Biomedical subjects

V Miler

Publications and source records attributed to V Miler.

5 recordsLinked to original sources

PubMed1999

Detection of angiographic coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA): usefulness of angina combined with rest electrocardiogram.

PURPOSE: To evaluate the value of recurrent anginal symptoms combined with seriation of conventional EKG in detecting coronary restenosis (renarrowing > or = 50% at the site dilated) after PTCA. Two hundred and seventy patients (204 men, mean age 53.1 +/- 9.4 years) with angina who submitted to successful PTCA of single-vessel coronary disease were followed and restudied angiographically 5.2 +/- 1.6 months after the procedure. At any moment from PTCA to follow-up: 1) typical angina pectoris was classified as either absent or present; 2) a 12-lead EKG was classified as improved, unchanged or worsened in comparison with the EKG either before or early after PTCA on the basis of ST-T alterations; 3) all patients underwent coronariography and were then classified as either having or lacking restenosis. The sensitivity and predictive positive value of recurrent angina, worsened EKG, or both, in detecting restenosis were respectively: 74.6% and 68.6%, 44.3% and 85.3%, and 55.9 and 91.7%. The specificity and predictive negative value of no recurrence of angina, improved EKG, or both, in detecting the absence of restenosis were respectively: 85.8% and 89.1%; 69.6% and 91.0%; and 75.6% and 93.9%. CONCLUSION: In single-vessel coronary disease, the detection of coronary restenosis after PTCA based on behavior of the symptoms plus rest EKG seriation shows acceptable degrees of sensitivity, specificity and mainly of predictive values when comparison with respective historical values of the ergometric test is considered.

Adult↗

PubMed1998

Detection of Restenosis After Percutaneous Transluminal Coronary Angioplasty by an Angiographic Score.

BACKGROUND: Restenosis, or ÒAchilles heelÓ of balloon angioplasty, remains in a range near 30% and cannot be predicted with certainty. To find adequate methods for its foresight is a challenge. OBJECTIVES: To determine risk factors and an angiographic score to predict the appearance of restenosis after one-site percutaneous transluminal coronary angioplasty (PTCA). METHODS: We restudied prospectively 315 (239 men, 76 women, age range from 29 to 78, 53.6 +/- 9.5 years) of 360 patients who underwent PTCA to a native coronary artery. The study didnÕt include patients with left main disease, total occlusion, side-branch involvement, ostial stenosis, acute phase of myocardial infarction or those who repeat PTCA. Two-hundred twenty-eight patients underwent PTCA of the left anterior descending artery, 56 of the right coronary artery and 31 of the left circumflex artery. RESULTS: Restenosis, defined as a luminal renarrowing > 50% at follow-up, was present in 82 (26%) patients between 1 and 8 months after the procedure. Univariate and multivariate analysis revealed four vascular factors related to restenosis (p < 0.05): a) lesion length and; b) irregularity of the lesion borders before PTCA; c) perivascular and/or endovascular haziness and; d) intensity of residual stenosis after PTCA. To construct the score, a zero was given to a lesion length < 8 mm; to smooth lesion borders; to residual stenosis up to 20%; and to absence of haziness after PTCA. A one was given to a lesion length between 8 and 10 mm; and to a lesion with irregular borders. A two was given to a lesion length > 10 mm. A three was given to a residual stenosis > 20%; and to the presence of haziness after PTCA. The sum of all terms was considered the final score. So, it could oscillate from 0 to 9. Calculated score from 0 to > 5 showed respective restenosis rates of (%): 5.2; 15.1; 24.0; 39.4; 44.8; 60.8; and 84.2. The calculated correlation coefficient (0.98) among the scored values and the correspondent restenosis rates was highly significant (p < 0.001). CONCLUSIONS: It is concluded that restenosis is primarily a multifactorial problem based on vascular factors and may be predicted with a high degree of probability by the proposed score.

Journal Article↗

PubMed1997

Changes in Left Ventricular Function After Coronary Recanalization by Percutaneous Transluminal Coronary Angioplasty (PTCA).

Forty-six patients (21 with stable angina and 25 with chronic myocardial infarction, 37 men) with a total chronic proximal coronary occlusion and collateral vessels to the distal part of the occluded artery (30 LAD, 10 RCA and 6 CX properly distributed in both groups) were studied angiographically before and 2 to 8 months (mean 6) after balloon angioplasty. The patients were divided in six subgroups: A) Angina pectoris no matter the result of recanalization (n = 21); B) Myocardial infarction no matter the result of recanalization (n = 25); C) Angina pectoris with successful recanalization and open coronary (O.C.) > 50% at follow-up (n = 13); D) Angina pectoris with unsuccessful recanalization and/or restenosis or closed coronary (C.C.) at follow-up (n = 8); E) Myocardial infarction with successful recanalization and O.C. > 50% at follow-up (n = 8); F) Myocardial infarction with unsuccessful recanalization and/or restenosis or C.C. at follow-up (n = 17). No subgroup showed statistical differences (p > 0.05) in LVEDP before (B) and at follow-up (FU). On the other hand, several measurements were statistically different in the subgroup A at B and at FU: Ejection fraction (EF) [57.3 +/- 12.3 and 64.2 +/- 19.4%; p = 0.02]; Regional wall motion (RWM) measured in the region of the affected coronary [18.7 +/- 9.6 and 23.6 +/- 11.8%; p = 0.05]; Minimal wall motion (MWM) measured in the site of lesser parietal movement [14.3 +/- 13.1 and 25.8 +/- 26.2%; p = 0.02]. In the subgroup C the following differences were observed: EF [58.4 +/- 12.3 and 69.0 +/- 12.4%; p = 0.003]; RWM [16.3 +/- 8.4 and 25.4 +/- 8.2%; p = 0.005]; MWM [14.7 +/- 15.1 and 27.9 +/- 18.0%; p = 0.0001]. In the other considered subgroups we did not reach significant differences (p > 0.05) in these measurements. We conclude that recanalization of a chronic coronary occlusion improves left ventricular contractile function in the presence of viable myocardium and that MSF is the most sensitive among the studied variables to separate anginal patients from the patients without viable myocardium after successful recanalization.

Journal Article↗

PubMed1989

Neuromuscular and cardiovascular effects of mivacurium in children.

The neuromuscular and cardiovascular effects of mivacurium chloride (BW B1090U) were evaluated in 90 children (2-12 yr) during N2O:O2 halothane or N2O:O2 narcotic anesthesia. Neuromuscular response was evaluated by recording the force of contraction of the adductor of the thumb during train-of-four stimulation at 0.1 Hz. The children were divided into two groups. Patients in group A (n = 45) were anesthetized with N2O:O2 and halothane (1% inspired) and patients in group B (n = 45) were anesthetized with N2O:O2 and fentanyl or morphine. Each group was further divided into five subgroups of nine children. Children in the first three sets of subgroups (A1-A3, B1-B3) received an initial dose of 0.02, 0.04, 0.05, 0.06 or 0.07 mg/kg mivacurium to determine dose response relationships under the different anesthetic regimens. The ED50 and ED95 neuromuscular blocking doses calculated from this single dose technique were 0.051 mg/kg and 0.095 mg/kg, respectively, in children anesthetized with halothane N2O:O2, and 0.059 mg/kg and 0.11 mg/kg in children anesthetized with N2O:O2 narcotic. The fourth subset of each group (A4 and B4) received 0.09 mg/kg and 0.11 mg/kg mivacurium, the estimated ED95 for each respectively. The last subsets (A5 and B5) received 0.2 mg/kg. This dose induced 100% depression of the twitch response in all 18 patients in 1.8 +/- 0.1 min, with recovery to 5%, 25%, and 95% of control occurring in 8.4 +/- 0.5, 11.2 +/- 0.6 and 18.4 +/- 1.6 min, respectively. The recovery indices for all patients were 4.6 +/- 0.6 min for 25-75% recovery and 9.7 +/- 1.3 min for 5-95% recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗

PubMed1982

Breast masses in adolescent females.

The clinical records of 51 female patients between the ages of 8 and 20 years who underwent excision of breast masses at Boston's Children's Hospital Medical Center were reviewed. In most instances excisional biopsy using local or general anesthesia was performed on an ambulatory basis. Fibroadenomas account for the majority of breast masses (81.4%). There were no malignancies. Breast tumors in pediatric and adolescent populations are best managed by careful physical examination, careful follow-up, needle aspiration when feasible, observation and surgical excision of persistent, enlarging or symptomatic masses. Patient education and breast self-examination teaching are highly recommended. Excisional biopsy of unilateral subareolar masses in the early pubertal female should be avoided, since these usually represent a physiologically enlarged breast bud.

Adenofibroma↗