarray" of myocardial cells typical of hypertrophic cardiomyopathy.
Idiopathic severe dilatation of bilateral atrial and urethero-pelvic systems was found in a 53-year-old woman. Degeneration of muscle fibers without inflammation is a constant feature of idiopathic atrial enlargement. Degenerative process can extensively involve atrial wall (generalized dilatation) or can be localized (aneurysmal dilatation). In both types of lesion clinical features are related to atrial arrhythmias and to compression on atrio-ventricular valves and ventricles by the enlarged atria. Only the outcome of the atrial arrhythmias can help to distinguish between the two conditions: development of irreversible atrial standstill in generalized dilatation and definitive restoration of sinus rhythm, following surgery, in aneurysmal dilatation. In each atrium, a different rate of incidence of the two types of dilatation has been documented in the literature: as for the right atrium, more than 40 cases of generalized dilatation have been reported and only 4 of the aneurysmal type. On the other hand, isolated left atrial enlargement was of aneurysmal type in all 30 reported cases. Biatrial dilatation was generalized in 7 cases and due to multiple aneurysms in a single case. The Authors support the hypothesis that idiopathic atrial dilatation could be due to a degenerative process affecting the atrial components derived from primitive atria, in which the muscular layer is structured into pectinate muscles. They also suggest to distinguish, even from the etiopathogenetic point of view, between aneurysmal dilatation (localized and fortuitous lesion) and generalized dilatation (diffuse degeneration of pectinate muscles). This distinction could well related with the different outcome of atrial arrhythmia in the two types of dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)