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Biomedical subjects

J L Acosta

Publications and source records attributed to J L Acosta.

4 recordsLinked to original sources
PubMed1999

Myocardial infarction in patients with systemic lupus erythematosus with normal findings from coronary arteriography and without coronary vasculitis--case reports.

The authors present the cases of two young patients, a man and a woman, who presented with myocardial infarction, in the absence of ischemic heart disease or stenosis of the coronary arteries. The woman was known to have systemic lupus erythematosus (SLE) for the past 3 years (the immunoglobulin M [IgM] anticardiolipins antibodies were positive), without a history of coronary risk factors. Suddenly she presented with acute chest pain on rest that lasted 4 hours and culminated in anterior wall myocardial infarction. She was admitted to the coronary care unit, where no thrombolysis was given. She did not have echocardiographic evidence of Libman-Sacks endocarditis, but myocardial infarction was evident at the electrocardiogram (ECG). The young man had SLE (the IgM anticardiolipins were absent, but he was positive for lupus anticoagulant antibodies), he was hyperlipidemic, was a moderate smoker and moderately obese, and had no history of ischemic heart disease. He suddenly presented with an acute myocardial infarction documented by ECG, enzymes, and gammagraphy. In both patients, coronary angiography findings were normal and myocardial biopsy did not show evidence of arteritis. The relevance of these cases is the rare association of ischemic heart disease in SLE, with normal coronary arteries and without evidence of arteritis or verrucous endocarditis.

Adult↗
PubMed1977

Selective mediastinoscopy.

Mediastinoscopy is often utilized for staging bronchogenic carcinoma. Whether it should be used routinely or selectively is controversial. Fifty-four patients with bronchogenic carcinoma were prospectively assigned to one of two groups based on the presence (group A) or absence (group B) of one or more of the following criteria: (1) central location; (2) mediastinal nodal enlargement; (3) involvement of laryngeal nerve; and (4) noncentral location plus linear stranding toward the hilum. Mediastinoscopy was performed on all patients in group A. Thoractomy for definitive staging was performed on those patients in group A with negative mediastinoscopic findings for neoplasm and on all patients in group B. Criteria 1, 2, and 3 were found to be valid; 22 of the 27 patients in group A who had any of these criteria had positive mediastinoscopic findings for neoplasm. Criterion 4 per se was found to be invalif; all seven of the patients in group A who had this isolated finding had negative mediastinoscopic findings for neoplasm and had resectable lesions. Twenty-three of the 27 patients in group B had no mediastinal involvement and had resectable lesions. These data indicate that selective mediastinoscopy using criteria 1 through 3 reduces the number of negative examinations and unnecessary thoracotomies to a minimum.

Humans↗
PubMedDate not supplied

[Percutaneous pulmonary valvuloplasty. Short-term and long-term results].

Percutaneous angioplasty was performed in twenty consecutive patients, with congenital pulmonary valve stenosis. Ages ranged from eight months to thirty-two years (mean 9.5 years old). We achieved a valvular gradient dropping from 91 +/- 39 to 19 +/- 11 mm Hg (P less than 0.001) in early post angioplasty level and it was practically unchanged at three months and one year later. (19 +/- 12, 19 +/- 17 mm Hg) (P less than 0.001). Similar change was observed in the right ventricle systolic pressure which was diminished in a progressive way during the follow-up from 113 +/- 37 to 39 +/- 35 (P less than 0.001), 59 +/- 18 and 53 +/- 25 mm Hg (P less than 0.001) immediately, three months and one year later, respectively. The ratio right ventricle systolic pressure/left ventricle was diminished from 0.96 +/- 29 to 0.63 +/- 0.35 in the early post angioplasty period and later from 0.50 +/- 0.16 and 0.44 +/- 0.22 (P less than 0.001). Only one case had restenosis one year later and we repeated the angioplasty with good results. Most of the patients are asymptomatic, the pulmonary murmur features changed. We observed improvement in electrocardiographic and echocardiographic signs. One patient died of anesthetic complications. The remainder of patients did not have severe complications and they were discharged from 48 to 72 hours after angioplasty. In conclusion, valvuloplasty is an effective procedure in a short and long term basis. We considered valvuloplasty in congenital pulmonary valve stenosis the treatment of choice in this group of patients.

Adolescent↗