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P Kosolcharoen

Publications and source records attributed to P Kosolcharoen.

10 recordsLinked to original sources
PubMed2003

Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: Treatment algorithm based upon a large series.

BACKGROUND: The development of a saphenous vein graft aneurysm (SVGA) after coronary artery bypass graft surgery is a rare occurrence. There are approximately 60 cases reported in the literature, the majority being single case reports. There is no consensus on the treatment of SVGA. METHODS: Retrospective analysis of the patients treated with SVGA was performed at our institution. Demographic and co-morbidity data were acquired on the patients. Patients who underwent surgical treatment were compared to those treated conservatively with the primary outcome being survival time from diagnosis of the SVGA. RESULTS: Thirteen patients with 15 SVGA were identified. The average age at the time of the most recent coronary artery bypass grafting (CABG) was similar in the conservative and the surgically treated groups (55 vs. 56.5 years, respectively). The average number of grafts per patient at the most recent CABG was similar (3.83 vs. 4.0, respectively). The average time from CABG to diagnosis was similar in both the groups (12.6 vs. 15 years, respectively). The average survival from diagnosis was similar in both the groups (2.3 vs. 1.5 years, respectively, p>0.05). CONCLUSIONS: Early surgical treatment of SVGA does not provide longer short-term survival compared with conservative management. A treatment algorithm for SVGA based upon patient co-morbidities and aneurysm characteristics is proposed.

Adult↗
PubMed1998

Fungal purulent constrictive pericarditis in a heart transplant patient.

Purulent pericarditis caused by Candida species is rare and is associated with very high mortality. Immunosuppressed transplant patients are particularly susceptible to fungal infections. We report a case of Candida purulent constrictive pericarditis in an immunocompromised heart transplant patient who was treated successfully with antifungal agents, surgical drainage, and pericardiectomy.

Amphotericin B↗
PubMed1997

Effect of rapid intra-atrial saline infusion on atrial pressures and atrial natriuretic hormone secretion.

To evaluate the relationship between the right atrial pressure and atrial natriuretic hormone secretion, we studied 16 healthy males, ages 18-24, after five days on a low-salt diet (mean 24-h urinary sodium excretion: 17 +/- 3 mEq). After 90 min of equilibration to the supine position, a multilumen catheter was inserted into the right atrium, and 11 of isotonic saline was infused intra-atrially over 15 min through this catheter. Blood pressure, heart rate, and right atrial pressure were recorded just before (0 min), immediately after completion of the infusion (15 min), and every 15 min for 45 min thereafter. Two blood samples were drawn at each time point for atrial natriuretic hormone assay: one from the right atrium (central) and the other from a peripheral vein. Blood pressure did not change significantly during the entire study. Heart rate increased by 5 beats/min on average at 15 min (p < 0.005) and returned to baseline at 60 min. Good correlation occurred between central and peripheral atrial natriuretic hormone levels at times 0, 30, 45 and 60 min (r2 = 0.66, 0.45, 0.76 and 0.70, respectively; p < or = 0.02). An increase in right atrial pressure and an increase in central atrial natriuretic hormone levels correlated well at times 30, 45 and 60 min, but there was no such correlation between an increase in right atrial pressure and an increase in peripheral atrial natriuretic hormone levels at any time point. Similarly, a maximum increase in right atrial pressure correlated with a maximum increase in central atrial natriuretic hormone levels (r2 = 0.48; p < 0.02), but not with a maximum increase in peripheral levels of this hormone. We concluded that an increase in right atrial pressure caused by a rapid infusion of isotonic saline induces secretion of atrial natriuretic hormone in the right atrium. The observed discrepant course of change in central and peripheral atrial natriuretic hormone levels suggests the additional contribution of secretion beyond the level of the coronary sinus.

Adolescent↗
PubMed1988

Five-year changes in coronary arteries of medical and surgical patients of the Veterans Administration Randomized Study of Bypass Surgery.

Progression of coronary artery disease was evaluated after 5 years of follow-up in 119 medically and 109 surgically treated randomized patients who adhered to their assigned therapy. Progression was defined as the appearance of a new lesion (greater than or equal to 50% stenosis) or worsening of a preexisting lesion in a coronary artery. Progression occurred in 36% (97 of 268) of the arteries in medical patients, in 38% (35 of 93) of the ungrafted arteries in surgical patients, in 74% (72 of 97) of the arteries with patent grafts at 5 years, and in 63% (29 of 46) of the arteries with closed grafts. After adjustment for the vessel system and the severity of disease at baseline, the risk of progression was three to six times higher in grafted arteries than in ungrafted arteries (p less than 0.01). For grafted arteries, the risk of progression was twice as high in arteries with patent grafts compared with those with closed grafts (p = 0.14). The majority (78%) of the progression in grafted arteries was to 100% occlusion. Proximal and distal progression rates in arteries with patent grafts were 74% and 11%, respectively. In the majority of arteries with closed grafts that progressed, the site of progression could not be determined. Regardless of treatment, the risk of progression was two times higher in the right coronary artery than in the left anterior descending or circumflex arteries. Progression risk was also twice as high in arteries with moderate disease at baseline compared with those with minimal or severe disease.

Coronary Angiography↗
PubMed1986

Is milking and stripping chest tubes really necessary?

The purpose of this study was to determine if chest tubes that are not milked or stripped occlude more frequently than milked or stripped tubes, and if the amount of drainage varies according to the treatment of the tubes. Following coronary artery bypass graft procedures, 49 male subjects had their chest tubes milked every 2 hours, had them stripped every 2 hours, or served as controls (i.e., their tubes were neither milked nor stripped). An analysis of variance was applied to the results. There was no significant difference in total drainage volume, hourly zero drainage, heart rate, or occurrence of arrhythmias among the three groups of subjects. Four to 16 hours postoperatively, a significantly higher volume of drainage occurred in the subjects whose chest tubes had been stripped. Stripping is particularly discouraged during this interval. The chest tubes remained patent with or without milking or stripping. We conclude that neither milking nor stripping is necessary for the proper care of chest tubes. We recommend that tubes be positioned such that they promote continuous drainage.

Aged↗
PubMed1983

Detection and estimation of rheumatic mitral regurgitation in the presence of mitral stenosis by pulsed Doppler echocardiography.

The sensitivity and specificity of pulsed Doppler echocardiography (PDE) in diagnosis and estimation of the severity of mitral regurgitation in the presence of rheumatic mitral stenosis was studied in 34 patients (18 women and 16 men) ranging in age from 33 to 70 years (mean 55). Definitive diagnosis of mitral regurgitation was confirmed in all patients by angiography and in 20 patients also by indicator dilution technique. Mitral regurgitation was detected by PDE in all patients with angiographically proven severe mitral regurgitation and in 7 of 8 patients with moderate mitral regurgitation. In patients with trace to mild mitral regurgitation, PDE was positive in only 7 of 13 patients. When subdivided for mild, moderate and severe mitral regurgitation, PDE sensitivity for diagnosis was 54, 88, and 100%, respectively; overall accuracy was 79% and specificity was 100%. Average systolic dispersion on time-interval histogram was 59% for mild, 89% for moderate, and 100% for severe mitral regurgitation. Groups of patients with mild mitral regurgitation could be differentiated from those with moderate (p less than 0.05) and severe (p less than 0.01) mitral regurgitation. A significant overlap of individual values, however, occurred. In 7 of 11 patients with moderate to severe mitral regurgitation, systolic turbulence also was detected in the left atrium. PDE was sensitive and specific in diagnosing moderate to severe mitral regurgitation in the presence of mitral stenosis. Assessment of precise severity of mitral regurgitation is still a problem in individual patients.

Adult↗
PubMed1983

Estimation of absolute left ventricular volume from gated radionuclide ventriculograms. A method using phase image assisted automated edge detection and two-dimensional echocardiography.

Twenty-four patients underwent gated cardiac blood pool (GBP) imaging, two-dimensional echocardiography (2-D echo), and single-plane contrast ventriculography (within 24 hours). Variable left ventricular (LV) regions of interest on GBP images were identified by an automated threshold radial search. To avoid excluding LV counts we indexed the search threshold to the threshold identified by a phase image generated by Fourier analysis. LV depth calculated by 2-D echo was used for attenuation correction of LV counts. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were calculated by dividing attenuation, background and deadtime corrected LV count rates by the background corrected count rate/ml of venous blood drawn during the study. Correlations between radionuclide and contrast volumes were good (EDV + ESV r = 0.97, EDV r = 0.94, ESV r = 0.95). Regression lines were close to the lines of identity. This method, in which GBP imaging and automated LV edge finding are complemented by 2-D echo for count attenuation correction, demonstrated reliable and reproducible noninvasive estimates of absolute LV volume.

Adult↗
PubMed1976

Liver dysfunction and polymyalgia rheumatica. A case report.

Hepatic dysfunction may be a manifestation of polymyalgia rheumatica. We present a second patient with the polymyalgia rheumatica syndrome and a significantly elevated alkaline phosphtase who, on liver biopsy, demonstrated granuloma formation and massive infiltration of the portal spaces with lymphocytes. The alkaline phosphatase elevation was favorably influenced by low dose steroid therapy.

Aged↗