Fibrin and fibrin-related antigens in coronary artery disease.
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Antigens↗
Biomedical subjects
A Gallino
Publications and source records attributed to A Gallino.
[Indications and contra-indications for heart transplantation].
Indication and contraindications for selection of patients for cardiac transplantation are given on the basis of 2 years' experience in evaluating a total of 65 patients, 30 of whom received heart transplant. Heart transplant must be considered in patients with: 1. Severe heart failure without response to maximal medical treatment. 2. End stage coronary artery disease where clinical heart surgery is no longer feasible. 3. Intractable malignant arrhythmia associated with pump failure. Heart transplant is contraindicated in: 1. Patients with extracardiac polymorbidity. 2. Cardiac low output with renal and hepatic impairment. 3. Compliance failure. 4. Increased pulmonary artery resistance. 5. Age over 60 years.
Adult↗
[Treatment and follow-up care after heart transplantation].
Today survival rates after heart transplantation of around 80% at 1 year and around 65% at 5 years are realistic. Most patients attain NYHA functional class I. Due to progress in donor and recipient selection, in immunotherapy, and in a systematic follow-up program post transplant, heart transplantation today has become an accepted treatment in special forms of terminal heart disease. Between September 23, 1985, and May 15, 1987, 19 patients were transplanted in Zurich. After an average of 7 months (1-20), 18 patients are alive with NYHA functional class I. The follow-up program checks systematically for the three main problems post transplant (rejection, infection, and drug-induced side-effects). Regular endomyocardial biopsy is the gold standard for diagnosis of rejection. Non-invasive methods, such as cyto-immunological monitoring, neopterin, or beta 2-microglobulin, are not a substitute but valuable adjunctive diagnostic methods.
Adult↗
[2-1/2 years of heart transplantation in Zurich: experiences and results].
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Adolescent↗
Does exercise-induced myocardial ischaemia cause enhanced platelet activation and fibrin formation in patients with stable angina and severe coronary artery disease?
In this study, betathromboglobulin (BTG) and fibrinopeptide A (FPA) in peripheral venous blood were measured in 20 patients with stable angina pectoris before and immediately after exercise-induced myocardial ischaemia; in 5 of the 20 patients stable angina was associated with typical peripheral artery disease. A total of 10 patients with angiographically documented peripheral artery disease without angina and 10 normal volunteers were taken as control groups. BTG and FPA in the 15 patients with stable angina before exercise were 41 +/- 14 ng ml-1 and 2.3 +/- 0.9 ng ml-1 and were not statistically different from the values in normal controls; after exercise-induced myocardial ischaemia no significant increase occurred in these patients. Conversely, in the 5 patients with stable angina associated with peripheral artery disease BTG and FPA before exercise were 61 +/- 10 ng ml-1 and 3.5 +/- 0.8 ng ml-1 and increased to 114 +/- 14 ng ml-1 (P less than 0.001) and 4.1 +/- 0.5 ng ml-1 (P less than 0.01): These results were similar to those found in the 10 patients with isolated peripheral artery disease. We conclude that BTG and FPA in peripheral venous blood in patients with stable angina are not elevated either at rest or after exercise-induced myocardial ischaemia. Elevated values of BTG and FPA in patients with stable angina may reflect a major interaction between blood and atherosclerotic vessel wall, suggesting the presence of associated atherosclerotic lesions in peripheral artery disease.
Angina Pectoris↗
Early results after mitral valvuloplasty for pure mitral regurgitation.
In this study we present the results of 105 consecutive patients with pure mitral regurgitation who underwent surgical treatment. In all patients mitral regurgitation was associated with mitral valve prolapse: 54 patients underwent mitral valvuloplasty and 51 patients mitral valve replacement. Clinical assessment and echocardiography were used as follow-up criteria at one year after surgery. After mitral valvuloplasty, NYHA decreased from 2.7 +/- 0.8 to 1.1 +/- 0.7 (P less than 0.01) and workload capacity increased from 65 +/- 28% to 96 +/- 25% (P less than 0.001); left endsystolic atrial dimension and enddiastolic dimension decreased from 6.2 +/- 0.8 to 4.8 +/- 1.2 cm (P less than 0.001) and from 7.2 +/- 1.3 to 5.9 +/- 0.8 cm (P less than 0.01); ventricular contraction fraction did not change significantly. After mitral valve replacement, clinical and echocardiographic improvement was significant but less remarkable than after valvuloplasty; ventricular contraction fraction fell from 39 +/- 7% to 29 +/- 8% in contrast to patients undergoing mitral valvuloplasty in whom no significant change occurred. Complications were rare in both groups though only a minority of patients undergoing mitral valvuloplasty received anticoagulants. We conclude that mitral valvuloplasty in patients with pure mitral regurgitation when compared with the patients after mitral valve replacement.
Echocardiography↗
Combination of suloctidil and anticoagulation in the prevention of reocclusion after femoro-popliteal PTA.
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Adult↗
Fibrin formation and platelet aggregation in patients with acute myocardial infarction: effects of intravenous and subcutaneous low-dose heparin.
Fibrinopeptide A (FPA) and beta thromboglobulin (BTG) were measured in 42 patients with acute myocardial infarction (AMI) allocated on admission to one of three groups: 14 patients received a heparin bolus injection of 5000 IU intravenously followed by a 2-hour intravenous infusion (830 IU/hr) (group 1), 14 patients received a heparin bolus of 5000 IU subcutaneously (group 2), and the remaining 14 patients received no anticoagulant treatment (group 3). In group 1 the initially elevated FPA level of 5.8 +/- 1.8 ng/ml dropped to 2.0 +/- 1.5 ng/ml 30 minutes after the intravenous heparin bolus injection of 5000 IU (p less than 0.001) and returned to normal (1.9 +/- 0.8 ng/ml) in 8 of 14 patients. The initially elevated BTG level of 64 +/- 21 ng/ml did not change significantly during intravenous heparin treatment, whereas there was a rapid but only transitory increase in platelet factor 4, (PF4) from 25 +/- 9 to 74 +/- 16 ng/ml (p less than 0.01) after the intravenous heparin bolus. In group 2 the initial FPA of 5.0 +/- 2.3 ng/ml was similarly elevated as in group 1 and dropped to 2.7 +/- 1.7 and 3.3 +/- 1.5 ng/ml 2 and 4 hours after 5000 IU subcutaneously (p less than 0.05), whereas 6 and 8 hours after subcutaneous heparin bolus the mean FPA levels were 4.2 +/- 1.7 and 5.5 +/- 2.0 ng/ml and no more significantly different from the initial FPA values. BTG and PF4 did not change significantly after the subcutaneous heparin bolus. In group 3 the initially elevated mean FPA level of 4.9 +/- 2.4 ng/ml did not change significantly during the first 8 hours after admission, whereas the FPA level 24 hours after admission was 8.4 +/- 3.9 ng/ml and higher than the initial value (p less than 0.01). We conclude that heparin may reduce the elevated FPA level in plasma found in patients with AMI; however, neither subcutaneous nor intravenous heparin in a dosage frequently used is sufficient to consistently normalize the elevated rate of fibrin formation found in these patients.
Aged↗
Fibrinopeptide A excretion in urine in patients with atherosclerotic artery disease.
Urinary fpA excretion and fpA in plasma were studied in patients with peripheral artery disease, aortic aneurysm, severe coronary artery disease, acute myocardial infarction and in normal controls. Mean urinary fpA was significantly higher in all groups of patients than in normal controls whose excretion was 1.9 +/- 1.2 micrograms/24 hours (mean +/- SD). We found a good correlation between urinary fpA excretion and plasma fpA (r = 0.68, p less than 0.01, n = 81). The highest levels of urinary fpA were found in 9 patients with aortic aneurysm (11.9 +/- 6.1 micrograms/24 hours). The 10 patients with acute myocardial infarction had also abnormally elevated values (4.3 +/- 1.8 micrograms/24 hours) which were only slightly higher than the levels found in another 10 patients with myocardial infarction receiving subcutaneous heparin in a dosage of 2 X 5000 IU daily (2.9 +/- 1.7 micrograms/24 hours). The 13 patients with peripheral artery disease showed an increase in urinary fpA excretion from 4.0 +/- 1.7 to 10.5 +/- 2.3 micrograms/24 hours after percutaneous angioplasty (p less than 0.001). These data demonstrate that urinary fpA excretion may represent a valid means to detect the cumulative effect of thrombin action on fibrinogen in patients with atherosclerotic vascular disease and after therapeutic intervention.
Aortic Aneurysm↗
Fibrin formation and platelet aggregation in patients with severe coronary artery disease: relationship with the degree of myocardial ischemia.
Fibrinopeptide A (FpA) concentrations in plasma and in 24 hr urine specimens as well as beta-thromboglobulin (BTG) in plasma were measured in 17 patients with severe angina pectoris, including both stable and unstable angina, and in 19 patients with acute myocardial infarction. Patients with unstable angina had plasma FpA and BTG levels of 5.2 +/- 1.7 ng/ml and 91 +/- 23 ng/ml, respectively. The corresponding concentrations of FpA in the 24 hr urine specimens were 8.2 +/- 1.4 micrograms/24 hr. These values were similar to those measured in patients with acute myocardial infarction and higher than the corresponding levels in patients with stable angina (p less than .05) and in normal control subjects (p less than .01). The similarity of the platelet and coagulation findings in patients with unstable angina and in those with myocardial infarction favors the hypothesis that coronary thrombosis may play a major role in the pathogenesis of acute myocardial infarction.
Angina Pectoris↗
Role of heart rate in pathophysiology of chronic stable angina.
11 patients with chronic, stable, effort angina, off medication apart from glyceryl trinitrate, were monitored continuously by electrocardiogram (ECG) during normal, unrestricted daily activity. Computerised ECG analysis demonstrated during 33 twenty-four hour periods of monitoring, 278 episodes of transient ischaemic ST segment depression of which 52 were associated with angina. In the 15 minutes preceding the onset of ischaemia, heart rate did not increase in 164 episodes, increased slightly (greater than or equal to 5 beats/min) in 61, and increased moderately or markedly (greater than or equal to 10 beats/min) in 53. Findings were similar when episodes with or without angina or episodes of different severity were analysed separately. In all patients, periods of sinus tachycardia exceeding the control rate by more than 30 beats/min and lasting more than 10 minutes, often occurred in the absence of angina and/or ST segment depression. Also, in 65% of the ischaemic episodes, heart rate at the beginning of the ST change was either below or less than 10 beats/min above the modal value of the twenty-four hour heart rate. This suggests that increased myocardial demand is not necessarily the only or the most common cause of acute ischaemia in patients with chronic effort angina during unrestricted daily activity. Factors which only transiently interfere with myocardial oxygen supply are probably important in this syndrome.
Aged↗
Evaluation of the effects of catheter sampling for the study of platelet behavior in the pulmonary and coronary circulation.
To study the effects of sampling through cardiac catheters on indices of platelet function, we measured the levels of platelet factor 4 (PF4), beta thromboglobulin (BTG), and platelet aggregate ratio (PAR) in 10 patients with atrioventricular accessory pathway (AVNAP), six patients with primary pulmonary hypertension (PPH), and six patients with critical narrowing of the left anterior descending artery (LAD). In AVNAP and LAD patients samples were drawn simultaneously from a peripheral vein, coronary sinus, and brachial artery; in AVNAP patients samples were also obtained from the axillary vein before the coronary sinus was entered. In PPH patients samples were drawn from pulmonary artery, aorta, and a peripheral vein; in these patients the effects of an intravenous infusion of prostacyclin (PGI2) (2 to 8 ng/kg/min) on PF4, BTG, and PAR were also studied at all sampling sites. In all patients arterial, coronary sinus, pulmonary arterial, and axillary venous levels of PF4, BTG, and PAR significantly exceeded those measured in the peripheral vein. PGI2 infusion resulted in a significant decrease of PF4 at all sampling sites, while no consistent BTG changes were observed and PAR levels did not decrease in the peripheral vein. Although a considerable interpatient variability in PF4 levels was observed, a significant (r = 0.91) correlation was found in patients with AVNAP between simultaneous coronary sinus and arterial PF4 levels. The value of PF4 coronary sinus-arterial difference in LAD patients was consistently higher than that calculated in AVNAP patients (54.5 +/- 28.9 vs 4.2 +/- 3.8 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Computer system for analysis of ST segment changes on 24 hour Holter monitor tapes: comparison with other available systems.
The accuracy of a computer system that was developed for the analysis of ST segment changes recorded on Holter ambulatory electrocardiographic monitoring tapes was compared with conventional visual scrutiny, beat by beat analog printouts and a commercial J point trend system. The program calculates and plots multiple electrocardiographically derived variables in a high temporal resolution trend format. Fifty tapes of good recording quality obtained from 19 patients (13 with chronic stable angina and 6 with variant angina) were assessed visually and with the computer system; of these, 20 were analyzed by all four techniques. In the 50 tapes, 629 episodes of diagnostic ST segment changes (all true positive results) were identified by using the computer system. In contrast, only 507 were identified by visual scrutiny; none of these 507 episodes was missed by computer analysis. On the 20 tapes assessed using computer, visual, beat by beat analog and J point trend system analysis, 268, 221, 230 and 178 episodes, respectively, were documented. For the four techniques, false negative and positive results were 0, 47, 38 and 90 and 0, 10, 6 and 24, respectively. The results indicate that, of the systems assessed in this study, the computer program provides the highest accuracy for detection of transient ST segment changes. This is probably accreditable to the compact presentation of multiple electrocardiographically derived variables, allowing a detailed quantitative assessment of 24 hour tapes. It is of particular value for pathophysiologic and pharmacologic studies.
Angina Pectoris↗
Percutaneous transluminal angioplasty of the arteries of the lower limbs: a 5 year follow-up.
A total of 482 percutaneous transluminal angioplasties (PTAs) of the arteries of the lower limbs were performed in 411 patients between 1977 and 1983. The 5 year patency rate, calculated by the life table method, was 83% for iliac and 58% for femoropopliteal PTA. Clinical improvement after the procedure was confirmed by a significant drop of the arm-ankle pressure difference: 48 +/- 5 mm Hg before vs 17 +/- 5 mm Hg 2 years after iliac PTA (p less than .01) and 73 +/- 5 mm Hg before vs 28 +/- 6 mm Hg after femoropopliteal PTA (p less than .01). The majority of reocclusions occurred within the first year after angioplasty. Patients with stenoses or occlusions of less than 3 cm had a favorable long-term patency rate of 74%. Conversely, patients with femoropopliteal occlusions presenting with pain at rest, diabetes, occlusions of greater than 3 cm, or poor distal runoff had an elevated rate of reocclusion. Complications, which occurred in 8% of the patients in whom PTA was attempted, included local hemorrhage, dissection, embolism, and spasm necessitating surgical intervention in 2%. No deaths or amputations were a direct consequence of PTA. PTA of arteries of the lower limbs may thus be regarded as a valid complementary treatment to vascular surgery in patients with occlusive disease of the peripheral arteries.
Aged↗
Progression to total occlusion of lower limb artery stenoses selected for percutaneous transluminal angioplasty.
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Adult↗
[Immigrant osteomalacia].
The case is reported of a 32-year-old female Asian immigrant admitted with incapacitating pain and suspected diffuse malignant neoplasia. A detailed history and typical laboratory and radiological findings confirmed the diagnosis of osteomalacia caused by lack of sun exposure and a diet poor in vitamin D. Pathogenetic, diagnostic and therapeutic aspects of "immigrant osteomalacia" are discussed.
Adult↗
[Early and late results in 250 cases of percutaneous transluminal dilatation in the lower extremities].
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Angioplasty, Balloon↗
Orthotopic heart transplantation: an efficient treatment in a young boy with doxorubicin-induced cardiomyopathy.
We present the case of a boy who underwent orthotopic heart transplantation at the age of 14 years because of doxorubicin-induced cardiomyopathy 9 years after treatment of a Wilms tumor of the left kidney. Three years after heart transplantation the patient enjoys a normal daily life. Invasive studies show normal cardiac hemodynamic results and in spite of previous nephrectomy and long-term cyclosporine treatment, renal function is only slightly impaired. So far no secondary neoplasia has occurred under chronic immunosuppression.
Adolescent↗