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Biomedical subjects

V M Gil

Publications and source records attributed to V M Gil.

At least 19 recordsLinked to original sources

NMR study of the complexation of D-gulonic acid with tungsten(VI) and molybdenum(VI).

By using multinuclear (1H, 13C, 17O, 95Mo, 183W) magnetic resonance spectroscopy (1D and 2D), D-gulonic acid is found to form ten and seven complexes, respectively, with tungsten(VI) and molybdenum(VI), in aqueous solution, depending on pH and metal-ligand molar ratios. Two isomeric 1:2 (metal-ligand) complexes involving the carboxylate and the adjacent OH group are present in the pH range 2-9. At intermediate and high pH, molybdate forms a 2:1 tetradentate complex involving the four secondary hydroxyl groups, whereas tungstate forms one 2:1 terdentate species. At low and intermediate pH values, three 2:1 complexes are found for both metals, involving the carboxylate group and three secondary hydroxyl groups, as well as a 5:2 species involving the carboxylate group and all the secondary hydroxyl groups; the concentration of this species increases in time mainly at the expense of 2:1 and 1:2 complexes. Tungstate can also form two additional species, probably a 5:2 species involving the carboxylate group and all the hydroxyl groups, and a 2:1 pentadentate species involving the carboxylate group and all the secondary hydroxyl groups. In alkaline solutions, tungstate is able to form an additional 2:1 pentadentate complex involving all the hydroxyl groups.

Carbohydrate Conformation↗

Relationship between radionuclide right ventricular ejection fraction and clinical status in patients with left ventricular dysfunction after myocardial infarction.

OBJECTIVE: To evaluate the influence of right ventricular (RV) function, determined by RV ejection fraction, on the clinical status of patients with ischemic heart disease and left ventricular (LV) EF under 40%. BACKGROUND: The role of RV function as a marker of prognosis in heart failure has been debated. We hypothesized that the degree of RV dysfunction is a determinant of the clinical status and outcome of patients with LV dysfunction after myocardial infarction. PATIENTS AND METHODS: 30 patients, 25 male, with previous myocardial infarction, more than 6 months age, were studied by equilibrium radionuclide angiography. Functional capacity was evaluated by cardiopulmonary exercise test with Naughton protocol. Patients were followed during a 12 month period for major clinical events: death or hospitalisation for congestive heart failure. Two groups of patients were considered according the value of RVEF (< or = 30% and > 30%). RESULTS: The values of EF were: LV = 25 +/- 7% and RV = 35 +/- 9%. Maximum oxygen consumption correlated with RVEF (r = 0.78, p < 0.001) but not with LVEF (r = 0.12, NS). The group of patients with RVEF > 30% had a greater exercise time (712 +/- 229 versus 441 +/- 208 seconds, p = 0.003), higher oxygen consumption (19.8 +/- 5.3 versus 13.5 +/- 3.3 ml/kg/min, p = 0.001) and oxygen consumption in relation to the maximum predicted for age and sex (71 +/- 19 versus 50 +/- 13%, p = 0.002). Cumulative frequency of major clinical events was greater in the group with RVEF < or = 30% (58% vs 6%, relative risk 3.14, 95% CI 1.23 to 5.05). There was no correlation between the values of LVEF and outcome. CONCLUSIONS: In this setting of ischemic LV dysfunction, the RVEF correlates with functional capacity in cardio-pulmonary exercise test and the presence of RV dysfunction is associated to a higher incidence of clinical events.

Adult↗

Myocardial viability in ischemic ventricular dysfunction.

In this paper, some controversial points regarding myocardial its definition hibernation are discussed, including its definition (improvement in contractility versus improvement in clinical or functional status or in prognosis), the histology and pathophysiology (dedifferentiation versus cellular degeneration) and the responses to the diagnostic methods more currently utilised, stress echocardiography and myocardial perfusion scintigraphy. The predictor factors for recovering after revascularization are also discussed.

Heart↗

[Pulmonary embolism: a clinical case documented, in acute setting, using pulmonary scintigraphic perfusion].

The acute clinical evolution is presented of a patient with previous myocardial infarction who was admitted for dyspnea and chest pain. Acknowledging the possibility of a new ischemic event, confronted with aortic dissection or pulmonary embolism, the clinical investigation is described up to the scintigraphic diagnosis of pulmonary embolism. The clinical presentation, diagnostic investigation and therapeutic decisions are discussed, with emphasis on the usefulness of pulmonary scintigraphy.

Adult↗

[Hibernating myocardium. An incomplete adaptation to ischemia].

BACKGROUND: We tested the hypothesis that hibernating myocardium represents an incomplete adaptation to a reduced myocardial oxygen supply. METHODS AND RESULTS: In 38 patients, areas of hibernating myocardium were identified by angiography, multigated radionuclide ventriculography, thallium scintigraphy with reinjection, and low-dose dobutamine echocardiography. Biopsies removed at cardiac surgery showed structural degeneration characterized by a reduced protein and mRNA expression and disorganization of the contractile and cytoskeletal proteins myosin, actin, desmin, titin, alpha-actinin, and vinculin by electron microscopy, immunohistochemistry, and in situ hybridization. Additionally, an increased amount of extracellular matrix proteins resulting in a significant degree of reparative fibrosis was present. Dedifferentiation, i.e., expression of fetal proteins, was absent. Apoptosis indicating suicidal cell death was found by the terminal deoxynucleotidyl transferase end-labeling method and electron microscopy. Radionuclide ventriculography showed improvement of regional function at 3 months postoperatively compared with preoperative values (mean values, 23.5% and 48%, respectively), and the echocardiographic wall-motion score index decreased from 3.4 to 1.8. The degree of severity of the morphological changes (three stages) correlated well with the extent of postoperative functional recovery: more advanced clinical improvement was observed in patients with slight and moderate morphological degeneration (stages 1 and 2), but recovery was only partial in severe degeneration (stage 3). CONCLUSIONS: Cellular degeneration rather than adaptation is present in hibernating myocardium. The consequence is progressive diminution of the chance for complete structural and functional recovery after restoration of blood flow. The practical consequence from this study should be early revascularization in patients showing areas of hibernating myocardium.

Humans↗

Left ventricular function after late thrombolysis with alteplase in myocardial infarction.

OBJECTIVE: Late thrombolytic treatment (after 6 hours from pain onset) for acute myocardial infarction has been shown to improve survival in a cohort of patients. The mechanisms underlying such benefit have been debated and a controversy exists about the influence of late thrombolysis over left ventricular function as one potential mechanism. The present study intended to clarify the effects of late thrombolysis with alteplase on left ventricular function parameters. DESIGN: Prospective, multicenter, randomised, double-blind study. Ancillary study to LATE trial. PATIENTS: We studied 103 patients, 81.6% men, randomly allocated to alteplase (100 mg over 3 hours) or placebo 6 to 24 hours after onset of myocardial infarction. METHODS: Left ventricular function parameters by radionuclide ventriculography were evaluated at 1 and 6 months after myocardial infarction. RESULTS: At 1 month, left ventricular ejection fraction was 48.86% on alteplase and 43.19% in placebo group (p = 0.028), with greater benefits for septal and apical regions. At 6 months no significant differences were found. CONCLUSIONS: Those data suggest that late thrombolysis with alteplase improves left ventricular function 1 month after myocardial infarction although the difference did not persist at 6 months. Improvement of left ventricular function shall, therefore, be considered as one of the possible mechanisms underlying the benefit of late thrombolysis.

Double-Blind Method↗

[Myocardial infarction in patients with single-vessel disease: are there clinical or angiographic markers of viability?].

OBJECTIVE: To assess whether some of the clinical and angiographic variables usually associated with the severity of coronary artery disease could be considered as markers of viability after myocardial infarction. PATIENTS: We studied 41 patients with previous Q wave infarction and single-vessel coronary artery disease. METHODS: Patients were studied with thallium-201 SPECT, two imaging acquisitions were performed: stress and reinjection three to four hours later under nitroglycerin effect. Perfusion and viability were compared to clinical and angiographic variables, including the degree of patency and colateralization. RESULTS: In the infarct related area, 66 % of the 177 perfusion defects were considered reversible (definite in 40 %). In patient analysis, 28 patients were considered as having reversibility (18 with definite and 10 with possible reversibility). None of the clinical or stress test variables were significantly associated with reversibility; all these variables had extremely poor negative predictive values and only stress-induced ST depression had a reasonable positive predictive value (85 %). There was no association between TIMI grade and reversibility. In segments supplied by a TIMI 0 artery, a higher rate of fixed perfusion defects was associated with the absence of collateral circulation (75 % vs 22%; p < 0.013). Furthermore, severe impairment of contractility did not predict absence of viability, we identified as viable 55 % of akinetic segments and 29 % of segments classified angiographically as aneurysm. CONCLUSIONS: These data suggest that common clinical and angiographic markers of severity of coronary artery disease are not useful in the detection of viable myocardium after myocardial infarction. Collateral circulation to occluded arteries was associated with viability, but its absence did not exclude it. Viability detection with appropriated tests, namely stress reinjection thalium scintigraphy should perhaps be considered as a routine procedure after myocardial infarction, especially when interventional therapy is to be considered.

Adult↗

Complexes of ciprofloxacin with metal ions contained in antacid drugs.

Simultaneous administration of antacids containing magnesium or aluminium and ciprofloxacin or other quinolones decreases the gastrointestinal absorption of those antibacterial agents. Current speculation about the mechanism of this interaction has focused on drug-cation chelation. The present study was designed to detect the protonation in solutions and the formation of the complex species at the pH levels typical of the gastrointestinal tract. It involves the study of ciprofloxacin in aqueous solutions containing Al3+ and (or) Mg2+ by combining the results of potentiometric and spectroscopic (1H nuclear magnetic resonance) techniques. Calculations were only performed for data in the range 4.5 < pH < 5.5 (pH levels typical of gastrointestinal tract) and the results of both methods are made self-consistent, assuming an equilibrium model including complex species MHL, MLOH (where H2L denotes ciprofloxacin and M is Al3+ or Mg2+); their formation constants are given.

Aluminum↗

[Effectiveness and safety of coronary vasodilation with adenosine triphosphate with thallium-201 for the diagnosis of coronary disease].

OBJECTIVE: To evaluate the accuracy and safety of pharmacologic stress testing with adenosine triphosphate (ATP) associated with thallium-201 scintigraphy for detection of coronary artery disease. PATIENTS: We studied 44 patients, 35 male and 9 female with a mean age of 59 + 9 years. Previous myocardial infarction was present in 15 patients. Thirty-two patients underwent coronariography that revealed coronary artery disease in 28 patients. METHODS: ATP (Stryadine) was infused at a rate of 140 micrograms/kg/min for 6 minutes and 2 mCi of thallium-201 was injected at the third minute. Stress and redistribution SPECT acquisitions were performed respectively 5-10 minutes and 4-6 hours after ATP infusion. RESULTS: The incidence of side effects was 77% and chest pain was the most frequent (45%). Dyspnea occurred in 2 patients and only one patient presented transient first degree AV block. No serious or severe side effect occurred. In patients without myocardial infarction 14 of 16 patients with significant coronary artery disease had reversible perfusion defects demonstrated by ATP thallium-201 scintigraphy (sensitivity 88%) and all of 4 patients without significant coronary artery disease had normal myocardial perfusion (specificity 100%). The overall accuracy for detecting the presence of coronary artery disease was 90%. The test demonstrated an overall accuracy of 88% for detecting left anterior descending artery disease, 91% for circumflex artery disease and 80% for right coronary artery disease. CONCLUSIONS: Pharmacologic stress with ATP associated with thallium-201 scintigraphy, is a safe and high accurate alternative to dipyridamole and adenosine for the diagnosis of coronary artery disease.

Adenosine Triphosphate↗

[Superiority of the reinjection method compared with the redistribution of thallium-201 in the evaluation of reversibility after myocardial infarction].

OBJECTIVE: To assess the relative capacity of thallium-201 reinjection (RI) and redistribution (RD) for detection of reversibility in patients after myocardial infarction. DESIGN: We prospectively studied patients referred to myocardial scintigraphy for viability evaluation with stress, redistribution and reinjection images. METHODS: Patients were studied with thallium-201 SPECT using three imaging acquisitions--stress, redistribution three to four hours later and reinjection 30-60 minutes after a second injection of thallium under nitroglycerin effect. Thallium uptake was classified in a 0 to 4 intensity scale in each of 13 myocardial segments and a score obtained. Reversibility was classified as "definite" if the increase in thallium uptake was > or = 2 in a myocardial segment and as "possible" if the increase was one. PATIENTS: We studied 44 patients with previous myocardial infarction. RESULTS: The perfusion score after stress was 37.3 +/- 6.0, improving to 39.8 +/- 6.7 after redistribution and to 43.6 +/- 7.6 after reinjection (p < 0.02 between RD and RI). RD identified reversibility in 38% and RI in 63% (p < 0.001) of the 232 segments with perfusion defects. RI showed reversibility in 39% (definite in 25% and possible in 14%) of the 137 fixed perfusion defects in RD. For the detection of reversibility RI was superior to RD in all sub-groups analyzed. We found a relationship the degree of collateral circulation in the infarct related artery and the amount of reversibility in the infarcted area. CONCLUSIONS: These data suggest a clear superiority of reinjection over redistribution in thallium-201 scintigraphy for the detection of reversibility of perfusion defects after myocardial infarction, and must probably be considered as a routine procedure for myocardial viability assessment.

Adult↗

[Evaluation of myocardial reserve as a contribution to the surgical indication in aortic insufficiency].

Surgical indication in symptomatic patients with chronic aortic regurgitation is mandatory, but it is sometimes doubtful in two extreme situations: asymptomatic patients and patients with severe left ventricular dysfunction. The authors review the contribution of radionuclide angiography (RNA) for the selection of surgical indication in these two groups of patients, by the evaluation of baseline ejection fraction and of contractile reserve, defined as ejection fraction variation with exercise in asymptomatic patients and with inotropic stimulation in patients with severe left ventricular dysfunction. In asymptomatic patients, RNA may contribute to the selection of patients with incipient ventricular dysfunction (manifested only with exercise), in which a closer follow-up should be obtained, to propose surgery early when baseline ventricular dysfunction appears. In patients with severe ventricular dysfunction, RNA may give us some clues on the probability of left ventricular function recovery after surgery, contribution to the decision of proposing conventional surgery or heart transplant. The authors shortly review preliminary data on the follow-up of 48 patients with chronic aortic regurgitation, studied by RNA with exercise (44 patients) or dobutamine infusion (4 patients) at the Hospital de Santa Cruz from 1987 to 1991. Fifteen of these patients have been submitted to surgery.

Aortic Valve Insufficiency↗

[Reversibility in perfusion scintigraphy after myocardial infarct: a comparison between the protocol of single-day rest-stress with 99mTc sestamibi and reinjection with thallium-201].

OBJECTIVE: To compare thallium-201 stress-reinjection SPECT (TL) and single-day rest-stress 99mTc-sestamibi SPECT (MIBI) for detection of reversibility of perfusion defects after Q-wave myocardial infarction. DESIGN: Prospective study with the two scintigraphic methods. PATIENTS: We studied 31 patients with previous Q-wave myocardial infarction referred for assessment of myocardial viability. METHODS: Patients were studied with thallium-201 stress-reinjection SPECT and single-day rest-stress 99mTc-sestamibi SPECT. Tracer uptake was classified in a 0 to 4 intensity scale in each of 13 myocardial segments. RESULTS: Segmental comparison indicated that the identification of perfusion defects was similar by the two methods. Some reversibility was present in 51% of TL perfusion defects and in 26% of MIBI perfusion defects (p < 0.001). Twenty-seven percent of fixed perfusion defects in MIBI showed some reversibility by TL, but only 8% of the fixed perfusion defects by TL were reversible by MIBI (p < 0.001). In infarct-related perfusion defects, TL showed reversibility in 46% and MIBI in 22% (p < 0.001). TL detected reversibility in 84% of patients and MIBI in 48% (p = 0.007). CONCLUSIONS: Although the two methods were similar for perfusion defects identification, the present study suggests that thallium-201 reinjection is superior to single-day rest-stress 99mTc-sestamibi for the detection of reversibility. Clinical relevance of these differences, as a marker of viability, requires further evaluation of these patients after successful revascularization.

Adult↗

Prognosis in patients with left bundle branch block and normal dipyridamole thallium-201 scintigraphy.

BACKGROUND: The presence of complete left bundle branch block (LBBB) is commonly associated with a poorer prognosis, especially in patients with coronary artery disease (CAD). In the general population with suspected CAD and normal intraventricular conduction, a normal dipyridamole-thallium scintigraphy is a strong marker of a favorable outcome. OBJECTIVE: Our objective was to assess the prognosis in patients with LBBB and a normal dipyridamole thallium-201 scintigram. POPULATION AND METHODS: Patients with complete LBBB and normal myocardial perfusion on dipyridamole SPECT thallium-201 scintigraphy performed in our center for suspected CAD between 1988 and 1995 were monitored for clinical events. RESULTS: Sixty-nine patients (36 women and 33 men) with a mean age of 59 years (range 56 to 61) were monitored for a mean period of 33 months (range 25 to 35). During this period, 4 patients had unstable angina, 2 of whom underwent myocardial revascularization. There were no deaths or myocardial infarction. All events occurred at least 2 years after the thallium-201 scintigraphy. CONCLUSION: The presence of a normal myocardial perfusion with dipyridamole thallium-201 scintigraphy in this group of patients with suspected CAD and LBBB was associated with a very good prognosis, a low rate of clinical events occurring only 2 years after the myocardial scintigraphy, and no hard events.

Bundle-Branch Block↗