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Biomedical subjects

A Pacifico

Publications and source records attributed to A Pacifico.

At least 73 records · Page 4Linked to original sources
PubMed1991

A case of hyperglycemic hyperosmolar non-ketotic coma during anesthesia: a possible cause of failed re-awakening.

The case of a non diabetic 6-year-old boy affected by Down's syndrome, who developed hyperosmolar hyperglycemic non-ketotic coma following the infusion of hypertonic dextrose solution during general anesthesia for a surgical procedure for cryptorchidism is reported. Following surgery, the patient remained deeply comatose and generalized seizures occurred. Hyperosmolarity due to hyperglycemia and acidosis were reduced by administration of insulin at low rate, hypotonic saline and sodium-bicarbonate solutions. The patient's clinical conditions promptly improved following normalization of blood glucose levels. An oral glucose tolerance test performed three months later was normal. The authors emphasize the potential risk of hyperosmolar hyperglycemic non-ketotic coma also in non diabetic patients treated with hypertonic dextrose solutions, during surgery events.

Anesthesia, General↗
PubMed1991

Factors predictive of results of direct ablative operations for drug-refractory ventricular tachycardia. Analysis of 80 patients.

During a 9-year period 80 patients with drug-resistant sustained ventricular tachycardia underwent direct surgical ablation of arrhythmogenic myocardium. Sixty-nine were male (86%) and 11 female (14%), with 1.9 +/- 1.1 (standard deviation) ventricular tachycardia morphologies per patient. The mean number of drugs failed was 3.7 +/- 1.6 per patient. The preoperative left ventricular ejection fraction was 36.4% +/- 14.4%. Complete preoperative endocardial mapping data (greater than 4 endocardial sites in each ventricular tachycardia) were available for 60 of the 80 patients (75%) and intraoperative endocardial data in the clinical ventricular tachycardia was obtained in 37 (46.3%) of the patients. In 17 patients mapped intraoperatively by computer-assisted techniques, complete epicardial and endocardial data in the clinical ventricular tachycardia were obtained in 14 patients (82.4%). Overall, 73 of 80 (91.3%) had some mapping data available. Hospital mortality occurred in 10 patients (12.5%) at a mean interval of 13.5 days, range 0 to 62 days. Postoperatively the clinical ventricular tachycardia has not recurred in 65 of 70 surviving patients (92.9%). Nonclinical ventricular tachycardia occurred in another four patients. All nine patients with postoperative ventricular tachycardia responded to drugs. The major factors predictive of hospital mortality were prolonged cardiopulmonary bypass (greater than 150 minutes), preoperative ejection fraction less than 31%, and incomplete preoperative mapping. Hospital mortality in patients with an ejection fraction below 31% was significantly associated with a history of amiodarone usage. At 3 years of follow-up, freedom from sudden cardiac death was 95.7%, and 86.7% of patients were free of ventricular tachycardia on no antiarrhythmic drugs. These results suggest that direct ventricular tachycardia operations are an effective form of therapy for patients with sustained monomorphic ventricular tachycardia.

Adult↗
PubMed1990

Insulinemia and blood pressure. Relationships in patients with primary and secondary hypertension, and with or without glucose metabolism impairment.

In order to investigate the relationships between insulinemia and hypertension, fasting insulinemia has been assessed in 117 subjects: 69 normotensive subjects, 36 with essential hypertension, and 12 with renovascular hypertension, all untreated and newly diagnosed, classified in subgroups (euglycemic nonobese, euglycemic obese, with impaired glucose tolerance and with non-insulin-dependent diabetes mellitus). In the patients with essential hypertension fasting insulinemia was significantly higher than in normotensive subjects (P less than .0005). The patients with secondary hypertension and the normotensive subjects had similar fasting insulinemia values. In each subgroup fasting insulinemia was higher in hypertensive patients than among normotensive subjects (P less than .05). A significant correlation between fasting insulinemia and mean blood pressure has been found in patients with essential hypertension (r = 0.408, P less than .05), but not in patients with renovascular hypertension. Our data suggest a possible direct relationship between fasting insulinemia and blood pressure, especially in obese patients or patients with impaired glucose metabolism, and that increased blood pressure per se is not an insulin resistant state.

Adult↗
PubMed1989

Can two-dimensional echocardiography and Doppler color flow mapping identify the need for tricuspid valve repair?

Tricuspid regurgitation severity was assessed preoperatively with Doppler color flow mapping and these assessments were compared with surgical findings in 90 patients undergoing mitral or aortic valve replacement, or both. Group I (n = 52) required tricuspid valve annuloplasty because tricuspid regurgitation was judged intraoperatively to be severe; in Group II (n = 38), tricuspid valve annuloplasty was not performed because tricuspid regurgitation was judged intraoperatively not to be severe. With use of the apical four chamber and parasternal short-axis imaging planes, the severity of tricuspid regurgitation by Doppler color flow mapping was assessed by comparing the maximal area of tricuspid regurgitant signals with the right atrial area taken in the same frame in which the maximal tricuspid regurgitant signals were noted. This ratio was found to be greater than or equal to 34% (mean 50.2 +/- 11.8%) in 50 (96%) of 52 patients in Group I and less than 34% (mean 27.5 +/- 6.9%) in 36 (95%) of 38 patients in Group II (p less than 0.001). The maximal diastolic tricuspid anulus diameter measured with the same two-dimensional imaging planes was greater than or equal to mm/m2 body surface area (mean 26.7 +/- 5.2 mm/m2) in 46 patients (88%) in Group I and less than 21 mm/m2 (mean 17.8 +/- 2.5 mm/m2) in 36 patients (95%) in Group II (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1989

Right mini-thoracotomy: an adjunct to left subcostal automatic implantable cardioverter defibrillator implantation.

High defibrillation thresholds are encountered in some patients during implantation of the automatic implantable cardioverter defibrillator (AICD). In a consecutive series of 52 patients with AICD implants, 46 had allepicardial implants by left subcostal thoracotomy, and 8 of these patients had thresholds greater than 30 J. Placement of an apicolateral large left ventricular patch and an extrapericardial large right atrial patch electrode through a limited right thoracotomy produced substantial reduction in their thresholds. Especially in patients who have had previous intrapericardial operations, this technique provides a simple solution to the problem of high thresholds.

Electric Countershock↗
PubMed1989

Plasma lipids in beta-thalassemia minor.

Because total cholesterol levels have been found to be lower in patients affected by thalassemia major and intermedia, we examined the plasma lipid pattern of 628 beta-thalassemia trait carriers and 4552 controls in order to evaluate whether the plasma lipid impairment is also present in the heterozygous state. Total cholesterol and low density lipoprotein (LDL)-cholesterol levels were significantly lower in beta-thalassemia trait carriers when compared to controls, whereas plasma triglycerides and high density lipoprotein (HDL)-cholesterol levels did not differ between the two groups. We suggest that accelerated erythropoiesis and increased uptake of LDL by macrophages and histiocytes of the reticuloendothelial system are the main determinants of low plasma cholesterol levels in heterozygous thalassemia.

Adolescent↗
PubMed1989

Results of direct surgical ablation of ventricular tachycardia not due to ischemic heart disease.

Surgical treatment of sustained ventricular tachycardia due to nonischemic causes is uncommon. Nonischemic ventricular tachycardia was treated in 14 patients by map-directed surgical ablation of an arrhythmogenic site. There were 9 male and 5 female patients. The mean age was 33 +/- 13.4 years (range, 15 to 57 years). The etiology was idiopathic in 4 patients, cardiomyopathy in 3, acute myocarditis in 1, arrhythmogenic right ventricular dysplasia in 2, tumor in 1, postoperative Tetralogy of Fallot in 2, and acute bacterial endocarditis in 1. Pre- and/or intraoperative electrophysiologic mapping was achieved in 13 of 14 patients. A variety of operations were performed without death. Two late deaths have occurred, neither of them, however, from arrhythmias. After operation two patients had recurrent arrhythmias. Surgery for nonischemic ventricular tachycardia is safe and effective and should be considered early in the course of these mostly young patients.

Adolescent↗
PubMed1989

Transannular cryoablation of ventricular tachycardia. Surgical technique and results.

Intraoperative mapping and cryoablation of ventricular tachycardia was achieved without ventriculotomy in seven patients, who are a subgroup of the 80 patients undergoing map-directed ablation of ventricular tachycardia over a 9-year period. There were four male and three female patients. Their mean age was 53.6 +/- 24.1 years. Coronary artery disease was present in five patients, and two patients had idiopathic ventricular tachycardia. The mean preoperative ejection fraction was 42.4% +/- 13.6%. The mean number of ventricular tachycardia morphologies was 1.7 (range 1 to 3). Epicardial mapping was obtained intraoperatively in all seven patients and endocardial data in five of seven patients (71.4%). There were no hospital deaths and no early or late spontaneous recurrence of clinical monomorphic ventricular tachycardia. Nonclinical monomorphic ventricular tachycardia was inducible in two patients postoperatively and both were treated with procainamide. Death occurred late after operation in two patients: One death was related to recurrent nonclinical VT at 8 months and one at 3 months was due to carcinoma of the stomach. These results suggest that the transannular approach is feasible in selected cases, especially when computerized mapping systems with endocardial balloon electrode arrays can be used.

Adolescent↗
PubMed1988

Surgical treatment of right atrial focal tachycardia in adults.

Although successful operative treatment of atrial focal tachycardia has been reported in children, there are only isolated reports of surgical treatment of this arrhythmia in adults. In this case series of eight patients (aged 10 to 53 years) with drug-resistant right atrial focal tachycardia, results of electrophysiologic studies, surgical techniques and long-term follow-up are described. Atrial focal tachycardia was reproduced during electrophysiologic study, and endocardial mapping localized the earliest onset of atrial activation in the right atrium in all patients. Epicardial mapping confirmed the location of atrial tachycardia foci in seven of eight patients whose tachycardia was inducible intraoperatively. Of four patients treated with epicardial cryoablation alone, two had recurrent tachycardia and required a second procedure. None have had arrhythmia recurrence. In all four patients after right atrial excision (two of whom had intraoperative recurrence of atrial focal tachycardia after epicardial cryoablation alone), there has been no recurrence during a clinical follow-up period of 11 to 67 months (mean 30). It is concluded that in adult patients 1) electrophysiologic study with endocardial and epicardial mapping permits successful surgical treatment of atrial focal tachycardia; 2) epicardial cryoablation alone may be associated with recurrence of atrial focal tachycardia either intraoperatively or postoperatively; and 3) subtotal right atrial resection appears to be a well tolerated procedure with no long-term recurrence of atrial focal tachycardia.

Adult↗
PubMed1987

Diabetic polyneuropathy and insulin secretion in type II diabetic patients.

Electrophysiological examination was performed on 50 type II diabetic patients to verify whether insulin secretory reserve is a factor influencing the susceptibility to develop polyneuropathy. The results showed that less significant metabolic derangement related to high insulin secretory reserve, and not the high insulin secretory reserve by itself, may prevent the development of neuropathic disorders. These data are consistent with the current opinion that diabetic polyneuropathy is the consequence of the metabolic derangement caused by chronic hyperglycemia.

Adult↗
PubMed1987

Effect of nifedipine and verapamil on carbohydrate metabolism in hypertensive patients with impaired glucose tolerance.

Intracellular Ca2+ influx is an essential step in insulin (I) release. Calcium antagonists are reported to reduce I release in vitro and in patients with impaired glucose tolerance (IGT) during acute administration. Their effects during long-term therapy are still controversial. To evaluate the effects of chronic verapamil (V) and nifedipine (N) on carbohydrate metabolism, 12 hypertensive patients (WHO II; aged 37-64 years) with IGT underwent intravenous glucose tolerance tests (IVGTT) (0.33 g/kg body weight in 3 min), arginine (A) infusion (30 g/30 min), and hypoglycemic stress (regular insulin 0.15 U/kg body weight) during which blood levels of glucose (G), I, growth hormone (GH), glucagon (IRG), and cortisol (C) were measured. The patients were then randomized to V (120 mg b.i.d.) or N (20 mg b.i.d.) treatment and, 1 month later, both IVGTT and A infusion were repeated. Hormone determinations were performed by the radioimmunoassay (RIA) and G by the enzymatic method. The patients were maintained on their usual diet for the duration of the study. The rate of decline of G during IVGTT was expressed as Conard's K coefficient (K; normal values greater than 1.3). I and GH during IVGTT were evaluated as the differences between basal and peak values. I, IRG, and GH during A infusion were analyzed as incremental areas. Our results show that neither V nor N impaired carbohydrate metabolism in hypertensive patients with IGT.

Adult↗
PubMed1986

The membrane proteins of the methanol-induced peroxisome of Candida boidinii. Initial characterization and generation of monoclonal antibodies.

Peroxisomes are massively induced when methylotrophic yeasts are cultured on methanol as the sole carbon and energy source. An analysis of the protein composition of the peroxisomal membrane and the generation of probes against two peroxisomal membrane proteins (PMPs) have been undertaken. Peroxisomes from Candida boidinii were obtained from sucrose gradients as previously described or from a novel one-step purification of the organelle on a Percoll gradient. The protein composition of the membranes from these two preparations was virtually identical. About 10 proteins comprise nearly all of its protein mass. The most prominent proteins have molecular masses of 120, 100, 47, 31-32 (a triplet), and 20 kDa; significant amounts of alcohol oxidase and dihydroxyacetone synthase, the two abundant matrix proteins, also remain associated with the membrane. Glycosylation of the membrane proteins could not be detected. Exposure of the membrane to chaotropes shows that PMPs 100 and 20 are the most easily removable, whereas PMP 47 appears to be the most tightly associated. Mice were injected with peroxisomal membrane, and hybridoma lines were isolated that produced antibody against PMP 20, PMP 47, and dihydroxyacetone synthase. Indirect immunofluorescence with these monoclonal antibodies confirmed that all three proteins are localized to the peroxisomal cluster. Immunoblotting experiments demonstrated that peroxisomal membrane as well as matrix proteins are induced by methanol.

Antibodies, Monoclonal↗
PubMed1986

Pneumococcal endocarditis update: analysis of 10 cases diagnosed between 1974 and 1984.

We analyzed the clinical characteristics of 10 patients with pneumococcal endocarditis hospitalized between 1974 and 1984. Patients with pneumococcal endocarditis were typically middle-aged men. Forty percent were alcoholic. They sought medical attention early in the course of their illness and were given appropriate antibiotics promptly. The aortic valve was involved in seven patients. Five patients developed signs of severe valvular insufficiency, and congestive heart failure was present at the time of admission in four patients. Only three patients were recognized to have endocarditis prior to death or to the occurrence of a major complication of their infection. The total in-hospital mortality rate among these patients was 50%. Thus pneumococcal endocarditis is generally an acute, left-sided endocarditis that is associated with rapid valvular destruction and a high mortality rate. Unfortunately, recent advances in diagnosis and treatment of bacterial endocarditis have not substantially improved the outcome of this devastating infection.

Adult↗