Biomedical subjects
R Tager
Publications and source records attributed to R Tager.
Long-term follow-up of rheumatic patients undergoing left-sided valve replacement with tricuspid annuloplasty--validity of preoperative echocardiographic criteria in the decision to perform tricuspid annuloplasty.
Between September 1989 and December 1991, modified De Vega tricuspid annuloplasty was performed in 43 patients who survived surgery for mitral or mitral plus aortic valve replacement. The preoperative indications for tricuspid annuloplasty were moderate to severe tricuspid regurgitation (TR) in 33 patients and mild or no TR but with a dilated tricuspid annulus (> or =30 mm) as measured by 2-dimensional echocardiography at end-diastole in 10 patients. The mean age was 31 +/- 13 years. The mean duration of follow-up was 57 +/- 18 months. Overall long-term mortality was 12%. On Doppler color flow mapping, postoperative severe TR was present in 1 patient and moderate TR in 4 patients at latest follow-up. The tricuspid annulus diameter decreased from 37 +/- 5 mm preoperatively to 24 +/- 6 mm at latest follow-up. During the study period, an additional 77 patients underwent mitral valve replacement or double valve replacement, but without tricuspid annuloplasty. Within this group, 38 patients had a preoperative tricuspid annulus diameter of > or =30 mm, and 5 of these patients (13%) developed moderate or severe TR in the postoperative period, which may have been prevented had clinicians adhered to the preoperative indications for tricuspid annuloplasty. Thus, preoperative echocardiographically documented moderate or severe TR or a tricuspid annulus diameter of > or =30 mm are valid indications for performing tricuspid annuloplasty; modified De Vega tricuspid annuloplasty is a durable procedure in rheumatic patients; it appears that reducing the diastolic tricuspid annulus diameter to 24 mm is adequate to prevent residual TR in the long term.
Repeated automated versus daytime ambulatory blood pressure measurement in mild, moderate and severe untreated black hypertensive patients.
OBJECTIVE: To examine the extent to which one session of repeated automated (30-45 min) blood pressure measurements in non-treated, hypertensive patients can be used to predict daytime ambulatory blood pressure (ABP). METHODS: Two hundred untreated black hypertensive patients (mean age 50.2+/-11.2) were retrospectively stratified on the basis of the daytime ambulatory diastolic blood pressure (DBP) into mild, moderate and severe hypertensives (90 mmHg <DBP < 140 mmHg). Office blood pressure was determined at 3 min intervals for a total of 30-45 min using the Dinamap Critikon 1846 SX monitor. Twenty-four hour ambulatory blood pressure (ABP) was performed on the same day in all patients using a SpaceLabs 90207 device. RESULTS: The mean diastolic Dinamap measurements compared with the mean ambulatory daytime DBP were very similar in terms of 'traditional' statistics (mean: 114 +/- 14.6 versus 113 +/- 12 mmHg, correlation: 0.80). However, agreement analysis according to Bland and Altman showed a poor agtreement with an error as high as 19 mmHg. The mean systolic Dinamap measurements compared with the mean ambulatory daytime SBP were significantly overestimated (mean: 185 +/- 25.0 versus 170 +/- 19.3 mmHg, correlation 0.82) and the error was as high as 43 mmHg. On residual analysis, 75% of the diastolic Dinamap values and only 35% of the systolic Dinamap measurements were within an error of +/- 10 mmHg. The average of the first five Dinamap measurements had the greatest predictive ability for the daytime ABP. CONCLUSION: As a result of the poor agreement between the two methods, we suggest that, from the clinical point of view, the two techniques should be treated as two separate entities.
Effectiveness of enalapril in combination with low-dose hydrochlorothiazide versus enalapril alone for mild to moderate systemic hypertension in black patients.
The importance of concomitant low-dose hydrochlorothiazide was assessed in black hypertensive patients treated with enalapril. Left ventricular (LV) mass and function, metabolic parameters, 24-hour ambulatory blood pressure (BP), exercise duration, and systolic BP response were evaluated before and after drug therapy. Enalapril 20 mg (group 1) or enalapril 20 mg plus hydrochlorothiazide 12.5 mg (single tablet; group 2) was given to 38 patients for 9 weeks in a double-blind, placebo-controlled, randomized study. LV mass measured 61 +/- 17 versus 102 +/- 23 g/m2, and 24-hour ambulatory BP measured 120 +/- 8/75 +/- 6 versus 155 +/- 12/100 +/- 6 mm Hg in matched control subjects (n = 40) versus hypertensive patients, respectively. No clinically important changes occurred in total cholesterol, serum uric acid or potassium in either group. Enalapril slightly reduced 24-hour ambulatory BP from 154 +/- 15/100 +/- 7 mm Hg to 148 +/- 19/96 +/- 11 mm Hg after treatment (p < 0.05 for systolic BP); systolic BP load (70% to 59%, p < 0.05), and diastolic BP load (67% to 60%, p = NS) decreased. Baseline BP decreased from 157 +/- 9/101 +/- 6 to 132 +/- 13/86 +/- 8 mm Hg (p < 0.0001); systolic BP load (64% to 29%, p < 0.0001), and diastolic BP load (64% to 33%, p < 0.0001) decreased in group 2. Exercise systolic BP was attenuated (p = 0.007, group 2; p = NS, group 1) and duration increased (p = NS) only in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)
Improved cognition after external carotid endarterectomy.
Recent clinical results support the conclusion that internal carotid endarterectomy not only serves as a prophylactic measure against catastrophic stroke, but may improve cognitive functioning as well. Improvement in cognitive testing after internal carotid endarterectomy has been amply substantiated in recent literature. 3, 4, 5, 8, This report illustrates that improvement in cerebral blood flow by any means is equally effective in improving cerebral function.
Neurological decompression sickness: report of two cases at minimal altitudes with subsequent seizures.
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