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Biomedical subjects

P Spagna

Publications and source records attributed to P Spagna.

9 recordsLinked to original sources
PubMed1992

Continuous noninvasive cardiac output as estimated from the pulse contour curve.

We developed a noninvasive computer-based system for estimating continuous cardiac output by a modified pulse contour method using a finger pressure waveform. The method requires no individual patient calibration or baseline cardiac output. First, we calibrated the system in a "learn" group of 20 patients. The computer-based cardiac output was then compared with thermodilution cardiac output in 27 patients undergoing coronary artery bypass surgery. A total of 94 cardiac outputs were performed (three averaged per determination) at four predetermined time periods: preinduction, postinduction, prebypass, and postbypass. During determination of each thermodilution cardiac output, the pulse wave data were simultaneously recorded on cassette tape. The patients had cardiac outputs ranging from 2.9 to 6.4 L/min. The correlation coefficient was 0.75. The average thermodilution cardiac output was 4.50 (+/- 0.83 SD) L/min, while the cardiac output derived from the finger pressure wave was 4.48 (+/- 0.7 SD) L/min (95% confidence interval [CI] of difference, 0-3.2%). The mean difference between the two methods was 0.02 (+/- 0.55 SD) L/min. The 95% CI for the bias was 0.0001 to 0.036 L/min. The 95% CI for the lower limit of agreement was -1.12 to -1.06 L/min; the upper limit for the 95% CI was 1.09 to 1.16 L/min. The program demonstrated that information about cardiac output can be obtained by using the Finapres device (Ohmeda, Boulder, CO). The cardiac output values obtained by this continuous noninvasive technique were within +/- 20% of the simultaneous thermodilution values 87% of the time. This was true over the narrow range of cardiac outputs (2.9 to 6.4 L/min) and wide range of heart rates (45 to 140 beats/min).

Adult↗
PubMed1983

Transvenous pacemaker insertion with a zero dislodgement rate.

A non-retractable transvenous screw-in lead which gives both stability of placement and low acute and chronic stimulation thresholds was used in 64 patients during the period April, 1979 to June, 1981. The average threshold at implant was 0.7 volts; the current threshold average was .86 milliamps with the pulse width at the standard setting for the pacemaker employed. Chronic thresholds were usually below the lower programmable limit of the pacer as tested at 3 months. In one patient, the fact that the screw was fixed in the exposed position caused trouble. The lead became knotted in the superior vena cava and was removed by thoracotomy. Although this experience with the Osypka lead was not entirely satisfactory, newer developments with retractable leads may make the principle more acceptable.

Adult↗
PubMed1980

Charge levels in programmable pacemakers.

The method of calculation of charge in one series of programmable pacemakers is described. Accurate charge tables are constructed and examples of their use are given. With the tables the margin between the threshold and the pacemaker setting can be more precisely determined and consequently, at least in some cases, it can be reduced for greater pacemaker longevity.

Electric Conductivity↗
PubMed1978

Massive mitral regrgitation from chordal rupture and coronary artery disease.

The precise mechanism that causes spontaneous rupture of chordae tendineae remains unknown. That it may occur in patients with no disease other than underlying or associated coronary artery occlusion has not been previously reported. Six patients with chordal rupture were found among 600 patients who underwent operation for mitral regurgitation in a 6-year period. All 6 patients without exception underwent simultaneous mitral valve replacement and coronary revascularization. The salient clinical features of these patients are summarized, and 1 case is reported in detail.

Aged↗
PubMed1976

Results of mitral valve replacement with the Beall prosthesis in 209 patients.

In this 3 year study of 209 patients who underwent mitral valve replacement with the newer Beall prostheses (Models 104 and 105) the operative mortality rate was 5.2 per cent. None of these deaths was related to the valve. This prosthesis features a larger frustrum area and a "turtle-neck" sewing ring which permits its rapid insertion with a continuous suture technique. Of the 20 (9.5 per cent) late deaths, two were due to thrombosis of the valve. Among the 178 survivors, 17 developed thromboembolic complications; however, 10 of these patients recovered. Late clinical results have been quite satisfactory in over 90 per cent of the survivors. In the 15 patients who underwent hemodynamic studies postoperatively, the cardiac index and pulmonary artery pressure showed significant improvement; however, they still had transvalvular gradients at rest. The improvement in the design of this prosthesis has been an important factor in lowering the operative risk and improving the late results of mitral valve replacement.

Adult↗
PubMed1974

Pneumocephalus: an unusual cause.

A 60 year old male had an open thoracotomy for bronchogenic carcinoma. On the twelfth hospital day he became obtunded and complained of headache. Radiographs revealed intracranial air. It was thought that the pneumocephalus in this patient was most likely secondary to a tension pneumothorax continuously forcing air through a dural tear sustained at the time of initial surgery. The causes of pneumocephalus are reviewed and no similar case report has been found in the literature.

Carcinoma, Bronchogenic↗