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Biomedical subjects

M Romero

Publications and source records attributed to M Romero.

At least 163 records · Page 9Linked to original sources
PubMed1990

Drug use in pregnancy: an overview of epidemiological (drug utilization) studies.

The need for further information on drug utilization patterns during pregnancy in different countries was assessed by reviewing literature obtained by hand and computer searches for the years 1960-1988. The 13 identified studies showed that pregnant women used an average of 4.7 drugs. The most commonly ingested medications were vitamins and iron preparations (almost all women), analgesics, antiemetics and antacids. However, the important variables taken into account differently in each study, such as date of surveillance, country, size of population, personal habits, and physiopathological and demographic characteristics, may it impossible to construct a comprehensive, detailed, up-to-date picture of drug utilization during pregnancy. The evaluation confirmed the need for systematic permanent surveillance of drug utilization in pregnancy, so as to avoid the use of data based on widely differing contexts, times and methods, in a field where knowledge is often derived from scanty information.

Drug Utilization↗
PubMed1990

Balloon valvuloplasty for mitral restenosis after previous surgery: a comparative study.

We studied 203 patients with mitral stenosis treated by transarterial valvuloplasty. Forty two (group A) had undergone closed (n = 30) or open n = 12) surgical commissurotomy 15 +/- 5 years before. The remaining 161 had not undergone previous surgery (group B). There were no significant differences between both groups in terms of age, sex, functional class, left atrial size, two-dimensional anatomic features of the valve, incidence of mild basal mitral regurgitation, or ejection fraction. A comparative analysis of both groups showed no significant differences in terms of changes in the mean gradient, mitral valve area, and incidence of severe postvalvuloplasty mitral regurgitation (9.5% versus 5.5%). Echo-Doppler follow-up studies (11 +/- 7 months) showed persistent gradient relief in either group. We conclude that the immediate and short-term results of balloon valvuloplasty in patients who had undergone previous surgery are similar to those observed in patients who had not had commissurotomy.

Catheterization↗
PubMed1990

[The blood rheology of diuretics].

We have studied a group of 33 (27 female and 6 male) patients suffering pure essential arterial hypertension, with a mean age of 54.06 years, and who received a daily monodose of chlortalidone. Arterial pressure, blood viscosity at different shearing levels, as well as those parameters capable of modifying this viscosity were determined at days 0, 30, 60, 90, and 180 of treatment. Similarly, blood viscosity in this group of patients on day 0 is compared to a normotense control group. We observed a statistically significant (p less than 0.05) increase in blood viscosity in the hypertense group at day 0 when compared to the control group. No significant changes due to treatment could be observed in blood viscosity or any of the parameters studied. However, there was a significant decrease (p less than 0.0001) in arterial blood viscosity. "Chronic" treatment of essential hypertense patients have an inherent increase in blood viscosity. "Chronic" treatment of essential arterial hypertension with diuretics (chlortalidone) does not modify the hematocrit nor other biochemical parameters studies, nor blood viscosity. Treatment normalises blood pressure levels, but it does not "primarily" hemodynamically prevent ischemic events at the microcirculatory level.

Adult↗
PubMed1990

[Role of percutaneous valvuloplasty in rheumatic mitral valve stenosis. Córdoba-Las Palmas cooperative study].

This article describes our findings on a prospective and cooperative study (Córdoba-Las Palmas) in 203 patients with mitral stenosis who underwent balloon valvuloplasty using a retrograde transarterial technique. We analyzed the immediate and mid-term results, and studied the factors determining an optimal result and those related to the new appearance or worsening of mitral incompetence after the procedure. On the other hand, we analyzed the results of mitral valvuloplasty in patients with previous mitral surgery, mild mitral stenosis and patients dilated while having an acute pulmonary edema. We observed a marked decrease in mean mitral gradient (17 +/- 7 to 6 +/- 3 mmHg; p less than 0.001) as well as a significant increase in mitral valve area (1.02 +/- 0.4 to 2.04 +/- 0.7 cm2; p less than 0.001). Echo-Doppler follow-up did not show significant changes in the residual mitral valve gradient. Multivariate analysis selected, as independent predictors of an optimal result, the presence of a pliable valve and the absence of basal mitral regurgitation. On the other hand, the presence of a lower ejection fraction, an older age and a higher baseline left ventricular endiastolic volume were independent factors determining progression of mitral regurgitation. In patients with previous mitral surgery, the clinical, echo and hemodynamic profiles, as well as the immediate results, were similar to those observed in patients with unoperated mitral stenosis. In the subgroup of mild mitral stenosis, we observed and optimal result in all cases, without major complications. Mitral valvuloplasty was dramatically effective in 8 patients treated during acute pulmonary edema.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Infarct size determination using enzymatic methods in patients with early coronary recanalization].

To evaluate the usefulness of the infarct size determined by serial creatine kinase (CPK) measurements in patients with early reperfusion, we have studied 189 patients meaning in age 59.2 +/- 8.6 years, with acute myocardial infarction treated with streptokinase (STK); 81 of them by intracoronary route (group A), and 108 by intravenous administration (group B). In the group A we performed serial angiographic studies in the following conditions: baseline, immediately after STK infusion and before hospital discharge. In group B we performed only one angiographic control 5 +/- 3 days after. In patients with reperfusion, the parameters of left ventricular function correlated with cumulative creatine kinase release (MAX-CPKr) by linear regression in both groups. We observed a tendency to closer correlations in patients with left anterior descending or circumflex artery as the infarct related artery, in patients without previous infarction and in those who did not receive electrical shock for ventricular arrhythmias. In patients with unsuccessful reperfusion (n = 11), we also obtain a significant correlation (r = 0.72) between ejection fraction and MAX-CPKr. The slope of the regression line (b = 7.7 X 10(-5) was steeper (p less than 0.05) than that observed in recanalized patients, who were evaluated within the first 3 days (b = 2.2 X 10(-5), after 8 +/- 5 days (b = 2.7 X 10(-5), or before discharge, at 22 +/- 9 days (b = 2.6 X 10(-5).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Abrupt homeostatic responses to transient intracardiac occlusion during balloon valvuloplasty.

The present study analyzes the hemodynamics of intracardiac occlusive periods during balloon mitral or aortic valvuloplasty and compares them with immediate plasma levels of atrial natriuretic factor (ANF), vasopressin and renin activity. Forty-nine patients were studied; 33 of them had mitral stenosis and 16 had aortic stenosis. The mean age was 52 +/- 17 years. During dilations pressures were monitored from the ascending aorta and left atrium. Plasma levels of ANF, vasopressin and renin were serially determined at baseline, after diagnostic procedures, within 15 to 30 seconds after the first 2 occlusive dilations, and 1 and 7 hours later. There were no significant changes in plasma renin throughout the study stages. ANF and vasopressin significantly increased after the dilations. These hormonal changes were related to the significant hemodynamic changes observed during intracardiac occlusion. The left atrial pressure correlated directly and significantly (r = 0.54, p less than 0.001) with plasma ANF levels throughout the conditions. On the other hand, the plasma vasopressin also correlated (r = 0.76, p less than 0.001) with systemic pressure in an exponential fashion. These findings show that abrupt releases of ANF and vasopressin occur immediately after intracardiac occlusive periods as a response to the acute and transient hemodynamic changes observed.

Adolescent↗
PubMed1989

Angiographic follow-up after balloon angioplasty for coarctation of the aorta.

Balloon angioplasty for coarctation of the aorta was performed in 45 patients; 17 (Group 1) were infants (mean age 34 +/- 43 days). This study focuses on the remaining 28 patients (Group 2), children and adults ranging in age from 2 to 31 years (mean 13 +/- 8). Two patients had had previous surgery for coarctation; in the remaining 26 the coarctation had not been surgically treated. Twenty patients (71%) had a discrete type of coarctation; the remaining eight had a diffuse or eccentric stenosis. Angiographic studies of the aorta were performed before and immediately after angioplasty in all 28 patients; 16 (57%) of them also underwent angiographic reevaluation 10 +/- 2 months later. The pressure gradient decreased immediately after angioplasty and was unchanged at follow-up. Residual gradient at follow-up ranged from 0 to 40 mm Hg (mean 11 +/- 13). Patients with a discrete type of coarctation had a lesser residual gradient than did patients with other anatomic types of coarctation. Angiographically, the stenosis also decreased after angioplasty (68 +/- 10% versus 24 +/- 17%; p less than 0.01); a new small, but significant decrease was observed at follow-up (9 +/- 18%; p less than 0.05). A quantitative analysis of the aorta at different levels revealed no significant changes proximal and distal to the coarctation segment; however, at the level of coarctation, a significant (p less than 0.01) and homogeneous increment was observed after dilation that was unchanged at follow-up. One (6%) of 16 reevaluated patients had a clear aneurysm at the site of dilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Physiopathology of transient ventricular occlusion during balloon valvuloplasty for pulmonic or aortic stenosis.

Hemodynamic observations were made at different cardiac levels during transient balloon occlusion at the time of aortic or pulmonary valvuloplasty in 37 patients (mean age 8 +/- 9 years); 22 had pulmonary stenosis and 15 had aortic stenosis (6 valvular and 9 discrete subvalvular types). Eighty-two tentative dilatations were performed in patients with pulmonary stenosis and 61 in patients with aortic stenosis. The hemodynamics of the right and left heart were monitored during inflation-deflation time. From selected tracings mean beat-to-beat pressures curves were constructed during occlusion-recovery time. The cycle length (RR interval) did not change significantly during occlusion, except for patients with pulmonary occlusion and patent foramen ovale, where a significant increase in cycle length (p less than 0.01) was observed during recovery time. The mean maximal increase in ventricular pressure reached 95% of basal values for the right ventricle and 58% for the left ventricle. The hypertension was retrogradely transmitted to all cardiac chambers. Angiographic observations during occlusion suggest that the atrioventricular valves and the foramen ovale, when patent, become escape orifices during occlusion, for adapting and relieving intracavitary pressures. The ventricle seems to adapt to sudden occlusion by generating hypertensive and hypokinetic contractions, with atrioventricular regurgitation.

Aortic Valve Stenosis↗
PubMed1988

Information on drug use in pregnancy from the Viewpoint Regional Drug Information Centre.

The need for information on drug use during pregnancy was assessed by reviewing the requests for information arriving at a drug information centre in the past nine years. Of all the queries received 24% concerned this aspect, of which the majority were focused on drug use during pregnancy. Mothers received an average of 2.6 prescriptions, most frequently for antiinfectives, psychotropics, hormones and non-narcotic analgesics. Questions were answered personally after a literature search. A profile of questions and a summary of model cases registered in the archives of the centre are reported. The evaluation confirmed the need for and value of a drug information service in relation to pregnancy, so as to avoid alarmist and falsely reassuring attitudes in a field where knowledge is often based on scanty information.

Drug Information Services↗