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Biomedical subjects

R Villavicencio

Publications and source records attributed to R Villavicencio.

At least 19 recordsLinked to original sources
PubMed1992

Magnum/Magnarail versus conventional systems for recanalization of chronic total coronary occlusions: a randomized comparison.

The Magnum/Magnarail system consists of "over-the-wire" balloon catheters and a 0.021 inch (0.53 mm) guide wire with a 1 mm olive-shaped tip. To compare it to conventional systems, 100 consecutive unselected patients with chronic total coronary occlusions were randomly assigned to one of two groups. If the balloon could not be placed within 20 minutes of fluoroscopy time with the allocated system, a crossover to the other system was imposed. The Magnum group comprised 50 patients and 52 occlusions, and the conventional group included 50 patients and 51 occlusions. There were no significant differences with regard to the length of the occlusions (Magnum 1.4 +/- 1.3 mm, conventional 1.6 +/- 1.7 mm) or the duration (Magnum 1.4 +/- 1.9 months, conventional 1.4 +/- 1.8 months). The primary success rate before crossover with the Magnum/Magnarail system was 67% versus 45% with conventional systems (p less than 0.05). The Magnum/Magnarail system as a second tool after crossover was successful in 11 of 28 patients (39%) versus 2 of 16 patient (12%) in whom success was achieved with a conventional system as a second tool (p less than 0.05). An increase in the creatine kinase level (more than twice normal) was seen in one patient (2%) in the Magnum/Magnarail group and none in the conventional group. Q wave infarctions were not seen. There was one in-hospital death (2%) in the conventional group. There were no significant differences with regard to the number of guiding and balloon catheters or fluoroscopy time. The Magnum/Magnarail system proved superior to conventional systems for balloon recanalization of chronic total coronary occlusions in terms of higher success rates.

Aged↗
PubMed1991

Coronary balloon angioplasty through diagnostic 6 French catheters.

We investigated the use of ultralow profile balloon catheters (Scimed ACE, USCI Probe, Cordis, Orion) for coronary angioplasty through 6 French diagnostic catheters (Schneider, Cordis). Contrast injection was assisted with a Hercules pump (Cordis) in all cases. During 21 procedures, angioplasty of 27 lesions in 20 selected patients was attempted (1.3 lesion/procedure). Twelve lesions were in the right, 10 in the left anterior descending, and 5 in the left circumflex coronary artery. Balloon size varied between 2.5 and 3.5 mm. Twenty lesions could be successfully dilated (74%) through the 6 French catheter and 7 lesions required an exchange to a 7 French angioplasty guiding catheter. For 5 cases, another balloon was also necessary to complete the procedure. The final overall success rate was 100% per patient and per lesion and there were no major complications. Despite the small internal catheter lumen (1.22 mm) coronary visualization was adequate, and mechanical support was good. Failures of 6 French catheters were attributed to insufficient torque control and excessive friction when the balloon crossed the tapered end of the diagnostic catheter. Coronary angioplasty through a diagnostic 6 French catheter is feasible and may represent a reasonable alternative for simple cases that are done during the same session as the diagnostic angiography. Once available, 6 French high flow angioplasty guiding catheters without a tapered tip should improve success while retaining the advantage of a small femoral puncture site.

Angiography↗
PubMed1991

Coronary angioplasty with 7F guiding catheters.

The performance of 7F guiding catheters for percutaneous transluminal coronary angioplasty (PTCA) was investigated in 300 patients. A total of 233 patients had single-vessel PTCA and 67 had multivessel PTCA. Angioplasty was attempted for 371 lesions (141 [38%] in the left anterior descending, 124 [33%] in the right coronary artery, and 95 [26%] in the left circumflex coronary artery or their branches; 10 [3%] in a bypass graft, and one in the left main stem). The mean degree of stenosis was 86 +/- 11% (range 60% to 100%). The monorail technique was used in 83%, and balloon-on-a-wire devices were used in 6% of cases. The balloon sizes varied between 2.0 and 4.25 mm. There was a 98% technical success rate for the 325 nontotal lesions. Five could not be crossed with the wire. Exchange to an 8F guiding catheter was done in four cases (1.2%) and yielded success in two of them. In 46 occlusions the success rate was 72%. Nine were failures due to an inability to cross the wire, another two were balloon failures, and in two cases the residual stenosis was greater than 50%. The mean residual stenosis of successful cases was 24 +/- 18%. Overall, the primary success rate was 95%. The complications were: in-hospital death in five patients (1.7%); infarction in 12 (4%); emergency bypass surgery in one; and significant inguinal hematoma in five (1.7%). Coronary angioplasty through 7F guiding catheters yields a high success rate with less coronary wedging and a smaller puncture hole.

Angioplasty, Balloon, Coronary↗
PubMed1991

Coronary angioplasty with second generation Monorail catheters.

The Monorail system (Schneider) consists of a balloon catheter in which the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the length of the guiding catheter. It offers distinct advantages over conventional systems of coronary angioplasty. It facilitates contrast injections and permits rapid balloon exchanges. This system was used for coronary angioplasty in 273 unselected consecutive patients (age 59 +/- 10, mean 35 to 73 years). There were 216 patients (84%) undergoing single-vessel and 57 patients (16%) with multi-vessel coronary angioplasty. A total of 335 coronary stenoses were dilated, which included 35 total occlusions. The size of balloon used ranged from 2.0 to 4.25 mm (3.0 +/- 0.5 mm) and the severity of stenosis was 85 +/- 11%. Technical success was defined as a residual stenosis of less than 50% as determined angiographically. Clinical success was defined as technical success, and absence of a major inhospital complication defined as absence of myocardial infarction, lack of need for coronary arterial bypass surgery, and survival. The Monorail system was technically successful in 294/300 stenotic lesions (98%). It was clinically successful for 281 lesions (94%). Of the 35 total occlusions, technical success was obtained in 25 (71%). The residual stenosis of successful cases was 26 +/- 21%. The Monorail system was also successful in 5 patients with stenosis of more than 90% in whom conventional systems failed. The complications included acute occlusion causing acute myocardial infarction in 13 cases (5%), emergency coronary arterial bypass surgery in 1 patient (0.4%), and death in 4 patients (1.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Esthesioneuroblastomas. Could a preoperative chemotherapy improve their prognosis?].

The prognosis of malignant tumours of the olfactory epithelium of the nasal vault stays very poor. In the literature, the 5-year actuarial survival rate ranges between 50% and 65%; the 5-year recovery rate is 15% due to the high frequency of locoregional reoccurrences (60%) and metastasis (35-40%). Up to now chemotherapy was suggested as palliative treatment; but as Esthesioneuroblastomas (ETNB) appear to be sensitive to several chemotherapeutic agents (such as CDDP and 5-FU), we have decided to administer, from now on, to all patients harbouring an ETNB, an inductive chemotherapy whatever the staging and eventual diffusion of the tumour. The present paper presents our recent experience, dealing with such lesions: since 1984, 60 tumours of the ethmoid were treated in our department among which 7 ETNB (11.5%). We discuss our results concerning ETNB.

Adult↗
PubMed1989

Long-term hemodynamic effects of ketanserin, a 5-hydroxytryptamine blocker, in portal hypertensive patients.

Ketanserin, a 5-hydroxytryptamine-2 receptor blocker, has been shown to decrease portal pressure in recent acute hemodynamic studies that have been performed both in experimental animals and portal hypertensive patients. The present study was designed to investigate the effects of chronic oral administration of ketanserin in portal hypertensive patients with cirrhosis. The mean baseline hepatic venous pressure gradient in the 13 patients with alcoholic cirrhosis who completed the study was 15.7 +/- 2.7 mmHg. It decreased significantly to 13.3 +/- 2.0 mmHg (p less than 0.001) after ketanserin was administered at a mean dose of 51 mg per day for a mean period of 32 days. This 14.6% reduction in hepatic venous pressure gradient resulted mainly from a decrease in mean wedged hepatic venous pressure (from 22.2 +/- 4.0 to 20.1 +/- 3.6 mmHg) and was accompanied by significant decreases in cardiac index (18.8%) and in mean arterial pressure (8.1%). However, changes in cardiac index or in mean arterial pressure were not predictive of modifications in the hepatic venous pressure gradient. Eight of 16 patients entered in the study developed side effects, the most significant being a reversible portosystemic encephalopathy, which occurred in three patients who had poor liver function. This study confirms evidence in favor of a role for 5-hydroxytryptamine in portal hypertension and adds a new group of agents for the chronic treatment of portal hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1987

Coronary artery aneurysms in Kawasaki disease: the Puerto Rican experience.

Kawasaki disease is a newly recognized clinical entity of unknown origin that occurs in the pediatric age and is characterized by multisystemic involvement. Pathologically, widespread vasculitis is present and approximately 10 to 20% of affected children have coronary aneurysms. The latter are mostly silent but 1-2% of them progress to coronary artery obstruction and death from myocardial infarction. Such aneurysms can be visualized by echocardiography and 50% of them apparently resolve, although in some cases, residual coronary artery damage persists after resolution of the aneurysm. The local experience with 116 patients of KD is reported. In only 4 of them significant coronary artery involvement was present. They all remained asymptomatic, the affected arteries were slowly recovering and no fatalities were present. The low incidence of coronary aneurysms and the uneventful course of the disease suggests a milder, less virulent course of KD in our environment. Residual changes in the affected coronary arteries are considered a late risk factor for coronary artery disease in man.

Adolescent↗