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F Alfonso

Publications and source records attributed to F Alfonso.

144 records · Page 8Linked to original sources
PubMed1989

[Coronary angioplasty performed at the same time as diagnostic coronarography].

To evaluate the results of coronary angioplasty performed during the diagnostic coronary angiogram, we have compared 185 of these procedures with the characteristics of 446 consecutive angioplasties accomplished in a separate procedure from the diagnostic angiogram. There were no differences in the clinical characteristics in both groups, but more angioplasties during diagnosis were indicated after a myocardial infarction (23% vs 10%, p less than 0.001), whereas less angioplasties in this group had prior stable angina (12% vs 21%, p less than 0.025). In addition, a greater number of the angioplasties during diagnosis were used in the treatment of restenosis (24% vs 5%, p less than 0.001), and the procedure was performed as a clinical emergency in 28% vs 2%, p less than 0.001. The initial angiographic success, and the final angioplasty success in the absence of mayor complications was 93% vs 88%, p less than 0.1, and 81% vs 82%, in the angioplasties performed during diagnosis and as a separate procedure, respectively. Therefore, in our experience, the angioplasty performed during the diagnostic coronary angiogram is an effective means of treatment in patients with coronary artery disease, in particular those after myocardial infarction or those presenting with restenosis, yielding a similar rate of success both, per lesion and per procedure, than the conventional approach, the angioplasty in a separate independent procedure. These results suggest that angioplasty performed during diagnosis probably could be extended to a greater number of patients.

Aged↗
PubMed1987

Arrhythmogenic effects of antiarrhythmic drugs in patients with an old myocardial infarction and asymptomatic ventricular ectopic activity as studied by programmed electrical stimulation.

In 22 patients with a previous myocardial infarction and documented Lown class II to IV asymptomatic ventricular arrhythmias, the arrhythmogenic effect of mexiletine (18 patients) and propafenone (10 patients) has been assessed by programmed electrical stimulation. Ventricular arrhythmias induced during the basal study were: repetitive ventricular responses (RVR) (11/22, 50%), nonsustained ventricular tachycardia (VT) (3/22, 14%), sustained VT (7/22, 32%) and ventricular fibrillation (VF) (1/22, 4%). The induction of sustained VT or VF increased to 50% after mexiletine and to 80% following propafenone. An arrhythmogenic effect was found in 7/11 patients (64%) without VT at the control study (P = 0.004). One patient of this group spontaneously developed sustained VT both after mexiletine and propafenone. Only 1/8 patients (13%) with sustained VT/VF at the basal study had RVR after drug administration. The R-R interval of sustained VT at the basal state tended to be faster than that after the drugs (260 +/- 60 ms vs 293 +/- 56 and 332 +/- 77 ms for mexiletine and propafenone, respectively) (P = 0.052). Statistical significance was only reached in the propafenone group (P = 0.03). Facilitation of VT induction after antiarrhythmic drugs is most likely due to a modest lengthening of refractoriness in contrast with a more evident reduction in conduction velocity within the reentry pathway. Our study illustrates that treating asymptomatic ventricular ectopic activity in patients with an old myocardial infarction may be dangerous and that antiarrhythmic drugs show a significant arrhythmogenic potential at least in the laboratory setting.

Adult↗
PubMed1987

Echocardiographically revealed collapse of the right ventricle and prolonged inversion of both atria without clinical cardiac tamponade.

In a patient with a large pericardial effusion without any clinical signs of cardiac tamponade, echocardiography revealed collapse of the right ventricle and prolonged (greater than 34%) inversion of the free wall of both atria, maximal in early systole. The presence of such findings in the absence of clinical signs of haemodynamic compromise is discussed.

Adult↗
PubMed1987

Cerebral infarction due to radiation accelerated arteriosclerosis.

Radiation therapy may cause accelerated arteriosclerosis of carotid and vertebral vessels which can cause cerebral infarction. This is a late complication which usually occurs several years after therapy and often affects vessels in locations where severe arteriosclerotic change is uncommon.

Adult↗
PubMedDate not supplied

Urine cytology and the diagnosis of renal allograft rejection. I. Studies using conventional staining.

OBJECTIVE: To determine the reproducibility and validity of urine cytology for the diagnosis of acute renal allograft rejection (AR). STUDY DESIGN: We conducted a blind, prospective study of 10 renal allograft recipients. Freshly voided aliquots of urine were obtained on each hospital day and at each outpatient visit for a mean of 52.8 +/- 26.2 (SD) days following transplantation. The samples were prepared by cytocentrifugation and then stained by a modified Papanicolaou method. To determine interobserver reproducibility, the differential cell counts of two blinded cytopathologists were compared. A cytodiagnosis of AR was made when the urine sample contained < 55% neutrophils and > 20% lymphocytes. To determine the validity of the cytology, the result was compared to the histologic and clinical diagnoses. Biopsies were obtained one hour following vascular anastomosis and at the time of graft dysfunction and were scored by two blinded pathologists according to the Banff classification. The clinical diagnosis was determined by a retrospective review conducted by four blinded clinicians. RESULTS: The interoperator reading of urine cytology was more reproducible than histology, with kappa values of 0.40 +/- 0.15 (SE) and 0.21 +/- 0.10 (SE), respectively. Urine cytology was accurate for the diagnosis of AR, with a sensitivity of 80% and a specificity of 96% as compared to the clinical and histologic findings. CONCLUSION: Our observations support the claim that urine cytology is useful for diagnosing AR.

Acute Disease↗
PubMedDate not supplied

Urine cytology and the diagnosis of renal allograft rejection. II. Studies using immunostaining.

BACKGROUND: Urine immunocytology may provide a noninvasive method of investigating the antigens expressed by renal tubular cells. In previous investigations of patients with acute renal allograft rejection (AR), we showed that the adhesion molecule ICAM-1 is expressed by voided tubular cells. The up-regulation of ICAM-1, in turn, may be due to high circulating levels of interferon-gamma and/or TNF-alpha. We investigated the regulation of receptors for these cytokines and found a correlation between their expression and clinical events. STUDY DESIGN: For 10 patients who received transplants consecutively, freshly voided aliquots of urine were obtained on each hospital day and on each outpatient visit for a mean of 52.8 +/- 26.2 (SD) days. After cytocentrifugation, the samples were prepared by the avidin-biotin-immunoperoxidase technique in order to detect the presence or absence of ICAM-1, interferon-gamma receptor and TNF-alpha receptor (p 80) on the tubular cells. RESULTS: In nonrejecting patients, the tubular cells expressed the interferon-gamma receptor but not ICAM-1 or the TNF-alpha receptor. In patients with AR, the pattern was different. The tubular cells expressed ICAM-1 and the TNF-alpha receptor but not the interferon-gamma receptor. CONCLUSION: Urine immunocytochemistry may be useful to demonstrate the expression of cytokine receptors by renal epithelia.

Adult↗
PubMedDate not supplied

Predictors of failure in direct stenting in the real world.

INTRODUCTION: Stent implantation without predilation simplifies a large proportion of coronary intervention procedures, with a significant reduction in costs and procedure time. OBJECTIVES: To determine the variables associated with a higher probability of failure in direct stent implantation in daily practice in a wide range of clinical contexts and types of lesions. POPULATION AND METHODS: Over a period of 28 months, direct implantation of 931 stents was attempted in our Center (811 patients, 83% male, mean age 62 +/- 12 years; 1.1 stent per patient). In 59 patients (7.3%), balloon predilation was necessary, and the factors associated with direct implant failure were determined. RESULTS: The vessels treated were: anterior descending (373 lesions: 40.1%), right coronary artery (306 lesions: 32.9%, circumflex (210 lesions: 22.6%), saphenous vein (35 lesions: 3.8%), left main (5 lesions: 0.4%) and internal mammary artery (2 lesions: 0.2%). 54% of the lesions were of type B2/C (ACC/AHA classification). The characteristics significantly associated with, or with statistical tendency towards, a lower success rate in direct stent implantation were: Lesion in the circumflex (11% vs. 5.5%, p = 0.012); reference vessel diameter less than 3.0 mm (9.8% vs. 6.2%, p = 0.097); age over 65 years (8.5% vs. 4.5%, p = 0.017); left main disease, irrespective of the vessel treated (23.5%% vs. 6.5%, p = 0.023); B2/C lesion (7.8%, vs. 4.8%, p = 0.086); calcification (9.9% vs. 4.9%, p = 0.012); vessel angulation greater than 45 degrees (9.9% vs. 4.9%, p = 0.009); and Express stent implant (19.6% vs. 6.0%, p < 0.001). On multivariate analysis, independent predictors of failure in direct stent implantation were: left main lesion (RR 6.6; 95% CI 1.73-24.93; p = 0.013), presence of calcium (RR 1.9; 95% CI 1.02-3.37; p = 0.049), vessel curvature (RR 2.0; 95% CI 1.13-3.64; p = 0.018), reference vessel diameter less than 3 mm (RR 2.2; 95% CI 1.15-4.32; p = 0.023), lesion type B2/C (RR 1.9; 95% CI 1.0-3.52; p = 0.044) and Express stent (RR 2.7; 95% CI 1.07-6.79; p = 0.05). CONCLUSION: In a large and heterogeneous series of patients, direct stenting was not possible in 7.3% of cases, which required balloon predilation. Certain clinical and angiographic features can predict when this is more like to occur.

Equipment Failure↗
PubMedDate not supplied

[Color-coded Doppler in the diagnosis of vascular complications following heart catheterization].

To determine the value of color Doppler in the diagnosis of vascular complications resulting from cardiac catheterization 5 consecutive patients, with the clinical suspicious of vascular iatrogenesis potentially requiring surgical repair, were analyzed. In 2 patients a femoral mass developed after a diagnostic catheterization but 3 patients underwent previously an interventional catheterization technique. In 3 patients color Doppler readily visualized a systolic jet originated in the femoral artery entering an anterior echo-free cavity, and a reversal flow in diastole, suggesting a femoral pseudoaneurysm. In 1 patient the clinical diagnosis of arteriovenous fistulae was confirmed by color Doppler which demonstrated a continuous turbulent flow within the femoral vein. In the remaining patient a diagnosis of simple femoral haematoma was made after the demonstration of a relatively echogenic structure overlying the femoral artery and vein but not interfering with their flows. In the 3 patients with femoral pseudoaneurysms and in the patient with arteriovenous fistulae the diagnosis was confirmed by angiography and during surgery. Our preliminary findings underscore the value of color Doppler, using the technology currently available in echocardiographic laboratories, in the differential diagnosis of vascular complications after cardiac catheterization.

Aged↗
PubMedDate not supplied

[Coronary angioplasty with a rotary atherotome].

Several new coronary dilatation systems, including those using laser energy, atherectomy devices and stent implantation, are being developed as alternative or complementary procedures to coronary artery balloon angioplasty. We report our initial experience performing coronary angioplasty with a new rotational atherectomy device, the transluminal extraction catheter, which simultaneously cut and aspirate fragments from the atherosclerotic plaque. The components of the whole system are a special guidewire to cross the stenosis, the atherectomy catheter and the conduction-control unit. This unit, connected when the atherectomy catheter is positioned across the lesion, produces rotation of the conical bladder located in the catheter distal tip and simultaneous aspiration of residual particles. The procedure was performed in 11 patients in whom 13 lesions were dilated. All patients were male (mean age 55 +/- 23 years, range 45-77). The reason for the angioplasty was stable angina in 2 patients and unstable angina in the remaining seven. Initial success (residual stenosis less than 50% of vessel diameter) was obtained in 10 of 13 lesions. In two, conventional balloon angioplasty was required to improve atherectomy result. The only unsuccessful procedure was in a proximal right coronary artery venous graft, in which a large dissection occurred. Patient had angina but no myocardial infarction. Pathologic examination of aspirated material revealed fibrous tissue in 12 cases and cholesterol crystals in four. We conclude, with the limitation of a preliminary study, that rotational atherectomy with the transluminal extraction catheter is a useful procedure to relief coronary stenosis of the coronary arteries.

Aged↗
PubMedDate not supplied

[Percutaneous mitral valvulotomy using the Inoue balloon technique].

We have reviewed our initial experience with percutaneous mitral valvulotomy (PMV) in 29 consecutive patients with mitral stenosis using the Inoue mono-balloon technique. In all cases, the venous transeptal anterograde approach was used. Age was 49.5 +/- 12.5 years (range 21-78) and only 5 (17%) patients were male. Clinical status was as follows: 15 patients were in NYHA class II, 13 NYHA class III and one in NYHA class IV. Atrial fibrillation was present in 15 (52%) patients and 16 (55%) were on coumarin. An echocardiographic score was employed to assess mitral valve anatomy, parameters including degree of thickening, mobility, calcification and subvalvular involvement were scored independently from 1 to 4. The echocardiographic score so determined was 7.72 +/- 2.1 for the entire group. Ten patients presented mild (+) mitral regurgitation prior to PMV. The mean duration of PMV was 76.2 +/- 29.6 minutes. In only one patient an inadequate positioning of the balloon prevented dilatation of the valve whereas the remaining 28 patients had their valves successfully dilated. Mitral valve area, by means of both Gorlin and Doppler (pressure half time) methods, increased in all cases: from 0.95 +/- 0.17 cm2 to 1.92 +/- 0.31 cm2 (p less than 0.001) and from 0.97 +/- 0.22 to 1.84 +/- 0.33 cm2 (p less than 0.001), respectively. Mitral regurgitation increased angiographically in more than 1 degree only in 1 patient, but no other cardiac or vascular complication occurred. Thus, in our experience PMV with the Inoue mono-balloon catheter is a safe and effective method for dilating mitral valve stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Color Doppler study of 2 complicated aortic abscesses ruptured into the right ventricle and left atrium].

This report describes 2 patients with infective endocarditis who subsequently developed aortic abscesses which eventually ruptured, in one case to the right ventricular outflow tract and, in the other, to the left atrium causing, in both patients, severe hemodynamic derangement. The site of communication between the abscesses and the receiving chamber was accurately diagnosed by color flow Doppler imaging which provided more valuable preoperative information than conventional techniques.

Abscess↗
PubMedDate not supplied

[Clinical profile and results of transluminal coronary angioplasty in women. Comparison with men].

To determine if the results of percutaneous transluminal coronary angioplasty are similar in women and in men or any difference between both sexes exists, we have compared 43 clinical and 61 angiographic or procedural variables of 85 consecutive transluminal coronary angioplasties performed in women with 421 similar consecutive procedures in men. Only cigarette smoking was more frequent in men (84 vs 11%, p less than 0.001), being the remaining coronary risk factors more common in women (hypertension 69% vs 37%, p less than 0.001; hypercholesterolemia 46% vs 33%, p less than 0.05, and diabetes mellitus 42% vs 14%, p less than 0.01). In addition, unstable angina was a more frequent indication of coronary angioplasty in women than in men (74% vs 61%, p less than 0.05), whereas coronary angioplasty after intravenous thrombolysis was more frequent in men (12% vs 1%, p less than 0.001). Coronary angioplasty angiographic success (87% vs 91%), and minor (16% vs 10%) or major (5% vs 3%) complications were not statistically different in the two groups. Nevertheless, success of the procedure in the absence of any complication was achieved in a higher percentage (86% vs 76%, p less than 0.05) of men than in their female counterparts. After coronary angioplasty 88% of women had an angiographic follow-up available which yielded a restenosis rate of 41% (vs 32% in men, NS), despite the absence of symptoms in the 89% of these patients in their last visit. In conclusion, we have found that the feminine population subjected to coronary angioplasty have a higher incidence of coronary risks factors and more frequently unstable angina than the masculine group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

[Repeat coronary angioplasty in the treatment of restenosis. Results and follow-up].

With the aim of assessing the value of repeat angioplasty in the treatment of coronary restenosis we have compared the clinical, hemodynamic and procedural variables of 404 consecutive angioplasties, where 468 original lesions were treated, with 57 repeat angioplasties with 63 restenosed lesions attempted. The procedure was performed in the treatment of a myocardial infarction only in the group with original lesions (13% vs 0%, p less than 0.05). The hemodynamic variables including ejection fraction (63 +/- 14 vs 67 +/- 15) and the presence of multivessel disease (38% vs 41%) were similar in both groups, but more angioplasties in the restenosed group were performed in the left anterior descending coronary artery (70% vs 50%, p less than 0.01) whereas less were performed in the circumflex artery (6% vs 19%, p less than 0.05). Long lesions (greater than or equal to 12 mm), and concentric lesions, were more frequently found in the group with restenosis (33% vs 16%, p less than 0.05, and 48% vs 32%, p less than 0.05, respectively). In addition, more angioplasties in the restenosed group were performed during the diagnostic coronary angiogram (68% vs 24%, p less than 0.001). The results both per lesion (98% vs 88%, p less than 0.05) and per procedure (96% vs 86%, p less than 0.05) were better in the restenosed group, with a similar rate of major complications (2% vs 4%). With an angiographic follow-up higher than 90%, the restenosis rate was again similar in both groups (36% and 35%). We conclude that repeat angioplasty is an effective means of treating coronary restenosis with a higher success than the original procedure, probably reflecting an anatomic substrate more prone to be successfully dilated in the restenosed lesion. Accordingly, we are using repeat angioplasty as the treatment of choice for symptomatic restenosis.

Angioplasty, Balloon↗
PubMedDate not supplied

Analysis of adhesion molecule expression by tubular epithelial cells using urine immunocytology.

On their surface, renal tubular cells present intercellular adhesion molecule-1 (ICAM-1) during acute renal allograft rejection. We propose that the extent of ICAM-1 expression by renal tubular cells can be estimated from urine immunocytology. To test this hypothesis, we obtained 52 samples of urine from 31 renal transplant recipients with either acute tubular necrosis, rejection or stable renal function. Cytocentrifuged aliquots of urinary sediment were incubated with monoclonal antibodies to ICAM-1 in an avidin-biotin-peroxidase technique. To corroborate our findings, biopsy specimens were obtained for conventional and immunohistology one hour following vascular anastomosis and during rejection episodes. The proportion of renal tubular cells that expressed ICAM-1 was low in patients with acute tubular necrosis (23.8 +/- 3.6%) and high in patients with rejection (53.1 +/- 4.4% [SEM]) (P < .001). In 11 patients who recovered from rejection, the proportion of ICAM-1-positive renal tubular cells decreased from 55.9 +/- 5.6% to 25.5 +/- 4.3% (P < .05). In two patients who initially had acute tubular necrosis and then rejected their transplants, the expression of ICAM-1 on renal tubular cells tended to increase (from 27.5 +/- 2.5% to 60.0 +/- 20.0%, P = .12). In eight patients with acute tubular necrosis who never rejected their transplants, ICAM-1 expression remained low (23.1 +/- 3.8%). Immunocytology correlated well with immunohistology and the clinical diagnosis. Our findings suggest that urine immunocytology may be useful in monitoring adhesion molecule expression by renal tubular cells.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of peripheral lymph node cryptococcosis. A report of three cases.

Aspiration cytology of lymph nodes allows rapid diagnosis of disseminated cryptococcosis. Three cases of lymph node cryptococcosis diagnosed by aspiration cytology in three patients with acquired immunodeficiency syndrome are presented. The organisms were easily seen with a routine modified Wright and Papanicolaou stain as variably sized yeasts, 5-15 microns in greatest diameter, with thick capsules. Many of the organisms showed narrow base budding. In one case occasional pseudohyphae were observed. The diagnoses were confirmed easily with mucicarmine stain.

AIDS-Related Opportunistic Infections↗