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Biomedical subjects

A Oto

Publications and source records attributed to A Oto.

At least 73 records · Page 4Linked to original sources
PubMed1999

Effects of stroke localization on cardiac autonomic balance and sudden death.

BACKGROUND AND PURPOSE: Stroke has been shown to alter autonomic function. The purpose of this study was to show the differential effects of stroke localization on autonomic function parameters assessed by heart rate variability (HRV). METHODS: To determine the differential effect of ischemic stroke localization on autonomic cardiac innervation, we evaluated 62 patients with ischemic stroke and 62 age- and sex-matched controls. The localization of the infarct was determined by CT and MRI. Power spectrum analysis of HRV was performed. Myocardial necrosis was ruled out by echocardiography and creatine kinase myocardial isoenzymes measurements. RESULTS: All stroke patients had significantly decreased low frequency, high frequency, and standard deviation of all relative risk intervals values (P<0.001). However, patients with right-middle cerebral artery (R-MCA) and insula lesions had significantly lower power spectrum analysis values compared with all other localizations (P<0.001). In addition, 5 patients with R-MCA insular lesions died suddenly compared with 2 patients with left-middle cerebral artery insular lesions during hospitalization. Both sympathetic- and parasympathetic-controlled HRV were decreased in patients with ischemic stroke. The most pronounced decrease was found in the territory of R-MCA insular cortex, which suggests that cardiac autonomic tone may be regulated by insula and that these patients are more prone to cardiac complications such as arrhythmias and sudden death due to autonomic imbalance. CONCLUSION: We conclude that stroke in the region of insula (especially the right) leads to decreased HRV and to increased incidence of sudden death.

Aged↗
PubMed1999

MR characteristics of oxidized cellulose (Surgicel).

OBJECTIVE: Oxidized regenerated cellulose (Surgicel) is one of the most commonly used bioabsorbable topical hemostatic agents. Surgicel may mimic an abscess on both CT and sonography when a patient undergoes imaging early in the postoperative period. The objective of our study was to describe the appearance of Surgicel on postoperative MR imaging. CONCLUSION: Surgicel has a short relaxation time on T2-weighted images, resulting in low signal intensity in the early postoperative period. MR imaging may be helpful in differentiating Surgicel from an abscess and therefore in preventing unnecessary attempts at aspiration.

Abscess↗
PubMed1998

Increased QT dispersion in the absence of QT prolongation in patients with Behcet's disease and ventricular arrhythmias.

In Behcet's disease, prominent clinical manifestations include involvement of mucocutaneous, ocular, gastrointestinal, respiratory, neurologic, urogenital, articular and cardiovascular systems. Patients with Behcet's disease have higher incidence of ventricular arrhythmia than healthy subjects. However there is a little information about the mechanism of ventricular arrhythmias in Behcet's disease. The aim of the study was to investigate whether dispersion of ventricular repolarisation was an arrhythmogenic mechanism. QT dispersion parameters were measured in 73 Behcet patients and QT dispersion was defined as the difference between the maximum and minimum QT interval in any of the 12 leads of surface electrocardiogram. Corrected QT dispersion for heart rate was calculated by Bazett's formula. The results were compared with the data from 51 matched controls without a history of cardiac disease. We found QT dispersion was greater in Behcet patients (58+/-12 vs. 37+/-8 ms, P=0.001) as was corrected QT dispersion (81+/-14 vs. 52+/-11 ms, P=0.001). There was no significant difference in minimum or maximum QT intervals between Behcet patients and controls (P>0.05). We found a correlation between QT dispersion and grade of premature ventricular complexes (r=0.7, P=0.002). Our findings suggest that increased dispersion of repolarisation may account for the development of ventricular arrhythmias in Behcet's disease.

Adult↗
PubMed1998

Randomized multicenter comparison of conventional anticoagulation versus antiplatelet therapy in unplanned and elective coronary stenting. The full anticoagulation versus aspirin and ticlopidine (fantastic) study.

BACKGROUND: Dual therapy with ticlopidine and aspirin has been shown to be as effective as or more effective than conventional anticoagulation in patients with an optimal result after implantation of intracoronary metallic stents. However, the safety and efficacy of antiplatelet therapy alone in an unselected population has not been evaluated. METHODS: Patients were randomized to conventional anticoagulation or to treatment with antiplatelet therapy alone. Indications for stenting were classified as elective (decided before the procedure) or unplanned (to salvage failed angioplasty or to optimize the results of balloon angioplasty). After stenting, patients received aspirin and either ticlopidine or conventional anticoagulation (heparin or oral anticoagulant). The primary end point was the occurrence of bleeding or peripheral vascular complications; secondary end points were cardiac events (death, infarction, or stent occlusion) and duration of hospitalization. RESULTS: In 13 centers, 236 patients were randomized to anticoagulation and 249 to antiplatelet therapy. Stenting was elective in 58% of patients and unplanned in 42%. Stent implantation was successfully achieved in 99% of patients. A primary end point occurred in 33 patients (13.5%) in the antiplatelet group and 48 patients (21%) in the anticoagulation group (odds ratio=0.6 [95% CI 0.36 to 0.98], P=0.03). Major cardiac-related events in electively stented patients were less common (odds ratio=0.23 [95% CI 0.05 to 0.91], P=0.01) in the antiplatelet group (3 of 123, 2.4%) than the anticoagulation group (11 of 111, 9.9%). Hospital stay was significantly shorter in the antiplatelet group (4.3+/-3.6 versus 6. 4+/-3.7 days, P=0.0001). CONCLUSIONS: Antiplatelet therapy after coronary stenting significantly reduced rates of bleeding and subacute stent occlusion compared with conventional anticoagulation.

Administration, Oral↗
PubMed1998

Prediction of restenosis after successful percutaneous coronary angioplasty by dobutamine thallium-201 scintigraphy.

We evaluated the accuracy of dobutamine thallium-201 myocardial perfusion scintigraphy in predicting restenosis after successful percutaneous coronary angioplasty. Restenosis is one of the most important problems in patients who have undergone percutaneous coronary angioplasty. Exercise thallium-201 myocardial perfusion scintigraphy has been a well accepted non-invasive method to predict the restenosis of the dilated vessel after percutaneous coronary angioplasty, however, the role of thallium-201 myocardial perfusion using dobutamine, as a substitute for exercise in patients unable to exercise, in predicting restenosis is not well known. Therefore, 34 consecutive patients underwent dobutamine tomographic (single photon emission computed tomography) thallium-201 myocardial perfusion scintigraphy following a total of 37 successful angioplasties. No serious side effects during dobutamine infusion occured. The interval between percutaneous coronary angioplasty and scintigraphy ranged between 8 weeks to 2 years. All patients underwent control angiography within one month following myocardial perfusion scintigraphy. Sensitivity, specificity and accuracy of dobutamine myocardial imaging for predicting restenosis were 76%, 79% and 77%, respectively. Sensitivity and specificity related to the vascular territories were: left anterior descending artery 66-69%, left circumflex artery 75-100%, right coronary artery 83-66%, respectively. In conclusion, our findings demonstrating high accuracy of dobutamine myocardial single photon emission tomography for angiographic restenosis suggest its usefulness as a non-invasive tool in the follow-up of percutaneous coronary angioplasty patients.

Aged↗
PubMed1998

QT dispersion and autonomic nervous system function in patients with type 1 diabetes.

Cardiac arrhythmias and markedly increased mortality rate have been demonstrated in patients with diabetic autonomic neuropathy. Abnormal prolonged QT dispersion interval (QTd) is associated with a higher risk of ventricular arrhythmias. The aim of this study was to evaluate the relationship between autonomic dysfunction, QT and JT interval dispersion parameters and ventricular arrhythmias. Twenty-six patients with type 1 diabetes mellitus and 20 healthy subjects as controls were enrolled in the study. Resting 12-lead electrocardiograms were recorded for measurement of QTd, corrected QTd (QTcd), JT dispersion (JTd) and corrected JT dispersion (JTcd). After taking ECG, all patients underwent autonomic function tests. Patients and control group were also evaluated by 24-h Holter monitoring. Fourteen patients were identified who had autonomic dysfunction. QTd, QTcd, JTd, and JTcd values were significantly higher in patients with autonomic dysfunction than both patients without autonomic dysfunction and the control group (QTd: 78+/-16 vs. 51+/-13 ms, P=0.002; 78+/-16 vs. 48+/-9 ms, P<0.001; QTcd: 91+/-14 vs. 66+/-12 ms, P=0.001; 91+/-14 vs. 61+/-11 ms, P<0.001; JTd: 81+/-12 vs. 58+/-13 ms, P=0.001; 81+/-12 vs. 49+/-7, P<0.001; JTcd: 96+/-15 vs. 73+/-11 ms, P<0.001; 96+/-15 vs. 67+/-8 ms, P=0.001). There was no significant difference between the dispersion parameters in diabetic patients without autonomic dysfunction and the control subjects (P>0.05). Also, patients with autonomic dysfunction had higher Lown classes of ventricular arrhythmias and patients with higher Lown classes of ventricular arrhythmias had more prolonged QTd and QTcd values. The data suggest that diabetic patients with autonomic dysfunction have increased dispersion of ventricular refractoriness, which may be one of the factors contributing to the increased incidence of arrhythmias and sudden death observed in these patients.

Adolescent↗
PubMed1998

Imaging of pancreatic transplantation using portal venous and enteric exocrine drainage.

OBJECTIVE: We describe the normal radiologic appearance of pancreatic allografts transplanted using portal venous drainage with enteric drainage of exocrine secretions. We also describe the radiologic appearance of postsurgical complications. MATERIALS AND METHODS: Of 56 patients who received pancreatic transplants using the portal-enteric technique, 24 patients subsequently required radiologic examination for suspected complications involving the pancreatic allograft. Twenty-three patients underwent CT scanning; a total of 58 CT scans were obtained. Nine abdominal sonograms were obtained in five patients, and one patient underwent angiography. The radiologic appearance of each transplant and the complications were analyzed retrospectively and correlated with the clinical course. RESULTS: The most common indications for CT scanning were fever, elevated levels of serum amylase, and evaluation or follow-up of fluid collections. CT showed the normal and abnormal anatomy of the allograft. Abnormal findings seen in the 58 CT scans included fat stranding (30 scans), ascites (21 scans), peripancreatic fluid or pseudocyst (13 scans), and heterogeneity of the allograft (five scans). One patient had pancreatic infarction with pneumatosis and pneumoperitoneum. The allograft was obscured by bowel gas on three sonograms. Four sonograms showed no abnormalities (one Doppler sonogram showed the arterial supply and venous drainage), and one sonogram showed a pseudocyst. In the one patient who underwent angiography, imaging showed no arterial blood flow to the transplant. CONCLUSION: Pancreatic transplantation with portal venous drainage and enteric drainage of exocrine secretions and the complications of such transplantation were revealed with CT, sonography, and angiography. Knowledge of normal anatomic configuration will allow proper interpretation of normal and abnormal findings.

Adult↗
PubMed1997

Long-term clinical experience with a steroid-eluting active fixation ventricular electrode in children.

In this study, the first study performed in pediatric patients, we assessed the safety and efficacy of a steroid-eluting active fixation ventricular electrode in 18 children. Our study shows that steroid-eluting active fixation leads are safe and effective in children, and suggests that these leads with their easy implantation and low chronic threshold values may be considered as the first choice in this age group.

Adolescent↗
PubMed1997

Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI.

Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural mass and gradual resolution of spinal cord oedema.

Adult↗
PubMed1996

Silent myocardial ischemia in Behçet's disease.

OBJECTIVE: Behçet's disease (BD) is a multisystemic disorder usually described as a triple symptom complex consisting of aphthous stomatitis, genital ulcerations, and uveitis. Vasculitis is a key feature of the disease, which may lead to functional disturbances in highly vascularized organs. However, cardiac involvement is seldom recognized. We investigated the prevalence of silent myocardial ischemia (SMI) in BD as the clinical presentation of microvascular disease. METHODS: Ambulatory cardiac monitoring (Holter) was used in 36 patients with BD to detect silent myocardial ischemia. 201Thallium myocardial perfusion scintigraphy and radionuclide ventriculography were also performed. All patients fulfilled International Study Group for Behçet's Disease criteria and 11 of them had major vascular involvement. The same method was also performed on 38 control subjects for comparison of SMI positivity in patients with BD. RESULTS: Ambulatory cardiac monitoring was performed for 9.2 +/- 0.9 h, mean heart rate was 82 +/- 9 bpm, and no serious rhythm disturbance was recorded. SMI was described in 9 of 36 patients (25%) (median age 38 years, range 30-46) as ST segment depression of 3.00 +/- 0.42 mm with a duration of 4.01 +/- 0.9 min. One SMI positivity only was recorded in the control group in a 52-year-old man with a stenotic lesion in the left anterior descending coronary artery (p < 0.001). Eight of 9 patients with SMI showed a partially reversible myocardial perfusion defect after exertion, and 7 demonstrated some degree of left ventricular wall motion abnormality by radionuclide ventriculography. Coronary angiography was normal in 7 of 9 patients with SMI. Additionally, 7 of 9 patients with SMI had major vascular involvement, while only 4 of 27 without SMI had major vascular disease (p = 0.0022). CONCLUSION: SMI incidence is significantly higher in BD compared to the control group. Impaired endothelial cell function may be the underlying cause in the pathogenesis of BD or of its vascular complications such as SMI.

Adult↗
PubMed1995

Balloon valvuloplasty during pregnancy.

Although rheumatic diseases are reported to be almost eradicated in the developed countries, they still continue to contribute significantly to maternal mortality in the developing world. Surgical therapies need to be considered for those patients who do not respond satisfactorily to medication. However, valve replacement or valvulotomy during pregnancy carries significant risks for both the mother and the fetus. Two patients with severe mitral stenosis refractory to medical therapy are presented. Both patients were subjected to percutaneous balloon valvuloplasty during pregnancy without any complications. They were able to discontinue medication and deliver vaginally at term. Balloon valvuloplasty appears to be a safe alternative to conventional surgical approaches in pregnancy.

Adult↗
PubMed1993

Late percutaneous extraction of an intracardiac catheter fragment.

A patient was found to have a mobile catheter fragment in the right atrium incidentally during echocardiography. On further investigation, it was learned that the catheter had been inserted 9 years earlier during surgery and had probably been broken during removal. The patient did not experience any symptoms during this period. The catheter was removed percutaneously without any complications using a system similar to the loopsnare catheter.

Catheterization, Central Venous↗
PubMed1991

[Balloon mitral valvuloplasty during pregnancy].

A 26-year-old woman with severe pliable mitral stenosis underwent successful balloon mitral valvuloplasty at the end of the second trimester of pregnancy. The indication for intervention was severe shortness of breath during most daily activities, despite combined beta-blocker and diuretic treatment (FC III, NYHA). After use of a 2 x 19 bifoil balloon there was significant clinical and hemodynamic improvement. Shortness of breath disappeared, the mean mitral valve diastolic gradient decreased from 24 to 7 mmHg and the mitral valve area increased from 0.8 to 1.8 cm. There were no complications of the treatment, and estimated radiation exposure of the fetus was less than 0.2 rad. Subsequent abdominal ultrasound examination revealed normal fetal functioning. 2.5 months after mitral dilatation delivery was normal. Balloon mitral valvuloplasty may safely be used instead of surgery as a palliative procedure for relief of symptoms in pregnant women with severe pliable mitral stenosis.

Adult↗