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Biomedical subjects

A Serradimigni

Publications and source records attributed to A Serradimigni.

At least 109 records · Page 6Linked to original sources
PubMed1982

[Angiography imaging in pulmonary embolism (author's transl)].

The principal angiography images found in cases of recent pulmonary embolism include intravascular lacunae, dome-shaped obstructions, a "dead tree" appearance and an avascular region. The first two are specific, but are mainly observed during the few days following the embolism. Highest quality images are obtained by selective angiography of the pulmonary artery, but this technique, which involves transfer of the patient to a specialized unit and catheterization of the pulmonary artery, is not without risk and, more particularly, does not explore the veins of the lower limbs. However, in a series of 110 cases of recent pulmonary embolism, venous thrombosis, usually femoroiliocaval, was present in 102 patients. A new technique is therefore proposed, ascending venous angiopneumography, which has two advantages: --It can be performed in any radiological department as a catheter does not have to be inserted. --It explores both pulmonary and venous systems. Though pulmonary images are less specific (false positives occur more frequently), the simultaneous exploration of the veins allows logical determination of therapy based on the size and site of the embolus and possible associated extension of the venous thrombosis.

Angiography↗
PubMed1981

Binding of 99mTc plasminogen on fibrin.

Binding of plasminogen to fibrin was studied in vitro and in vivo using 99mTc Glu- and Lys-plasminogen. Binding of Glu-plasminogen on the clot was not observed in vitro, and in vivo in the dog. Conversely, the binding of Lys-plasminogen to fibrin displays a linear relationship to the concentration of Lys-plasminogen, up to doses exceeding equimolarity; thus suggesting the existence of several Lys-plasminogen binding sites on fibrin. Binding levels were identical, regardless of whether plasminogen was incubated in normal plasma or in plasma devoid of antiplasmin. In the dog, Lys-plasminogen bound specifically to the clot, however, clot sites could not be localized by scintigraphy in the dog or in man.

Animals↗
PubMed1981

[Effects of thrombolytic agents on pulmonary and venous clots in severe pulmonary embolism (author's transl)].

Thirty-eight patients admitted to hospital for pulmonary embolism of recent onset were divides into four treatment groups. Group I patients (10) received streptokinase in does of 250,000 units over 20 minutes, followed by 100,000 units/hour for a total of 24 hours. Group II patients (8) received urinary urokinase 4,500 CTA units/kg/hour during 12 hours. Group III patients (10) were treated with urinary urokinase (112,500 CTA) units/hour during 24 hours) and heparin (500 units/kg/24 hours). Group IV patients (10) were given tissue urokinase and heparin, both in the same dosage as in group III patients. Pulmonary angiography and cavography were performed in all patients before treatment and within 24 hours of its termination. With regard to pulmonary emboli, improvement was most pronounced with streptokinase, with a gain of 15.7 points on Miller's index of severity, as against 9.6, 10.5 and 5.7 points for Group II, III and IV patients respectively. In peripheral venous thrombosis, streptokinase showed even greater superiority over other treatment, with a gain of 16 points of Marder's index, as against zero, 4.5 and 11.2 points for patients in Groups II, III and IV respectively. On biochemical tests, the decrease in fibrinaemia was more pronounced in Group I patients than in other groups.

Adult↗
PubMed1981

[An approach to the diagnosis of coronary artery spasm in spontaneous angina pectoris (author's transl)].

Spontaneously occurring spasms are more likely to be detected by performing coronary angiography during an acute ischaemic attack. This was achieved in 28 out of 41 cases. Spasm was found to be present in 23/25 attacks with elevated S-T segment but in only 5/16 attacks with other changes on ECG. The difference was statistically significant (p less than 0.01). When coronary angiography was performed outside anginal attacks, arterial spasm was detected in 16 out of 1071 cases (1.48%). The percentage increased in patients with spontaneous angina: 13/15 cases (8.6%). These spontaneous spasms are painless and can be differentiated from catheter-induced spasms and organic stenosis by the nitroglycerin test. Spasms which do not occur spontaneously can be provoked by methylergometrine maleate. This was done 175 time with 16 positive results. The criteria of positivity of the test, as well as its value, indications and dangers are discussed.

Angina Pectoris↗
PubMed1981

[Medical treatment of ilio-caval venous thrombosis].

120 patients with ilio-caval thrombosis were managed medically. 55 patients were given heparin (5 mg/Kg/day for 15 days), 50 patients received streptokinase (loading dose 250,000 u; maintenance dose 100,000 m/h for 48 hours) and 15 patients had urokinase (112,500 u/h for 44 hours). Thrombolytic therapy was prescribed, in the absence of contraindications, for patients below 70 year of age: other patients were treated with heparin. The results were assessed by venography performed before and after treatment: success was defined as the complete disappearance of the thrombus of disobliteration of the ilio-caval axis. The overall success rate was 32%, with 68% failures. Success was higher with streptokinase (50%) than with heparin (20%) or urokinase (13%). The site, extension ans aetiology of the thrombosis did not affect the results. On the other hand, two other factors seemed to play an important role: - the duration of thrombosis: this only affected the streptokinase group; 23 of the 25 successes were obtained in patients treated before the tenth day. The results were unaffected by the duration of the thrombosis in the heparin group; - the biological effectiveness of therapy: 7 out of the 11 successes in the heparin group had been constantly well anticoagulated; there were only 4 successes out of 38 patients in whom the biological effectiveness had been intermittent. There were 21 successes out of 32 patients treated by streptokinase with serum fibrin levels of less than 1 g. There were only 4 successes in the 18 other cases. The incidence of haemorrhage was identical in the 3 groups. Embolism was slightly commoner in the streptokinase (3) than in the heparin group (2).

Adult↗
PubMed1981

[Use of intramuscular lidocaine in the acute stage of myocardial infarction].

Methods of using intramuscular lignocaine and its relay with an intravenous infusion were studied in 34 patients with reference to serum levels. A first group of 9 patients with myocardial infarction received an intramuscular injection of 300 mg lignocaine into the deltoid or gluteral muscles at five day intervals. The deltoid appears to be the better site of injection in patients confined to bed because of its quick absorption, higher serum levels between the 15th and 90th minute (+47%), and longer duration of action (180 compared to 120 minutes). The difference is not observed in ambulatory patients and seems to be related to sluggish circulation in the gluteral muscles during bed rest. Its relay with intravenous infusion was studied in 14 patients. In the first 6 patients, intradeltoid injection was immediately followed by an infusion of 2.5 mg/mn, giving an average plasma lignocaine level between the 15th and 60th minute greater than 5 mu/ml. In the 8 other patients, a period of I hour was allowed to elapse before starting the infusion. The plasma levels were found to be within the therapeutic range in all patients and no side effects were observed. The administration of an intravenous infusion of 150 mg/hr of lignocaine for 48 hours led to excessively high plasma levels in 8 patients at the 24th hour, 3 of whom had side effects. Reducing the dosage to 100 mg/hr from the 12th hour onwards in II patients avoided this complication. A 300 mg intradeltoid injection of lignocaine is easy to give in the patient's home and therefore, is the best adapted method for the pre hospital treatment of myocardial infarction. When necessary, it may be relayed with an intravenous infusion one hour later, in the coronary care unit.

Aged↗
PubMed1981

[The intravenous nitroglycerin test during coronary angiography].

The effects of intravenous nitroglycerin (Lenitral) on the calibre of coronary arteries and their lesions was studied in 100 consecutive patients undergoing coronary angiography. The coronary arteries were divided into segments (3 for the right coronary, 2 for the left anterior descending, and 2 for the circumflex artery). 510 segments were assessed (279 normal, and 231 pathological). The diameter of each was measured through the mid point before and after injection of a bolus of 0.3 mg nitroglycerin. The calibre of the coronary segments increased in 325 cases (63.7%). In 49 cases, the increase was greater than 50%. It remained the same in 151 cases (29,6%) and decreased in 84 cases (6,7%). The average increase in calibre was 16% (p less than 0.01). This had little relation to the artery under study, the location of the segment or whether the segment was pathological or normal. However, two findings were of interest: - the percentage of segments which increased their calibre was significantly higher in the normal segments (191 out of 279 cases, 68%) than in the pathological segments (134 out of 231 cases, 58%) (p less than 0.01). - Coronary lesions may change in appearance: images of stenosis or obstruction completely regressed in 4 cases, the degree of stenosis seemed to increase in 11 cases because of dilatation of the coronary vessel proximal and distal to the narrowing, and distal vessels appeared much more dilated in 5 cases. The factors which seem to affect the vasomotor response are multiple, and include the state of the arterial wall, the presence of vasodilatation or vasoconstriction prior to injection and the mode of administration of the nitroglycerin. The test should be performed by intravenous or intracoronary injection at the end of coronary angiography so as not to mask spastic phenomena. Some errors in the interpretation of the degree of stenosis or the quality of the distal post-stenotic coronary bed could thus be avoided.

Blood Pressure↗
PubMed1981

[Ascending venous angiopneumography. A new method of exploration in pulmonary embolism].

Selective angiopneumography is considered to be the best diagnostic investigation for pulmonary embolism. However, the technique has to be performed in a specialised unit, is associated with a certain degree of risk and does not explore the lower limb veins which are the usual site of migratory thrombi. The authors have therefore developed a new angiographic technique, ascending venous angiopneumography (AVAP) which successively opacifies the lower limb veins, inferior vena cava (IVC) and pulmonary arteries. It was used in 180 patients suspected of having a recent pulmonary embolism. It has three main advantages: 1) TECHNIQUE: this only involves injection of a vein on the dorsum of the foot, may be carried out in any radiological centre and is repeatable. 2) DIAGNOSIS: the investigation is more sensitive but less specific than selective angiopneumography when compared in a series of 25 cases: it was never normal in the 16 cases of pulmonary embolism, but in its absence there were 4 doubtful cases out of 8. This lack of specificity is compensated by the data obtained during the initial phlebocavographic times. The diagnosis of pulmonary embolism may be made when the context is suggestive and radiological evidence of venous thrombosis is obtained (124 cases). The diagnosis is very improbable when all phases of AVAP are normal (45 cases). 3) THERAPY: treatment should take the initial venous thrombosis into account, especially with regards to the choice of thrombolytic agents and surgical clipping of the IVC. Finally, this is a low-risk procedure.

Angiography↗
PubMed1980

[Comparative study of three oral nitrate derivatives. A hemodynamic assessment in 10 patients with chronic heart failure (author's transl)].

The efficacy of three long-acting, orally administered nitrate derivatives was assessed in 10 patients with chronic heart failure. The compounds were: isosorbide dinitrate (ID) 5 mg, nitroglycerin microcapsules (NGMC) 7.5 mg and pentaerythritol tetranitrate (PETN) 160 mg. Pulmonary blood pressures were measured at regular intervals until the 6th hour following oral administration of all three compounds successively to 7 patients and of two compounds (ID and NGMC) to 3 patients. In addition, a hemodynamic study was performed in 3 of these patients while under placebo. The results showed a significant decrease in pulmonary artery diastolic pressure with all three compounds. The effects appeared after 30 minutes with ID and NGMC and after 1 hour with PETN. They lasted 1 hour with ID and 3 to 4 hours with NGMC and PETN. Maximal effect occured at 1 hour with ID (-28%; p < 0.001), at 1.5 hour with NGMC (-18%; p (< 0.01) and at 3 hours with PETN (-21%; p <0.01).

Administration, Oral↗
PubMed1980

[Carotid sinus syndrome. Apropos of 6 cases with the cardio-inhibitory type].

The hyperirritable carotid sinus syndrome may have three different expressions: 1. a prolonged ventricular pause, the cardioinhibitory type and the most common; 2. hypotension without slowing of the heart rate, the vasodepressor type; 3. the association of a prolonged ventricular pause and hypotension, the mixed type. The aim of this communication is to present 6 cases of the cardioinhibitory type of hyperirritable carotid sinus syndrome. Three cases were selected from a series of 242 patients investigated for syncopal episodes. The results of carotid sinus massage and electrophysiological investigation could be classified into 4 goups: --Carotid sinus massage reproducing the clinical symptoms negative electrophysiological investigation: pure carotid sinus syndrome. --Carotid sinus massage negative, electrophysiological investigations negative: pure hyperirritable carotid sinus syndrome. --Carotid sinus massage reproducing the clinical symptoms, electrophysiological investigation positive: associated carotid sinus syndromes. --Carotid sinus massage negative: electrophysiological investigations positive: associated hyperirritable carotid sinus syndrome. The diagnosis of the cardioinhibitory type of hyperirritable carotid sinus syndrome was made on four criteria: 1. the association of hyperirritable carotid sinus and spontaneous syncopal or minor syncopal episodes; 2. the reproduction of symptoms together with a ventricular pause of over three seconds by carotid sinus massage under cover of pacing (to exclude the rare mixed forms); 4. the absence of associated sinus node dysfunction or atrioventricular conduction defects on endocavitary electrophysiological recordings. This syndrome should be tested for as a routine in patients with syncope as usually no suggestive trigger factors are found. Carotid sinus massage in this series of patients caused quite long ventricular pauses (average: 7,5 sec.) with serious symptoms (2 syncopes). Therefore, in the investigation of patients with syncope it would seem to be useful to perform this manoeuvre during electrophysiological investigation with pacing cover. The treatment of choice of the cardioinhibitory carotid sinus syndrome is permanent pacing. This was undertaken in 5 out of four 6 patients leading to total regression of all symptoms. It seems justifiable to propose permanent pacing for patients who have syncope with hyperirritable carotid sinus syndrome, easily demonstrated by carotid sinus massage, but in whom massage does not provoke symptoms, reasoning by analogy with patients with atrioventricular conduction defects or sinus node dysfunction.

Aged↗