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Biomedical subjects

J Marco

Publications and source records attributed to J Marco.

At least 217 records · Page 12Linked to original sources
PubMed1981

[Transluminal angioplasty of the coronary vessels. Preliminary results].

Transluminal coronary angioplasty is a new therapeutic procedure perfected by Gruntzig in 1977 consisting of compressing atheromatous plaques and dilating the arterial lumen with an inflatable balloon-tipped catheter of fixed external diameter. This catheter is introduced into the coronary artery through a preformed catheter guide under radioscopic control. The authors describe their experience of 36 attempts at coronary angioplasty performed over a one year period. The stenosis was catheterised in 30 cases and a good immediate result was obtained in 28 patients (77%). The percentage narrowing was reduced from an average of 79 +/- 8% to 26 +/- 12% (p less than 0.001) and the trans stenotic gradient from 40 +/- 11 mm Hg to 4 +/- 8 mm Hg (p less than 0.001). No serious complications were observed during these procedures. The 8 other patients underwent aorto-coronary bypass surgery as an emergency (2 cases) or otherwise (5 cases). 26 patients with good immediate results are asymptomatic at medium term follow-up, 1 has improved from functional Class IV to II, and I has recurrent Class IV effort angina. 15 patients have been followed up after six months. 14 remain asymptomatic with negative maximal exercise stress testing; 1 has angina. 14/15 stenoses remain dilated, 1 stenosis has progressed (60%). 2 patients developed a new stenosis, 1 of whom underwent another angioplasty procedure (functional Class III). In the 13 remaining patient, clinical improvement was confirmed by exercise stress testing. With strict selection of patients and a prudent operative technique this method seems to be an attractive intermediate therapeutic procedure (over 60% good results at medium term) between medical and surgical management of patients with severe angina and a tight monotruncular stenosis.

Adult↗
PubMed1981

[Rupture of the heart in the acute phase of myocardial infarction operated on successfully].

This case of rupture of the left ventricular wall in the acute stage of myocardial infarction, presenting clinically as cardiac tamponnade with no electrical signs of transmural infarction, is reported. After cardiac catheterisation and angiography which confirmed the adiastole, the worsening of the patient's condition necessitated pericardial aspiration which showed the presence of a haemopericardium. This led to surgical exploration and to the repair of a cardiac rupture under cardiopulmonary bypass. The authors recall the incidence of cardiac rupture during myocardial infarction, its poor prognosis, the difficulty of preoperative diagnosis, the anatomical features of the infarct which are theoretically favourable for surgical repair and the rarity of survival after surgery which relies essentially on the availability of medicosurgical facilities for very early surgical intervention.

Acute Disease↗
PubMed1981

[Pump and muscle functions and the index of perfusion of the subendocardium in severe aortic stenosis in adults].

47 patients with severe aortic stenosis (AS) (valve area less than 0.7 cm2) and normal coronary angiography were divided into three groups, according to their functional class (NYHA classification): - Group 1 (n = 21): Classes 1 and 2 - Group 2 (n = 18): Class 3 - Group 3 (n = 8): Class 4. Haemodynamic and angiographic parameters and the index of subendocardial perfusion (ISEP) defined by Buckberg's method were compared with a control group (n = 14). In group 1, pump function was normal without end diastolic dilatation. Moderate hypertrophy was compensatory and isofunctional (SW/mass = normal). Despite normal EF and VCF, contractile function was reduce (dp/dt/p, % shortening, % thickening and velocity of systolic thickening were lower than the control group (p less than 0.05)), and there was chronic subendocardial ischaemia (ISEP = 0.58 +/- 0.2, p less than 0.01). In groups 2 and 3, pump function was depressed (Group 2: CI = 2.5 +/- 0.5 1/min/m2 (p less than 0.05)) (Group 3: CI =2.0 +/- 0.6 1/min/m2, p less than 0.01)) despite an increased preload (LVEDP and EDV increased), and a greater degree of hypertrophy (Mass Index, Group 1 = 130 +/- 30 g/m2, Group 2 = 190 +/- 30 g/m2 (p less than 0.01), Group 3 = 210- +/- 30 g/m2 (p less than 0.01)). (SW/mass decreased, p less than 0.01). EF and VCF and all other indices of contractility were depressed and subendocardial ischaemia was the same (0.5 +/- 0.2). The complete lack of adaptation of the preload, non-compensatory hypertrophy, decreased contractility and chronic subendocardial ischaemia, all affect the operative prognosis and the long-term result after valve replacement. This data is in favour of early surgical correction of severe AS before the appearance of signs of cardiac failure.

Aged↗
PubMed1980

Human pancreatic polypeptide secretion in conditions of exogenous and endogenous hyperglycaemia.

The effects of exogenous and endogenous hyperglycaemia on human pancreatic polypeptide secretion have been studied. In normal subjects elevation of plasma glucose concentration by glucose infusion both depressed the basal levels of circulating human pancreatic polypeptide (by 40-50%) and consistently reduced the human pancreatic polypeptide response to the ingestion of a portion-rich meal (areas above pre-meal value: 19.5 +/- 4.1 (mean +/- SEM) vs. 9.6 +/- 2.1, p < 0.01) as well as to caerulein infusion (areas above pre-caerulein value: 8.8 +/- 2.2 vs. 4.6 +/- 1.4, P < 0.01). In diabetic subjects treated with sulphonylureas or diet (fasting plasma glucose: 166 +/- 11 mg/dl, n = 24), human pancreatic polypeptide secretion evoked by food was similar to that of 24 healthy individuals (areas above basal value: 46.6 +/- 9.9 and 33.6 +/- 3.6, respectively). In insulin dependent diabetics (fasting plasma glucose: 231 +/- 19 mg/dl, n = 21) the human pancreatic polypeptide response to the meal (area above basal value: 78.2 +/- 13.7) was significantly greater than that of the controls as well as that of the noninsulin-dependent group (P < 0.05). Since the administration of pancreatic polypeptide to man has been shown to decrease pancreatic exocrine output, postprandial human pancreatic polypeptide hypersection may contribute to the decreased exocrin function of the pancreas often found in insulin-dependent diabetics.

Adolescent↗
PubMed1980

[Floating thrombus of the left ventricle after recent myocardial infarction, treated by surgery].

The case of a 55 year old man admitted with an uncomplicated anteroseptal myocardial infarction is reported. At the third week this young patient underwent complete assessment. On coronary angiography severe double vessel disease was demonstrated and ventriculography showed a "floating" pediculated thrombus attached to the akinetic anterior wall. The ejection fraction was calculated at 40%. Subacute ischaemia of the right lower limb developed in the hours following catheterisation. In the face of all these findings surgery was proposed; ablation of the "fresh" thrombus was associated with a ventricular resection and an aorto-coronary bypass graft on the left marginal branch, together with disobliteration of the distal ilio-femoral artery of the right leg. The following points are emphasised with respect to this report: - the rarity of such cases in the litterature despite the high incidence of mural thrombi after infarction; - the value of diagnosing this complication by systematic investigation of patients under 60 years of age in full socio-professional activity; - the indications of rational surgery comprising ablation of the thrombus and any necessary prophylactic coronary revascularisation.

Coronary Angiography↗
PubMed1979

[Outcome of myocardial infarctions complicated by heart conduction disorders in the acute phase].

Of 945 patients hospitalised for myocardial infarction between January 1st 1972 and December 31st 1975, 40 with anterior myocardial infarction (Group I-A) and 53 with posterior myocardial infarction (Group II-A) were complicated by atrioventricular and/or intraventricular arrhythmias. The average follow up period is now of 48 months (range 24 to 78 months). Their outcome was compared to two control groups of 50 anterior myocardial infarctions (Group I-B) and 50 posterior myocardial infarctions (Group II-B) uncomplicated by arrhythmias in the acute phase. The immediate (10%) and secondary (30%) mortality was identical in the two groups II-A and II-B with posterior wall necrosis. The immediate (32%) and secondary (40%) mortality in Group I-A was much higher than in Group I-B (22% and 28% respectively). Sudden death was the most frequent form of demise in all groups (I-A, II-A, II-B) except Group I-B in which heart failure predominated. Death occured earlier in Group I-A than in the control Group II-B. These results pose the problem of the indication of prophylactic permanent pacing to decrease the incidence of sudden death.

Acute Disease↗
PubMed1979

[Secondary tamponade following cardiac surgery with reference to 3 cases].

Secondary tamponnade after cardiac surgery occurs after a variable period, generally between the 15th day and the 5th post-operative week. Although this is a rare complication, it occurred three times in a consecutive series of 225 patients (1.3 p. 100). Based on this short experience as compared to the number of cases already published, the authors discuss their opinions on: -- the factors of inflammation and post-operative anticoagulation which predispose to this complication; -- the progress in diagnosis brought about by echocardiography; -- the minimal suggested management of pericardocentesis completed or not by surgical drainage; -- the possibilities of prevention based on prolonged follow-up of patients who present post-operative "pericardial problems". In this way it may be possible to eliminate a not negligeable cause of secondary mortality after cardiac surgery.

Aged↗