Biomedical subjects
C Spaulding
Publications and source records attributed to C Spaulding.
Bacterial vaginosis.
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[Management during the first hours following myocardial infarction. Round table].
Myocardial infarction, due to complete occlusion of a coronary artery, is a frequent disease which must be diagnosed as rapidly as possible on the basis of clinical and electrocardiographic arguments in order to allow rapid medicalized management; medical ambulance, followed by admission to the intensive care unit. Treatment is designed to disobstruct the coronary occlusion as rapidly as possible, either by intravenous fibrinolysis or by percutaneous transluminal coronary angioplasty in a specialized centre. The subsequent assessment (stress test, coronary angiography) guides the indications for secondary revascularization.
Should we avoid ostial implantations of Wiktor stents?
Complications arising during stent implantations in coronary arteries have been reduced by technological progress and the accumulated experience of interventional cardiologists. Retrospective and prospective randomized studies with several types of stents are currently available and show improved short and mid-term results. Wiktor stent provides increased flexibility for ease of implantation particularly in curved lesions. However, the flexibility of the Wiktor stent is also associated with low resistance in the longitudinal axis. We report four cases (in 4 out of 6 ostial lesions treated and 4 out of 43 Wiktor stents implanted during a 9-month period) in which stents have become unraveled during procedures on ostial lesions (2 saphenous venous grafts and 2 native coronary arteries). Death occurred in one case and one patient was treated by emergency coronary bypass surgery. In three cases the distal extremity of the guiding catheter stretched the stent meshes during the final control angiograms, and in one case the stent was stretched during withdrawal of the deflated balloon into the guiding catheter. We believe that it is preferable to avoid using this stent in ostial lesions.
Rotational coronary atherectomy with adjunctive balloon angioplasty for the treatment of ostial lesions.
Conventional balloon angioplasty (PTCA) of ostial lesions (OL) is associated with suboptimal results and a higher complication rate. Partial plaque ablation with rotational atherectomy (RA) before PTCA might improve results. This approach was used in 63 patients (pts) (mean age 64 +/- 10 yrs; 44 men, 19 women) with 69 OL. There were 15 aorto-OL and 54 branch-OL. Calcification was more frequent in aorto-OL than in branch-OL (67% vs. 35%, P < 0.05). Mean burr size was 1.8 +/- 0.3 mm. Burr-artery ratio was 0.74 +/- 0.10. Adjunctive PTCA was systematically performed. Procedural success was achieved in 58 pts (92%): 14 aorto-OL (93%) and 50 branch-OL (93%) were successfully treated; major complications occurred in 1 (7%) aorto-OL and 1 (2%) branch-OL. Uncomplicated failure occurred in three cases. Minimal lumen diameter (MLD) increased from 0.69 +/- 0.31 mm before RA to 1.43 +/- 0.28 mm after RA (P < 0.001) and 2.16 +/- 0.29 mm after PTCA (P < 0.001). Diameter stenosis (DS) decreased from 75 +/- 13% before RA to 32 +/- 12% after RA (P < 0.001) and 14 +/- 10% after PTCA (P < 0.001). All successfully treated pts underwent repeat angiography 24 h later and exercise testing or repeat cardiac catheterization > 6 mo later. At 24 h repeat angiography, DS was 17 +/- 15% (P = NS vs. after PTCA); no lesion had a DS > or = 50%. Follow-up coronary angiography was performed in 30 pts (52%) who had abnormal stress testing: 13 pts (43%) showed angiographic restenosis in at least one successfully treated OL. (ABSTRACT TRUNCATED AT 250 WORDS)
Initial experience with the Europass: a new ultra-low profile monorail balloon catheter.
One of the causes for percutaneous transluminal coronary angioplasty (PTCA) failure is the inability to cross the lesion with the balloon catheter after guidewire positioning. The Europass coronary angioplasty catheter is a monorail Duralyn balloon catheter developed to enhance lesion crossability and to overcome this limitation. This system was evaluated in 50 patients in which target lesions were chronic total coronary occlusions (12 cases) or stenoses that could not be reached or crossed by other new monorail balloon catheters. Overall procedural success was obtained in 49/50 patients (98%), using a single Europass balloon catheter in 46/50 patients (92%), with no in-hospital complications. Its low profile, small distal shaft, and excellent trackability allowed successful angioplasty in cases where other catheters failed. This balloon catheter represents a significant advance in angioplasty technology and can be considered as a first-choice device for a safe and expeditious single-operator procedure.
Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction.
BACKGROUND: When used in the setting of acute myocardial infarction, intravenous thrombolytic agents fail to achieve early infarct artery patency in 15% to 50% of patients. We tested the hypothesis that immediate balloon angioplasty applied to patients with failed early reperfusion would improve left ventricular function and clinical outcome at 30 days compared with conservative management alone. METHODS AND RESULTS: One hundred fifty-one patients with first anterior wall infarction treated with any accepted intravenous thrombolytic regimen and angiographically demonstrated to have an occluded infarct vessel within 8 hours of chest pain onset were randomized to aspirin, heparin, and coronary vasodilators (conservative therapy) or to this therapy and balloon angioplasty supplemented by further thrombolytic therapy as needed. Left ventricular function was assessed using multiple-gated equilibrium radionuclide technique to determine ejection fraction, and adverse clinical outcome was assessed evaluating death, ventricular tachycardia, and class III or IV heart failure at 30 days. Seventy-three patients were randomized to conservative therapy and 78 to angioplasty. The two groups were well balanced for patient age (59 +/- 11 years), sex (82% were male), and time to randomization (4.5 +/- 1.9 hours). Angioplasty was technically successful in 72 of 78 randomized patients (92%). Two patients randomized to conservative therapy crossed over to angioplasty within 72 hours. Resting 30-day ejection fraction was 40 +/- 11% in the angioplasty group and 39 +/- 12% in the conservative group (P = .49), but ejection fraction with exercise was 43 +/- 15% and 38 +/- 13% for the angioplasty and conservatively treated groups, respectively (P = .04). Adverse clinical outcomes included death in 5% and 10% (P = .18), severe heart failure in 1% and 7% (P = .11), and either death or severe heart failure in 6% and 17% (P = .05) of the angioplasty and conservatively managed groups, respectively. CONCLUSIONS: When applied to patients with first anterior infarction, rescue angioplasty appears to be useful in the prevention of death or severe heart failure, with improvement in exercise, but not resting, ejection fraction. This strategy deserves further study and highlights the potential advantage of early mechanical restoration of infarct vessel patency when thrombolytic therapy has failed.
Possible bromocriptine-induced myocardial infarction.
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Extracranial absorbed doses with Gamma Knife radiosurgery.
Radiosurgery is used with increasing frequency, not only for the treatment of cerebral arteriovenous malformations (AVMs), but also for the treatment of other well-defined lesions including acoustic neuromas, meningiomas, pituitary adenomas as well as solitary metastases. Although investigators have addressed dosimetric aspects of stereotactic radiosurgery in terms of target volume, little if any attention has been focused on the absorbed doses received at extracranial sites. Therefore, absorbed doses to the eye, thyroid, sternum and gonads were measured in 111 patients (100 adults and 11 children) using thermoluminescent dosimetry (TLDs). For the 100 adults, the average maximum target absorbed dose was 35 +/- 8 Gy. The measured absorbed dose in selected organs of adults from Gamma Knife radiosurgery using one or more isocenters was 9 +/- 8 cGy for the eye, 15 +/- 7 cGy for the thyroid, 20 +/- 10 cGy for the sternum and 3 +/- 2 cGy for the gonads. The absorbed doses received by the children (13 years and younger) was similar with the exception of a marked increase in gonadal dose. The use of multiple isocenters is associated with higher absorbed doses to extracranial sites.
[Left pulmonary artery originating from the ascending aorta in tetralogy of Fallot. Therapeutic strategy].
The authors report the rare case of a 12 year old child with an anomalous origin of the left pulmonary artery from the ascending aorta associated with Tetralogy of Fallot. This complex congenital malformation was treated surgically by a Deleval anastanosis between the right subclavian and right pulmonary arteries. The result was good with a 9 year follow-up, the patient having only Grade II effort duspnoea and cyanosis. The authors discuss the advantages and drawbacks of the different possible surgical approaches to this problem in the light of the outcome of this case and a review of the literature.
Transient left ventricular dyskinesia as a consequence of myocardial stunning.
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Surgical treatment of an atherosclerotic aneurysm of the left main coronary artery.
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Coronary artery spasm triggered by oral administration of methylergometrine.
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[Factors influencing survival after surgery of pure non-ischemic mitral insufficiency].
Uni and multifactorial (Cox) statistical analysis of the results of surgery in a series of 247 patients operated between 1969 and 1988 for pure, non-ischaemic mitral regurgitation was undertaken to determine the factors influencing operative and late mortality. All but 3 cases were adults, average age 51 years, and very symptomatic (75 per cent Class III et IV of NYHA Classification). Dystrophic or degenerative lesions were responsible for 53 per cent of cases of regurgitation whilst rheumatic valvular disease was only observed in 30 per cent of cases. Mitral valve replacement was performed in 137 patients (96 mechanical and 41 bioprostheses) and conservative surgery was possible in 110 cases. There were 12 operative deaths (4.9%); the operative risk increased with age and with the practice of valve replacement. Eleven of the 235 survivors (4.7%) were lost to follow-up. During the follow-up period (average 58 months) there were 37 late deaths of which nearly a half were due to left ventricular dysfunction. Multifactorial analysis identified cardiothoracic ratio and atrial fibrillation as predictive factors of late mortality whilst left ventricular ejection fraction and the type of surgery were related to the development of left ventricular dysfunction. The postoperative left ventricular ejection fraction was significantly lower after valve replacement than after valvuloplasty (11 +/- 13% vs 3 +/- 13%; p less than 0.01). These results are therefore in favour of early correction of severe mitral regurgitation by conservative surgery whenever possible.
[Dilated cardiomyopathy with deep, completely reversible dysfunction of the left heart in alcoholic patients. Report of 2 cases].
Two cases of dilated, hypokinetic cardiomyopathy complicated by cardiac failure, are reported in a 29 year old woman and a 55 year old man, with no etiological factors other than chronic major alcoholism (consumption of over 100 ml of alcohol per day for over 5 years). This was completely reversed 10 and 14 months after cessation of alcohol consumption. The isotopic left ventricular ejection fraction increased from 22 to 70 p. 100 and from 12 to 73% respectively. These cases are are and are evidence in favour of an alcoholic cardiomyopathy rather than alcohol being an aggravating factor in patients with cardiomyopathy.
Congenital valvular aortic stenosis in adults.
Based on a study of 20 patients operated on between the ages of 21 and 38 for congenital valvular aortic stenosis, the distinguishing features of congenital aortic valvular stenosis in adults are reviewed: valvular calcification (75%), valvular dome rarely present (10%), usually moderate cardiac disability (70%), diminished or inaudible second heart sound (50%), associated diastolic murmur (75%), electrocardiographic left ventricular hypertrophy (70%), and an infrequent protosystolic click (30%). Surgery is necessary for symptomatic patients. If patients are asymptomatic, surgery is decided after measuring the left ventricle-aortic pressure gradient by continuous Doppler wave study, or by cardiac catheterization. If surgery is not performed, a regular follow-up is necessary because stenosis can evolve. Valvular replacement by a mechanical valve is preferable. Even if the aortic valve is not calcified and a simple commissurotomy is technically possible, it is only a palliative method with unsatisfactory results and an annual mortality rate after surgery of 1%.
[Thoracic metastases of ependymoma. Apropos of a case and review of the literature].
A 27-year old woman with occipital ependymoma treated by surgery and radiotherapy for multiple recurrences developed a right lymphocytic pleural effusion. After 3 inconclusive needle biopsies of the pleura, pleurectomy was performed. Pathological examination with a specific immunohistochemical marker provided a diagnosis of pleuro-pulmonary metastases from the ependymoma. This rare case of extraneuraxial metastasis from a cerebral ependymoma is discussed in the light of published data. Its originality lies in that a positive diagnosis of pleural metastases was obtained with an immunohistochemical marker, the gliofibrillary antiprotein serum (anti-GFAP) specific of glial tissue.
Thyroid tuberculosis associated with mediastinal lymphadenitis.
A 25-year-old man developed thyroid tuberculosis associated with mediastinal lymph node enlargement. He was treated by antituberculosis chemotherapy and hemithyroidectomy.