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Biomedical subjects

D de Bono

Publications and source records attributed to D de Bono.

At least 19 recordsLinked to original sources
PubMed2001

Prevalence and aetiology of heart failure in an Arab population.

BACKGROUND: The epidemiology of heart failure in Arabia, with a population different from the West in cultural and ethnic origin, has not been studied before. AIMS: To determine the prevalence and aetiologies of symptomatic heart failure in an indigenous Arab population over a 3-year period. METHODS: All patients with heart failure > or =13 years of age, treated at the only secondary care hospital of the Dhakliya region of Oman between 1992 and 1994 were evaluated prospectively by clinical history and physical examination. Chest radiograph and echo-Doppler studies were used to confirm the diagnosis of heart failure. Exercise stress testing and/or coronary angiography were also performed in patients >30 years of age, or earlier if ischaemic heart disease was suspected. RESULTS: A total of 1164 patients were identified giving a prevalence of 5.17/1000 population during the study period (6.04/1000 among males and 4.21/1000 among females; P<0.001). The prevalence increased with age from 1.05/1000 in age group <45 years to 15.7/1000 in 45-64 years (P<0.001) and 25.2/1000 in > or = 65 years (P<0.001). Common causes of heart failure were ischaemic heart disease (51.7%), hypertensive heart disease (24.9%) and idiopathic dilated cardiomyopathy (8.3%). Valvular heart disease and lung diseases causing heart failure were less common. CONCLUSION: The prevalence of symptomatic heart failure was appreciably significant in the population studied, showed a male preponderance and was frequent in people aged > or =45 years. Ischaemic heart disease and hypertension were the commonest aetiologies but idiopathic dilated cardiomyopathy was also present in a significant number of patients being relatively more prevalent than reported from the West.

Adolescent↗
PubMed2001

Low proportion of familial dilated cardiomyopathy in an arab population with a high prevalence of consanguineous marriages.

UNLABELLED: In this study, 770/890 (87%) first-degree relatives from 108 families of hospitalized patients with idiopathic dilated cardiomyopathy (IDC) were screened using clinical examination, electrocardiography and echocardiography. Thirty percent of the patients were born to consanguineous parents. Familial dilated cardiomyopathy (FDC) was found in 7 (6.5%) families, which is lower than the earlier published figures of 20-25%. Patients with IDC were younger at presentation (p = 0.002) and were more often associated with parental consanguinity (p = 0.04). but the survival rates of familial patients did not differ significantly. CONCLUSION: Despite the high prevalence of consanguinity, there was a low proportion of FDC in the study population. With the prospects of treatment of asymptomatic IDC to slow the progression of the disease, all family members of newly identified IDC patients should receive screening and counselling, with appropriate therapy where indicated.

Adolescent↗
PubMed2000

Coronary artery disease: combined stress MR imaging protocol-one-stop evaluation of myocardial perfusion and function.

The authors developed and tested a dual stress magnetic resonance (MR) imaging protocol to evaluate myocardial perfusion, function, and hibernation. The technique was well tolerated, and high-quality images were achieved. The comprehensive information obtained can be used to guide clinical management decisions regarding coronary artery revascularization procedures. This protocol offers a one-stop assessment of patients with coronary artery disease with use of a clinical MR imager.

Adenosine↗
PubMed1998

The significance of coronary arterial patency and ventricular function for prognosis after myocardial infarction.

This paper assesses the evidence that early, complete and sustained recanalisation of the infarct related artery is the most important factor in limiting myocardial damage and improving outcome after coronary thrombosis. Besides the results of experimental studies, clinical support for the 'open artery' concept comes from, first, the consistent demonstration that patients with patent arteries survive better that those in whom patency is not achieved; second, from the observation that early treatment is associated with a better outcome, and third, from the demonstration that reperfusion by angioplasty or bypass grafting produces results as good or better than those of fibrinolytic therapy. Validation of adequate reperfusion as both the mechanism of, and a surrogate for, improved clinical outcome encourages 'perfusion endpoint' clinical trials to develop new reperfusion strategies.

Coronary Vessels↗
PubMed1997

Drugs for cardiovascular disease. Spoilt for choice?

It is believed that the number of drugs, and indeed different classes of drugs, potentially available for treating cardiovascular disease has increased enormously. The object of this conference, held at the Royal College of Physicians in London on 1st and 2nd May 1997, was to evaluate both current treatment options and alternative research strategies.

Journal Article↗
PubMed1997

Alteplase.

Alteplase (recombinant human tissue type plasminogen activator, rt-PA) was identified as a naturally occurring plasminogen activator in 1975, cloned from a human melanoma cell line in 1981, introduced into clinical trials in 1982, and received a product licence for the treatment of acute myocardial infarction in 1986. The present review will concentrate on assessing its current status as a clinically effective thrombolytic agent, but will touch briefly on its biochemical, physiological and pharmacological properties. Since alteplase is an approved pharmaceutical name, the term tPA will be used to refer to the naturally occurring substance in its physiological context.

Journal Article↗
PubMed1996

New training guidelines: what are the implications for cardiological research?

The recognition of the importance of research experience is welcomed; committed research supervisors should be identified for each trainee and research planning should start as early as possible in the traineeship. It would be welcome if employing authorities and postgraduate deans were to provide personal support for up to one year and modest research expenses for trainees undertaking research. In the absence of such support, application would need to be made to grant-giving bodies well in advance. Certain posts may need to be earmarked for the training of future clinical scientists. Academic units should regard themselves as challenged, but not necessarily threatened, by the new proposals. With appropriate consultation and involvement, and a modest allocation of funding, the overall result should enhance the quality of both service and academic communities.

Academic Medical Centers↗
PubMed1995

Effect of intraluminal application of tissue-type plasminogen activator on the fibrinolytic activity of experimental vein grafts.

OBJECTIVE: The aim was to quantify the effect of intraluminally applied tissue-type plasminogen activator (tPA) on the fibrinolytic activity of experimental vein grafts and assess the effect of pretreatment of the vein on early platelet and thrombus formation using histological techniques. METHODS: A pig model of bilateral saphenous venin-carotid artery grafts was used. In each animal one side of the neck was grafted using vein distended to 230 mm Hg and pretreated with tPA (1 mg.ml-1) for a period of 15 min before grafting (treated graft). The perfused in situ for 2 h after implantation and before analysis. Changes in local fibrinolytic activity were quantified using fibrin plate techniques and specific chromogenic assays for tPA and urokinase (uPA) in tissue extract (n = 6 animals). Histological assessment was made using light and scanning microscopy (n = 4 animals). RESULTS: Surgical preparation and distention significantly reduced the fibrinolytic activity of pig saphenous vein in terms of areas of lysis produced on fibrin plates (P < 0.05), tPA activity (P < 0.05), and uPA activity (P < 0.05). Pretreatment of distended vein with tPA before grafting significantly enhanced its fibrinolytic activity after 2 h perfusion compared to control (untreated) grafts, as assessed by areas of lysis on fibrin plates (P < 0.05) and specific tPA activity (P < 0.05). Treated grafts also showed qualitatively less platelet and thrombus formation on histological examination. CONCLUSIONS: Pretreatment of surgically harvested vein by intraluminal application of tPA before grafting enhances its fibrinolytic activity after exposure to 2 h perfusion in vivo. This technique requires further investigation to validate its potential as a means of providing local anticoagulation to veins implanted as arterial grafts thereby reducing the incidence of early graft thrombosis.

Animals↗
PubMed1994

Management of thrombosis in coronary heart disease.

Management of thrombosis in coronary heart disease comprises the management of acute coronary thrombosis presenting as myocardial infarction or as unstable angina, the use of anticoagulant therapy to prevent or treat complications of myocardial infarction, and prophylaxis in patients identified as being at increased risk. Thrombolytic therapy and aspirin independently and additively reduce mortality in evolving myocardial infarction. Aspirin and heparin, but not thombolytic agents, improve outcome in unstable angina. Heparin and warfarin reduce the risk of embolism from left ventricular thrombus forming post-infarction. Aspirin has been shown to reduce the risk of further cardiovascular events or cardiac death in patients identified as at high risk. Current research is evaluating the role of antithrombins and platelet adhesion inhibitors as adjuvant therapy after thrombolysis, in unstable angina, and as heparin substitutes during coronary angioplasty, and of low dose warfarin as long-term prophylaxis in high risk patients.

Angina, Unstable↗
PubMed1994

Randomized trial of a GPIIb/IIIa platelet receptor blocker in refractory unstable angina. European Cooperative Study Group.

BACKGROUND: Patients with unstable angina despite intensive medical therapy, ie, refractory angina, are at high risk for developing thrombotic complications: myocardial infarction or coronary occlusion during percutaneous transluminal coronary angioplasty (PTCA). Chimeric 7E3 (c7E3) Fab is an antibody fragment that blocks the platelet glycoprotein (GP) IIb/IIIa receptor and potently inhibits platelet aggregation. METHODS AND RESULTS: To evaluate whether potent platelet inhibition could reduce these complications, 60 patients with dynamic ST-T changes and recurrent pain despite intensive medical therapy were randomized to c7E3 Fab or placebo. After initial angiography had demonstrated a culprit lesion suitable for PTCA, placebo or c7E3 Fab was administered as 0.25 mg/kg bolus injection followed by 10 micrograms/min for 18 to 24 hours until 1 hour after completion of second angiography and PTCA. During study drug infusion, ischemia occurred in 9 c7E3 Fab and 16 placebo patients (P = .06). During hospital stay, 12 major events occurred in 7 placebo patients (23%), including 1 death, 4 infarcts, and 7 urgent interventions. In the c7E3 Fab group, only 1 event (an infarct) occurred (3%, P = .03). Angiography showed improved TIMI flow in 4 placebo and 6 c7E3 Fab patients and worsening of flow in 3 placebo patients but in none of the c7E3 Fab patients. Quantitative analysis showed significant improvement of the lesion in the patients treated with c7E3 Fab, which was not observed in the placebo group, although the difference between the two treatment groups was not significant. Measurement of platelet function and bleeding time demonstrated > 90% blockade of GPIIb/IIIa receptors, > 90% reduction of ex vivo platelet aggregation to ADP, and a significantly prolonged bleeding time during c7E3 Fab infusion, without excess bleeding. CONCLUSIONS: Combined therapy with c7E3 Fab, heparin, and aspirin appears safe. These pilot study results support the concept that effective blockade of the platelet GPIIb/IIIa receptors can reduce myocardial infarction and facilitate PTCA in patients with refractory unstable angina.

Abciximab↗
PubMed1993

Myoglobin protects against endothelial cell membrane damage associated with hydrogen peroxide or xanthine/xanthine oxidase.

Oxymyoglobin at 'physiological' concentrations of 20-100 micromolar protected cultured endothelial cells from damage by xanthine/xanthine oxidase or by hydrogen peroxide. Metmyoglobin also provided a degree of protection, but apomyoglobin was ineffective. Protection was enhanced in the presence of ascorbate (0.01-1 mM). Myoglobin may have a physiological role in the protection of muscular tissue from ischaemia/reperfusion-induced damage.

Adenine↗