Biomedical subjects
Publications and source records attributed to A Cortina.
We report the case of a 72-year-old female with alkaptonuric ochronosis and symptomatic aortic stenosis requiring aortic valve replacement. She was the seventh of nine children, and four of the nine siblings were diagnosed as having ochronosis. Only one, however presented with aortic stenosis.
Lipoprotein(a) [Lp(a)] had been shown to be a strong independent risk factor for ischaemic heart disease. Our aim was to investigate the relationships between Lp(a) and other cardiovascular risk factors. 423 male miners (age 40 +/- 8 years) were analysed according to the following variables: age, arterial blood pressure, alcohol and cigarette consumption, total cholesterol and Lp(a). Analysis of the data was performed using the Kruskal-Wallis and Spearman tests. Analysis of variance showed statistical differences in Lp(a) levels with cigarette consumption (p < 0.02) and age (p < 0.001). No differences with corrected total cholesterol, blood pressure and alcohol consumption were found. Lp(a) and total cholesterol were correlated (p < 0.0001), but after correction for the estimated contribution of Lp(a) cholesterol this significant correlation disappeared. We conclude that male smokers have significantly lower Lp(a) values than non-smokers and those who quit. Our findings suggest that cigarette consumption is a probable environmental factor that might influence Lp(a) levels.
The long-term follow-up of 35 patients with mean age of 74.3 +/- 8 years (64-86) who underwent percutaneous aortic valvuloplasty (PAV) is presented. The mean duration of the follow-up study was 33 months (range 1-48). Global mortality was 42% (14 patients) and was related to post-PAV aortic valvular area (47% mortality in less than 0.7 cm2 area group vs 28% in greater than or equal to 0.7 cm2 group) and left ventricular ejection fraction (67% in EF less than 35% group vs 35% in EF greater than or equal to 35% group). The actuarial probability of remaining alive and free of symptoms and of cardiac surgery or new PAV was 57, 41, 33, and 20% at 1, 2, 3 and 4 years. After PAV clinical improvement was obtained in most of the patients (68%), but only 42% of those with successful dilatation remain asymptomatic after a 24 months period (85 +/- 28 mmHg, p = NS). Transvalvular gradient studied by Doppler decreased immediately after PAV (92.8 +/- 26 mmHg vs 51 +/- 16 mmHg, p less than 0.001), but returned to baseline values after 12 months. These results show that PAV yields a clinical improvement in most of the patients, but this improvement is transitory, does not modify the natural history of the disease and has a high degree of restenosis. Thus, its use must be limited to a reduced group of patients who are not candidates for cardiac surgery.
Calcific embolism from an aortic stenosis is an uncommon event that can be seen after cardiac surgery or left heart catheterization but extremely rare in a spontaneous way. We report a case of a patient with calcified aortic stenosis presenting a spontaneous calcareous embolism in the retinal artery. We review the literature about this problem as well.
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There is a paucity of information correlating the angiographic findings immediately after myocardial infarction with the clinical status before infarction. Therefore, the coronary anatomy, collateral circulation and quantitative left ventricular function were studied in 39 patients who underwent angiography within 3 weeks of a first transmural myocardial infarction. In all patients, the vessel supplying the infarct was totally occluded at the time of angiography. Patients without angina before infarction (Group I) had fewer coronary obstructions than did patients with a long history of angina before infarction (Group II) (1.5 +/- 0.5 versus 2.5 +/- 0.5, respectively, p less than 0.001) but worse overall and regional left ventricular function. These paradoxical differences between Groups I and II were evident in patients with anterior as well as inferior infarction. Patients in Group I had significantly lower collateral scores than did patients in Group II (0.6 +/- 0.8 versus 1.9 +/- 0.9, respectively, p less than 0.0001) and 13 of 22 patients in Group I had no collateral vessels compared with only 1 of 17 in Group II (p less than 0.001). Partial preservation of anterior wall function in Group II patients with anterior infarction was related both to the presence of collateral vessels and to the more distal obstruction of the left anterior descending coronary artery in these patients as compared with patients with anterior infarction in Group I. In contrast, in patients with inferior wall infarction, no relation could be found between the presence of collateral vessels and regional left ventricular function, although only two patients in this series with inferior infarction did not have collateral vessels.(ABSTRACT TRUNCATED AT 250 WORDS)
A 50-year-old man was treated for a dysplasia-type congenital tricuspid insufficiency. The tricuspid valve ring was repaired with a perforated Teflon patch graft and the valve was replaced. The patient was discharged in good condition and is well after 18 months of follow-up.
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In order to determine the role of two polymorphisms in the factor VII gene (R353Q and intron 7 hypervariable region) in the susceptibility to develop early myocardial infarction, a total of 175 patients with acute myocardial infarction aged 50 years or less (mean age 41+/-7 years) and 200 controls (average age 42+/-6) without cardiovascular disease were genotyped for these polymorphisms. Gene and genotype frequencies did not differ between patients and controls. Although the 353-QQ genotype was at a higher frequency among controls (4%) compared to patients (1%), the difference did not reach statistical significance. Carriers of the H7-allele (intron 7 polymorphism) were at a slightly higher frequency among patients (51 vs. 43%; P=0.19; OR=1.36; 95% CI=1.09-1.70). Our data suggest a lack of association between both polymorphisms in the factor VII gene and early myocardial infarction in our population.
The author examines how Bioethics should be approached in a pluralist society. She argues that through the gradual discovery of shared ethical values and principles for judging which practices are humanizing and which or not, ever-more dense civil Bioethics helps bring out--in contrast to relativism and subjectivism--an ethical intersubjectiveness, the fundaments of which should be addressed by moral philosophy if it hopes to fulfill one of its main tasks.
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A case of calcificated intramyocardiac hydatid cyst is presented. The initial diagnosis was coronary artery disease and the onset was chest pain and typical abnormalities of the electrocardiogram. The diagnosis of hydatid disease was suspected from chest roentgenogram and confirmed by two-dimensional echocardiography and left ventriculography. Coronary arteriography was normal and surgical treatment successfully carried out.
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