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J Figueras

Publications and source records attributed to J Figueras.

At least 127 records · Page 7Linked to original sources
PubMed1996

Reliability of electromechanical dissociation in the diagnosis of left ventricular free wall rupture in acute myocardial infarction.

The reliability of electromechanical dissociation (EMD) in diagnosing acute left ventricular free wall rupture (LVFWR) was assessed in 479 consecutive patients with acute myocardial infarction (AMI). EMD was the mechanism of death in 193 patients, 140 without heart failure (group A, 74%), and 53 with heart failure (group B, 26%). Autopsies performed on 121 patients with EMD showed LVFWR in 81 (95%) of 85 from group A and in 7 (17%) of 36 from group B. Of the 106 patients without EMD (group C) autopsied, 5 (4.7%) had LVFWR. Excluding the eight patients with associated septal rupture, LVFWR occurred in 79 (95.2%) of 83 patients from group A, 4 (12.1%) of 33 from group B, and 2 (1.9%) of 103 from group C. Predictive accuracy of EMD for LVFWR in group A was 95% but only 17% in group B. Moreover, in 13 consecutive cases with a first AMI without heart failure and EMD, emergency surgery demonstrated LVFWR in all. Thus EMD has a highly predictive accuracy in diagnosing LVFWR in patients with a first AMI without overt heart failure.

Aged↗
PubMed1996

Additional elevation of the ST segment: a possible early electrocardiographic marker of experimental myocardial reperfusion.

OBJECTIVE: To analyze the early electrocardiographic changes during experimental coronary reperfusion after 1 to 4 h of coronary occlusion. METHODS: Recordings of epicardial and endocardial DC electrograms were performed in 35 open-chest pigs during coronary occlusions of 1 to 4 h duration followed by 1 h of reperfusion. RESULTS: During occlusion, maximal ST segment elevation was reached between min 10 and 30 which was followed by and a steady decline. During the first 30 min of reperfusion, however, there was a further elevation of the ST segment with a peak at 5 min. Thus, values at the end of occlusion and at 5 min of reperfusion were: (a) group with 1 h occlusion (n = 11), 15.5 +/- 7 and 37.4 +/- 11.4 mm, P < 0.005; (b) group with 2 h occlusion (n = 6), 10.2 +/- 4 and 24.7 +/- 9.4 mm, P < 0.03; (c) group with 3 h occlusion (n = 6), 7.5 +/- 3 and 16.8 +/- 5.6 mm, P < 0.03; and (d) group with 4 h occlusion (n = 12), 6.4 +/- 2.4 and 17.0 +/- 8.9 mm, P < 0.01. In 9 animals from the group with 1 h occlusion, a second cycle of 1 h occlusion and reperfusion also showed re-elevation of ST segment during reperfusion, although to a lesser extent than the first one (from 10.0 +/- 4.9 to 16.3 +/- 7.1 mm, P < 0.01). CONCLUSIONS: Thus, our findings provide experimental evidence of an additional and paradoxical ST segment elevation as the earliest electrocardiographic sign of coronary reperfusion after 1 to 4 h of coronary occlusion. These observations may help to improve the interpretation of early electrocardiographic changes during thrombolysis in acute myocardial infarction.

Animals↗
PubMed1996

Predisposing factors and prognostic value of sustained monomorphic ventricular tachycardia in the early phase of acute myocardial infarction.

OBJECTIVES: The purpose of the study was to analyze the factors that favor the occurrence of sustained monomorphic ventricular tachycardia in the early phase (< 48 h) of acute myocardial infarction and to establish its prognostic implications. BACKGROUND: Sustained monomorphic ventricular tachycardia early in the course of an acute myocardial infarction is an uncommon arrhythmia, and its significance has not been specifically studied. METHODS: The clinical characteristics and prognosis of sustained monomorphic ventricular tachycardia were studied in 21 (1.9%) of 1,120 consecutive patients admitted to the coronary care unit with a diagnosis of myocardial infarction. RESULTS: Patients with sustained monomorphic ventricular tachycardia had a larger infarct on the basis of peak creatine kinase, MB fraction (CK-MB) isoenzyme activity (435 +/- 253 IU/liter vs. 168 +/- 145 IU/liter, p < 0.001) and higher mortality rate (43% vs. 11%, p < 0.001). By logistic regression analysis, independent predictors of sustained monomorphic ventricular tachycardia were CK-MB (odds ratio [OR] 11.8), Killip class (OR 4.0) and bifascicular bundle branch block (OR 3.1). Moreover, sustained monomorphic ventricular tachycardia was itself an independent predictor of mortality (OR 5.0). Compared with patients with ventricular fibrillation, those with sustained monomorphic ventricular tachycardia had a worse Killip class (Killip class > I: 63% vs. 30%, p < 0.05), higher CK-MB activity (430 +/- 260 IU/liter vs. 242 +/- 176 IU/liter, p < 0.01) and higher arrhythmia recurrence rate (31% vs. 4%, p < 0.01). During the follow-up period, 5 (42%) of 12 survivors in the sustained monomorphic ventricular tachycardia group died of cardiac-related causes. Recurrence of ventricular tachycardia was seen in two patients (17%). CONCLUSIONS: Sustained monomorphic ventricular tachycardia during the first 48 h of myocardial infarction is a sign of extensive myocardial damage and an independent predictor of in-hospital mortality.

Adult↗
PubMed1996

Hepatocellular carcinoma: iodized-oil CT TNM classification.

OBJECTIVE: We conducted a prospective study to determine the efficacy of iodized-oil enhancement in CT for preoperative assessment of the T factor of the TNM classification in patients with hepatocellular carcinoma (HCC). SUBJECTS AND METHODS: Iodized-oil CT was performed as a part of preoperative staging in 28 patients with HCC. We determined the radiologic T factor. Pathologic correlation was obtained after orthotopic liver transplantation (n = 25) or autopsy (n = 3), and the histologic T factor was determined. RESULTS: The sensitivity of iodized-oil CT accurately distinguishing between stage-T4 tumors and tumors in stages T1-T3 was 88% (7/8) with a positive predictive value of 100% (7/7). CONCLUSION: Iodized-oil CT is useful for preoperatively assessing the T factor of the TNM classification in HCC, and it improves the accuracy of radiologic staging. Iodized-oil CT can help to better patients with HCC for orthotopic liver transplantation.

Adult↗
PubMed1996

[Pheochromocytoma, acute myocardial infarction and silent postprandial ischemia].

We report the case of a 70 years-old patient admitted for an acute anterior myocardial infarction and who subsequently presented postprandial episodes of astenia, dyaphoresis and arterial hypertension associated with re-elevation of the ST segment and positivization of T waves in the precordial leads, without chest pain. These episodes were interpreted as silent postprandial myocardial ischemia. A coronary angiography demonstrated a single vessel disease with a severe and proximal stenosis of the left descending coronary artery which was successfully dilated during angioplasty. However, the postprandial episodes persisted and re-estenosis was ruled out in a repeated coronary angiogram. A stress thallium myocardial scintigraphy was negative. Complementary tests documented the existence of a pheochromocyctoma and the refered postprandial symptoms did not recur after removal of the tumor. Thus, the persistence of postprandial episodes of myocardial ischemia associated with severe hypertension and dyaphoresis in the absence of a significant coronary stenosis, may possibly be related to a concomitant coronary and systemic vasoconstriction secondary to the adrenal tumor.

Adrenal Gland Neoplasms↗
PubMed1996

[NO and NO2 concentration curves in mixtures for clinical use].

Inhaled nitric oxide (NO) allows us to achieve selective pulmonary vasodilatation. The purpose of the present experimental study was to determine the concentrations of NO and NO2 produced by mixing two well-known and variable flows of 100% oxygen and 800 ppm NO, in a low or normally humid environment, as well as in a humid one. The mixture of NO and N2 is introduced by means of a standard low-flow blender (0.2 to 1 liter/minute) in the inspiratory tube of a ventilator at a distance of about 20 cm from the connection with the artificial lung. In order to obtain a humid circuit, we used a humidifier servocontrolled at a temperature of 36 degrees C. The concentration of NO and NO2 are continually determined by means of chemiluminescence in the expiratory tube at about 5 cm from the connection with the artificial lung. The study consisted of three parts: elaboration of the curves of NO and NO2 in low humidity (34 measurements), validity of the corresponding curves of NO in low humidity (80 new measurements) and elaboration of the curves of NO and NO2 in a humid circuit (32 measurements). We found that the concentrations of NO in low humidity follow a lineal equation, except for the flows lower than 10 L/min. Flows between 10-15 L/min reached concentrations of NO between 6-60 ppm. The concentrations of NO2 in low humidity produced some parallel curves, and exceptionally overcame the toxic figure of 5 ppm. The curves are valid only with flows higher than 10 L/min. Humidity does not influence the NO concentrations, while it diminishes NO2 concentrations 1.4 times.

Administration, Inhalation↗
PubMed1995

Early morning reduction in ischemic threshold in patients with unstable angina and significant coronary disease.

BACKGROUND: The objective of this study was to investigate in patients with unstable angina and significant coronary stenosis (> 70%) whether or not the morning peak of myocardial ischemia is associated with a reduction in the ischemic threshold. The morning increased incidence of ischemic episodes in stable angina appears to be attributable to a coincidence of several factors. Patients with unstable angina who remain at bed rest, however, also present a similar morning increased incidence of ischemia, but its mechanisms are not completely understood. METHODS AND RESULTS: The ischemic threshold was assessed by atrial pacing at 7 to 8 AM and at 12 to 1 PM in 46 patients. In the 34 with a positive pacing response (ST segment shift > 1.0 mm), ischemic threshold was lower at 7 to 8 AM than at 12 to 1 PM (131 +/- 16 versus 139 +/- 15 beats per minute, P < .001), whereas in the remaining 12 patients, the pacing response was negative. Moreover, 4 patients presented ST segment elevation during pacing in the morning but only 1 at noon and at a higher threshold. Baseline heart rate and diastolic blood pressure were higher at noon than in the morning (81 +/- 16 versus 76 +/- 13 beats per minute, P < .01, and 87 +/- 11 versus 82 +/- 10 mm Hg, P < .05). CONCLUSIONS: The morning lowering of ischemic threshold in the absence of increases in baseline blood pressure or heart rate suggests that a reduced coronary vasodilator capacity or an increased coronary tone may favor the increased incidence of ischemic events during this interval.

Angina, Unstable↗
PubMed1995

Relevance of electrocardiographic findings, heart failure, and infarct site in assessing risk and timing of left ventricular free wall rupture during acute myocardial infarction.

Clinical and electrocardiographic features of 227 patients who died of an acute myocardial infarction (AMI) were compared with those of 150 survivors of a first AMI. Left ventricular (LV) free wall rupture was found in 93 patients aged > 50 years, but not in 134. The incidence of healed infarct (4 [4%] vs 50 [37%], p < 0.001), heart failure (11 [12%] vs 112 [84%], p < 0.001), and bundle branch block (11 [12%] vs 54 [40%], p < 0.001) was lower in patients with than without LV rupture. In patients with anterior AMI and early rupture (1 day), admission ST elevation was higher than in those with late LV rupture (> 1 day, 6.8 +/- 4.0 vs 4.0 +/- 2.7 mm, p < 0.01). However, lateral wall AMI had minimal ST elevation and accounted for 10% of ruptures. On day 2, the decrease in ST segment in patients with late LV rupture was less than in survivors (0.5 +/- 1.6 vs 3.2 +/- 2.9 mm, p < 0.001). Admission systolic blood pressure in patients who had early rupture was higher than in survivors (155 +/- 22 vs 137 +/- 22 mm Hg, p < 0.001) and in those with late rupture (135 +/- 23 mm Hg, p < 0.001). Late rupture was associated with infarct thinning and triggered by a physical strain in 18 of 45 patients (40%); infarct thinning, however, was present only in 4 of 48 patients (8%) with early rupture (p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Post-transplant lymphoma in a liver allograft.

We describe the development of a lymphoma in a liver allograft shortly after orthotopic liver transplantation. Aspiration and core biopsies of the nodule were persistently negative so that a diagnosis could not be made until the patient underwent retransplantation, when examination of the liver resection specimen revealed a B-cell lymphoma. Using a rapid technique based on the polymerase chain reaction, we were able to demonstrate that the tumor was of donor origin.

Base Sequence↗
PubMed1995

Further elevation of the ST segment during the first hour of thrombolysis. A possible early marker of reperfusion.

OBJECTIVES: To evaluate the clinical implications of early electrocardiographic changes during thrombolysis in a randomized study in patients with an acute myocardial infarction. BACKGROUND: Re-elevation of a rapidly resolving ST segment during thrombolysis is currently interpreted as a sign of re-occlusion, but a further elevation at very early stages of lytic therapy may not necessarily have the same implications. METHODS: In 214 patients with a first transmural acute myocardial infarction of < or = 4 h randomized to fibrinolytic (streptokinase group, n: 110) vs non fibrinolytic medical therapy (control group, n: 104), a standard 12 lead ECG was continuously recorded during the first 60 min and at 2, 4, 10, 16 and 24 h. Serial enzymes were measured during 72 h, and in 156 patients (73%) a coronary angiogram was performed at 10-15 days. RESULTS: Within the first 20-40 min there was an additional ST segment elevation in 50 patients (45%) from the streptokinase group and in 19 from control group (18%) (P < 0.0001) but the increment was greater in the streptokinase group (1.2 +/- 1.4 vs 0.3 +/- 1.4 mm, P < 0.0001). In the streptokinase group, the interval from onset of pain to peak creatine kinase MB was shorter in patients with additional ST segment elevation than in those without it (699 +/- 193 vs 856 +/- 299 min, P < 0.01). Moreover, in-hospital mortality tended to be lower in patients whose ST segment was elevated than in those without such elevation (2150, 4%, vs 6160, 10%). Incidence of recanalization was high but comparable in these two subsets. In recanalized patients, with or without additional ST segment elevation, the ST segment declined significantly at 1 h (-1.0 +/- 1.7, P < 0.001, vs 0.1 +/- 1.5 mm, ns). CONCLUSIONS: Additional ST segment elevation is frequently observed during the first hour of intravenous thrombolysis with streptokinase. Its' association with a subsequent early decline of ST elevation, reduced mortality, a shorter time interval to peak creatine kinase, and a high rate of late recanalization, suggest that in some patients it is one of the earliest markers of reperfusion.

Adult↗
PubMed1995

Influence on fetal growth of exposure to tobacco smoke during pregnancy.

We analysed the effect of exposure to tobacco smoke during pregnancy on fetal growth parameters in 129 term newborns. Children were classified into four depending on exposure on the basis of a questionnaire completed by the mother. The results confirmed that tobacco smoking reduced weight, length, cranial and thoracic perimeters at birth when exposure was due to either active or passive smoking. Weight deficits of infants whose mothers smoked heavily (458 g) were higher than those whose mothers were exposed to passive smoking (192 g). We conclude that passive smoking is a very important variable and should be taken into account in any study of neonatal growth parameters.

Female↗
PubMed1995

[Neoplastic obstructive jaundice: palliative treatment with self-expandable metallic prosthesis].

PURPOSE: Study of the effectiveness and morbidity of palliative treatment of malignant obstructive jaundice with metallic biliary endoprosthesis compared to surgical palliation. DESIGN: Retrospective review. PATIENTS: 35 patients with non-resectable neoplasms causing jaundice were treated with percutaneous stent (pancreatic carcinoma, n = 11; cholangiocarcinoma, n = 11; gallbladder carcinoma, n = 4; extrahepatic metastases of various malignancies, n = 8). CONTROL GROUP: 23 patients with malignant jaundice treated with palliative surgery. RESULTS: Most frequent complications were cholangitis and stent obstruction. The mean hospital stay after the stent placement was 6.8 days, longer in patients with complications (p = 0.035). Recurrence of jaundice was seen in 22.9% of the patients and the rate of readmission was 42.9%. The mean survival was 163.33 days (range 19-522). Reduction in serum bilirubin after BE was significant (215 vs. 82 mmol/l, p < 0.001). CONCLUSIONS: Comparing to our previous experience with surgical palliative treatment, there was no significant difference neither in morbidity-mortality, nor recurrence or readmission. Patients with pancreatic cancer and cholangiocarcinoma benefit from a shorter hospital stay.

Aged↗