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Biomedical subjects

R Hidalgo

Publications and source records attributed to R Hidalgo.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Functional capacity and rhythm changes after atrial correction of transposition of great arteries].

A group of 12 patients, previously submitted to atrial correction of the transposition of the great vessels, were studied through stress test with direct metabolimetry and Holter to assess aerobic functional capacity and its relationship with conduction disturbances. The results were compared with those obtained with a control group of 23 non athletic healthy children. All the patients showed amputation of their heart rates on effort, though this parameter and the oxygen consumption were normal at low work load levels. The VO2 at anaerobic threshold, the maximum VO2, and the maximum work load were also decreased in most of the patients. Holter studies demonstrated sick sinus syndrome in nine of them. Aerobic functional capacity was reduced in most of the patients with atrial correction of the transposition of the great vessels. The amputation of the heart rate on effort is a common finding though its relationship with the decrease of the aerobic functional capacity in these patients is limited. Finally, the stress test is probably more sensible than Holter for the detection of slight degrees of sinus disfunction.

Adolescent↗
PubMed1990

[Postoperative left ventricle-right auricle fistula: a case report].

We present a case of a postoperative left ventricular--right atrial shunt in a 46 year-old patient operated for aortic valvulopathy. Through two-dimensional echocardiography and hemodynamic studies a communication between the left ventricle and the right atrium was observed. We review the literature about this rare anomaly.

Cardiomyopathies↗
PubMed1990

Utility and tolerance of stress testing in geriatric patients.

OBJECTIVES: To determine the sensitivity and specificity of stress testing in geriatric patients and to estimate the tolerance of these patients to exercise. DESIGN: A prospective study done in two populations with different ages. SETTING: Cardiologists and a stress testing laboratory. PATIENTS: Persons with ages above and under 65 years who were admitted in our center and submitted to stress testing and coronary angiography for suspicion of ischemic heart disease. PROCEDURES: All stress tests were performed on a Siemens Elama cicloergometer model 380-B adapted to a Hewlett Packard 1517 A ECG recorder. Our protocol started with an initial work load of 30 Watts with increments of other 30 Watts every three minutes. A 12 lead ECG was registered at rest, at maximum effort and in the recovery phase (approx. eight minutes after maximum effort). Three leads ECG's (V2, aVF, V5) were registered every three minutes. Stress finishing criteria were: symptom's limited, fatigue and maximum heart rate (220-age). Blood pressure was also controlled every three minutes during exercise and every two minutes during the recovery phase. Coronary angiographies were performed on a Siemens Cardoskop U (cine) using the Judkins technique. Left anterior oblique, right anterior oblique and postero anterior projections were used in all the procedures. RESULTS: Stress testing presents high sensitivity and low specificity in geriatric patients. A good tolerance to exercise was observed in this group of patients. CONCLUSIONS: A similar sensitivity was observed in the stress tests performed by patients with ages above and under 65 years. Sensitivity seems to be related to the severity of the coronary lesion. On the other hand stress testing presented a lower specificity in the geriatric patient. Finally, good tolerance to exercise was observed in patients older than 65 years.

Aged↗
PubMed1990

[Aneurysm of interauricular septum associated with mesosytolic click].

An echocardiographic study was performed to a patient with symptoms of cardiac failure and midsystolic click confirmed by phonocardiography. The echocardiograms suggested an incipient dilated myocardiopathy and also atrial septal aneurysm. We report the relationship between midsystolic click and atrial septal aneurysm.

Heart Aneurysm↗
PubMed1989

[Coronary ectasis: another form of atherosclerosis].

In a review of 3,693 coronary angiographies carried out in our department for suspected coronary artery disease we evaluated the 69 patients (1.86%) in whom lesions of coronary ectasia were found. Most of them (n = 51) had associated stenotic lesions and only 18 patients had isolated ectasia. The most common localization of the 96 ectasia lesions found in these patients was the right coronary artery, followed by the left anterior descending and, finally, the circumflex coronary artery. The ectasia lesions were classified according to the morphological classification proposed by Ducceschi in the following types: I) fusiform; II) saccular; III) spherical; IV) linear or diffuse, and V) mixed. Most lesions in our series were diffuse. Regarding clinical features, significant differences were found in the higher incidence of atypical angina presentation in those patients with isolated ectasia lesions.

Aged↗
PubMed1989

[Sensitivity and specificity of the exertion test in elderly patients].

One hundred and fifty four patients who presented at our Institution for suspected coronary artery disease were evaluated. They were divided in two groups: A) 77 patients older than 65 years (X = 68.35 +/- 2.99 years), and B) 77 patients younger than 65 years (X = 51.01 +/- 7.50 years). Diagnostic exercise test and coronary angiography were performed in all. Most tests in both groups were terminated due to physical exhaustion (71% and 74% in groups A and B, respectively). During the exercise test there was a higher incidence of ventricular premature beats and lower limb pain in the older group, while angina was more common in the younger group. The overall sensitivity of the test was similar in both groups (88%), with a high prevalence in both (86% in group A and 78% in group B). The sensitivity regarding the extension of coronary artery disease was higher for the detection of one-vessel disease in the younger group (76% vs 63%), while it was higher in the older group for the detection of two and three-vessel disease (86% and 91% vs 84% and 80% in the younger group).

Aged↗
PubMed1989

The extended digitorum brevis muscle flap.

The anatomy of the anterior tibial artery was studied in eight fresh cadavers. Consistently no major branches were found to the long toe extensor or anterior tibial muscle in the segment 15 cm preceding the lateral malleolus. This allowed the use of the extensor digitorum brevis muscle on a long anterior tibial vascular pedicle following release of the extensor retinaculum. The longer pedicle made this reliable muscle flap suitable for coverage of mid and lower tibial defects, in addition to ankle defects, as an alternative to free flaps. Its use is described in three complex cases.

Aged↗
PubMed1989

Stress testing in patients one year after orthotopic cardiac transplantation.

To evaluate the circulatory response of the denervated heart to exercise, the authors studied 15 patients with an orthotopic transplanted heart (TH). Mean age was 48 +/- 10 (range twenty-five to sixty-two) years. All patients underwent a symptom-limited bicycle stress testing following a continuous protocol increasing the work load by 30 watts every three minutes. Exercise test was performed 16 +/- 9 months after operation. Fifteen healthy subjects matched for age were used as the control group. There were significant differences (p less than 0.01) in heart rate, at rest, peak exercise, and at five minutes of the recovery period, in maximal oxygen consumption (VO2 max) and in duration of exercise between TH patients and controls. Synchronization between recipient and donor sinoatrial nodes was observed in 10 of 15 patients. A case of silent myocardial ischemia was also observed in a patient with vasculitis and acute rejection. In conclusion, the lack of neural control in TH patients allows them to maintain a normal resting cardiac output but precludes attaining a normal maximum oxygen uptake, despite a normal contractile state. The high resting heart rate due to parasympathetic denervation constitutes an important limiting factor for an adequate chronotropic reserve. Functional capacity of transplanted patients is slightly impaired, but it does not preclude a good quality of life.

Adult↗
PubMed1989

Stress testing in patients with coronary spasm: comparison of those with and without fixed coronary artery disease.

Stress testing is one of the preferred noninvasive methods of identifying patients with coronary artery disease (CAD). Its value in patients with coronary artery spasm (CAS) is, however, difficult to ascertain. The authors studied 91 consecutive patients with angiographically documented CAS. All patients underwent a symptom-limited bicycle exercise test before coronary angiography. Eight patients (8.8%) showed ST-segment elevation during exercise; 37 (40.7%), ST-segment depression; and 46 (50.5%), no changes. Thirty patients had normal coronary arteries; 19, one-vessel disease; 19, two-vessel disease; and 23, three-vessel disease. Stress testing yielded abnormal results in 7 of 30 patients (23%) with no CAD and in 38 of 61 (62%) with fixed CAD (p less than 0.01). ST-segment response to exercise did not correlate with most clinical findings such as age, type of angina, duration of pain episodes, or the degree of disease activity. However, a significant correlation was found with the extent and severity of CAD. Absence of ST changes or ST-segment elevation did not differentiate those patients with or without CAD, but only 4 of 37 patients with ST-segment depression had no significant fixed lesions. In conclusion, half of the patients with CAS had a normal stress test. ST-segment elevation is an uncommon finding in these patients and does not reliably differentiate those with and without fixed CAD. The only relevant finding of stress testing in CAS patients is ST-segment depression, which strongly suggests the presence of underlying CAD.

Angiography↗
PubMed1989

[Left ventricular diverticulum at the subaortic level].

We report a case of a left ventricular diverticulum located immediately under the aortic valve ring. The patient presented both aortic insufficiency and stenosis, and was submitted to valve replacement surgery and closure of the diverticulum. The peculiarity of this case relies on its non atherosclerotic etiology, its unusual location and also because of the calcification of the diverticulum's wall.

Aortic Valve Insufficiency↗
PubMed1989

[Vascular effects of spinal cord electrostimulation. Possible mechanisms of action].

Spinal cord stimulation has been demonstrated to be effective in the treatment of peripheral arteriopathies where neither medical nor surgical treatment is possible. Although there are various theories proposed, the mechanism of action is not yet clear. We studied the changes in transcutaneous PO2 as well as the sympathetic and parasympathetic cardiac activity in 42 patients with peripheral arteriopathies treated with spinal cord stimulation. Transcutaneous PO2 measured in percentage values showed a statistically significant increase 15 minutes (p less than 0.05) and 60 minutes (p less than 0.01) after generator connection. Disconnection produced a gradual decrease of transcutaneous pO2 with a minimal value at 70-180 minutes, maintained for various hours above basal values. The study of the changes in the expiratory/inspiratory quotient of the heart rate during spinal cord stimulation did not show any statistically significant differences with respect to a control group of healthy subjects. This demonstrates a preservation of parasympathetic activity. While studying the changes in heart rate from the decubitus to orthostatic position, the spinal cord stimulation group behaved similar to the group of patients who, for having undergone heart transplantation, had complete cardiac denervation the difference being statistically significant. The results obtained can clear up some questions as to the mechanisms of action of spinal cord stimulation and explain the clinical improvement obtained in this type of treatment for peripheral arteriopathies.

Arm↗
PubMed1989

[Value of the stress test in patients with coronary spasm].

UNLABELLED: Ninety-one consecutive patients with angiographically documented spasm who performed a bicycle stress test within one week before diagnostic coronary angiography are studied. Stress test induced ST elevation in 8 patients (9%), ST depression in 37 (41%) and no ST shifts in 46 (50%). ST response to exercise did not correlate with any of the clinical variables assessed except for coronary anatomy. ST depression was a highly specific sign of underlying coronary lesions, with a high positive predictive value (89%). Patients were stratified according to the type of angina and their post-test probability of significant coronary disease was calculated following Bayes' theorem. The post-test likelihoods of significant coronary stenosis (positive and negative test, respectively) were: 82 and 37% for patients with angina at rest; 90 and 53% for those with effort angina, and 98 and 85% for those with mixed angina. IN CONCLUSION: 1) stress testing in patients with coronary spasm correlates well with coronary anatomy; 2) ST depression strongly suggests the presence of underlying coronary stenosis; 3) stress testing is especially useful in patients with angina exclusively at rest.

Adult↗
PubMed1988

Palmar-plantar erythrodysesthesia syndrome associated with short-term continuous infusion (5 days) of 5-fluorouracil.

A case of palmar-plantar erythrodysesthesia syndrome (PPES) observed during a 120-h infusion of 5-fluorouracil (5-FU) is presented. This syndrome has been described in the literature after protracted infusion chemotherapy of over 30 days. The agent most frequently associated with this syndrome was 5-FU. A 53-year-old man was admitted to the hospital with a well-differentiated squamous cell carcinoma of the retromolar trigone. The patient received 100 mg/m2 of cisplatin on day 1 and 120-h continuous infusion of 1000 mg/m2 of 5-FU every 3 weeks. After the second course, the patient developed clinical features consistent with PPES. This side effect has not been previously reported with short-term (5-day or 120-h) continuous infusion of 5-FU. Less frequently, the syndrome has also been described with 10-day continuous infusion. The etiopathogenesis of PPES is unclear, but it seems to be dose-dependent and probably related to cutaneous drug accumulation.

Carcinoma, Squamous Cell↗