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Biomedical subjects

M Valle

Publications and source records attributed to M Valle.

At least 127 records · Page 7Linked to original sources
PubMed1985

A sustained effect of coronary bypass surgery in stable angina pectoris.

One hundred patients with angina pectoris were randomly allocated for medical therapy and bypass surgery in groups of 50 patients each. The effect of the respective therapies was assessed by annual exercise testing for up to five years. The surgical group was also studied by postoperative coronary angiograms at three weeks, one year and five years after the operation. The medical group was subjected to repeated coronary angiography five years after randomization. All of the variables depicting exercise tolerance were significantly improved in the surgical group but remained largely at the initial level in the medical group. A subgroup analysis of the surgical series revealed that the sustained improvement was largely confined to the completely revascularized subset of patients. The slowly increasing use of beta blocking compounds in the surgical group also contributed to the favourable results for bypass surgery.

Angina Pectoris↗
PubMed1985

Coronary bypass surgery in stable angina pectoris. A randomized study of the effects on morbidity, mortality and employment.

The effects of coronary bypass surgery on morbidity, mortality and employment were assessed in a randomized prospective 5-year study. Exercise tolerance showed an immediate, striking improvement, which was maintained throughout the follow-up period. Corresponding patients treated with medical therapy showed no change. More than 40 percent of patients in the surgical group were free from symptoms over the five years. The annual mortality of the surgical patients was 0.8 percent as compared with 4.0 percent in the medical patients (p less than 0.05). The annual mortality of the intensively treated medical patients with multivessel disease was not significantly higher than the 3.1 percent for a group of patients with single-vessel disease followed concomitantly. The rate of work at 5 years after bypass surgery was 47 percent as compared with only 18 percent in the randomized medically treated group (p less than 0.01). It is concluded that coronary bypass surgery reduces morbidity and mortality and improves employment.

Angina Pectoris↗
PubMed1985

Nervous system effects of long-term occupational exposure to toluene.

Forty-three male rotogravure printers with long-term toluene exposure and 31 age- and sex-matched offset printers without toluene exposure were examined in detail. Clinical, neurophysiological, neuropsychological and neuroradiological examinations and assessment of autonomic functions did not reveal any statistically significant differences between the groups. The results suggest that occupational long-term exposure to toluene under these circumstances does not have clinically significant adverse effects on the nervous system. Exposure to toluene seemed to be associated with heavy drinking.

Adult↗
PubMed1985

Direct hospital costs in coronary bypass surgery.

The direct hospital costs of 100 coronary artery bypass grafting operations are calculated. The basis of the calculations is the detailed, function-based, market-priced analysis of the files, including the hospital deaths, complication and reoperations of this patient group. The price of a CABG operation proved to lie somewhere between FIM 30,000 and 50,000, the mean value being FIM 46,800. The variation range is wide: FIM 18,200-FIM 249,500 (SD +/- FIM 26,000). It must be emphasized, however, that all preoperative hospital costs including coronary angiography costs and also postoperative follow-up hospital costs fall beyond this study.

Coronary Artery Bypass↗
PubMed1984

Prevention of progression of coronary atherosclerosis by treatment of hyperlipidaemia: a seven year prospective angiographic study.

The progression of coronary atherosclerosis was assessed by repeat angiography in 28 patients and 20 controls with hyperlipidaemia (serum cholesterol concentration greater than 7.2 mmol/l (278 mg/100 ml) or serum triglyceride concentration greater than 2.0 mmol/l (177 mg/100 ml), or both) and symptomatic coronary artery disease of two or three vessels. Twenty eight patients (26 men and two women) were treated with diet and drugs (clofibrate or nicotinic acid, or both) to lower lipid concentrations. Twenty men taking part in a simultaneous study served as non-randomised controls. They received medical treatment for coronary artery disease but no treatment to reduce lipid concentrations. The initial levels of coronary risk factors and the angiographic state were comparable in the two groups. In the 28 patients total cholesterol, total triglyceride, and low density lipoprotein cholesterol concentrations were reduced by an average 18%, 38%, and 19% respectively by treatment for hyperlipidaemia and high density lipoprotein cholesterol concentration was increased on average by 10%. The treatment maintained these concentrations during a follow up of seven years. By all criteria coronary lesions progressed significantly less in the patients than the controls: the angiographic state remained completely unchanged in nine (32%) of the patients compared with only one (8%) of the surviving controls; of the arterial segments at risk, 46 (16.5%) progressed in the patients compared with 50 (38.2%) in the controls (p less than 0.001); and the coronary obstruction increased less in patients than in controls (p less than 0.05). Cardiac survival was 89% in seven years in the patients compared with 65% in five years in the controls (p less than 0.01). The anginal symptoms diminished or remained stable in 16 of the 24 patients who survived until the end of the study. The progression of coronary atheromatosis was significantly greater in those patients who during the seven years of treatment had an average total cholesterol concentration, VLDL plus LDL cholesterol concentration, or ratio of LDL to HDL cholesterol concentration above the respective median value than in those with the corresponding values below median. On the other hand, the patients with HDL cholesterol concentrations above the median during treatment showed less progression than those with lower HDL cholesterol concentrations. The increase in coronary obstruction was inversely related to the average HDL cholesterol concentration during treatment. The progression was not, however, related to LDL cholesterol concentration during treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Arteriosclerosis↗
PubMed1984

Sequential internal mammary artery (IMA) grafts in coronary artery bypass surgery.

Since 1972, double or triple left IMA bypasses have been made on 61 consecutive patients with a total of 123 distal anastomoses to the LAD or to the LD branches of the LAD. There were 54 additional vein grafts with 102 distal anastomoses. The number of single IMA grafts in the same period of time was 400. Hospital mortality was 2 patients (3.3%), with a late mortality of 7 patients (11.3%), 2 of them being heart-related, one of hypernephroma, one suicide, and of unknown cause in the remaining 3 patients. Five patients refused postoperative angiography. There were 50 patients with one or more postoperative angiograms available for the analysis after a mean follow-up time of 35.1 (0.5 to 128) months. The late patency of the left IMA anastomoses was 97% (98/101) and 82.4% (84/102) of the vein anastomoses. There were 2 anastomotic left IMA occlusions to the LD at 2 weeks and 10 months, respectively, and to LAD at 13 months. No left IMA graft had become completely occluded. According to the trend analysis, there was a 97.5% patency at 5 years, and 95.7% at 10 years with left IMA grafts compared to 78.4 and 67.9, respectively, with vein grafts. Ten left IMA grafts were dilated, 2 narrowed and 36 unchanged at the late angiography. Sequential left IMA graft, in appropriate cases seems to result in the most superior patency rate of all types of grafts.

Adult↗
PubMed1984

Blood acetaldehyde concentration gradient between hepatic and antecubital venous blood in ethanol-intoxicated alcoholics and controls.

After ethanol (0.8 g kg-1 body weight orally) significant concentrations of acetaldehyde (2-20 mumol 1(-1] were found in hepatic venous blood of moderately intoxicated non-alcoholic male Caucasians in spite of the absence of detectable levels (less than 2 mumol 1(-1] in simultaneously taken antecubital blood. In thirteen chronic alcoholics the elevation of blood acetaldehyde was more constant in the hepatic than in the peripheral vein. Fructose infusion caused a marked elevation of acetaldehyde both in the hepatic and peripheral vein of four controls, but not of four alcoholics, who eliminated ethanol about 50% faster than controls. The rate of disappearance of acetaldehyde from sampled and in vitro incubated hepatic venous blood was similar to that observed after addition of acetaldehyde in vitro to ethanol-free control blood (2 nmol ml-1 min-1 at 20 mumol 1(-1) acetaldehyde; Km about 30 mumol 1(-1]. Uptake of acetaldehyde in blood was calculated to explain maximally 30-40% of the concentration gradient between central and peripheral blood.

Acetaldehyde↗
PubMed1984

Phase I trial of intermittent high-dose dacarbazine.

A phase I study was conducted with dacarbazine (DTIC) protected from light and administered iv as a single dose every 3 weeks. Eighteen patients received 47 courses of DTIC, with doses ranging from 850 to 1980 mg/m2. Hypotension was the dose-limiting toxic effect and it may be secondary to the citric acid present in the pharmaceutic preparation of DTIC. Sporadic myelosuppression was seen at doses greater than 1380 mg/m2. Other side effects noted were nausea and vomiting, acute diarrhea, headache, a "flu-like" syndrome, and a hypersensitivity reaction to sunlight. No antitumor activity was found. The results of this study indicate that this may be a qualitatively different way of giving DTIC, and that the side effects of this drug may be intermingled with those of citric acid in this particular schedule. If the conventional pharmaceutic preparation of this drug is not modified, further studies with high-dose DTIC protected from light should be discouraged.

Adult↗
PubMed1983

Progression of coronary artery disease in randomized medical and surgical patients over a 5-year angiographic follow-up.

Progression of coronary artery disease (CAD) was assessed prospectively in a randomized series of 36 medically treated and 42 surgically treated patients with angina pectoris. The medical patients were reexamined after 5 years and the surgical patients 3 weeks, 1 year and 5 years after operation. Sixty-seven percent of the medical patients and 69% of the surgical patients had progression. The frequency of new lesions in initially normal segments after 5 years in the medical group was 6.7%, versus 4.1% in ungrafted normal segments in the surgical group (p = 0.05 less than 0.010). The frequency of progression in abnormal arteries was 24.1% in the medical group, versus 22.6% in the ungrafted arteries of the surgical group (p = 0.90 less than 0.95). The rate of progression of obstructed segments proximal to the graft over 5 years was 43%, versus 27% of the corresponding segments in the medical group (p less than 0.01). Progression took place in 11.6% of normal segments proximal to the graft, versus 2% of the corresponding segments in the medical group (p less than 0.05); 69% of progression occurring in segments proximal to the graft had reached total occlusion, versus 38% of the corresponding segments in the medical group (p less than 0.01). Progression developed in 3.9% of segments distal to the graft, versus 3.1% of the corresponding segments in the medical group. Progression takes place at identical rates in medically treated patients and in ungrafted arteries and segments distal to the graft in surgical patients. Proximal to the graft the rates differ and total occlusions appear as early as 3 weeks after operation.

Coronary Angiography↗
PubMed1983

The effect of dipyridamole and warfarin on the patency rate of coronary artery bypass grafts.

Seventy consecutive patients who had undergone coronary artery bypass surgery were postoperatively treated with either dipyridamole or warfarin for 6 months. The dipyridamole series consisted of 28 patients given 150 mg dipyridamole 3 times daily and the warfarin series, of 42 patients who received the appropriate daily dose of warfarin needed to maintain the prothrombin time within the therapeutic range. The majority of patients in both series belonged to the NYHA class III. Sixty-one percent of the patients in the dipyridamole series and 66% of those of the warfarin series had triple vessel disease. In all, 70 and 105 coronary artery branches were bypassed in the dipyridamole and warfarin series, respectively. This resulted in 2.5 distal anastomoses per patient in each series. The patency of the grafts was confirmed angiographically. There was no mortality during the 23.6 +/- 2.4 months follow-up period in the dipyridamole series or the 12.8 +/- 2.7 months in the warfarin series. The patency rates were 95.7% and 88.6% in the dipyridamole and warfarin series, respectively. It is apparent that dipyridamole is not less effective than warfarin in preventing postoperative coronary graft occlusion.

Adult↗
PubMed1983

Prognosis of cryptogenic fibrosing alveolitis.

We have analysed retrospectively 100 consecutive patients with cryptogenic fibrosing alveolitis, who were treated with corticosteroids and followed for at least three years. At the time of diagnosis biopsy specimens were available in 64 cases. The clinical, radiographic, physiological, and histological features and the response to steroid treatment have been correlated with the prognosis. An early objective functional improvement was observed in 30%. Analysis of the survival data (life table and log rank test) showed a longer survival in younger patients and in patients with a shorter duration of symptoms before presentation, less radiographic abnormality, and less impairment of diffusing capacity, but not clearly in patients with more cellular histological appearances. The most favourable prognostic sign seemed to be an early response to steroid treatment.

Adolescent↗
PubMed1983

Persistent improvement after coronary bypass surgery: ergometric and angiographic correlations at 5 years.

One hundred patients with angina pectoris who fulfilled specific entry criteria were randomly assigned to either medical therapy or bypass surgery. These groups were subjected to annual exercise testing during a 5-year follow-up period. The degree of revascularization was assessed by graft and native vessel angiography at 3 weeks, 1 year and 5 years after the operation. The exercise tolerance of the medical group remained largely unchanged during the follow-up. Eighty-five to 95% of the patients were using beta-blocking compounds at the successive testing situations. The surgical group exhibited a sustained improvement in exercise tolerance: Total work increased by 39-66% (p less than 0.02-0.001) and maximal ergometric load by 23-35% (p less than 0.01-0.001), and maximal ST depression decreased by 39-61% (p less than 0.05-0.001). The use of beta-blocking compounds in the surgical group steadily increased, from 44% at 6 months after operation to 63% of patients at 5 years. Division of the surgical group into subsets of complete and incomplete revascularization revealed that the improvement was confined to complete revascularization. Thus, the improved exercise tolerance after bypass surgery was a result of successful reestablishment of effective coronary perfusion; despite graft attrition (15% in 5 years) and new lesions in the native arteries, this improvement persisted for 5 years with appropriate medical therapy.

Aged↗
PubMed1983

Experience with streptokinase treatment of major pulmonary embolism.

The efficacy of streptokinase was studied in an open trial on 30 consecutive patients with major pulmonary embolism, affecting at least three lobar arteries in pulmonary angiography. Streptokinase was started on average 26 hours from the onset of symptoms and usually given directly to the pulmonary artery. Conventional dosage was used and adjusted by thrombin time. The average treatment period was 32 hours. 26 patients (87%) survived and made a good clinical recovery. Improvement occurred early: signs of improved pulmonary perfusion appeared usually within four hours. Repeat angiograms in 20 patients showed remarkable increase in pulmonary perfusion and partial but not complete lysis of the emboli. Four patients (13%) died, three of them because of no response and one due to late cardiac arrhythmia. Bleeding requiring blood transfusion occurred in four patients, but caused no late sequelae. It is concluded that streptokinase treatment of major pulmonary embolism is effective and safe in rapidly restoring pulmonary perfusion.

Adult↗
PubMed1983

TruCut needle biopsy in sarcoidosis. Relationship between histology of the biopsy specimens and radiographic features and pulmonary function.

Ninety-nine TruCut needle biopsies were performed on 92 patients with sarcoidosis. Non-caseating granulomas were found in 77 of 92 patients (84%) and in 78 of 99 biopsies (79%). Granulomas were found in 67% of patients showing only slight radiographic opacity (ILO classification grades 0/0-1/1) and in 90% of patients with higher radiographic grades (ILO 1/2-3/3). There was also a positive relationship between the size of the biopsy specimen and the presence of granulomas. Granulomas were found in 68% of small biopsy specimens and in 90% of moderate or large specimens.

Adult↗