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Biomedical subjects

F Orzan

Publications and source records attributed to F Orzan.

At least 73 records · Page 4Linked to original sources
PubMed1986

Atypical chest pain: coronary or esophageal disease?

Retrosternal pain can be caused both by cardiac and esophageal disease. This work presents the results of cardiac and esophageal investigations in 55 patients, who had atypical chest pain. Isolated esophageal disease was found in 45% of the subjects while 14.5% had significant coronary arterial disease. Both diseases were found in 10.9% of the patients and neither disease in 29%. We conclude that esophageal disease is very frequent in patients with atypical chest pain but it does not always completely account for the symptoms. Such patients should, in our opinion, be submitted to an electrocardiographic stress test. If the result is positive or non-diagnostic, coronary cineangiography should be performed, irrespective of the results of esophageal investigations. If the electrocardiographic stress test is negative, coronary investigations can be deferred. Esophageal investigations can account for the symptoms in about half of such cases.

Adult↗
PubMed1986

Use of radionuclide angiography and an electrocardiographic stress test to diagnose multivessel disease after a first episode of uncomplicated myocardial infarction.

Sixty consecutive patients who were symptom free 2-12 months after an uncomplicated acute myocardial infarction underwent maximal treadmill exercise testing, radionuclide angiography before and during submaximal bicycle stress test, and coronary angiography. The results of the non-invasive procedures were compared with those of coronary angiography. The sensitivity and specificity of electrocardiogram stress test for detection of multivessel disease were 40% and 77% respectively. Failure of left ventricular ejection fraction to increase at least 5% with exercise identified 20 of the 25 patients with multivessel disease (sensitivity 80%) and 23 of the 35 patients with no additional coronary artery stenosis (specificity 66%). In patients with anterior Q waves the sensitivity was 78% and the specificity 50%, whereas in the presence of inferior Q waves these values were 81% and 87% respectively. Loss of left ventricle synchronicity during effort, as indicated by failure of the standard deviation of the phases to decrease during exercise, demonstrated a radionuclide angiography sensitivity of 80% (77% for anterior myocardial infarction and 81% for inferior myocardial infarction) and a specificity of 50% (33% for anterior myocardial infarction and 64% for inferior myocardial infarction). When the test was considered to be positive if either the ejection fraction or the standard deviation of the phases criteria were positive, the sensitivity was 100% and specificity 46% (30% for anterior myocardial infarction and 65% for inferior myocardial infarction). It is concluded that in patients who are free from angina 2-12 months after an episode of uncomplicated myocardial infarction, a simple exercise electrocardiogram cannot be relied upon to detect residual ischaemia. An abnormal ejection fraction response or an increased standard deviation of the phases during exercise nuclear angiography or both identified all the patients with multivessel disease. None of the patients in whom radionuclide angiographic criteria were negative had multivessel disease.

Coronary Disease↗
PubMed1986

Pathophysiological doses of glucagon cause a transient increase of the hepatic vein potassium concentration in man.

In order to evaluate whether glucagon-induced hyperkalemia is due to mobilization of potassium from the splanchnic region, we measured potassium changes in the hepatic veins following a glucagon injection into the ascending aorta. Twenty-seven subjects undergoing routine cardiac catheterization for diagnostic purposes were studied. Hepatic venous and aortic blood samples were withdrawn simultaneously under basal condition and 30, 60, 120, 180, 300, 600 s after a bolus injection of either saline, glucagon (100 ng/kg body weight) or glucagon +somatostatin (100 micrograms). After the intra-aortic injection, plasma glucagon in the hepatic veins reached levels comparable to those observed under pathophysiological conditions. Plasma potassium increased promptly with a peak at 60 s (delta max: 0.79 +/- 0.12 mmol/l, mean +/- SEM; p less than 0.01). The glucose increment peaked at 300 s (delta max: 2.36 +/- 0.20 mmol/l, mean +/- SEM; p less than 0.01). Potassium increment was potentiated by the addition of somatostatin, despite the abolition of insulin and C-peptide rises (potassium delta max: 0.56 +/- 0.10 mmol/l; p less than 0.05). In conclusion, these data demonstrate that glucagon induces a transient mobilization of potassium from the splanchnic region in man. This effect of glucagon on potassium is not antagonized by glucagon-induced insulin secretion.

Adult↗
PubMed1986

[Aortic regurgitation: evaluation by pulsed Doppler echocardiography].

Ninety-one consecutive patients with aortic regurgitation, either isolated (23 subjects) or associated with other valvular diseases (68 subjects), were studied with pulsed Doppler echocardiography and subsequent aortography, and the results were compared in order to assess the value of the noninvasive technique for a semiquantitative evaluation of the degree of the aortic regurgitation. Both the noninvasive and invasive estimations were graded on a four-point scale. In the long-axis parasternal view, the outflow tract of the left ventricle was divided in four areas going from the aortic valve to the apex. Echo-Doppler grading (from + 1 to +4) was obtained by assessing the area where the abnormal diastolic flow could still be recorded. In the group as a whole, concordant degrees of the aortic insufficiency were obtained in 73 of 91 patients (r = .93; p less than .001); the degree of the aortic regurgitation was overestimated in 8 cases (9%) and underestimated in 10 cases (11%). Most of the discrepancies between the Doppler and the aortographic evaluation were found in patients with intermediate degree (+2, +3) of aortic regurgitation; the degree of discordance was never more than +1 or -1. Correlation between Doppler and aortography was higher in the subjects with pure aortic regurgitation (r = .94, p less than .001) and lower in the subgroup of the subjects with associated mitral stenosis (r = .87, p less than .001). Two-dimensional pulsed Doppler echocardiography is a simple and little time consuming technique that in selected groups of patients can be relied upon for the semiquantitated evaluation of the degree of aortic regurgitation.

Adolescent↗
PubMed1985

[Aortic coarctation and aneurysms of the ascending aorta].

Dissection and rupture of the aorta account for 20% of death in the natural history of aortic coarctation. We describe here in four patients in whom an ascending aortic aneurysm was associated with aortic coarctation. Three patients had aortic valve incompetence. In two cases there was a dissection. This had not been recognized preoperatively in one, in whom the intimal tear was small; in the other patient, with dissection and shock, the associated mild coarctation was demonstrated only at autopsy. Surgical treatment of patients with aortic coarctation and associated aortic aneurysm must include resection of both the stenotic isthmus and dilated section of the aorta, because of a documented poor prognosis. Furtherly, when evaluating patients with aortic dissection a coexisting coarctation although infrequent must be ruled out. If such an association is identified in emergency cases the dissected aorta should be repaired first, employing a suitable technique (double arterial cannulation, above and below the isthmus) in order to ensure adequate perfusion. When there is no acute dissection, repair of the coarctation should be undertaken first.

Adolescent↗
PubMed1984

Absent pulmonary valve syndrome with associated anomalies of the pulmonary blood supply.

We report four cases of so-called absent pulmonary valve syndrome associated with absence or anomalous origin of the left pulmonary artery. The fate of the patients with this condition appears to be affected mainly by the occurrence of pulmonary complications (three of our patients died of pulmonary causes, two of them after surgery). The proper timing of corrective surgery is still uncertain. Preoperative investigations should strive to obtain a clear-cut identification of the pulmonary arteries, particularly the left one or, in its absence, of the anomalous vascular supply to the lung. Right ventriculography, as employed by us, is insufficient. Pulmonary angiography, aortography and pulmonary vein "wedge" angiography may be needed.

Adult↗
PubMed1983

[Left atrial myxoma and calcified aortic stenosis in a patient with syncope].

A 59-year-old man who suffered several episodes of syncope had both calcific aortic stenosis and a left atrial myxoma. As syncope occurred during effort, rather than after postural changes, we believe that the symptom was caused by aortic stenosis. In fact the myxoma was only mildly obstructive both by haemodynamic measurements and at visual inspection at surgery.

Aortic Valve Stenosis↗
PubMed1982

Bedside evaluation of atrioventricular block with narrow QRS complexes: usefulness of carotid sinus massage and atropine administration.

Second-degree intra-His bundle block is frequently of type I (Wenckebach periods) or 2:1. In this situation, the surface electrocardiogram does not permit distinction between intranodal (atrioventricular [A-V] and subnodal (intra-His) block. This study examined the value of bedside carotid sinus massage and atropine administration in diagnosing the site of block from the standard electrocardiogram in subjects with chronic A-V block and narrow QRS complexes. Fifteen patients had intra-His bundle block and 10 had intranodal block. The combination of two tests correctly located the site of block in 22 subjects, and was noncontributory in 3. Thirteen of the 15 intra-His bundle blocks and 9 of the 10 intranodal blocks were properly identified; in three cases the results were nondiagnostic, but no wrong diagnoses were made. The noninvasive bedside method of carotid sinus massage and the use of atropine permit both the localization and the determination of the type of block in the majority of cases of second degree A-V block and narrow QRS complexes. In a proper clinical context they can obviate the need for invasive electrophysiologic studies.

Adult↗
PubMed1981

[Factors determining peroperative morbidity and mortality from the resection of left ventricular aneurysms].

An analysis was made of the operative results of 175 patients who underwent resection of chronic postinfarction left ventricular aneurysm, with or without associated cardiac surgery at Texas Heart Institute in one year period. The operative mortality was 11%. The surgical outcome of a subset of 96 patients was correlated with the indices of ventricular performance. Our findings indicate the risk of aneurismectomy is low for discrete aneurysm. Mortality and morbidity correlate significantly with total ejection fraction and our weighted scoring system as a determinant of left ventricular dysfunction. Total ejection fraction below 20% correlated with pump failure postoperatively, and total ejection fraction above 40% aided in predicting absence of pump failure. A total score above 20 correlated with pump failure and a total score below 20 supported prediction of absence of pump failure. Conversely, ejection fraction of the contractile part, percentage of perimeter involvement with left ventricular aneurysm and left ventricular end diastolic pressure were found to be poor predictors of surgical outcome.

Adult↗
PubMed1980

[Small fistulas between circumflex coronary artery and left atrium associated with rheumatic valvular cardiomyopathy. A case report (author's transl)].

Multiple small fistulas between the circumflex coronary artery and the left atrium were found in a patient with mitral stenosis, aortic and tricuspid regurgitation. Although their origin was proximal and they drained in a low pressure cavity, the anomalous channels were small and caused no clinically recognizable signs or symptoms. These findings support the view that hemodynamics (and hence clinical manifestations) of coronary artery fistulas are mainly determined by their developmental anatomy.

Aortic Valve Insufficiency↗
PubMed1979

Scintigraphic, electrocardiographic, and enzymatic diagnosis of perioperative myocardial infarction in patients undergoing myocardial revascularization.

To assess the incidence of perioperative myocardial infarction, 214 consecutive patients were evaluated 1-5 days after coronary bypass surgery, using Tc-99m pyrophosphate (TcPPi) myocardial imaging, serial electrocardiograms (ECG), and enzyme levels (SGOT, LDH, CPK). On the basis of the clinical course and scintigraphic, enzymatic, and ECG changes, the diagnosis of perioperative infarction was definite in 17 of 241 cases (7.9%) and probable in six of 241 (2.8%). In all of these 23 patients, TcPPi scans were abnormal; one additional patient had a false-positive scintigram. Only 13 of the 23 had ECG evidence of infarction, but there were no false positives. We set the threshold for abnormality of enzyme changes quite high, owing to experience in more than 900 postoperative patients (SGOT greater than 200, LDH greater than 500, CPK greater than 500 on the same day). Using these criteria, 22 of the 23 infarct patients had abnormal enzymes, and six others were falsely positive. These results indicate a relatively low sensitivity for the ECG in diagnosing perioperative infarction, but the lack of false positives suggests high specificity. The sensitivity and specificity of the enzymes and the TcPPi image were both excellent and quite similar; the main difference was a reduction of certainty of infarction with the enzyme criteria, caused by the six patients whose enzyme values were falsely positive. Considering its sensitivity, specificity, and ability to locate and to a certain extent quantitate necrosis. TcPPi imaging is probably the most valuable means of diagnosing perioperative myocardial infarction.

Clinical Enzyme Tests↗