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Biomedical subjects

H Carrasco

Publications and source records attributed to H Carrasco.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Percutaneous pulmonary valvuloplasty at the cardiovascular center of the Universidad de Los Andes].

PURPOSE: To compare balloon valvuloplasty and surgical valvulotomy in the management of pulmonary valvar stenosis. PATIENTS AND METHODS: Balloon pulmonary valvuloplasty was performed in 10 consecutive patients, 6 girls and 4 boys, age ranges 3 to 19 years (mean 11), between April 1987 to November 1988. RESULTS: Immediate hemodynamic and angiographic changes consisted in reduction of the peak transvalvular gradient from 93 +/- 42 mmHg to 39 +/- 26 (p less than 0.01), the right ventricular systolic pressure from 108 +/- 16 mmHg to 58 +/- 27 mmHg (p less than 0.01) and in increasing of the pulmonary valve diameter from 9.59 +/- 3.28 mm to 19.55 +/- 6.16 mm (p less than 0.01) and the systolic pulmonary artery pressure from 15.15 +/- 3.28 mmHg to 18.4 +/- 6 (NS). No relationship between right ventricular systolic pressure and transpulmonary valvular gradient could be found. We only observed one case of mild pulmonary insufficiency as a complication of the procedure. The intermediate follow up (7 to 14 months), in 4 of 10 patients showed maintenance of the initial finding. CONCLUSION: The results of the percutaneous pulmonary valve valvuloplasty are as good as those obtained by the surgical valvulotomy.

Adolescent↗
PubMed1990

Pediatric osteosarcoma: therapeutic strategies, results, and prognostic factors derived from a 10-year experience.

Ninety-eight pediatric patients were treated with three separate protocols (Treatment and investigation of Osteosarcoma [TIOS] I, II, and III) and 47 developed recurrent disease (metastases and/or local recurrence). Actuarial overall disease-free survival (hereafter designated survival) was 43%. Over 90% of the patients were treated initially with preoperative intraarterial cisplatin (CDP). Postoperative chemotherapeutic regimens comprised high-dose methotrexate with leucovorin rescue (MTX-CF), Adriamycin [( ADR] doxorubicin; Adria Laboratories, Columbus, OH), and cyclophosphamide. Primary definitive treatment comprised amputation or limb salvage (TIOS I and TIOS III). Patients treated with preoperative CDP and surgery (TIOS I and III) had a 62% survival. Patients in TIOS II refused surgical extirpation; they were treated exclusively with chemotherapy and had a 23% survival. Survival in patients treated with amputation was 55% and limb salvage 58%. Prognostic factors considered significant in relation to development of pulmonary metastases comprised tumor burden (P = .04) and the percentage of tumor necrosis induced by preoperative chemotherapy (P = .01). Histopathologic subtype was marginally significant: chondroblastic was more favorable as opposed to osteoblastic (P = .05). These findings are compared with results and prognostic factors published in the literature.

Child↗
PubMed1989

Small cell osteosarcoma. A clinicopathologic study of 27 cases.

We report a study of 27 patients with small cell osteosarcoma (SCO), 17 from the M. D. Anderson Cancer Center (MDAH) and ten from the Pediatric Oncology Group (POG). There were 12 male patients and 15 female patients; 19 were white, five were black, and three were Hispanic. They ranged from 6 to 28 years of age with a median of 14 years. Histologically there were three patterns: Ewing's-like, lymphoma-like, and spindle cell. All cases showed osteoid formation and a few had chondroid areas. There was cytoplasmic glycogen in ten cases. Initial treatment for MDAH patients included intraarterial infusion of cisplatin in ten, amputation in four, partial mandibulectomies in two, and biopsy with local radiotherapy and systemic chemotherapy in one. All POG patients had resection or amputation followed by adjuvant chemotherapy. Twelve patients are alive, of whom nine have had significant follow-ups for 25 to 90 months. Fourteen patients are dead of lung, spine, and brain metastases from 1 to 23 months after initial diagnosis. One patient is alive with lung relapse at 4 months. In summary, SCO is a high-grade variant of osteosarcoma, with an incidence of up to 4% of all osteosarcomas, that affects patients of the same age group and has the same anatomic location as conventional osteosarcoma. Currently, SCO appears to have a prognosis that is the same as or slightly worse than that of conventional osteosarcoma. Furthermore, although intraarterial infusion is effective for the primary tumors in the bone, distant metastases are difficult to control.

Adolescent↗
PubMed1989

Ultrastructural characteristics of different stages of human chagasic myocarditis.

Myocardial damage was analyzed in the different stages of Chagas' disease. Myocardial biopsies from chagasic patients, whose clinical histories were initially unknown to the examiner, were examined and evaluated by electron microscopy using a table in which 244 characteristics were considered. When the ultrastructural results were associated with their respective clinical reports, it was found that Chagas' disease stages showed significant myocardium damage between stages IA and II: IA (normal EKG and cineventriculogram), 13.0%; IB (early left ventricular damage with normal EKG), 14.5%; II (advanced left ventricular damage, abnormal EKG), 25.5%; stage III (congestive heart failure) showed a decrement to 22.5% if compared with stage II. The acute stage of the illness was characterized by the presence of the parasites within the myocytes which were surrounded by inflammatory cell infiltrate. During Chagas' disease evolution the most affected organelle was the sarcoplasmic reticulum.

Adult↗
PubMed1989

[Left ventricular mechanics in Chagas' disease and dilated cardiomyopathy: echocardiographic study].

For purposes of studying left ventricular mechanics, 184 chronic chagasic and 85 primary cardiomyopathy patients were submitted to an extensive invasive (LV cine, right and left cardiac catheterization and coronarography) and non-invasive protocol. The afterload, (mean wall stress), the contractile status (ejection fraction and circumpherential shortening) and the degree of hypertrophy (mass index) were assessed by M mode echocardiography. There was a very early increase of afterload in 8% of chagasic patients without evidences of LV myocardial involvement in the left cineventriculogram (group I-A). This increased afterload was accompanied by signs of inadequate hypertrophy in 15% of patients with early segmental myocardial damage (group IB). In contrast, ejection fraction and % circumpherential shortening were depressed only in patients with clinical evidences of congestive heart failure. Dilated primary CM patients showed similar findings, except for a more evident depression of contractility in those cases without signs of congestive heart failure (group II) and more hypertrophy than equivalent group III chagasic patients. Measurements of mean systolic wall stress and mass index are valuable parameters for identification of those patients with early increased after-load and inadequate hypertrophy which could benefit from the administration of oral vasodilators.

Adult↗
PubMed1989

[Clinical and paraclinical differences between chronic Chagas' cardiomyopathy and primary dilated cardiomyopathies].

With the purpose of establishing clinical and paraclinical differences among chronic chagasic (MCh) and primary dilated cardiomyopathies (MCDP), 96 MCh and 104 MCDP patients with abnormal ECG were submitted to a study protocol which included clinical history, routine laboratory serology for Chagas' diseases, resting ECG, Chest-X-rays, and cardiac catheterisation. Patients with congestive heart failure (CHF) had common clinical and para-clinical findings. However, chagasic patients without CHF showed more prevalence of RBBB and LAH, complex ventricular arrhythmias and more left ventricular dilation while primary dilated cardiomyopathy patients with CHF had predominantly LBBB, simple ventricular arrhythmias, atrial fibrillation and less LV dilation than MCh patients. In order to establish the prognostic value of these findings and response to modern medical therapy, prospective studies on these two groups of patients are needed.

Cardiomyopathy, Dilated↗
PubMed1987

Pathologic fracture in osteosarcoma. Impact of chemotherapy on primary tumor and survival.

Twenty patients with osteosarcoma and pathologic fractures were treated with a chemotherapeutic regimen consisting of cis-diamminedichloroplatinum-II (CDP), Adriamycin (ADR) (doxorubicin) and high-dose methotrexate with citrovorum factor "rescue" (MTX-CF). Before the introduction of the regimen, the primary tumor in two patients was treated by immediate amputation and in 13 with preoperative intra-arterial CDP. Among these 13 patients, responses (healing) were observed in 11 (one required the addition of radiation therapy). In three patients, the responses were so dramatic that, at their request, surgery was deferred and treatment exclusively with chemotherapy was instituted. Based on this experience, treatment exclusively with chemotherapy was also administered to an additional five patients who were admitted without pathologic fractures. In the course of such treatment, pathologic fractures also developed; notwithstanding, chemotherapy was maintained and healing also occurred. One of the 20 patients had pulmonary metastases at diagnosis; these were resected after treatment and pathologic examination revealed no evidence of viable tumor. The remaining 19 patients were free of pulmonary metastases but these later developed in seven patients. These data were compared to a historical control series in which 16 of 21 patients with pathologic fractures developed pulmonary metastases. Three of the chemotherapy treated patients died of nonosteosarcoma related causes (leukemia, generalized varicella, and a metabolic complication). Overall, survival was improved in the chemotherapy treated patients as compared to the historical control series: 10 of 20 versus 6 of 21, respectively. Pathologic fractures in osteosarcoma may heal under treatment with chemotherapy, which also has a favorable impact on the eradication of pulmonary metastases and survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Control of primary osteosarcoma with chemotherapy.

High-dose methotrexate with citrovorum factor "rescue" (MTX-CF) produced an apparent complete response of the primary tumor in three patients with osteosarcoma. The response was sustained with MTX-CF, intra-arterial cis-diamminedichloroplatinum II (CDP) and Adriamycin (doxorubicin) for 18 months. Treatment was then electively discontinued. Local recurrence occurred in two patients, 6 and 4 months later, respectively. MTX-CF was reinstated and a complete response was again achieved in one patient. This has been maintained for 15+ months with MTX-CF and intra-arterial CDP administered for 13 of the 15+ months. Reinduction with MTX-CF failed in the second relapsed patient but an apparent remission was again achieved with radiation and intra-arterial CDP. This has been maintained with intravenous CDP, cyclophosphamide and phenylalanine mustard for 14+ months. A complete response in the primary tumor was still present in the nonrelapsed patient, 42 months from diagnosis. All patients have remained free of pulmonary metastases, 40+ to 42+ months from diagnosis.

Adolescent↗
PubMed1983

Treatment of hepatic neoplasm through extrahepatic collaterals.

Twenty-nine patients with hepatic artery occlusion were treated with additional hepatic infusion or embolization through extrahepatic collaterals. Seventeen courses of hepatic infusion were performed in 13 patients through the inferior pancreaticoduodenal artery, left gastric artery, or right gastric artery. Twenty-five hepatic embolization procedures were performed in 16 patients through the right and left phrenic arteries, left and right gastric arteries, pancreaticoduodenal artery, gastroduodenal artery, or omentoepiploic artery. In one patient gastric ulcers developed following left gastric artery infusion. No complication related to the embolization procedure was observed in the embolization group. The extrahepatic collaterals are important alternative routes for continuous transcatheter management of hepatic neoplasms following hepatic artery occlusion.

Adult↗
PubMed1983

Estradiol, testosterone, apolipoproteins, lipoprotein cholesterol, and lipolytic enzymes in men with premature myocardial infarction and angiographically assessed coronary occlusion.

A series of thirty-three Venezuelan men with premature myocardial infarction (mean age (M +/- SEM) 45 +/- 1.5 yrs) and with greater than 50% occlusion of at least 2 coronary arteries, and 19 weight matched control men (age 44 +/- 2 yrs) with normal coronary arteries on coronary angiography were studied. The percentages of significantly abnormal (greater than +/- 2 S.D. of controls) serum or plasma concentrations of various measurements (in decreasing order) were: estradiol (33%), total apolipoprotein (apo)B (24%), estradiol/testosterone ratio (21%), low density lipoprotein (LDL) apo B (19%), apo AI (17%), apo AI/total plasma apo B ratio (17%), total cholesterol (17%), and LDL-cholesterol (LDL-C) (11%). In addition, a multivariate discriminant function analysis showed that only estradiol, apo AI, LDL-C, estradiol/testosterone ratio and total cholesterol were statistically significant independent markers of myocardial infarction with occlusive coronary disease in these patients. Both serum estradiol and estradiol/testosterone ratio correlated positively with plasma apo B and LDL apo B, and inversely with apo AI; serum testosterone correlated inversely with plasma apo B (p less than 0.05). The data suggest that circulating sex hormones (estrogens, testosterone) are not only independent markers of coronary disease but may be pathogenetically linked to apo B and apo AI metabolism.

Adult↗
PubMed1982

Transcatheter embolization of abdominal aortic aneurysms.

Four patients are reported with unresected abdominal aortic aneurysms in whom axillary bifemoral bypass surgery was performed with subsequent transcatheter embolization of steel coils and Gelfoam. Three embolization procedures resulted in complete thrombosis of the abdominal aortic aneurysm and one resulted in partial thrombosis.

Aged↗