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Biomedical subjects

J Kuri

Publications and source records attributed to J Kuri.

36 records · Page 2Linked to original sources
PubMedDate not supplied

[Corrected transposition of the great arteries without associated abnormalities].

We studied 5 cases of corrected tansposition of big arteries without associated defects. Four of them showed situs solitus with apex to the left, and the fifth one showed dextroversion. In four of the cases the second sound was the only one, strong and to the left of the precordium; in four we found mild sistolic murmur in the third left intercostal space. In all of them, XR plates showed the largest liver lobe to the left, apex to the left in four and to the right in one, being possible to see the ascending aorta to the left in four cases. A patient with complete auriculoventricular block showed cardiomegaly and excavated middle arch. Three of them presented sinusal rithm, one had auriculoventricular block of variable degree and the last had complete auriculoventricular block. In four cases the AQRS showed a deviation to the left, and the other one to the right. In the foreground of the first septal vector was going from right to left. The analysis of the unipolar and thoracic morphologies had alterations in the intraventricular conduction which suggested a right branch block in derivations exploring the ventricle located to the left and potential QS in the right pre-cordials. We found a pattern of sistolic overload of the sistemic ventricle. Through determination made by the His Ecg we found that the alterations in conduction were distal. The electro-mechanic latent period of the ventricle located to the right was shorter than the opposite. The angiographic studio helped to establish the auriculoventricular discordant relations and to identify the ventricles position through their angiographic morphology. In the cases showing point to the left, the ventricle anatomically considered as the left one showed a triangular form and smooth walls, while the ventricle anatomically consider being the right one presented trabeculated walls. In dextroversion the anatomically left ventricle was egg-shaped with smooth walls. All of them presented the aorta above the pulmonar artery.

Adolescent↗
PubMedDate not supplied

[A low-level stress test, in the early phase of myocardial infarction and its correlation with coronary angiography].

In a prospective 24-month trial at the Instituto Nacional de Cardiologia, 56 patients were studied. All patients had acute myocardial infarction (AMI), diagnosed by clinical, electrocardiographic and enzymatic means. They were studied in two groups: Group A with single localized AMI (n = 30) and Group B with AMI at two locations (n = 26); a resting electrocardiogram (EKG) was analyzed in each case and a low level stress test was performed within the 2nd and 3rd postinfarction weeks; coronary angiography was done between the 8th and 9th postinfarction weeks. In Group A the low level stress test (LLST) was positive for ischemia at a distance from the infarction site in 21, and eighteen of them had multi-vessel injuries (MVI); in 9 the LLST was negative; of these 7 had single-vessel injury; only the remaining 2 had MVI (p less than 0.001) with 90% sensitivity and 78% specificity. In Group B there was no significant relationship between LLST and coronary angiography (64% sensitivity, and 62% specificity). Relating the ischemic change at a distance in the resting EKG with coronary angiography, we found 75% sensitivity and 55% specificity in Group A. In Group B, sensitivity and specificity were even lower. We conclude that LLST in the early postinfarction phase in Group A is a safe and reliable method to suspect MVI, allowing the early identification of patients with lesions that could be treated by surgical means.

Coronary Angiography↗
PubMedDate not supplied

[The renin angiotensin system in the pathology of arterial hypertension of aortic coarctation].

Nine patients with aortic coarctation were studied. On the fourth day of a low diet, blood samples were obtained for plasma renin activity (PRA) at 8:00 A.M., 11:00 A.M. and 5:00 P.M. On the same day a 24 hour urinary collection was obtained for the determination of aldosterone excretion. The following day 60 mg. of furosemide were given orally at 8:00 A.M. and another blood sample was drawn at noon. This study protocol was done before and after surgical correction of the aortic lesion. Mean systolic and diastolic blood pressure decreased significantly (P less than 0.005), while mean PRA and urinary aldosterone values showed no significant modifications after surgery. With these results, it is concluded that the renin-angiotensin-aldosterone system, does not seem to play a role in the chronic hypertension of the coarctation of the aorta. However, tests with angiotensin II specific blockers have to be performed before a definite conclusion can be drawn on this point.

Adolescent↗
PubMedDate not supplied

[The system of complement in active rheumatic fever].

Pathogenesis of inflammation in acute rheumatic fever is still unknown. There is humoral immune response against streptococcal products and streptococcal infection plays a role in etiopathogenesis. When inflammation is due to humoral immune mechanisms, the serum Complement system is the most important mediator. We studied functional aspects of the Complement system in nine patients suffering acute rheumatic fever, all of them with clear humoral immune response against streptococcus. We could not show any abnormalities in Complement. Probably, inflammation during acute rheumatic fever depends on Complement independent mechanisms.

Complement System Proteins↗
PubMedDate not supplied

[Fixed fibrous subaortic stenosis. Postoperative evaluation].

Fibrous sub-aortic stenosis in 19 patients surgically treated is discussed. The clinical, radiologic, EKG and cardiac catheterization data in the pre and post-operative evaluations are reviewed. There were no surgical deaths in this series. In 14 cases post-operative cardiac catheterization was carried out, in 11 patients a significant decrease in the gradient was found. In 4 cases pharmacological testing was done during catheterization before and after surgery, without significant change in gradients.

Adolescent↗
PubMedDate not supplied

[Acute electrocardiographic effects of minoxidil in hypertensive subjects].

Unexplained ST-T segment (ST-TD) or T wave depressions (TWD) in the electrocardiogram (EKG) are seen during minoxidil therapy. To study the possible cause of this phenomenon 69 essential systemic hypertensive patients were evaluated. At the 5th day of a double therapy (DT) period consisting in the administration of atenolol 100 mg/day and chlorthalidone 50 mg/day systolic blood pressure (SBP), Sokoloff Index (SI) (EKG: Svl + Rv5-v6), EST-T (sum of ST-TD and TWD areas in 9 derivations of EKG) and potassium (K) serum levels were determined. Minoxidil (10 mg/day) was added and 3 to 6 days after, all parameters were repeated. Patients were classified in group A: (GA, n25 =) or B: (GB, n = 44) at the end of the study according to the absence or presence of ST-TD or TWD, respectively. During DT, SBP and SI were lower in GA (145.3 +/- 20.9 mm of Hg and 23.8 +/- 7.5 mm, respectively): (all values in X and S) than GB (173.5 +/- 24.4 and 34.0 +/- 8.3 respectively) (p less than 0.001 for both values) delta SBP (X and S of changes at the end of the study) diminished more in GB (-40.7 +/- 22.2 mm of Hg, p less than 0001) than in GA (-20.1 +/- 15.0, p less than 0.001) (GB-GA p less than 0.001). Correlation coefficient of SBP -delta SBP in both groups and delta SBP-delta EST-T in GB was 0.75 and 0.66 (p less than 0.001 for both values) respectively. delta K was not significant. Twenty five out of 27 patients of GB didn't have stenotic lesions by coronariography. Minoxidil induced ST-TD or TWD may be due to a fall in coronary perfusion pressure in patients with left ventricular hypertrophy and poor coronary circulatory reserve. This hipothesis implies that coronary autoregulation is lost in this stage of disease.

Blood Pressure↗
PubMedDate not supplied

[Prevention of recurrence of rheumatic cardiopathy in 564 patients].

In a group of 564 patients with rheumatic heart disease seen in the period from 1971 to 1975, who were under benzatinic prophylaxis, 23% were seen in the clinic and 77% at home. The object of this revision is to analyze the latter group in order to obtain the frequency of pharyngoamigdaline infections, and of relapses. 1. During the observation, those patients who did not present pharyngeal infections had no relapses. On the other hand, all relapses were observed in those patients who presented infections. 2. Those patients who carried out the prophylaxis incorrectly and who also presented pharyngeal infections, had almost twice the percentage of relapses as those who carried out the prophylaxis correctly. 3. In the group with effective prophylaxis, including those cases with or without pharyngeal infection, 5% had recurrences. In the group with ineffective prophylaxis, 16% had relapses. 4. Those patients with subsequent attacks doubled the percentage of relapses in comparison with those with initial attacks. 5. The plurivalvular patients have a higher frequency of recurrences than the univalvular patients. 6. During the first year of post-attack prophylaxis, the incidence of relapses is only 1.7%, in comparison with the following years in which there is a higher incidence of around 10%. 7. The total number of recurrences in 564 patients was 8%.

Adolescent↗
PubMedDate not supplied

[Isolated hypoplasia of the right ventricle].

Four cases of hypoplastic right ventricle with intact ventricular septum are presented. All of them were diagnosed by means of an angiographic study, and one case was examined postmortem. The anatomic, physiologic and clinical features of this malformation are analyzed and the differential diagnosis with similar congenital cardiac diseases is discussed.

Adolescent↗
PubMedDate not supplied

[Pulmonary atresia with intact interventricular septum].

Ten cases with pumonary atresia with intact interventricular septum were studied; they were divided in type I (6 cases) and type II (4 cases). In the cases with necropsy no distinct characteristics were observed in comparison to those reported in the literature. Cyanosis, heart failure, cardiomegaly and pulmonary oligohaemia were present in all cases. No correlation was found neither between right atrial middle pressure and the P wave amplitude (r = 0.014), nor between the AQRS and the right ventricular systolic pressure (r = 0.039). All the cases from type II showed hypertrophy of the two ventricles and only one case from type I showed right ventricular hypertrophy. In nine cases right ventricular hypertension was registered. Right atrial middle pressure and right ventricular telediastolic pressure were found increased in nine cases; the other one showed normal values (type II). The angiocardiographic study is a necessary diagnostic procedure. By means of it is possible to determine the ventricular cavity size, the right ventricular infundibulum characteristics and the atresic segment size.

Arteriovenous Malformations↗
PubMedDate not supplied

[Coronary angioplasty in patients not accepted for surgical treatment. The initial experience of the Ignacio Chávez Instituto Nacional de Cardiología].

Coronary angioplasty has shown its efficacy in "high-risk" patients for surgical treatment (severe left ventricular failure, serious pulmonary or systemic disease). We studied a subgroup with multivessel coronary heart disease treated with coronary angioplasty because they were no candidates for surgery due to unsuitable coronary anatomy. Revascularization rate was determined in each patient as revascularization percentage obtained, compared with all the technically suitable lesions for coronary angioplasty. Ten patients (mean age 63 years) were studied, eight of them had unstable angina. Overall, 44 lesions were considered technically suitable for angioplasty and thirty-five could be dilated, technical success rate was 88% (31/35 lesions) and revascularization rate was 71% (31/44 lesions). Primary success rate was achieved in nine patients. Clinical follow-up varied from two to thirteen months (mean 7.8 months); eight patients have remained asymptomatic (class I of NYHA), another patient had stable angina and the other one had sudden death six months after the procedure. In conclusion, we demonstrated a high success rate in a short and long term with coronary angioplasty in a subgroup of patients with multivascular coronary heart disease that had been rejected for surgery due to unsuitable coronary anatomy.

Aged↗
PubMedDate not supplied

[A case of elevated transaminases caused by congestive heart failure simulating chronic hepatitis].

We report the case of a young man first seen by is in 1989 at the age of 20 years. The diagnoses of hypertrophic cardiomyopathy, Wolf-parkinson-White syndrome, congestive heart failure and pulmonary hypertension were made. One month later the patient had jaundice and hepatomegaly and a diagnosis of acute viral hepatitis A was established by laboratory findings. The ALT and AST levels were persistently elevated, seven times the normal mean, during six years. Two liver biopsies in 1991 and 1993 showed liver injury secondary to congestive heart failure (CHF) as the only abnormality. This case illustrates the importance of liver injury secondary to CHF as a cause of a marked and persistent increase of ALT and AST that resembles that of other liver diseases.

Adult↗
PubMedDate not supplied

[Tetralogy of Fallot in adults].

We present the clinical and hemodynamic profile of 33 patients, older than the 18 year with tetralogy of Fallot. Cardiac catheterization and selective angiocardiography were performed in all cases. We excluded patients with valvular pulmonary atresia associated with tetralogy of Fallot. Most of the patients were in functional class II or IV of the New York Heart Association and all presented with cyanosis. In the electrocardiogram of 23 patients we found right bundle branch block. None had significant cardiomegaly, 19 of 20 cases had reduced pulmonary blood flow and reticular pattern in the lung fields as observed in the chest X-ray. We did not find correlation between the age and the degree of cyanosis, but the level of arterial desaturation correlated with the functional class. The right ventricular systolic pressure was elevated in all patients. In all cases but one the pulmonary arterial systolic pressure were normal of slightly increased. One case with mild pulmonary infundibular stenosis had pulmonary systolic pressure similar to the systemic pressure. Multivariate analysis for functional class showed significant value for cyanosis. Systemic-pulmonary shunt was performed in 10 patients with hypoplastic pulmonary arteries plus reduced pulmonary blood flow, with one postoperative death. We did not find postoperative mortality in patients who underwent corrective surgery. The anatomic and functional behavior of patients who underwent surgery, allowed better tolerance to their heart defects.

Adolescent↗
PubMedDate not supplied

[Aortic prosthesis, long-term results and evolution].

The results and evolution of 126 aortic prosthesis implanted from 1964 to 1971 were reported. The results are appraised according to the criteria of the NYHA. The hospital mortality in the first five years was 40%; in those operated on in the following 3 it fell to 21% and finally those treated in the last 2 years had 16%. The delayed mortality was 19%. Depending on the type of valvular lesion, the stenosis have the highest mortality (50%). The group II and II of the NYHA had less mortality. In the evolution of the survivors at ten years, the incidence of actual survivors shows that after the first two years of prosthetic change, the survival rate tends to stabilize staying at 77% at the end of 10 years; of which 75% evolve well and 17% badly. A separate analysis was made of the factors which modify the results and evolution such as calcifications, associated mitraltricuspid lesions, and myocardial damage. The most frequent complications were embolisms 14%, prosthetic dysfunction 12.8%, endocarditis 3.8%, and hemolysis 2.5%.

Adolescent↗