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Biomedical subjects

R Carere

Publications and source records attributed to R Carere.

8 recordsLinked to original sources

Pullback atherectomy with the Arrow-Fischell atherectomy device.

The Arrow-Fischell pullback atherectomy catheter is designed to circumferentially debulk and retrieve coronary atheroma. We performed pullback atherectomy before balloon angioplasty or stenting in 41 patients. The device crossed the target lesion in 38 (93%) and obtained tissue in 36 (88%). All procedures were completed successfully and without myocardial infarction, emergency cardiac surgery, or death. Complications included major spasm in 8 patients, postprocedural abrupt closure in 1, and otherwise uncomplicated arterial perforation in 2. Pullback atherectomy can be performed relatively safely, but is more difficult than balloon angioplasty, obtains less tissue than directional atherectomy, and is associated with significant limitations.

Aged

Effect of rotational atherectomy on quality of life.

OBJECTIVE: To evaluate whether percutaneous coronary rotational atherectomy (RA) improves quality of life. DESIGN: Prospective sequential study of the first 20 patients who had RA at St Paul's Hospital, Vancouver from November 1993 to April 1994. SETTING: Tertiary care teaching hospital. PATIENTS: There were nine males and 11 females with a mean age of 68 +/- 9.3 years. All had angina pectoris with type B or C coronary lesions. INTERVENTIONS: RA was performed using the Rotablator device. RESULTS: The procedure was angiographically successful in 20 patients and clinically successful in 18 patients. Two patients who sustained acute myocardial infarctions underwent coronary bypass surgery. Before RA there was one patient in Canadian Cardiovascular Society angina class I, five patients in class II, 12 in class III, and two in class IV. At six months' follow-up there were 11 patients in class I, seven in class II and two in class III. The mean Duke Activity Status Index improved from 21.3 +/- 15.8 (mean +/- SD) before the procedure to 36.9 +/- 15.8 (P < 0.001) at six months' follow-up. The consumption of anti-anginal medications also decreased. CONCLUSIONS: RA was associated with improved functional status and quality of life in patients having angina pectoris with type B or C coronary lesions.

Aged

Multicenter clinical experience with the development of a novel short coronary stent and its prototype device.

Our initial experience with the Micro Stent PL and its prototype intracoronary stent is described. A total of 206 stents were implanted in 84 patients for threatened closure or restenosis following balloon angioplasty. The stenting procedure was successful and uncomplicated in 83 of 84 patients. Potential advantages of this particular stent relate to its short length, low surface area, expandability over a range of diameters, radiopacity, low profile, and ease of delivery.

Angioplasty, Balloon, Coronary

Spontaneous coronary artery dissection in young women.

Spontaneous dissection of the coronary arteries is quite rare. It is usually a catastrophic event with fatal outcome. We report two interesting cases of spontaneous dissection whose presentations exemplify the variable course the disorder may take. The first is the only report to our knowledge associated with aerobic exercise; the second is the only reported attempt at treatment with intracoronary thrombolysis.

Adolescent

Alterations in fatty acid metabolism in adriamycin cardiomyopathy.

Myocardial fatty acid metabolism may be impaired in adriamycin cardiomyopathy. In order to determine the extent of fatty acid metabolism alterations, we measured steady state [14C]palmitate oxidation and the incorporation of [14C]palmitate into the neutral lipid pool in a rat model of adriamycin cardiomyopathy. Isolated hearts from control rats and rats treated with adriamycin were perfused with 1.2 mmol/l of [14C]palmitate for 30 min to achieve steady state oxidation measured as [14C]O2 production; then perfused with 1.2 nmol/l of unlabelled palmitate. Hearts were killed early (0-5 min) or late (10-30 min) after the [14C]palmitate perfusion, to determine incorporation into the neutral lipid pool, and neutral lipid utilization. In the control group steady state oxidation was reached in 10 min ([14C]O2 production = 580 +/- 61 nmol/min/g dry wt) of perfusion. In the adriamycin treated group, mean CO2 production was significantly reduced at 10 min (329 +/- 44 nmol/min/g dry wt, P < 0.01 v control). At 30 min, [14C]O2 production in the treated group was not significantly different than controls (521 +/- 65 nmol/min/g dry wt v 617 +/- 36 nmol/min/g dry wt, P = N.S.). The incorporation of [14C]palmitate into the neutral lipid pool measured in the early subgroup was significantly reduced for adriamycin treated hearts v controls (7.2 +/- 0.6 v 12.0 +/- 1.4 mumol/g dry wt respectively, P < 0.01). In the control group 14C labelled neutral lipid reduced with time to 8.4 +/- 1.1 mumol/g dry wt (P < 0.05) in the late group. The adriamycin group demonstrated no significant change between early and late measurements. In conclusion, in adriamycin cardiomyopathy: (1) there is significant delay in achieving steady state palmitate oxidation, although the steady state rate is near normal; (2) palmitate incorporation into the neutral lipid pool is reduced; (3) neutral lipid pool utilization may also be reduced. These data suggest impaired uptake of palmitate into the cell in adriamycin cardiomyopathy, with a relatively maintained capacity for oxidative metabolism.

Animals

Extensive cutaneous plasmacytomas.

An unusual case of extensive cutaneous and subcutaneous plasmacytomas is reported. Breast involvement was also a feature in this individual. The relevant literature relating to this unusual presentation of myeloma is reviewed.

Breast Neoplasms

'Salvage atherectomy' for discrete arterial dissections resulting from balloon angioplasty.

OBJECTIVE: To review the outcome of attempted salvage atherectomy performed following failed balloon angioplasty at a single centre. DESIGN: Retrospective study. PATIENTS: All patients undergoing percutaneous directional atherectomy shortly after failed coronary or peripheral balloon angioplasty at St Paul's Hospital, Vancouver, British Columbia, are reported. INTERVENTIONS: Salvage atherectomy was performed in six patients following failed balloon angioplasty prior to hospital discharge. In each case, a discrete mural flap resulted in a compromised lumen and ischemia. MAIN RESULTS: Percutaneous directional atherectomy successfully recovered atheromatous intimal fragments with restoration of arterial patency in all patients. Media was identified in one specimen and adventitia in none. Perforation did not occur and there were no complications. One patient had documented restenosis and a second had a significant lesion at a more proximal site with a follow-up of four to 15 months (mean nine). Both patients underwent uncomplicated repeat balloon angioplasty without angiographical dissection. CONCLUSIONS: Salvage atherectomy has a limited--but still useful--role in the management of discrete, obstructive arterial dissection flaps complicating balloon angioplasty.

Adult

Right and left ventricular performance after single and double lung transplantation. The Toronto Lung Transplant Group.

Twelve single lung and nine double lung transplant recipients were studied before transplantation and at 3 months and 1 year after transplantation with serial right and left ventricular radionuclide angiograms. The resting right ventricular ejection fraction increased in the double lung recipients from 31% +/- 5% before transplantation to 43% +/- 11% at 3 months after transplantation (p less than 0.05) and then remained stable to 1 year. The single lung recipients also demonstrated a significant rise in ejection fraction from 25% +/- 11% before transplantation to 36% +/- 12% at 3 months after transplantation. Again, this remained stable to 1 year. The exercise right ventricular ejection fraction also showed a significant posttransplantation rise in the double lung recipients (p less than 0.005) that remained stable to 1 year. In the single lung recipients a trend was seen for a rise in the exercise right ventricular ejection fraction that did not reach statistical significance by 1 year after transplantation. Neither group had a significant change in rest or exercise left ventricular ejection fraction. The systemic blood pressure increased significantly by 1 year after transplantation in both groups. The heart rate increase with exercise at 3 months after transplantation was significantly greater in the single lung group (42 +/- 13 beats/min) than in the double lung group (14 +/- 13 beats/min) (p less than 0.005). These data indicate that a significant improvement in right ventricular function occurs after single and double lung transplantation.

Adult