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Biomedical subjects

A Olmos

Publications and source records attributed to A Olmos.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Percutaneous mitral valvuloplasty: immediate and late results in 300 patients].

Between December 1987 and July 1992, we performed a balloon mitral valvuloplasty to 300 patients aged 48 +/- 23 years, with pure or predominant, symptomatic mitral stenosis, with an hemodynamic area < 1.5 cm2 and a mean echocardiographic score of 8.8 +/- 1.3 (6-13). Young subjects with mobile and flexible valves as well as elders with highly damaged valves were included. A transeptal technique employing 2 balloons was used in 97% of cases. There were 3 failures and 9 deficient results. In 284 patients, the procedure was considered successful with a mean increase in mitral area (measured using modified Gorlin's formula) from 0.88 +/- 0.13 to 2.19 +/- 0.38 cm2. Four patients died two due to a left ventricular traumatism, one due to an irreversible low cardiac output and one due to a massive systemic embolism. In five, a cardiac tamponade was treated with pericardiocentesis or surgery. One hundred patients were followed for a mean of 40 +/- 3 months. Mitral areas remained over 1.5 cm2 in 87% and 14 had a significant reestenosis. The latter had an initial echocardiographic score over 8 or previous surgical commissurotomy. Multifactorial analysis identified valvular motility and global echocardiographic scores as predictors of immediate success. Likewise, the last parameter and subvalvular thickening were predictors of late reestenosis and of increase in mitral regurgitation post valvuloplasty. According to our experience, percutaneous balloon mitral valvuloplasty is a first choice therapeutic alternative in patients with mitral stenosis.

Adolescent↗
PubMed1993

[Fatigue resistance of inspiratory muscles in patients with severe mitral valve stenosis].

The strength and endurance of the inspiratory muscles was assessed in 14 patients with severe mitral valve stenosis uncomplicated by other diseases. Strength was evaluated measuring the maximal static inspiratory pressure (MIP). Endurance was measured using a two minute weight incremental test, to obtain the maximal sustainable pressure (SIP), which is the highest pressure that a subject can generate to mobilize air with incremental weight during inspiration. MIP was similar to that of 8 normal subjects (110 +/- 21 and 128 +/- 27 cm H2O respectively p = NS). SIP, maximal sustainable weight and SIP as percentage of MIP were 47 +/- 10 cm H2O, 261 +/- 81 g and 43 +/- 6% respectively, all lower than in normal subjects (89 +/- 25 cm H2O, 525 +/- 167 g and 71 +/- 15% respectively) We conclude that patients with severe mitral valve stenosis have decreased inspiratory muscle endurance compared to normal subjects and this feature may be related to their decreased exercise tolerance.

Adult↗
PubMed1992

Mitral valve resistance as a hemodynamic indicator in mitral stenosis.

Variability of the valve area calculated by the Gorlin formula has been noted in bioprosthetic and aortic valves, but few data are available for native stenotic mitral valves. Valve resistance has been proposed as an alternative hemodynamic indicator; however, its value in mitral stenosis has not been assessed. Thirty-four patients had simultaneous recordings of left atrial and ventricular pressures, 26 after percutaneous balloon mitral dilatation (PBMD). Patients with shunt or mitral regurgitation were excluded. Mitral valve resistance correlated exponentially with Gorlin mitral area (y = 133*[area]-1.5; p less than 0.0001). Both Gorlin mitral area and mitral resistance improved after PBMD (0.89 +/- 0.07 cm2 to 2.22 +/- 0.15 cm2; p less than 0.001; and 166 +/- 20 to 40 +/- 8 dynes.s.cm-5; p less than 0.001). Gorlin area and mitral resistance correlated with New York Heart Association functional class. After infusion of isoproterenol in 17 patients, there was an increase in Gorlin area (baseline 1.77 +/- 0.22 cm2, change 0.23 +/- 0.10; p less than 0.03), whereas mitral resistance did not change (baseline 96 +/- 16 dynes.s.cm-5, change 2 +/- 5; p = not significant). Mitral resistance is valuable in the assessment of mitral stenosis. It varies less than Gorlin mitral area under changing hemodynamic conditions.

Adolescent↗
PubMed1992

[Cutaneous trophic disorders secondary to arteriovenous fistula for hemodialysis].

The arteriovenous fistula is the vascular access of choice for hemodialysis treatment in patients with chronic renal failure. Clinical occurrence of local circulatory troubles caused by the fistula in addition to arterial robbery or venous hypertension are infrequent but may provoke serious consequences. Two patients with arteriovenous fistula with cutaneous trophic disorders secondary to the venous hypertension syndrome (case 1) and to the arterial robbery syndrome (case 2) are present. Prevalence, pathogenic factors, physiopathology, clinical aspects, and diagnosis and treatment of both syndromes are reviewed. Finally, the difficulty and morbidity of the creation of an efficient arteriovenous fistula in the diabetic patient is underlined.

Adult↗
PubMed1992

Long-term immunogenicity and efficacy of hepatitis B vaccine in hemodialysis patients.

Although the efficacy of hepatitis B vaccines in patients under chronic hemodialysis treatment has been well documented, the persistence of immunity in this population remains largely unknown. In this study we have followed 60 hemodialysis patients up to 3 years after primary hepatitis B vaccination (four doses of recombinant hepatitis B vaccine; Engerix B, 20 mg/dose) to evaluate the persistence of immunity (as indicated by serum levels of antibody to hepatitis B surface antigen-anti-HBs-higher than or equal to 10 mIU/ml). Fourty-four (73%) patients developed anti-HBs levels above 10 mIU/ml after vaccination; the remaining 16 (27%) vaccinees were considered nonresponders and were given a booster dose that again failed to elicit an immunoresponse. After 3 years of follow-up, 18 out of 44 (41%) responders had no detectable anti-HBs levels in the serum (antibody loss occurring within 8 and 12 months in 3 cases, within 1 and 2 years in 13, and within 2 and 3 years in 2 other cases). When compared with the responders that lost their antibodies during the follow-up period, those who remained immunoreactive 3 years after vaccination was initiated were younger and had higher anti-HBs levels at 8 months of follow-up. Two hepatitis B virus infections were detected among nonresponders during the follow-up period. Based on these data, we conclude that patients undergoing chronic hemodialysis therapy not only have lower response rates to hepatitis B vaccination than healthy adults, but also that these are frequently transient.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1992

[Percutaneous aortic valvuloplasty in the adult: immediate results and follow-up of 43 patients].

From June 1986 to June 1991, percutaneous balloon valvuloplasty was performed in 43 patients with severe symptomatic aortic stenosis. Their age ranged from 52 to 81 years (mean 69). The retrograde approach was used in 34 and the transseptal technique in the remaining 9. One patient died from severe tamponade, another developed a large cerebral infarct and the procedure failed in a third. The procedure was considered successful in the remaining 36 patients. Cardiac output increased from 3.5 +/- 0.6 to 4.7 +/- 0.7 l/min, (p < 0.01) and aortic valve area from 0.53 +/- 0.21 to 0.97 +/- 0.2 cm2 (p < 0.01). After a follow up period of 24 +/- 9 months 3 patients, all with initially poor results, died. 10 of 19 patients with adequate initial results experimented a deterioration of functional class. The other 9 patients have preserved the initial improvement obtained with dilatation. Thus percutaneous aortic valve dilatation in adults with severe aortic stenosis is risky and of limited clinical value.

Aged↗
PubMed1992

[Percutaneous mitral valvuloplasty during pregnancy].

The mitral valve stenosis is the most frequently valvuloplasty in pregnant patients. When it carries a significant risk of mortality for both mother and fetus, it can be performed a surgical commissurotomy, with a high risk for the fetus. We report our experience in percutaneous mitral valvuloplasty (PMV) in 3 patients during the third trimester of pregnancy with severe mitral stenosis. In this cases, we performed PMV in NYHA (New York Heart Association) CF III patients refractory to medical treatment. We used the transseptal double balloon technique protecting the abdominal wall using a lead apron. The mitral areas increased from 1 to 2 cm2, without a significant development of mitral regurgitation. In all cases, the infants delivered at term without complications and with normal weight. The PMV arise like an ideal intervention for the treatment of mitral stenosis during pregnancy.

Adult↗
PubMed1991

[Percutaneous mitral valvuloplasty as a treatment of choice for mitral stenosis. Immediate results and long-term follow-up].

We evaluated 77 patients with symptomatic mitral stenosis for balloon valvuloplasty. Five patients were excluded from the procedure due to the presence of intra-atrial thrombi or mitral valve endocarditis as detected by 2D echocardiography. The mean age of the 72 treated patients was 38 +/- 11 years, 68 were NYHA functional class II or IV: only 6 patients had valvular calcification. Three patients had severe liver failure, 2 were chronic alcoholics, one had liver cirrhosis, 2 had severe weight loss and 13 had pulmonary hypertension at systemic levels. 69 patients had a technically adequate procedure, one patient died, 1 developed cardiac tamponade and 1 failed. Mitral valve area increased from 0.93 +/- 0.34 to 2.38 +/- 0.67 cm2. Mitral incompetence increased in only 16 patients. After a mean follow up period of 15 +/- 5 months (range 8 to 27), 56 patients remained in FC I or II. Mitral valve area remained satisfactory in 54 patients. Mitral valve anatomy evaluated by echocardiography is helpful to predict immediate and late outcome. We conclude that balloon mitral valvuloplasty is the first choice for patients with severe symptomatic mitral stenosis.

Adolescent↗
PubMed1990

[Evaluation of the involvement of the internal anal sphincter by the measurement of the amplitude and duration of the ano-rectal inhibitory reflex].

The aim of this study was the evaluation of a possible correlation between the resting tone of the anal canal (RT) and amplitude and duration of the recto anal inhibitory reflex (RAIR). 94 subjects, 72 women and 22 men, aged 9-91 years (mean 53 years) were studied. Manometric testing was performed on all subjects with a three balloon system. The maximal anal canal resting tone, the amplitude and duration of the RAIR, were measured. According with the RT, subjects were divided on three groups: GROUP I: RT up to 79 mmHg GROUP II: 80 to 120 mmHg and GROUP III: with RT more than 121 mmHg. The amplitude of RAIR was for GROUP I: mean = 7.09 SD:4.93, GROUP II: mean-10.5 SD:7.3, GROUP III: mean 15.14 DS: 8.19. p less than 0.001 between GROUPS I and III. The duration (d/s) of RAIR was for GROUP I: mean = 180 DS:70, GROUP II: 175.6 DS: 68, GROUP III mean: 201.6 DS 86.4. No differences were found between GROUPS I and II (p less than 0.13), I and III (p less than 0.17), and II and III (p less than 0,33). Positive Sperman correlation (p less than 0,001) was found between RT and amplitude of RAIR. The observation of a positive correlation between RT and RAIR amplitude suggest that the functional integrity of the internal sphincter could be also evaluated by the amplitude but not duration of the RAIR.

Adolescent↗
PubMed1989

[Volume, flow and respiratory muscle strength in mitral stenosis].

Pulmonary function and respiratory muscle strength was assessed in 20 patients with mitral stenosis uncomplicated by other illness. Pulmonary function was evaluated by spirometry, flow-volume curves, functional residual capacity (FRC) and total lung capacity (TLC). Respiratory muscle strength was evaluated by measurement of maximal static inspiratory and expiratory mouth pressure (PIM, PEM cmH2O) at FRC and TLC respectively. Spirometric, FRC and TLC average values were normal. The maximal expiratory flow rate at 50 and 25% of vital capacity were decreased to 49.5 and 38.3% from predicted values. The values of PIM and PEM in patients (-93 +/- 17; 128 +/- 32 cmH2O, respectively) were similar to those of 12 normal subjects studied at comparable lung volume. Our results were similar to previous reports. There was no evidence of decreased respiratory muscle force, probably because the patients nutritional status and cardiac output were normal.

Adolescent↗
PubMed1989

[Mitral commisurotomy in extracorporeal circulation: long term follow-up with clinical and hemodynamic control].

We reviewed the clinical and hemodynamic findings in 52 patients undergoing open mitral commisurotomy. 85% were female and the mean age was 31 + 9 years. Before operation 21% were in functional class II, 73% in class III and 56% in class IV. Pure mitral stenosis was found in 61% and congestive heart failure in 42%. The mitral valve area was less than 1 cm2 in 61%, the wedge pressure over 25 mmHg in 59% and the pulmonary artery systolic pressure over 50 mmHg in 59%. There was no operative morbidity in 79% of cases. Operative mortality was 2% (1 patient). All survivors were followed for a mean of 40 + 26 months. At the final visit 79% were improved in their functional class and only 13% remained in heart failure. The mitral valve area increased from 0.98 + 0.26 to 1.5 + 0.48 cm2. Pulmonary wedge pressure was under 25 mmHg in 79% and pulmonary artery systolic pressure under 50 mmHg in 73%. We conclude that open mitral commisurotomy offers a low morbidity and mortality and good longterm results for the treatment of mitral stenosis.

Adult↗
PubMed1989

[Percutaneous mitral valvuloplasty in 6 patients].

We performed a percutaneous mitral balloon valvuloplasty in 6 patients with severe mitral stenosis, aged 21 to 50 years. The mitral valve gradient decreased from 14.7 +/- 4.9 to 6.3 +/- 4.0 mmHg, p = 0.03. Mitral valve area increased in 5 patients (0.92 +/- 0.23 to 2.32 +/- 0.26 cm2, p = 0.04). One patient developed a transient cerebral ischemic attack without sequelae and mild mitral insufficiency. The diameter of the mitral annulus as measured by echocardiography was 48.5 +/- 8.1 mm, significantly larger than that reported in other series. The curvature of the transseptal needle was selected after an echocardiographic view of the inferior vena cava and atria from the subcostal window. This allowed a successful procedure in all patients regardless of cavity size.

Adult↗
PubMed1985

The genetic basis of porphyria cutanea tarda.

In order to confirm the genetic character of porphyria cutanea tarda (PCT), the quantitative and qualitative porphyrin excretion from 56 unrelated PCT patients and 259 relatives was analyzed by a sensitive fluorimetric thin-layer chromatographic technique. Porphyrin excretion abnormalities were observed in 111 (35.24%) of the 315 subjects studied. Of the 259 relatives, 55 (21.24%) suffered from manifest (24 cases) or subclinical (31 cases) PCT. The relatives from the older generation or a generation similar to the propositi were more frequently affected than those from a younger generation. A clear family incidence was observed in 32 families, while PCT was apparently limited to the propositi in the remaining 24. It is discussed whether these latter families correspond to the so-called "sporadic" type of PCT or include porphyric gene carriers lacking biochemical expression of the disease. While the measurements of the activity of the defective enzyme (uroporphyrinogen decarboxylase) for the genetic research of PCT turned out to be impracticable in hepatic tissue and contradictory in erythrocytes, our study confirms that the familial character of this disease may be revealed by the chromatographic analysis of the porphyrin excretion pattern.

Adolescent↗
PubMed1985

Apoprotein A-I and high density lipoprotein subfractions in patients with chronic renal failure receiving hemodialysis.

Serum concentration of apoprotein A-I (apo A-I) and cholesterol content in high density lipoprotein (HDL) subfractions have been studied in 19 men and 11 women at the end stage of chronic renal failure undergoing hemodialysis. HDL2 cholesterol concentration was decreased in males [0.33 +/- 0.12 (mean +/- SD) mmol/l, controls 0.45 +/- 0.09 mmol/l; p less than 0.001]; in females HDL2 cholesterol was also decreased although without statistical significance (0.45 +/- 0.15 vs. 0.55 +/- 0.10 mmol/l). HDL3 cholesterol was significantly decreased in men (0.65 +/- 0.11 vs. 0.77 +/- 0.04 mmol/l; p less than 0.001) and also in women (0.61 +/- 0.12 vs. 0.82 +/- 0.07 mmol/l; p less than 0.005). However, serum concentration of apo A-I was within the normal range (1.13 +/- 0.16 milligram in males and 1.25 +/- 0.17 milligram in females; controls 1.24 +/- 0.17 and 1.35 +/- 0.19 milligram, respectively). The raised apo A-I/HDL2 cholesterol ratio in both men and women suggests the existence of qualitative changes in HDL subfractions as has been proposed in previous studies measuring total apo A and total HDL cholesterol in patients with chronic renal failure receiving hemodialysis. These abnormalities in the relative composition of HDL subfractions could play an important role as a vascular risk factor in patients with chronic renal failure undergoing hemodialysis.

Adult↗