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Biomedical subjects

A Medina

Publications and source records attributed to A Medina.

At least 127 records · Page 7Linked to original sources
PubMed1991

[The electronystagmographic protocol for tracking vestibular dysfunction].

This prospective protocol for vestibular exploration offers the results gained through 296 patients complaining from vestibular disorders. The aim of the AA. is to check the validity of the test proposed (in the midst of the battery of electronystagmographic explorations), consisting in the thermal bilateral and simultaneous stimulation of the labyrinths. They consider this trial very useful because of its sensibility, quickness and tolerance.

Electronystagmography↗
PubMed1991

[Coronary permeability and left ventricular function following thrombolytic therapy].

We study 40 patients, 55 +/- 7 years old with acute myocardial infarction treated early by thrombolytic therapy (20 STK and 20 rt-PA). All patients were angiographically studied in the following conditions: 1) baseline, before initiating therapy. 2) Three hours after treatment. 3) Twenty four hours later. 4) Before discharge. The infarct related artery was patent 24 hours after treatment in 31 patients (78%); five of them were patent before treatment, and we observed an early reperfusion in 20 patients (57%) and late reperfusion in 6 patients (17%). The number of patients with angiographic evidence of intraluminal thrombus decreased progressively through conditions while the grade TIMI of coronary perfusion increased in the absence of reocclusion. Final regional wall motion of infarct related myocardial zones and their degree of recovery were significantly higher in recanalized patients, as compared with non-reperfused patients. Similarly, left ventricular functional recovery was higher in patients with antegrade of collateral flow to the infarct area, as compared with totally occluded patients.

Coronary Angiography↗
PubMed1991

[Cardiac rhabdomyoma and tuberous sclerosis. Survival after the surgical resection of the cardiac tumor].

A 3-month-old boy with tuberous sclerosis was diagnosed of biventricular heart tumor by means of 2D-echocardiogram. Three masses of tumor were excised from the right ventricle with the aid of cardiopulmonary bypass. Pathologic examination disclosed a cardiac rhabdomyoma. The boy is symptoms-free after 5 years of the operation. An echocardiogram taken at this time showed no-evidence of heart tumor. Pathology, diagnostic methods and surgical indications are commented. A review of selected surgically resected cases is also presented.

Biopsy↗
PubMed1990

Factors influencing progression of mitral regurgitation after transarterial balloon valvuloplasty for mitral stenosis.

This study analyzes the clinical, echocardiographic and hemodynamic factors affecting progression of mitral regurgitation (MR) after transarterial balloon valvuloplasty in 200 consecutive patients with rheumatic mitral stenosis. After valvuloplasty, the mitral valve area increased in all patients, from 1.03 +/- 0.36 to 2.06 +/- 0.71 cm2 (p less than 0.0001). With regard to the basal stage, the mitral valve was competent in 139 patients and there was mild MR in 61 (grade I in 53, and grade II in 8). Three patients had progression of MR induced by a technical deficiency and they were excluded from analysis. Patients were classified into 2 groups on the basis of the degree of MR before and after valvuloplasty: group A--no progression of MR (n = 167; 85%) when the degree of MR did not change, disappeared after valvuloplasty, or increased from grade 0 to I; group B--progression of MR (n = 30; 15%) when the degree of MR increased to greater than or equal to grade II. Progression of MR was observed more frequently in older patients with presence of chronic atrial fibrillation, larger left atrial size and left ventricular volumes, baseline MR, more severe stenosis and a lower ejection fraction. Multivariate analysis selected age, left ventricular volumes and ejection fraction as independent predictors of progression of MR. All these factors suggest that progression of MR after balloon valvuloplasty could be related to a more advanced degree of disease.

Age Factors↗
PubMed1990

Natural history of left ventricular thrombi: their appearance and resolution in the posthospitalization period of acute myocardial infarction.

A series of 198 consecutive patients with acute myocardial infarction were prospectively studied before hospital discharge and during 24.0 +/- 8.6 months of follow-up. A predischarge thrombus was found in 38 (31%) of 124 patients with anterior infarction but in none of 74 patients with inferior infarction (p less than 0.001). Early thrombolytic therapy in 34 patients did not decrease the rate of thrombus occurrence. Acute anterior infarction, ejection fraction less than or equal to 35% and apical dyskinesia or aneurysm (but not akinesia) were significantly related to the appearance of thrombus during hospitalization by stepwise logistic regression analysis. Echocardiographic follow-up of 159 patients for at least 6 months (mean 26.6 +/- 8.4) revealed that thrombus disappeared in 14 (48%) of 29. Disappearance of thrombus was related to predischarge apical akinesia (but not dyskinesia) and to warfarin therapy during the follow-up period. A new thrombus first appeared after hospital discharge in 13 of 130 patients, and in 7 of the 13 it resolved during further follow-up. Thus, 30% (13 of 42) of thrombi in these patients appeared after discharge from the hospital. Three factors were related to occurrence of new thrombi during the follow-up period: deterioration in left ventricular ejection fraction, predischarge ejection fraction less than or equal to 35% and ventricular aneurysm or dyskinesia. Systemic embolism occurred in six patients, all with a predischarge thrombus (p less than 0.001). Mobility of the thrombus was the only variable significantly related to subsequent embolic events (p = 0.001) by logistic regression analysis. Thus, the predischarge echocardiogram identifies patients with thrombus and those at highest risk of embolic events. It can indicate patients who are likely to have thrombus resolution and those at risk of developing a new thrombus after hospital discharge. Follow-up echocardiograms may help in guiding the length of long-term anticoagulant therapy. Four additional patients with a predischarge apical mobile thrombus (not part of the consecutive series) received thrombolytic therapy. In two of the four, lysis of thrombus was achieved without complications, but systemic embolism occurred in the other two, and proved fatal in one.

Echocardiography↗
PubMed1990

Balloon valvuloplasty for mitral restenosis after previous surgery: a comparative study.

We studied 203 patients with mitral stenosis treated by transarterial valvuloplasty. Forty two (group A) had undergone closed (n = 30) or open n = 12) surgical commissurotomy 15 +/- 5 years before. The remaining 161 had not undergone previous surgery (group B). There were no significant differences between both groups in terms of age, sex, functional class, left atrial size, two-dimensional anatomic features of the valve, incidence of mild basal mitral regurgitation, or ejection fraction. A comparative analysis of both groups showed no significant differences in terms of changes in the mean gradient, mitral valve area, and incidence of severe postvalvuloplasty mitral regurgitation (9.5% versus 5.5%). Echo-Doppler follow-up studies (11 +/- 7 months) showed persistent gradient relief in either group. We conclude that the immediate and short-term results of balloon valvuloplasty in patients who had undergone previous surgery are similar to those observed in patients who had not had commissurotomy.

Catheterization↗
PubMed1990

Prevention of early aortocoronary bypass occlusion by low-dose aspirin and dipyridamole. Grupo Español para el Seguimiento del Injerto Coronario (GESIC)

To analyze the efficacy of low-dose aspirin in preventing early aortocoronary vein graft occlusion, 1,112 consecutive patients were enrolled in a multicenter, randomized, double-blind, placebo-controlled trial comparing 50 mg t.i.d. aspirin, 50 mg aspirin plus 75 mg t.i.d. dipyridamole, and placebo. All patients received 100 mg q.i.d. dipyridamole for 48 hours before surgery, and assigned treatment was started 7 hours after surgery. Vein graft angiography was performed in 927 patients (83%) within 28 days of surgery (mean, 10 days). Aspirin plus dipyridamole significantly (p = 0.017) reduced the occlusion rate of distal anastomoses from 18% (placebo) to 12.9%. Occlusion rate in the aspirin group was 14%, which approached statistical significance (p = 0.058). Furthermore, only aspirin plus dipyridamole reduced (p = 0.01) the number of patients with occluded grafts (placebo, 33%; aspirin, 27.1%; aspirin plus dipyridamole, 24.3%). Mediastinal drainage was slightly higher (p = 0.04) in the aspirin plus dipyridamole group (713 +/- 456 ml) than in the other two groups (placebo, 670 +/- 437 ml; aspirin, 629 +/- 337 ml), but hospital mortality (average, 4.6%) and early reoperation (average, 3.9%) rates were similar among the three groups. Thus, low-dose aspirin plus dipyridamole safely improves early saphenous vein aortocoronary graft patency; this effect is an added benefit to a preoperative regimen of dipyridamole.

Aged↗
PubMed1990

Results of treatment in locally advanced carcinoma of the endometrium.

The impact of treatment on survival was analyzed in 106 patients with carcinoma of the endometrium stage II (n = 61) and stage III (n = 45). There was no significant difference in survival in patients with stage II who were treated with radiation therapy alone or with combination of surgery and radiation therapy. Their five-year actuarial survival was 74.5% and 71.3% respectively (p = greater than 0.05). However, combined treatment was associated with significantly superior survival in patients with stage III disease where the survival was 57.3% versus 17.5% in patients who received irradiation alone (p = 0.01). Diagnosis of stage III disease based upon clinical (CS III) or pathological (PS III) findings was responsible for this difference in survival. Patients with CS III whose tumor could not be resected because of its extent carried poorer prognosis. Patients with stage II had excellent tumor control in pelvis as compared to patients with stage III. Treatment-related complications were minimal. Overall survival of patients with stage III was poor (33.8%) due to a high rate of pelvic and/or extrapelvic recurrences.

Adenocarcinoma↗
PubMed1990

Testing visual acuity of children using vanishing optotypes.

To test visual acuity in children, we developed a chart constructed so that the mean Fourier transform of the luminance of the figures on the chart at zero spatial frequency is the same as the background luminance. When the eye reaches its limit of resolution, the figures vanish into the gray background of the chart rather than becoming "blurred" as in conventional visual acuity charts. We compared the number of errors in determining the visual acuity of children aged 3-4.5 years using this high-frequency chart and a standard black-and-white high-contrast chart. Significantly fewer errors were found with the high-frequency chart, suggesting that this type of testing may improve the accuracy of visual acuity measurements in children.

Child, Preschool↗
PubMed1990

[Transesophageal Doppler color echocardiography in the evaluation of patients after percutaneous mitral valvuloplasty].

To determine the value of transesophageal ultrasound in the assessment of patients after percutaneous mitral valvuloplasty, 42 patients were studied by transthoracic (TTE) and transesophageal (TEE) two-dimensional and color Doppler echocardiography. All of them were studied as out-patients and without complications. We describe the technique, planes of examination and the advantages that this new acoustic window offers in patients after balloon valvuloplasty regarding to: detection of thrombus in the left atrium (LA), visualization of spontaneous echo contrast in the LA, evaluation of mitral regurgitation (MR), detection of small atrial septal defects (ASD) and evaluation of the stage of the commissures of the mitral valve. We detected thrombus by TEE, in 5/42 vs 1/42 by TTE approach. Spontaneous echo contrast was found in 35/42 by TEE and none by TTE. Small ASDs were visualized in 10/42 patients vs 2/42 by TTE. No differences were found in the evaluation of MR and mitral valve commissures either by TEE or TTE. We conclude that transesophageal echocardiography is a well-tolerated technique in outpatients which complements and improves the information obtained by the transthoracic approach in patients after balloon mitral valvuloplasty.

Adult↗
PubMed1990

[Role of percutaneous valvuloplasty in rheumatic mitral valve stenosis. Córdoba-Las Palmas cooperative study].

This article describes our findings on a prospective and cooperative study (Córdoba-Las Palmas) in 203 patients with mitral stenosis who underwent balloon valvuloplasty using a retrograde transarterial technique. We analyzed the immediate and mid-term results, and studied the factors determining an optimal result and those related to the new appearance or worsening of mitral incompetence after the procedure. On the other hand, we analyzed the results of mitral valvuloplasty in patients with previous mitral surgery, mild mitral stenosis and patients dilated while having an acute pulmonary edema. We observed a marked decrease in mean mitral gradient (17 +/- 7 to 6 +/- 3 mmHg; p less than 0.001) as well as a significant increase in mitral valve area (1.02 +/- 0.4 to 2.04 +/- 0.7 cm2; p less than 0.001). Echo-Doppler follow-up did not show significant changes in the residual mitral valve gradient. Multivariate analysis selected, as independent predictors of an optimal result, the presence of a pliable valve and the absence of basal mitral regurgitation. On the other hand, the presence of a lower ejection fraction, an older age and a higher baseline left ventricular endiastolic volume were independent factors determining progression of mitral regurgitation. In patients with previous mitral surgery, the clinical, echo and hemodynamic profiles, as well as the immediate results, were similar to those observed in patients with unoperated mitral stenosis. In the subgroup of mild mitral stenosis, we observed and optimal result in all cases, without major complications. Mitral valvuloplasty was dramatically effective in 8 patients treated during acute pulmonary edema.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Combined percutaneous mitral and aortic balloon valvuloplasty.

Between August 1987 and November 1988, combined mitral and aortic balloon valvuloplasty was performed in 10 patients (mean age 42 +/- 9 years), all of whom had symptomatic mitral and aortic stenosis. The procedure was performed using a transarterial approach with a multiballoon catheter and an exteriorized intracardiac long guidewire circuit. The procedure could be considered successful in 9 patients where significant increases in the mean mitral (0.97 +/- 0.19 to 1.80 +/- 0.26 cm2) and aortic (0.63 +/- 0.18 to 1.15 +/- 0.32 cm2) areas were achieved. Severe mitral regurgitation that required surgery developed in 1 patient in the following 24 hours. Femoral vascular surgery was necessary in 1 patient. Mid-term follow-up was available in 8 patients for a period averaging 8 +/- 3 months. The 9 patients in whom the procedure was successful showed persistent clinical improvement in functional class, Doppler echocardiography showed 2 cases of aortic restenosis and none of mitral restenosis. Combined mitral and aortic balloon valvuloplasty could be a valid alternative treatment in selected patients with both mitral and aortic rheumatic stenosis. Further experience and long-term hemodynamic follow-up are necessary to define the role of this mode of treatment.

Adult↗
PubMed1989

Radiation therapy in stage II carcinoma of the endometrium.

A retrospective analysis of 61 patients with Stage II carcinoma of the endometrium was carried out. Our results suggest that when given carefully and adequately, radiation therapy alone is as effective as a combination of surgery and irradiation and is well tolerated. Five-year actuarial survival was 74.5% in patients treated with radiation therapy alone (16 patients) as compared to those patients who received either preoperative radiation (35 patients) or postoperation radiation (ten patients) where the survival was 70.8% and 78.3%, respectively (P greater than or equal to 0.05). Tumor was controlled in the pelvis in 93.4% of patients. Complications of treatment were seen in 8.2%. With the exception of one patient with bowel obstruction requiring surgery, the rest of the complications were minor. From these results, it appears that a planned radiotherapy is a good alternative to combination of surgery and irradiation.

Combined Modality Therapy↗
PubMed1989

Use of cross-polarized light in anterior segment photography.

A photographic technique improved the quality of anterior segment photography by using one polarizer in the illumination path and another polarizer that was perpendicularly oriented to the first in front of the camera film back. A significant improvement was noted by impartial masked observers who assessed standard photographs of the iris, conjunctiva, and sclera. A crosslike artifact, observed in photographs using cross-polarizers, was present and originated from corneal birefringence. The significance of the artifact and its possible diagnostic applications were determined.

Anterior Eye Segment↗
PubMed1989

Long QT syndrome and complete situs inversus. Preliminary report of a family.

The familial long QT syndrome is a rare condition that may occur with or without deafness. Dextrocardia with complete situs inversus is a familial syndrome generally found in normal subjects with a high incidence of consanguinity among the parents. In this report we describe a Jerbian family with both disorders and with several cases of sudden death. Of 27 members of this family (3 generations) in whom ECG was performed, 15 had QT prolongation (QTc greater than 0.45). Four members (2 generations) had complete situs inversus, 3 of them also had ECG evidence of QT prolongation. The combined occurrence of these rare diseases within the same family has not been previously reported. It may be due to the high incidence of consanguinity and may raise the possibility that the loci responsible for the 2 conditions are closely related and located on the same chromosome. A more extensive study of the family is being carried out.

Arrhythmias, Cardiac↗
PubMed1989

Adherence of viable and nonviable bacteria to soft contact lenses.

Bacterial viability in bacterial adherence to new soft contact lenses (SCLs) was studied by exposing polymacon and lidofilcon A lenses to Pseudomonas aeruginosa: L, live, untreated bacteria; H, bacteria heated for 1 h at 100 degrees C; and P, bacteria treated with 3% hydrogen peroxide for 1 h. Cultures of groups L, H, and P showed heavy, no, and minimal bacterial growth, respectively. Scanning electron microscopy (SEM) showed significantly less bacteria on new SCLs in groups H and P. Transmission electron microscopy (TEM) showed that bacterial shape was mostly preserved in all groups, with marked intracellular and cell membrane changes and breaks (groups H and P), margination of intracellular electron-dense material (group H), and central and peripheral vacuolation (group P). Adherence to new SCLs appears to be an active process, as killed or altered bacteria adhere less.

Bacterial Adhesion↗