Biomedical subjects
S Klugmann
Publications and source records attributed to S Klugmann.
[Systemic thrombolysis contraindicated or ineffective in acute myocardial infarction: conventional therapy or mechanical revascularization or emergency surgery?].
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[Coronary stenting: indications and results].
Intracoronary stenting has been introduced to overcome the 2 main limitations of balloon angioplasty:acute vessel closure and late restenosis. Palmaz-Schatz stent is today the most diffuse prosthesis; the incidence of subacute occlusion and of restenosis reported by various Authors are acceptable. The risk of major complications however is definite and anticoagulation mandatory. Only controlled clinical studies and improvements in the stent design and in the knowledge of thrombotic processes will permit an enlargement of stent indications.
[Coronary angioplasty in the aged: short and long term efficacy in patients with unstable angina].
Coronary revascularization procedures in elderly patients are associated with an increase of perioperative complications and death in comparison with younger patients. To assess if a conservative coronary angioplasty approach is useful, 54 consecutive patients (pts) with severe unstable angina were retrospectively evaluated. Mean age was 73 years (range 70-82 years). Multivessel coronary disease was present in 26 pts (48%), angina at rest within the last 2 days in 26 (48%) and an episode of myocardial infarction within 2 weeks in 21 (38%). In 51 cases, regardless of the extension of the coronary disease, only the stenosis considered "culprit" of the symptoms, as assessed by angiography and by noninvasive studies, was dilated. The angiographic success rate was 98% (53 of 54 pts). Two pts had procedure--related myocardial infarction. One patient died after emergency bypass surgery for an abrupt left anterior descending artery occlusion. The mean hospital stay was 8 days (range 2-40 days) and in 75% cases was less than 6 days. Follow-up (achieved in 51 pts) ranged from 1 to 40 months (mean 20 months). In 3 pts a second vessel was treated with a new angioplasty 15-30 days after the first procedure due to the persistence of symptoms. During follow-up three pts died (1 death was cardiac). Of the survivors, 35 were asymptomatic in moderate medical regimen, 1 required bypass surgery and 3 were managed with repeat angioplasty. Survival was 95% at 6 months and 90% at 2 years. At six months 86% of pts were event free (80% and 70% at one and two years, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
[Unstable angina again].
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[Coronary angioplasty in Italy: why the delay?].
Percutaneous transluminal coronary angioplasty is a new-surgical therapy for the treatment of obstructive coronary artery disease. It has rapidly assumed a definitive role. Indeed, in the US alone more than 170,000 procedures were carried out in 1987. This form of treatment was introduced into Italy in 1980 but it has failed to achieve the popularity that it enjoys in other European countries. Perhaps the reason for this is the inadequate advancement of coronary angiography. The number of coronary artery disease patients studied in Italy is still quite low. Thus, a solid basis is necessary if we are to establish a cardiological intervention routine. It is also interesting to note that even though Italy has a similar number of percutaneous coronary angioplasty centres to other countries, the number of procedures performed here is lower. In order to try and understand the reasons for this, we drew up a questionnaire based on the difficulties encountered. A total of 21 centres answered. During 1988, a total of 1,944 angioplasties were performed in these centres. The reasons given for this low number were as follows: difficulties associated with cardiological institutions; shortage of catheterization laboratories and of experienced personnel; problems associated with the hospitalization of patients; lack of continuity in surgical back-up; bed shortage in the intensive care units. Given the above mentioned situation, the solution must be sought at a central level in order to have an effectively co-ordinated approach which can give positive results.
[Coronary surgery in the 90s in the light of the results of randomized multicenter studies].
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[Percutaneous coronary angioplasty in evolving myocardial infarction].
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[Thrombolytic therapy in the course of myocardial infarction].
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Coronary artery spasm after administration of dextran 40: implications concerning percutaneous transluminal coronary angioplasty.
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Reperfusion ventricular arrhythmias during intracoronary thrombolysis.
While coronary reperfusion arrhythmias are well defined in animal models, their prevalence and predisposing factors are still uncertain during pharmacologic coronary reperfusion in patients with acute myocardial infarction. In 80 patients, who underwent this procedure and had a continuous electrocardiographic monitoring (associated with a Holter recording in 34), 6 patients developed ventricular fibrillation. Ventricular fibrillation was the terminal event in 2/19 non-reperfused patients. The other episodes of ventricular fibrillation (controlled with DC countershock) occurred within 5 minutes and 3 minutes after angiographic documentation of coronary reperfusion. Ventricular fibrillation was observed in 4/10 patients with a residual stenosis less than or equal to 80% but in no case among the 39 patients with a residual stenosis greater than 80% (P = 0.01). Holter recordings in 19 reperfused patients showed ventricular tachycardia or accelerated idioventricular rhythm at reperfusion in 8/10 patients with a coronary stenosis less than or equal to 80% and only in 3/9 with a higher degree stenosis (P less than 0.05). Reperfusion ventricular fibrillation was found to occur in 8.1% of patients. A residual stenosis of 80% or less was found to be a predisposing factor in the occurrence of ventricular fibrillation, ventricular tachycardia or accelerated idioventricular rhythm at reperfusion.
[Unstable angina with recurrent episodes of transient elevation of the ST segment: role of transluminal percutaneous angioplasty].
Transluminal angioplasty was performed as an urgent treatment in 9 patients with unstable angina, refractory to medical therapy and ST elevation during pain. All had a coronary stenosis greater than 50% (89 +/- 12%; range 60-99%). The left anterior descending coronary artery was affected in 6 patients, the right coronary artery in 1 patient, the circumflex in 1 patient and 1 patient had two stenosis on both the left anterior descending and the first diagonal branch. A reduction of the luminal stenosis greater than 20% was obtained in all (residual stenosis 30 +/- 11%; range 11-40%). During a follow-up of 6-20 months, two patients only showed recurrence of chest pain. A maximal ergometric test was negative in all patients after 1, 3 and 6 months. A second arteriography, performed in 7 patients after 3-6 months, demonstrated a mean stenosis of 35% (range 30-40%). Transluminal coronary angioplasty is a feasible and effective therapeutic approach in patients with unstable angina and ST elevation, when a significant coronary stenosis is present.
[Thrombolysis in myocardial infarct: what to do afterward?].
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[Endomyocardial biopsy: experience with 156 patients].
Transcatheter endomyocardial biopsy (EMB) is a well known technique but its clinical value is still controversial. Our experience in the first 156 patients studied, in whom 182 EMB were performed, is reported and particular attention is given to the clinical value of the biopsy. Complications were observed in 7 patients and left ventricular EMB appeared to be more complicated (2/23) than right ventricular EMB (5/159). The clinical value of EMB was well documented (63.5%) in patients with congestive heart failure and a dilated heart (group 1) in whom a fairly high presence of myocarditis (17.5%), in different stages, was observed (13/74 patients). In patients with congestive failure and a restrictive/constrictive physiology (group 2), with angina and normal coronary arteries (group 3) and with acute advanced atrio-ventricular block and young age (group 5) the clinical value of EMB was good (85.7%, 58.3% and 60.6% respectively). The clinical value of EMB was on the contrary poor in patients with idiopathic ventricular arrhythmias (group 4) and in an heterogeneous group of patients (group 7), where EMB was mainly performed to exclude myocarditis. EMB had no clinical value in patients with aortic or mitral incompetence (group 6) studied according to a research protocol. EMB is a safe procedure which provides useful clinical informations in more than 50% of patients studied. The fairly high incidence of myocarditis (25 out of 156 patients studied) and the protean clinical presentations of the disease are stressed.
A reappraisal of the factors affecting early patency of aortocoronary saphenous vein bypass grafts. Current experience with extensive revascularization employing sequential grafting techniques.
A number of factors potentially influencing the patency rates of aortocoronary bypass grafts were investigated in a consecutive series of 50 patients by control angiography at 28 +/- 26 days and by univariate and multivariate analysis of a selected set of clinical, surgical and angiographic predictors. There were 234 anastomoses in this series, a mean of 4.7 per patient (range 1 to 9), 215 of which were connected to sequential vein grafts. After surgery, 40 patients were treated with anticoagulants and/or platelet inhibitors. Of the 234 coronary anastomoses studied, 219 were patent (93.6%). Coronary artery diameter, patient's age and previous myocardial infarction were shown to be independent predictors of increased risk of anastomotic occlusion. Arteries less than 1.5 mm in diameter had a patency rate of 84.9%, versus 96.1% for vessels 1.5 mm or larger (p = 0.009). The use of side-to-side anastomoses with sequential grafts seemed to counterbalance the unfavourable effect of small arterial size. Patients aged 65 or older had a lower probability of having all their grafts patent than younger patients did (50 vs 89%, p = 0.01). Patients with previous myocardial infarction similarly had a lower probability of having all their grafts patent compared to patients without previous infarction (68 vs 95%, p less than 0.05); this correlation was explained by a more frequent occlusion rate of grafts directed to fibrotic left ventricular areas. The effect of anticoagulants and of platelet-inhibitors was favourable, but did not reach statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)
May early exercise testing after myocardial infarction predict the extent of coronary artery disease?
To determine whether exercise testing performed soon after myocardial infarction may predict the degree of coronary artery disease, 78 patients performed stress testing and coronary angiography 15 +/- 5 and 64 +/- 35 days, respectively, after myocardial infarction. Out of 34 patients with a positive test, 22 (65%) demonstrated a multivessel disease, and 37 (84%) out of 44 patients with a negative test had normal coronary angiograms or single vessel disease (p = .0006). In addition to stress testing, no clinical parameter considered (infarct location, heart failure and cardiomegaly) was predictive of the extent of coronary artery disease.
[Protocol-guide in clinical experimentation on inotropic drugs].
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Effect of polyethylene glycol 400 on adriamycin toxicity in mice.
The effect of a widely used organic solvent, polyethylene glycol 400 (PEG 400), on the toxic action of an acute or chronic treatment with adriamycin (ADR) was evaluated in mice. PEG 400 impressively decreased both acute high-dose and chronic low-dose-ADR-associated lethality. Light microscopic analysis showed a significant protection against ADR-induced cardiac morphological alterations. Such treatment did not diminish the ADR antitumor activity in L1210 leukemia and in Ehrlich ascites tumor.