[Treatment of portal hypertension. Various aspects of minor pathology in the surgically treated cirrhotic patient].
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Biomedical subjects
Publications and source records attributed to M Mancuso.
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Electric and mechanical atrial paralysis is a condition usually associated with a primitive or secondary cardiopathy. Only extremely rare cases are characterized by early appearance in young subjects without evidence of cardiac disease of any kind whatever, without character of familiarity, with atrial paralysis being the only abnormality, and are thus defined as idiopathic atrial paralysis. One of these cases (the eighth in the literature, to our knowledge), presented with a complete study and the hypothesis that "chronic idiopathic atrial paralysis" and "idiopathic right atrial enlargement" (sometimes associated, as in this case) may be different manifestations of the same chronic myocardial disease.
In 100 consecutive patients, subjected to myocardial revascularization by aorto-coronary saphenous vein bypass grafting with a standard technique, several clinical, hemodynamic and angiographic data were studied in correlation with the short-term prognosis. The operative mortality (6% on the whole) appeared to be strictly correlated with the degree of left ventricular impairment. Among the considered hemodynamic indices (LVEDP, CI, EDV, EF), EF was the most significant one: mortality was 0% if EF was normal, but raised to 15 and 40% respectively, when this was moderately or severely reduced. The operative risk was heavily aggravated if 4 or more indices of left ventricular impairment were present, mortality being 45% versus 1% in patients with abnormality of 3 or less parameters. The extension of coronary artery involvement proved to be a lesser prognostic factor than the degree of complements of the surgical revascularization. No correlation was found between the preoperative value of the hemodynamic parameters and the incidence of perioperative myocardial infarction (18% in the total series).
The electro-vectorcardiographic findings of 59 patients with idiopathic cardiomyopathies, divided by means of hemodynamic and angiographic study into dilated (38 cases), hypertrophic obstructive (10 cases) and hypertrophic non obstructive (11 cases), were compared with those of a control group of 17 patients with left ventricular hypertrophy of known etiology. The statistical vectorial analysis of the 4 groups, excluding the patients with intraventricular conduction disturbances and patients below 10 years of age (46 cases), showed low voltage of the first vectors, especially at 0,01 sec., in the obstructive compared with the non obstructive type. On the basis of the data from the literature on histological findings in cardiomyopathies, these differences can be interpreted as due to a different myofibrillar arrangement in the free wall of the left ventricle.
A 22 year old man with Duchenne's progressive muscular dystrophy is presented. Because of electro-and vectorcardiographic features compatible with ischemic heart disease, coronary angiography was performed in order to rule out obstructive coronary disease, which has been excluded in our case. The coronary tree presented the same characteristics of idiopathic primitive cardiomyopathy. The authors assert that the coronary arteriography is a necessary complement to the diagnosis of Duchenne's muscular dystrophy.
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The case of a 64 year-old woman, hospitalized for cyanosis, clubbing of the fingers and probably cerebral embolism, in which the clinical and laboratory findings lead to a diagnosis of Tetralogy of Fallot of the Corvisart type, is presented. The possible reasons for benignity and long survival are discussed.
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