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Biomedical subjects

C Minale

Publications and source records attributed to C Minale.

At least 55 records · Page 3Linked to original sources
PubMed1984

[Resection of the septum im hypertrophic obstructive cardiomyopathy. Long-term results in 33 patients].

Interventricular septal resection (after Morrow) was performed in 33 patients (24 males, 9 females; average age 48 [13-72] years) with hypertrophic obstructive cardiomyopathy (HOCM). Indications for operation were high resting pressure gradient, severe symptoms despite chronic and high-dosage drug treatment. One patient died on the ninth postoperative day, all others survived. Repeat cardiac catheterization was performed on 20 patients, 1-16 months postoperatively. There was a significant decrease in resting pressure gradient (mean 67 +/- 29 to 7 +/- 10 mm Hg, P less than 0.05). After an average of 30 (range 1-76) months, 25 patients were re-examined: 18 had definite improvement in their symptoms, five partial improvement and only two reported no change. At an operation risk of 3% the procedure is the treatment of choice in patients with symptoms.

Adolescent↗
PubMed1984

[Parenteral feeding following heart surgery operations].

After aorto-coronary bypass operations 40 patients were treated in a prospective-randomized study with 3 types of hypocaloric parenteral nutrition consisting of the same content of amino acids (75 g/day) but different amounts of carbohydrates: 120 g dextrose, 120 g or 200 g dextrose/fructose/xylitol (1:2:1) per day. 18 patients received only 75 g/day of dextrose (controls). The fluid volume for parenteral nutrition did not exceed 1500 ml/day. Changes in carbohydrate and protein metabolism were investigated. Because of restricted carbohydrate dosage, we needed no insulin to keep blood glucose within values of about 7-10 mmol/l. Postoperative serum insulin levels were significantly raised to 4-5 fold of preoperative values in all groups. Serum potassium concentrations remained normal under a supply of 80-100 mmol/day. Cumulative nitrogen balances were improved by about 48-58% in groups receiving parenteral nutrition despite a calorie/nitrogen ratio of 40:1 or 66:1 respectively. The expected beneficial effects on the concentrations of visceral serum proteins (transferrin, prealbumin, retinolbinding protein, cholinesterases) could not be found.

Blood Glucose↗
PubMed1983

Percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris: analysis of early and late results.

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 50 patients with stable and in 50 patients with unstable angina pectoris, each patient showing an isolated stenosis of more than 80% of the cross-sectional area of a single coronary artery. The technical success rate was 66% in the stable groups (26 of 37 patients [70%] with left anterior descending artery [LAD], 7 of 12 patients [58%] with right coronary artery [RCA]) and 74% in the unstable group (27 of 34 patients [79%] with LAD, 10 of 15 patients [67%] with (RCA). The increase in stenotic area in the unstable group exceeding that in the stable group for LAD stenoses (41.5 +/- 15.1% vs 32.3 +/- 14.5%, p less than 0.03), while in RCA stenoses the results in the stable group were better (45.1 +/- 17.6% vs 32.7 +/- 12.3%, n.s.). One acute vessel occlusion necessitating an emergency bypass operation occurred in each group (2%). The patient in the stable group died (total mortality rate 1%). Sixty-three of the successfully treated patients were routinely restudied 6 months later. According to clinical symptoms, 23% of the stable and 36% of the unstable group were in functional classes III and IV. From the anatomical viewpoint, a restenosis (greater than 85%) was found in 17% of the stable and in 24% of the unstable group. A further spontaneous decrease (greater than 10%) of the vessel obstruction was found in 47% of the stable group and in 12% of the unstable group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

New developments in medical-surgical treatment of acute myocardial infarction.

Selective intracoronary thrombolysis with streptokinase was successful in 72 of 84 (86%) patients admitted to the hospital with definitive signs of acute transmural myocardial infarction due to complete occlusion of either the left anterior descending coronary artery, the right coronary artery, or the circumflex artery. The average time between onset of acute symptoms and medically induced reperfusion was 241 +/- 90 minutes (SD). Reperfusion resulted in prompt relief of pain, regression of cardiogenic shock, and normalization of electrocardiograms. Follow-up treatment was either medical or surgical. The 32 medically treated patients had a high reocclusion rate, with 6 fatal (19%) and 9 nonfatal (28%) reinfarctions. In order to the reduce the risk of reinfarction, additional simultaneous transluminal balloon angioplasty was done in a recent series of patients with stenoses accessible to this technique. The best early and long-term results were achieved in 17 patients who underwent coronary artery bypass grafting within three days after successful thrombolysis. There was no operative mortality, and subsequent bleeding has not been a problem. It is concluded that early operation is the treatment of choice in all patients suitable for such intervention who have undergone successful intracoronary thrombolysis within 4 hours after onset of acute myocardial infarction. Late coronary bypass operation should be reserved for symptomatic patients who have definitive signs of infarction in spite of successful thrombolysis.

Aged↗
PubMed1982

Repair of complete atrioventricular canal in early childhood.

From November 1977 to January 1981, 10 consecutive patients underwent intracardiac repair of the complete atrioventricular canal at our institution. Ages ranged from 14 months to 4.5 years (mean age 20 months). Four patients were predominantly of type A, while 6 were predominantly of type C according to Rastelli's classification. Three patients had associated cardiac anomalies (2 tetralogy of Fallot and one parachute mitral valve). Standard repair and correction of the associated anomalies were performed under cold cardioplegic cardiac arrest and deep hypothermia with low-flow perfusion or circulatory arrest. Two patients died early postoperatively in severe renal failure and one died 6.5 months postoperatively in cardiac failure due to progressive mitral valve incompetence. One patient, with parachute mitral valve, was reoperated and the mitral valve was replaced because of persistent mitral insufficiency. The patients were followed up for a period of 4 to 35 months (mean 14 months) with a total of 112 patient months. The result of the operation was very good and all patients with retarded growth curve preoperatively showed a marked acceleration of their growth curve after operation. The operative results in this group of patients are independent of age and weight at the time of operation but appear to be influenced by associated cardiac anomalies and by the quality and quantity of atrioventricular valve tissue available for reconstruction.

Age Factors↗
PubMed1982

Morphometric investigations in mitral stenosis using two dimensional echocardiography.

A method is proposed for comparing the orifice size and the morphology of stenotic mitral valves, removed intact at the time of replacement, with the preoperative two dimensional echocardiographic cross-sections. The excised mitral valve apparatus is suspended on a specially constructed mounting. To avoid shrinkage the orifice is stabilised with an airfilled balloon. A radiography is taken directing the x-ray beam perpendicular to the valve orifice. In 40 of 51 patients this method provided the means of relating the echocardiographic cross-sections to the morphology of the valve. Planimetry of the valve area compared favourably with the postoperatively determined orifice size. Agreement was found in 34 of 40 patients in orifice shape between preoperative echocardiograms and x-rays of th excised valve. The relation between intraoperative estimation of size of the valve, using dilators with known diameters, and the postoperative results was less favourable. Areas of calcification were identified on echocardiography as dense conglomerate echoes. In 30 patients (75%) the localisation of calcium deposits and in 67% the degree of calcification was in agreement with the x-rays of the valve taken after operation. In addition to determination of the area, two dimensional echocardiography allows detailed studies of the stenotic valves, and is of particular importance for planning operative treatment.

Adult↗
PubMed1982

Percutaneous transluminal coronary angioplasty immediately after intracoronary streptolysis of transmural myocardial infarction.

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 21 patients with acute myocardial infarction (AMI) treated by intracoronary infusion of streptokinase within 8 hours after the onset of symptoms. Streptolysis therapy began a mean of 3.6 +/- 1.2 hours (+/- SD) after the onset of symptoms. The vessel was occluded in 14 patients and highly stenosed in seven. After the infusion of 67,300 +/- 63,200 IU of streptokinase over 26.1 +/- 21.5 minutes, patency of the occluded vessels was reached. PTCA as performed 20-60 minutes after the end of streptokinase treatment in 19 patients and 24 and 31 hours after treatment in two patients. The dilation was successful in 17 patients (81%). The degree of vessel obstruction was reduced from 90.2 +/- 7.3% to 58.6 +/- 19.5% (area method) and from 71.4 +/- 12.4% to 39.2 +/- 19.7% (diameter method). The improvement was 31.5 +/- 18.4% and 32.2 +/- 19.3%, respectively. No reocclusion was induced by PTCA. Twenty patients were discharged. One died during hospitalization; at autopsy, the treated vessel was still patent. During the follow-up period, two reinfarctions and one asymptomatic reocclusion occurred. The clinical findings during the hospital course and the follow-up period were compared with those of a control group of 18 patients with AMI and comparable coronary stenoses who were treated only with streptokinase infusion. Four of these patients had a reinfarction during the hospital course, and three died during the follow-up period. PTCA can be performed safely and successfully immediately after intracoronary infusion of streptokinase in patients with AMI. By reducing the subtotal stenosis, this treatment contributes to the reperfusion of the ischemic myocardium, diminishes the risk of a reocclusion and seems to improve the prognosis.

Adult↗
PubMed1981

Treatment of unstable angina pectoris with percutaneous transluminal coronary angioplasty (PTCA).

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 40 patients (34 male, 6 female; 51.0 +/- 8.5 years) with the typical clinical picture of unstable angina. All had a short history of pain (2.9 +/- 2.0 months), angina at rest, transient ST and/or T wave changes during this period, and little or no enzyme elevations. The patients had a total of 41 stenoses (39 single, one double; one main-stem, 26 left anterior descending, 14 right coronary artery). The degree of the stenoses was 95.5 +/- 4.9% (area method) and 81.8 +/- 10.7% (diameter method). PTCA was successfully performed in 26 cases (63%), reducing the stenoses to 61.5 +/- 12.4% (area method) and 39.1 +/- 10.0% (diameter method). One patient (2.5%) received an immediate bypass operation because of an acute vessel occlusion. Eleven of the 14 not successfully treated patients received an aortocoronary bypass within the next three to 35 days. All still had symptoms of unstable angina. Three patients refused operation. Their treatment consisted of nitroglycerin, beta-blockers and nifedipin. Seventeen of the 26 successfully treated patients were restudied after 4.9 +/- 1.7 months. The degree of stenosis had risen to 69.2 +/- 17.4% (area method). While the stenoses in 12 patients were equal or less than before PTCA, stenosis recurred in five cases. Two patients were successfully retreated. PTCA can be performed with a good early success rate and a low concentration rate in patients with unstable angina. Relief of pain and improvement of blood supply to the jeopardized myocardium can be provided immediately and with a limited amount of expense. The method can therefore be regarded first-stage treatment in such patients.

Adult↗
PubMed1980

Improved technique in permanent atrial pacing.

At the present time, the relatively high atrial stimulation threshold and the low and often unstable P wave amplitude are the main concerns in atrial pacing. As a further contribution to the solution of this problem we used a screw-in atrial lead in 16 patients. During the implantation, atrial mapping was performed in order to establish the position with the best electrical performance. The acute threshold for voltage at a pulse duration of 1 ms averaged 0.49 +/- 0.18 Volt. The acute peak-to-peak P wave amplitude averaged 4.6 mV +/- 1.3. No complication occurred at the time of the implantation. Follow-up periods averaged 12 months. No dislocation or bleeding was observed during a follow-up period of up to 28 months. Using this lead together with intraoperative atrial mapping, it is possible to achieve an acute strength-duration relationship in the atrium at a level similar to that in the ventricle. The results of this study demonstrate that intraoperative mapping is an important stein in enhancing the safety margins and long-term performance of atrial pacing.

Action Potentials↗