[Cochleovestibular involvement in chronic suppuration of the ear].
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Chronic Disease↗
Biomedical subjects
D Predescu
Publications and source records attributed to D Predescu.
[Therapeutic options in nasosinus allergy].
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Humans↗
A comparative study of the renin-like activity in the heart and vascular system under various experimental conditions.
Renin-like activity in the heart and aorta of rats being slightly modified by binephrectomy, its variations in DOCA hypertension and infarcted ventricular muscle were studied. The daily i.p. administration of DOCA 12 mg/kg body weight for 35 days in male adult rats resulted in a significant decrease of renin activity in plasma and tissues of the heart, aorta, hypothalamus and hypophysis. In contrast to renin-like activity, cathepsin D measured in the same animals increased in all organs, except for the plasma. Similar changes of renin-like activity were observed in salt-loaded animals with 1.7% sodium chloride solution ad libitum for 35 days. In the infarcted myocardial ventricular muscle of the rats and rabbits, the tissue isorenin showed a tendency to decrease, associated with a significant increase in cathepsin D activity. Like in aorta, isorenin seems to be a different enzymatic entity of cathepsin D in the myocardial tissue. The measurement of isorenin content of the vascular endothelium and cardiac muscle fibers seems to reveal much higher amounts in the coronary vascular endothelium than in the myocardial fibres. The activation of the enzymatic angiotensin forming mechanisms in the coronary vascular bed could be one of the risk factors in myocardial infarction.
Animals↗
Exercise testing in patients with valvular diseases.
Sixty-eight patients with valvular diseases (VD) were subjected to maximal, symptoms limited, exercise testing (ET) using a cycloergometer. The exercise was limited in 82% of the valvular patients by dyspnea attributed to pulmonary capillary pressure rising, even if in the 20 patients with mitral stenosis the relation between the effort intensity and mitral valve area (MVA) (echo) was absent (r = 0.26). Myocardial aerobic impairment (MAI) was absent in 17%, mild in 41%, moderate in 39% and severe in 3% of the patients with VD. It was considered overestimated, the effort being stopped, in 2/3 of the patients, before a heart rate of 85% of maximal heart rate (MxHR) was reached. This suggests that the patients with VD unlike coronary patients, still have a reserve of increasing MVO2 when exercise is stopped. Even in the above condition, the average difference between functional aerobic impairment (FAI) and MAI was 6% for NYHA I, 10.6% for NYHA II and 17% for NYHA III showing a physical deterioration in patients above the limit imposed by the valvular disease itself. ST segment depression of 1 mm or more at 0.08 s after J point was registered in 30% of the patients. Due to the insufficient rise of the heart rate (HR) in the majority (2/3) of the patients with VD, these data probably underestimate the myocardial ischemia. Consequently other stress testings whose main action is not the increase of HR and MVO2 i.e., dypiridamole and adenosine, are preferred in the investigation of myocardial ischemia in the patients with VD.
Aortic Valve↗
The correlation between Doppler data and effort capacity in mitral stenosis.
UNLABELLED: The data concerning the relation between mitral valve area (MVA), estimated invasively or by 2 D-echo and effort capacity in mitral stenosis (MS) are still controversial. Consequently we have studied the same relation, using the Doppler indices. METHODS: 19 patients with MS were submitted to a Doppler examination--MVA, pressure half time (PHT), mean pressure gradient (MPG)--and to a symptoms limited exercise testing on cycloergometer--effort intensity (Watts, METs) functional aerobic impairment (FAI), myocardial aerobic impairment (MAI). The "r" correlation index between these parameters was calculated. The results show no significant correlation between Doppler estimated severity of mitral stenosis and the effort capacity of the patients, even if a weak negative correlation ("r" = - 0.32) is noted between effort intensity and MPG and a weak positive correlation ("r" = + 0.41) between FAI and PHT. The conclusion is that effort capacity of patients with mitral stenosis cannot predict the severity of the disease which is to be established through other methods.
Adult↗
The effect of handgrip upon Doppler data in mitral stenosis.
UNLABELLED: The usefulness of physical rehabilitation in patients with valvular heart disease is now well established. But, mainly in mitral stenosis, the isometric exercises are under question, because of the risk of sudden rise in capillary pulmonary pressure. In order to clarify this aspect we have studied the effect of isometric exercise upon Doppler data in mitral stenosis. METHODS: in 25 patients with mitral stenosis the Doppler indices of severity-mitral valve area (MVA), pressure half time (PHT), maximal velocity (MxV), mean pressure gradient (MPG)-were determined before and after 3-4 minutes of handgrip performed with a dynamometer at 30% of the maximal voluntary contraction (MVC). There are no significant differences of Doppler parameters before and during handgrip: MVA (1.56 +/- 0.30/1.49 +/- 0.53 cm2), PHT (171 +/- 72/150 +/- 58 ms) MPG (7.07 +/- 2.61/7.21 +/- 1.8 mmHg), MxV (2.186 +/- 0.79/2.276 +/- 0.73 m/s). The results suggest that mild isometric exercise does not alter hemodynamic parameters in mitral stenosis. Consequently isometric exercise can be included in physical programmes of rehabilitation for this category of patients.
Adult↗
The echo Doppler study of mitral and aortic prostheses function.
Doppler echography is now the most accurate noninvasive method for studying valvular prostheses, but the values considered to prove a normal function are still controversial. We studied by echo Doppler 95 valvular mechanical (M) and biological (B) prostheses, in mitral (Mi) and aortic (Ao) position in patients without clinical signs of prosthetic dysfunction. The data obtained for Ao prostheses (maximal transprosthetic gradient (MxG): M-20.47 mmHg, B-7.95 mmHg; mean transprosthetic gradient (MG): M-7.98 mmHg, B-3.9 mmHg) are in agreement or even better than literature data. For Mi prostheses the prosthetic area (PA) and pressure half time (PHT) values are in normal limits but the MG (M-5.087 mmHg, B-5.9 mmHg) is slightly superior to the data reported in the literature. Proving the value of echo Doppler for the study of valvular prostheses our results suggest to adopt larger limits of normality for mitral prostheses. They also sustain the necessity of a first Doppler examination before the patient is discharged from the hospital after valvular replacement.
Adult↗
[Primary abdominal parietorrhaphy and the cure of eventrations with the relon monofilament suture (N.I. 2402/76)].
Primary repair of the abdominal wall and the cure of incisional hernias using the relon mono-filamentous fibres (N.I. 2402/76) Confronted with long lasting parietal suppurations which are entertained by the classic nylon poly-filamentous fibres, suppurations that cannot be avoided unless the above fibres are removed on one hand assuming the risk of a possible subsequent incisional hernias and on the other hand because of the relative elevated price of the mono-filamentous fibres brought from abroad, within the last years (from 1982) we have utilised the relon mono-filamentous fibre (N.I. 2402/76) in abdominal wall reconstruction (initially for the surgical cure of the incisional hernias and there after in primary abdominal wall reconstruction when there were factors predisposing to a possible subsequent parietal for septic contamination, in overweight patients, immune-compromised patients, in patients following steroid therapy, chemotherapy, etc. Our present experience extends over more than 1000 patients who have undertook a surgical procedure.
Abdominal Muscles↗
Effect of isometric effort upon mitral regurgitation severity--echo Doppler study.
Isometric effort increases the severity of mitral regurgitation (MR) by augmenting the afterload and the regurgitant fraction. The worsening of MR may be different in various patients and can explain the differences in effort capacity of patients with identical rest mitral regurgitation. We studied 25 patients with MR of various etiologies, submitted to handgrip (maximal voluntary contraction), the severity of MR being evaluated by the determination of regurgitant area (colour Doppler). There was a 42% increase of the regurgitant area from 3.26 to 4.66 cm2 (p < 0.05). The increase was greater for ischemic MR (59%) than for MR in dilated cardiomyopathy (26%), the last value not being explained by a lower EF because rest EF was similar in patients with and without an increase of MR severity during maximal voluntary contraction. The individual analysis of the results showed an increase of the MR severity in 1/2 of the patients, in whom the left atrial dimension was greater, though the effort capacity was the same in the two subsets of patients. It is concluded that colour Doppler is a simple and valuable method for studying the influence of isometric exercise upon MR severity, this being increased in 1/2 of the patients, with a positive correlation with ischemic etiology of the disease, left atrial dimension, but not with the patients' effort capacity.
Adult↗
[Clinical and therapeutic considerations in pseudomyxoma peritonei].
Pseudomyxoma peritonei (PMP) is an uncommon clinical entity, lacking a precisely defined etiopathogenesis. Its clinical features are not specific and diagnosis is difficult. We analysed 10 patients, all of them women, whom we had treated surgically in combination with intraperitoneal chemotherapy. Postoperative complications had been minimal and no death had occurred. 5 patients were followed up in time, 4 of them presenting a favourable evolution (2 required reintervention), and 1 patient decreased. We analysed up-to-date therapeutic approaches and the benefit of their combinations in order to identify the optimal therapeutic strategy. We consider that the combinations surgery + intraperitoneal chemotherapy or surgery + intracavitary radiotherapy are the most effective up to date.
Adult↗
[Total duodenal diversion in hiatal hernia with pathological duodenoesophageal reflux (preliminary results)].
For some patients, reflux disease means also duodenogastric, as well as gastroesophageal reflux; they may suffer because of duodenoesophageal reflux. For these patients, a simple surgical restoration of the cardial competence may prove to be insufficient; on the contrary, an indirect approach, using vagotomy and duodenal diversion may be a good therapeutical option in selected cases. In our hands, total duodenal diversion has already proven to be a good technical solution for the surgical treatment of the postoperative reflux disease, so we decided to expand its first choice indications to hiatal hernia cases, in the presence of duodenoesophageal reflux. Therefore, our study presents the results of the first 7 cases, operated on since 1995. No case had been gastric operated before, but 4/7 had already suffered a cholecystectomy. Duodenoesophageal reflux is discussed: etiopathogenesis related to surgical approach, using standard antireflux surgery (failures of the hiatal techniques and their causes) or total duodenal diversion (technical aspects, antireflux efficiency, secondary functional effects, pros and cons, therapeutical indications).
Adult↗