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Biomedical subjects

A Serradimigni

Publications and source records attributed to A Serradimigni.

At least 37 records · Page 2Linked to original sources
PubMed1988

Percutaneous transvenous caval interruption with the "LGM" filter: early results of a multicenter trial.

From September 1985 to December 1986, 100 patients undergoing percutaneous placement of a transvenous "LGM" caval filter were included in a multicenter prospective trial. Peripheral venograms completed by pulmonary arteriography or scintigraphy were obtained for all patients. Eighty-five patients had experienced pulmonary embolism, 59 had iliocaval thrombosis, while 40 had venous thrombosis confined to the lower limbs. In two instances, insertion or passage of the catheter was impossible. Ninety-eight "LGM" filters were placed percutaneously through the internal jugular vein, 82 of which were correctly positioned in the infrarenal inferior vena cava. Eight filters were positioned with a tilt of more than 15 degrees with respect to the vertical axis, five failed to open correctly, and three were incompletely open and tilted. No postoperative deaths were observed; there were two recurrent embolisms, and seven caval thromboses occurred during the year that followed insertion of the filter. The "user-friendliness" and efficacy of this percutaneous filter makes it a treatment of choice in the partial interruption of the inferior vena cava.

Aged↗
PubMed1988

[The significance of the levels of D-dimer in thrombotic conditions].

A D Dimer ELISA test (Asserachrom D Di Stago) was used to quantify the modification of plasmatic D Dimer levels in two kinds of thrombotic diseases: DIC and deep venous thrombosis. Very high values were obtained in these two situations (m +/- sd): DIC (n = 22): 15.2 +/- 18.5 micrograms/ml. (Normal values were defined in 20 healthy subjects: 0.15 +/- 0.04 micrograms/ml). In DIC highest values were a bad prognosis, they were found in patients who died during the ten days following the diagnosis. In deep venous thrombosis the increase was not related to the size of the clot but to the endogenous fibrinolysis. An elevated concentration of D Dimer was often related to a good phlebographic evolution. During heparin therapy with standard heparin or low molecular weight heparin (LMWH) a greater decrease of D Dimer level was observed in patients with a good phlebographic evolution. Results expressed in percentage of decrease were (successful group against the failure group): J3/J10: 46.4 +/- 29.2 p. cent/13.4 +/- 11.0 p. cent (p less than 0.05); J7/J10: 52.3 +/- 31.5 p. cent/24.2 +/- 26.3 p. cent (p less than 0.05). The intensity of the decrease may have an indicative value for in vivo thrombolysis. This could be explained by a smaller clot mass to be lysed in successful group. During streptokinase treatment the D Dimer levels were very high (greater than 50 micrograms/ml). A problem of specificity could be evoked in presence of a massive quantity of fibrinogen degradation products levels.

Adult↗
PubMed1988

[Prevalence of arterial hypertension and its treatment in 2,595 adults].

The prevalence of arterial hypertension, as defined by the W.H.O. (systolic BP greater than 160 mmHg and/or diastolic BP greater than 95 mmHg), and the prevalence of its treatment were studied in 2595 local government employees of Marseilles, aged from 20 to 65 years. The prevalence of hypertension was 17.96 p. 100 (466/2595, including 222 men and 244 women). The prevalence of normal tension was 57.50 p. 100 (1492/2595, including 802 men and 690 women). The prevalence of treated hypertension was 37.98 p. 100 (177/466) divided into 29.27 p. 100 (65/222) in men and 45.90 p. 100 (112/244) in women (p less than 0.0001). Blood pressure was controlled by treatment in 32.30 p. 100 (21/65) of treated men and in 36.61 p. 100 (41/112) of treated women (NS). 81.14 p. 100 (198/244) of hypertensive women and 57/82 p. 100 (399/690) of normotensive women were active (managers, executives). In treated men, the plasma level of apoprotein A1 was decreased and that of apoprotein B was increased. Among men, the global score at Bortner questionnaire was significantly lower in the group of 175 untreated hypertensive patients (176 +/- 46) than in the group of treated hypertensive patients (192 +/- 48, p less than 0.05) and in the group of normotensive subjects (186 +/- 41, p less than 0.05). This indicated that untreated hypertensive men have a tendency to type B pattern and suggested a line of research aimed at a better understanding of the relative failure of anti-hypertensive treatments in the prevention of coronary disease.

Adult↗
PubMed1988

[Thrombolysis in the pre-hospitalization phase of myocardial infarction].

In myocardial infarction (MI), the sooner thrombolysis is performed, the greater the chances of it being effective. We report a 19-month experience (July 1, 1986 to December 31, 1987) of thrombolysis performed at home prior to hospitalization by an organization called SOS Myocardial Infarction (SOS MI). Method. Throughout 24 hours, any patient may call by telephone a doctor attached to SAMU 13. If the doctor suspects a coronary emergency, he sends to the patient's home the SOS MI team (1 doctor and 1 nurse) in a medically-equipped ambulance. The diagnosis of MI is made on the finding of a nitroglycerin-resistant chest pain of more than 30 minutes duration associated with a more than 2 mm elevation of the ST segment on at least two electrocardiographic leads. Patients aged under 70 and in whom thrombolytic drugs are not contra-indicated are then treated intravenously with either streptokinase (1.5 million units over 30 min) or the tissue plasmogen activator (10 mg followed by a 90 mg infusion over 90 min). Results. During the 19-month period, 648 coronary emergencies were suspected from data given by telephone. The diagnosis made by the SOS MI doctor was non-coronary chest pain in 119 cases (18.4 p. 100), angina pectoris in 211 cases (32.6 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

[Intravenous thrombolysis in myocardial infarction. Influence of the quality of the anticoagulation on the early recurrence rate of angina or infarction].

In this retrospective study the data of 70 patients treated with streptokinase in the acute phase of myocardial infarction were reviewed in search of a possible relation between recurrent ischaemic events and degree of anticoagulation. All patients had received a 30 mn infusion of streptokinase 1.500.000 units within a mean 175 mn period from the initial symptoms. They were followed up clinically (signs of angina or infarction), angiographically (coronary arteriography within 5.5 days on average) and biochemically (daily measurements of TCA values and blood fibrinogen concentrations). Fifteen recurrent ischaemic events (21.4 p. 100), including 6 attacks of angina and 9 myocardial infarctions, were observed. Angiography showed that the artery responsible for the initial infarction was occluded in 23.6 p. 100 (13/55) of patients without recurrent ischaemic accident. This figure rose to 46.6 p. 100 in patients who suffered a new anginal attack (7/15; NS) and up to 77 p. 100 in those who developed a new myocardial infarction (7/9; p less than 0.01). Biochemical data showed that 13 recurrent ischaemic accidents occurred when the APTT values were lower than 1.5 (176 measurements), as against 2 when these values were higher than 1.5 (359 measurements) (p less than 0.01). These two recurrent ischaemic accidents took place when fibrinogen concentrations abruptly rose above 1 g/litre. These results demonstrate that poor quality anticoagulation is responsible for the occurrence of recurrent ischaemic events within days of thrombolysis for acute myocardial infarction. They prompt the authors to recommend anticoagulation with heparin started at an early stage and carefully adjusted by means of repeated biochemical essays.

Adult↗
PubMed1988

[Prognosis of ventricular tachycardia].

The prognosis of monomorphous, sustained, non-iatrogenic ventricular tachycardia was studied in 86 patients followed up for a mean period of 42.8 months. The patients were divided into three groups as follows: group I, 46 patients with myocardial infarction beyond the acute phase; group II, 30 patients with non-ischaemic heart disease; group III, 10 patients without heart disease detectable at angiography and/or echotomography. Fifty patients died during the follow-up period. Forty (80 p. cent) of these deaths (26 in group I, 14 in group II) were due to cardiac causes: heart failure in 24 cases, sudden death in 15 cases, recurrent myocardial infarction in 1 case. The percentage of cardiac death was higher in patients with left ventricular dysfunction (66 p. 100 versus 15.2 p. 100) and when the ejection fraction was below 0.40 (52.9 p. 100 versus 11.8 p. 100). The proportion of sudden death was 66.7 p. 100 when Lown's grade IV ectopic rhythm persisted under treatment, and only 7.7 p. 100 when this was not the case (p less than 0.001). These results confirm that: ventricular tachycardia has a high mortality rate in patients with heart disease; ventricular tachycardia on a "healthy" heart is of good prognosis; left ventricular dysfunction and persistence of repetitive forms under treatment have a high predictive value for cardiac death.

Adult↗
PubMed1988

[Development of left intraventricular thrombi. Monitoring by two-dimensional echocardiography and scintigraphy with indium 111-labelled platelets].

Two-dimensional echocardiography and indium 111-labelled platelet scintigraphy have proved helpful in the diagnosis of left intraventricular thrombosis. In this study, both methods were used to investigate the time-related changes undergone by such thrombi in 30 patients (26 with myocardial infarction, 4 with dilated cardiomyopathy) who presented with left intraventricular thrombosis diagnosed by echocardiography and systematically explored by indium scintigraphy. These 30 patients were divided into 2 groups depending on whether the initial scintigraphy was positive (group I, 19 patients) or negative (group II, 11 patients). The follow-up (mean 21.6 months) was clinical and paraclinical, with control echocardiography repeated at 1.5 and 8.5 months in both groups and control scintigraphy at 1.5 month in group I patients. At the 1.5 month echocardiography, the intraventricular thrombosis persisted in 14/16 examinations in group I patients and in only 2/10 examinations in group II patients (p less than 0.01). At the 1.5 month scintigraphy, performed in 16/19 group I patients, this examination had become negative in 8 cases, whereas the 2D-echocardiography remained positive. During the follow-up period 4 patients in group I had an embolic accident, as against none of the group II patients (p less than 0.01); 3 of these 4 patients had persistent uptake at control scintigraphy. At echocardiography, only a protrusion image seemed to be predictive, as it was present in 3 of 4 patients with embolic accident.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticoagulants↗
PubMed1988

[Polyarterial pathology. Epidemiological aspects].

Polyarterial arteriosclerosis is a problem facing more and more clinicians because of the technical advances in exploration and revascularization methods. Epidemiologic data are rare in this field except for Framingham's study. We are reporting here the results of a French epidemiologic study regarding a representative sample of a group of 11,000 active men and women, with age ranging between 25 and 65 years. Methodologic difficulties cannot be avoided, but a minimal estimation may be expressed: polyarterial pathology represents approximately 15 p. cent of the pathology in each case. Polyarterial pathology is as prevalent as monoarterial pathology with a 10 years delay between the two sexes. Coronary diseases are the most frequent and represent the initial location in two-thirds of the cases. The same risk factors are found, but their chronology is different: more than ever, age is an essential factor since there is a ten years difference. Hyperglycaemia in men, overweight in women are major factors as important as tobacco abuse in men, arterial hypertension and dyslipidemia in both sexes. Finally the type A behavior seems to occupy an even larger role in polyarterial patients of both sexes.

Adult↗
PubMed1988

Effects of cicletanine in the left circumflex coronary artery occlusion-reperfusion canine model of sudden death: analysis of 107 experiments using Cox's proportional hazards model.

Multivariate analysis of survival using Cox's proportional hazards model demonstrates that several clinically measurable covariates are determinants of life-threatening arrhythmias following left circumflex coronary artery occlusion-reperfusion in 107 dogs. These are heart rate, ST segment elevation and mean aortic pressure immediately (3 min) following occlusion, and the presence of early (0-10 min) post-occlusion sustained ventricular tachycardia. The risk of occlusion-reperfusion ventricular fibrillation was determined according to Cox's solution based on ST segment elevation, thus enabling quantification of the role of cicletanine. Since cicletanine-treated dogs had reduced mean ST segment elevation at 3 min post-occlusion, lower incidence of early post-occlusion (0-10 min) sustained ventricular tachycardia, and increased endogenous production of prostacyclin, and the latter was inversely correlated with the level of ST segment elevation, it is concluded that such favourable effects on the ischaemic myocardium were contributory to the improved outcome in these experiments. These effects on the ischaemic myocardium obtained in spite of a hypotensive action in the experimental setting might be regarded as desirable and it is therefore suggested that they should be further investigated by pharmacodynamic studies in human subjects.

6-Ketoprostaglandin F1 alpha↗
PubMed1987

Deficient t-PA release and elevated PA inhibitor levels in patients with spontaneous or recurrent deep venous thrombosis.

The fibrinolytic system was investigated in 120 patients with spontaneous or recurrent deep vein thrombosis (DVT) without any known organic disease able to explain by itself the occurrence of a thrombosis and without any known defect of antithrombin III, Heparin Cofactor II, Protein C, or Protein S. The assays included: Euglobulin fibrinolytic activity (EFA), tissue-type plasminogen activator related antigen (t-PA-Ag) and plasminogen activator inhibitor activity (PA inhibitor), which were measured before and after 10 min of venous occlusion (V.O.). On the basis of the results, the patients could be classified in 3 groups: good responders with an at least two-fold increase of EFA after venous occlusion (n = 76), poor responders with a lesser increase of EFA due to deficient release of t-PA (n = 12), and poor responders with a normal t-PA release but an increased level of PA-Inhibitor (n = 32). The poor responders due to deficient t-PA release (10% of total) had a higher incidence of recurrence of deep vein thrombosis, than the other groups (p less than 0.01). An overall correlation was found between the level of PA-Inhibitor activity and the triglyceride level (r = 0.40, p less than 0.01), suggesting that these elevations may be due to a common cause, at least in some of the patients. It is concluded that a poor fibrinolytic response to venous occlusion occurs in 35 percent of DVT patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Comparison of bisoprolol with nifedipine for treatment of essential hypertension in the elderly: comparative double-blind trial.

Beta blockers are often considered to be less effective for blood pressure control in elderly patients with essential hypertension than calcium antagonists. We therefore compared the efficacy and tolerability of the new beta blocker bisoprolol with those of nifedipine. Fifty-nine patients over 60 years of age with essential hypertension (supine diastolic blood pressure, DBP: 95-115 mmHg) took part in a randomized double-blind study. After 14 days on placebo the patients received either 10 mg bisoprolol o.d. or 20 mg nifedipine SR b.i.d. for 4 weeks. The doses were doubled in patients whose DBP remained greater than 90 mmHg, for a further 4 week period. Blood pressure was measured about 24 hours after bisoprolol and about 12 hours after nifedipine administration. Fifty-six patients were available for efficacy analysis. After 4 weeks there was a distinct decrease of SBP and DBP in both groups (bisoprolol: -22 +/- 16; -15 +/- 9 mmHg; nifedipine: -24 +/- 17; -17 +/- 7 mmHg) with no significant difference between the treatments. DBP was normalized in 22/28 (79%) patients on bisoprolol and in 24/28 (86%) patients on nifedipine (bisoprolol vs nifedipine: NS). There were 7/29 bisoprolol and 14/30 nifedipine patients who experienced at least one side-effect. Overall the tolerability of bisoprolol was considered to be better than that of nifedipine (P = 0.043). In conclusion, bisoprolol 10-20 mg o.d. proved to be as equally effective as nifedipine SR 20-40 mg b.i.d. for the treatment of essential hypertension in the elderly.

Aged↗
PubMed1987

[Low molecular weight heparin CY 222 (Choay) potentiates the thrombolytic effect of 1-PA in rabbits with experimental thrombosis of the jugular vein].

The effect of a low molecular weight heparin CY 222 (Choay) on t-PA induced thrombolysis was investigated in the rabbit jugular thrombosis model. The compound CY 222 was administered as 1.4 mg/kg (group A) by IV injection immediately after start of t-PA infusion (0.125 and 0.250 mg/kg) and then hourly during the 4 hours of infusion of the thrombolytic; results were compared with those obtained in the absence of CY 222 (group B). A significant increase in percent thrombolysis was noted in the presence of CY 222: A versus B = 31 +/- 1/22 +/- 2 (p less than 0.02) (tPA = 0.125 mg/kg; 72 +/- 4/36 +/- 3 (p less than 0.01) (tPA = 0.250 mg/kg). Anti-Xa activity 60 minutes after 1.2 u/ml IV of CY 222 was comparable with that observed in patients with venous thrombosis treated with high-dose CY 222. The conclusion is reached of the interest of CY 222 in combination with t-PA, the CY 222 acting not only on coagulation by also on thrombolysis by potentiating the effect of t-PA.

Animals↗