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Biomedical subjects

R Casanova

Publications and source records attributed to R Casanova.

At least 19 recordsLinked to original sources
PubMed1992

Dose and test for dipyridamole infusion and cardiac imaging early after uncomplicated acute myocardial infarction.

To evaluate the relation of the dose of intravenous dipyridamole on results of thallium and echocardiographic testing, the results of standard- (0.56 mg/kg/4 minutes) versus high- (0.84 mg/kg/10 minutes) dose dipyridamole were obtained 9 +/- 3 days after uncomplicated acute myocardial infarction in 57 patients. New wall motion abnormalities were compared with redistribution of thallium imaging and results of discharge coronary angiography. The sensitivity of thallium in predicting the presence of multivessel coronary artery disease was significantly (p < 0.01) higher (85%) than echocardiography (53%) and was unaffected by the dose. However the sensitivity of echocardiography was better with the higher dose (53 vs 14%). Minor adverse effects occurred in 34 patients (59%) after receiving the high dose and only in 4 patients (7%) after the standard dose (p < 0.001). Thus, thallium-201 scintigraphy during standard-dose dipyridamole infusion is more effective than high-dose dipyridamole echocardiographic testing in safely identifying patients who could benefit from early invasive evaluation and therapy.

Angina Pectoris↗
PubMed1992

[Management and prognosis of acute myocardial infarct in advanced age: comparison of the cardiac intensive care unit and the cardiology ward].

The aim of this prospective study was to assess the prognostic and most suitable management of AMI in elderly patients (age > or = 75 years). From September 1988 to August 1991, 129 such patients (pts) were evaluated: 35 (27%) were admitted to CCU because of arrhythmias or severe hemodynamic complications; 94 (73%) were addressed, according to bed availability, to CCU (55 pts) or Cardiology Ward (39 pts), where all patients underwent continuous ECG monitoring for at least 72 hours. Age, gender, history of previous angina or myocardial infarction, presence of chest pain or ECG ischemia on admission, site and extent of AMI, delay on admission, CPK-MB peak, recurrent angina, arrhythmias, heart failure, emotional disorders, hospital mortality and length of hospital stay were compared. Our results show that elderly patients who suffered from complicated AMI were at high risk for death and severe in-hospital complications. No significant prognostic differences were observed between the two groups with uncomplicated AMI. Thus hospitalization in the Cardiology Ward seems to be valuable, safe and well tolerated in our population of elderly patients with AMI, and without initial complications.

Age Factors↗
PubMed1991

[Biological indicators of bacterial infection in newborn infants].

Biological markers of neonatal bacterial infection are useful if they bring early indications and if they are sensitive and specific. There are two kinds of tests: hematological signs and acute phase proteins. The most specific hematological signs are, in chronological order: leuconeutropenia--myelemia--neutrophilic polynucleosis. Gestational and post-natal ages have to be taken in consideration for correct interpretation of white cell count and differential. Several acute phase proteins increase in infected newborns: fibrinogen, C reactive protein, orosomucoïd. If determined quantitatively, C reactive protein is a sensitive, specific and early marker allowing, in addition, to follow the reaction to treatment: the return to normal range of CRP and later of orosomucoïd attest for recovery. These biological tests have to be sequentially determined during the first days in order to obtain a maximal information.

Aging↗
PubMed1991

Transcranial Doppler evaluation of cerebral infarction in the neonate.

We recorded cerebral artery flow velocities (CAFV) in two neonates with cerebral infarction, using transcranial Doppler sonography (TCD). Cerebral infarction was diagnosed by brain imaging. The arteries investigated were the middle cerebral artery (MCA), the internal carotid artery (ICA) and the anterior cerebral artery (ACA). The whole territory of right MCA was involved. A decrease in CAFV was noted in MCA and ICA of the affected side. Furthermore, early recordings of CAFV allowed us to distinguish perinatal infarction from antenatal infarction: in the former, Doppler signal was completely absent during the first days of life whereas in the latter, Doppler signal was reduced but present. The process of recanalization could be followed. The asymmetry of CAFV recorded in the neonatal period seems to persist definitively at least in MCA. These Doppler data correlate well with the evolutive stages of cerebral infarction shown by brain imaging. Beside US, CT and MRI scans, TCD may be a useful adjunct for identifying and following infants with suspected occlusion of major cerebral vessels.

Blood Flow Velocity↗
PubMed1991

[Thallium and echo- dipyridamole in the early selection of patients at risk after acute myocardial infarction. Which test? What dose?].

UNLABELLED: The optimal iv dose of Dipyridamole (Dip) in echocardiography (echo) or Thallium scintigraphy (Tl) remains undetermined. To select the high-risk patients (pts) subset, we performed echo and Tl with standard dose (SD) and high dose (HD) Dip infusion (0.56 mg/Kg/4'-0.84 mg/Kg/10' respectively) in 40 pts 9 +/- 3 days after admission for acute myocardial infarction (AMI). Of these, 38 pts had coronary artery disease at angiography and 2 had no significant lesions. Worsening in regional wall motion on echo and reversible perfusion defects on Tl were considered abnormal patterns. SD had no side effects; only in one pt was ischemic ventricular dysfunction detected on echo, whereas Tl redistribution was found in 24 pts (12 had multivessel disease and 12 had one coronary stenosis greater than or equal to 70%). HD caused adverse reaction in 24 pts, did not enhance SD-Tl sensitivity, but induced abnormal echo in 18/24 pts with transient defects on SD-Tl. Eleven of the 16 Tl negative pts had occlusive disease, 3 had one vessel disease and 2 showed no evidence of coronary artery disease. IN CONCLUSION: SD is safe but often provokes a submaximal coronary vasodilation. Failure to detect ischemia on echo may be explained by this. SD-Tl is, however, able to identify high-risk pts who may benefit from early myocardial revascularization. HD does not enhance SD-Tl sensitivity, but it is necessary to induce echo abnormalities which are all too often undetectable at SD.

Adult↗
PubMed1990

[Contribution of transcranial Doppler sonography to the diagnosis of brain death in children].

Brain death can be characterized by cessation of cerebral blood flow. We have measured blood flow velocity in cerebral arteries of 17 comatous children with a transcranial pulsed Doppler equipment. In 11 children who progressed to brain death, we have recorded a progressive decrease of Doppler signal with the following steps: decrease of diastolic velocity, no diastolic velocity, reverse diastolic flow, decrease of systolic signal, no signal at all. In the 6 surviving children (all except one with severe deficits), after an initial reduction but never to a retrograde flow, arterial cerebral blood flow velocity increased to high diastolic values before normalization. Transcranial Doppler technique is non invasive, reliable, can be used at the bedside and repeated; it allows evaluating the cerebral blood flow in comatous children and represents a useful adjunct to brain death diagnosis.

Brain Death↗
PubMed1990

Response of patients with hemophilia A and von Willebrand disease to desmopressin (DDAVP).

Factor VIII (FVIII) response to desmopressin (deamino-8-D-arginine vasopressin, abbreviated DDAVP) was studied in patients with mild Hemophilia A and von Willebrand Disease (vWD) who attend our Hemophilia Clinic. Thirty eight children and 9 adults had their F VIII components assayed 60 minutes after intravenous (IV) administration of DDAVP, 0.35 microgram/kg. Among 27 hemophiliacs, F VIII coagulant activity (F VIII: C) increased from a mean of 16.8 to 59.2 u/dL; with an average 3.2-fold increase. In 20 vWD patients, the mean F VIII:C and von Willebrand Factor increased from a mean of 50.1 to 136%; and from 22.6 to 75.6%; with an average 3.0 and 5.7-fold increase, respectively. The overall F VIII:C response was good or excellent in 81.5% of the hemophiliacs, and in 89.5% of the vWD patients tested. No significant side effects were observed. This study has demonstrated that IV DDAVP can cause an increase of F VIII:C and vWF to hemostatic levels, and thus it may be useful for the control of bleeding episodes in most of the patients tested in our clinic.

Adult↗
PubMed1990

Therapy for pediatric aplastic anemia; 7 years experience at the Puerto Rico Pediatric Oncology Program.

Nine pediatric patients with aplastic or hypoplastic anemia were seen at the Pediatric Hematology-Oncology service of the University of Puerto Rico, from 1980 to first trimester of 1987. Included were eight males and one female ranging from twenty months to sixteen 8/12 years (mean 13 years). Hematomas and fever were the most common complaints. The interval since the first symptoms and the diagnosis varied from one day to one week. The peripheral cell count was abnormal in all patients; pancytopenia being the most common finding. Five of seven who received antithymocyte globulin (ATG-AM), showed improvement in their peripheral count. The median time interval from the end of ATG-AM and response was two months (range 2 weeks to 15 months).

Adolescent↗
PubMed1989

Sutured retropupillary posterior chamber intraocular lenses for exchange or secondary implantation. The 12th annual Binkhorst lecture, 1988.

The histopathologic findings of four eyes obtained postmortem with iris-sutured posterior chamber intraocular lenses (PC IOLs) are described. These IOLs were implanted as exchange procedures. In most instances, the loops were not situated in the ciliary sulcus but rather were suspended behind the iris and ciliary body. Therefore, the primary mechanism of fixation of iris-sutured PC IOLs appears to be the sutures themselves rather than adherence to the ciliary tissues. This report of four eyes is preliminary, but the pathologic analysis, showing few significant lesions attributable to the IOL, provides a reason for optimism for using this technique. A long-term clinical study comparing the results of sutured PC IOLs with those of anterior chamber IOLs (AC IOLs) used in secondary or exchange implantation, as well as collection and analysis of more pathologic specimens, should provide a more definitive answer as to the preferred procedure.

Aged↗
PubMed1989

[Myocardial scintigraphy using 201-thallium and 2-dimensional echocardiogram after dipyridamole infusion in the early evaluation of post-infarct residual ischemia].

Dipyridamole thallium scintigraphy (TI-DP) and dipyridamole two-dimensional echocardiography (Echo-DP) were performed on 38 patients (pts), 11 +/- 4 days after acute myocardial infarction. Our study intends to assess whether or not imaging methods are useful both in identifying residual jeopardized myocardium and in selecting pts for coronary angiography. No serious side effects were induced during the DP test. In 11 pts angina was not induced, worsening of wall motion abnormalities was not detected on Echo-DP; no reversible defects were found on TI-DP. The remaining 27 pts who showed transient defects on TI-DP underwent coronary angiography. All pts had either multivessel coronary disease or severe single-vessel disease and myocardial revascularisation was performed in all of them. Of these 27 patients, only 5 suffered angina and showed ST-T depression; only in 15 dyskinetic wall motion development was detected on Echo-DP. Finally we can conclude: the DP-test can be safely performed in the early post-infarction period; both the reported imaging methods enable the identification of jeopardized myocardium even if with different ranges of sensitivity; pts negative to both TI-DP and Echo-DP can be safely followed without coronary angiography; pts with transient defects on TI-DP can be reasonably referred to coronary angiography.

Adult↗
PubMed1988

Clinical evaluation of flap viability with a dermal surface fluorometer.

A dermal surface fluorometer was used to monitor vascular perfusion in 22 patients who underwent reconstructive surgical procedures with a variety of flaps (e.g., skin flaps, musculocutaneous flaps, fasciocutaneous flaps, and Z-plasties). Sodium fluorescein (1.5 mg per kilogram of body weight) was administered intravenously at the completion of the operative procedure. Quantitative fluorescence readings were obtained at different points in each flap by means of the surface fluorometer (Fluoroscan). The readings were taken at several time intervals and compared with those of normal skin (control). A perfusion ratio was determined in each case according to the following formula: flap reading/(normal skin control reading X 100). Partial necrosis occurred in 4 patients, correlating with low fluorescein perfusion measurements. From our findings, it appears that a perfusion ratio of 15% or greater 10 minutes following injection will accurately predict tissue viability. No systemic reactions were observed in these patients. We believe that this minimally invasive technique should be of considerable assistance in the postoperative evaluation of flap viability.

Adult↗
PubMed1987

Microarterial sutureless sleeve anastomosis using a polymeric adhesive: an experimental study.

A new technique for microarterial sutureless anastomosis that involves telescoping one vessel into the other and placing a microdrop of a polymeric adhesive (iso-propyl-cyanoacrylate) is described. Sixty-six anastomoses were performed in rat femoral arteries with a patency rate of 95 percent. Light and electron microscopic studies were conducted at regular intervals, starting immediately to 90 days postoperative. From this experimental study, it appears that the described method of anastomosis is faster and easier to perform and at least as reliable as the conventional end-to-end suture anastomosis. In addition, it was observed that tissue reaction to the glue remained primarily adventitial and did not disturb vessel patency.

Animals↗
PubMed1986

Craniofacial reconstruction after tumor resections using vascularized outer table calvarial bone flaps.

The outer table of calvarium is a useful donor site for facial reconstruction after resection of tumors. Large defects, especially when associated with multiple operations and radiotherapy, are poor recipient beds for nonvascularized bone grafts. A technique for the transfer of vascularized outer table has been developed and used in 11 patients for reconstruction of tumor defects. Satisfactory correction of both functional and esthetic problems has been achieved with satisfactory long-term stability and low morbidity.

Adolescent↗