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Biomedical subjects

P Sergeant

Publications and source records attributed to P Sergeant.

At least 37 records · Page 2Linked to original sources
PubMed1997

Validation and interdependence with patient-variables of the influence of procedural variables on early and late survival after CABG. K.U. Leuven Coronary Surgery Program.

OBJECTIVE: First to identify the patient-, procedural- and surgical experience variables influencing the early and late survival after CABG. Second to identify patients likely to benefit, and those unlikely to benefit, from technical details aimed at improving the results of coronary artery bypass grafting (CABG). METHODS: A consecutive series of 9600 patients who underwent CABG using a variety of revascularization methods between 1971 and 1992 were followed with 99.9% success. A multivariable time-related analysis was performed. Patient-specific predictions and nomograms were constructed from it to explore and validate the influences and interdependences of patient-variables with variations in details of the procedure. RESULTS: The 1-, 10- and 20-year risk-unadjusted survival was 97, 81 and 50% respectively. Patient-variables influencing early survival included severity of symptoms, patient presentation and extent of coronary disease, while late survival was influenced importantly by left ventricular function and cardiac and non-cardiac comorbidity. Technical details of the operation influencing early survival included use of endarterectomy, while details such as use of arterial grafting, extensiveness of sequential grafting, completeness of revascularization and extent of grafting to small coronaries influenced late survival to a highly variable degree. CONCLUSION: The early survival is neither improved nor worsened by single, multiple, sequential or complete arterial coronary reconstruction. The late survival is modestly improved with the use of an arterial graft to a major vessel, preferably but not exclusively to the anterior descendens, except for patients with limited life-expectancy. Differences in time-related survival with and without an arterial graft are nearly the same across all levels of ejection fraction. No late beneficial or detrimental effect was identified with more extensive use of arterial reconstructive surgery in multisystem disease.

Adult↗
PubMed1997

Early and late outcome after CABG in patients with evolving myocardial infarction.

OBJECTIVE: To study the determinants of early and late outcome after coronary artery bypass grafting (CABG) for evolving myocardial infarction. METHOD: 269 consecutive patients underwent isolated primary or repeat CABG from 1971 to 1992 for evolving myocardial infarction. By institutional policy, these were patients, strictly diagnosed, infarcting either in the cardiac cateterization laboratory, shortly after a previous CABG, or on cardiac intervention waiting lists. At operation, 125 patients were hemodynamically stable, 89 patients in cardiogenic shock 55 patients in cardiopulmonary resuscitation (CPR). Interval between infarct onset and surgical reperfusion ranged from 53 min to 15 h (median, 135 min; 90% between 75 and 360). An internal mammary artery graft (IMA) was used in 81 patients. Cross-sectional follow-up was 100% complete and multivariable analysis was conducted in the hazard function domain. RESULT: One-month, 1-year and 10-year survival was 86, 84 and 66%, respectively. The 1-year and 10-year survival, stratified by hemodynamic class, was respectively 98 and 77% for the stable patients, 77 and 60% for the patients in shock and 62 and 49% for those undergoing CPR. Shock and CPR were incremental risk factors for early but not late risk. Use of an IMA graft was not a risk factor early or late in either stable or unstable patients. CONCLUSION: CABG can be performed with acceptable early and long-term risk in selected patients with evolving myocardial infarction, whatever their hemodynamic state. Outcome as regards survival is neither adversely or advantageously affected by choice of bypassing conduit. An evolving myocardial infarction with stable hemodynamics carries a lesser risk than an unstable anginal state with changing ST-segment.

Angina, Unstable↗
PubMed1997

Comparative study of three vaginal markers of the premature rupture of membranes. Insulin like growth factor binding protein 1 diamine-oxidase pH.

OBJECTIVE: To assess the diagnostic value of three vaginal markers-insulin-like growth factor binding protein 1 (= IGFBP1), diamine-oxidase (= DAO) and pH-for diagnosis of the premature rupture of membranes. STUDY: One hundred pregnant women participated in the study. They were divided into three groups: group A (34 cases with intact membranes), group B (35 cases with total rupture of the membranes), group C (31 cases of suspected rupture of the membranes). Each patient underwent three successive tests for each of the three markers. The test order was allocated at random. For pH the reaction is colorimetric, for DAO the reaction is radio-enzymatic and for IGFBP1 the reaction is immuno-chromatographic. All three reactions are qualitative in nature. The parameters studied were conventional statistical parameters (sensitivity = SN, specificity = SP, positive predictive value = PPV and negative predictive value = NPV). RESULTS: The analysis of the statistics gave the following results in percentages for SN, SP, PPV and NPV respectively; pH: 90.7%, 77.2%, 75%, 91.7%. DAO: 83.7%, 100%, 100%, 89%. IGFBP1: 95.3%, 98.2%, 97.6%, 96.5%. CONCLUSION: The determination of variations in pH is not satisfactory. IGFBP1 is at least better than DAO with, additionally, advantages of rapidity and simplicity.

Amine Oxidase (Copper-Containing)↗
PubMed1996

Vulval algesiometer.

Explore the source record for details and available documents.

Electronics, Medical↗
PubMed1996

Micro-albuminuria analysis and pregnancy. An approach to detect placentary insufficiency?

OBJECTIVE: To assess the value of micro-albuminuria analysis (MA) in predicting clinical complications of placentary insufficiency in women with no known risk factor. STUDY DESIGN: A blind prospective investigation 20-24 weeks into pregnancy in a nulliparous population with no known risk factor. A reactive strip with a positive threshold value of 10 mg/l is used to detect MA. Judgment criteria concerning the progress of pregnancy are based on blood pressure during the 8th and 9th month of pregnancy and on the 2nd day after delivery, on albuminuria analysis in the 8th and 9th month of pregnancy and by the existence of fetal hypotrophia at birth. RESULTS: Some 218 patients participated in the investigation. MA was positive in 62 cases (28.4%). Of the 197 births which occurred 54 (27.4%) cases of positive MA, 34 (17.2%) cases presented positive judgment criteria indicating placentary insufficiency. The 21 others pregnancies are in course. MA sensitivity was thus 79.4% and specificity 83.4%. Negative predictive value (NPV) was 95.1% and positive predictive value (PPV) 50%. CONCLUSION: Our test is a reliable, simple and easily reproducible indicator of micro-albuminuria. In comparison with other tests it gives a good detection rate of a risk group for complication of placentary insufficiency. NPV is excellent, virtually excluding the occurrence of excessive blood pressure or intra-uterine growth retardation. PPV is less good.

Albuminuria↗
PubMed1996

Transvaginal ultrasound studies of vascular and morphological changes in uteri exposed to diethylstilbestrol in utero.

The aim of this prospective study was to establish complementary data of uteri exposed to diethylstilbestrol (DES) in utero for transvaginal analysis and vascularity changes during the menstrual cycle. A total of 28 women with DES-exposed uteri were compared with 60 non-exposed women. Transvaginal ultrasound and colour Doppler imaging were performed on days 5 and 22 of the menstrual cycle. Uteri were measured on sagittal and transverse scans. Uterine length, width, thickness and uterine cavity length and width were measured. Uterine volume and uterine cavity area were calculated. DES-exposed uterine volume was equal to 31.84 +/- 3.37 cm3. The cavity area of DES-exposed uterus was equal to 35.85 +/- 3.93 cm2. Cervix length of DES-exposed uterus was significantly smaller than that of non-exposed uterus. The uterine artery pulsatility index (PI) of DES-exposed uterus was significantly higher than that of normal uterus. Blood flow remained stable throughout the menstrual cycle. The PI of DES-exposed uterus remained stable during the menstrual cycle, as in non-exposed uterus, and it decreased during the luteal phase. This lack of modification in vascularity of DES-exposed uterus may explain miscarriages and obstetric complications such as intrauterine growth retardation or pre-eclampsia. The data may have implications for the assessment of reproductive status and the design of future studies on disorders of implantation in DES-exposed uterus.

Adult↗
PubMed1996

Transvaginal hysterosonographic evaluation of septate uteri: a preliminary report.

The objective of this study was to evaluate the diagnostic value of hysterosonography in septate uterine congenital abnormalities and more particularly in septate uteri. A total of 14 patients with a history of repeated spontaneous abortion or infertility who had previously undergone hysterosalpingography were included in this study. Patients were first examined by standard transvaginal ultrasound. Hysterosonography was then carried out by the intrauterine injection of an isotonic saline solution. The septate uteri were diagnosed by hysterosonography in all 14 patients (100%). Hysterosonography permitted the measurement of the thickness and height of the septum. Hysterosonography and transvaginal ultrasound enabled the correct diagnosis of malformation type in eight cases (57%). The accuracy of hysterosonography in postoperative control was greater than that of hysteroscopy. Transvaginal hysterosonography with saline solution is a low-cost, easy and helpful examination method for septate uteri. We propose that hysterosonography should be performed for the primary investigation of infertility and repeated miscarriages.

Female↗
PubMed1996

Clinical and cost comparison of three postoperative skin preparation protocols in CABG patients.

This descriptive pilot study includes a clinical and cost comparison of three preoperative skin preparation protocols (razor, clipper, and depilatory cream, in combination with whole body disinfection) in 82 patients undergoing coronary artery bypass graft (CABG) surgery. The clinical research protocol included an evaluation of body surface area, index of body hair growth, depilatory effect, skin integrity after depilation, and side effects of body disinfection with chlorhexidine solution, as well as protocol-specific evaluation criteria. The cost comparison was performed by keeping a record of the materials used and the workload for each separate activity associated with the three preoperative skin preparation protocols. Material and labor costs were calculated for each of the different aspects of the protocols. Clinical evaluation revealed that the clipper protocol (if necessary, in combination with cream depilation) is most convenient for depilation of patients with heavy hair growth. The depilatory cream protocol is an appropriate method to depilate patients with slight or moderate hair growth. The razor method should be eliminated from clinical practice due to previous documented evidence of an associated increased risk of postoperative wound infection. Cost calculations revealed that the median hospital cost (standardized for differences in hair growth index, working hours and nurse qualification levels) of the razor, clipper, and cream protocols is $6.13, $9.84, and $8.16 (U.S. dollars), respectively. In 1995, yearly raw (i.e. non-standardized) hospital costs for the three procedures were $14,402, $16,114, and $16,765, respectively, with 708 CABG procedures performed. Although changing to a clipper and/or cream protocol may be associated with an initial, although moderate, increase in hospital costs, compared to the razor method, substantial cost savings could be expected long-term. The superiority of these protocols is primarily due to a decreased incidence of postoperative wound infections, as compared to that associated with the razor protocol.

Aged↗
PubMed1994

Combined valve and coronary artery bypass surgery: early and late results.

Determinants of early, late and event-free survival of combined valve and coronary artery bypass graft (CABG) surgery were studied in 420 patients using multivariate analysis. It was found that the risk of hospital death increases 5 times when the preoperative NYHA class was > or = IV, 3 times when left ventricular (LV) function is significantly impaired and is double when mitral regurgitation is present. The survival probability of hospital survivors was 91% (87.3-94.5%) at 5 years. Late mortality was determined by advanced preoperative NYHA class ( > or = IV) and the presence of mitral regurgitation. The event-free survival probability of hospital survivors, i.e. total events including death, valve-related complications, ischemic complications and recurrent NYHA class > or = IV, was 73.0% (66.7-79.5%) at 5 years. Postoperative events were determined by the presence of preoperative NYHA class > or = IV, impaired ventricular function, mitral regurgitation and non-sinus rhythm. It is concluded that these parameters can be considered as the most important predictors of clinical outcome after combined valve and CABG surgery.

Adult↗
PubMed1994

Mitral valve surgery combined with coronary bypass grafting: multivariate analysis of factors predicting early and late results.

Total of 123 patients (mean age: 63.8 +/- 7.3 years, (male/female 65/35 percent) underwent mitral valve surgery combined with coronary artery bypass grafting during a seven year period. Preoperatively 12% of them belonged to NYHA functional class II, 54% to class III, 29% to class IV and 3% was operated under emergency conditions. The mitral valve lesion was most frequently either ischaemic (45%) or rheumatic (33%) in origin. Left ventricle function was moderately decreased in 18% and severely damaged in 3% of the patients as documented by preoperative ventriculography. Coronary surgery was performed in all cases with an average number of distal anastomosis of 2.2 +/- 1.1 per patient. The hospital mortality was 13%. Risk factors for early and late mortality were determined by univariate and multivariate analysis. Advanced preoperative functional class and decreased left ventricular function or ischaemic etiology were identified as significant risk factors for early mortality. The patients were followed for an average of 33 +/- 25 months. The majority of them experienced significant functional improvement postoperatively with 69% belonging to NYHA class I or II. The late survival for the 107 hospital survivors was 94.7% at one year, and 84.7% at five years, respectively. Late survival was independently determined by preoperative functional class or previous myocardial infarction. Freedom from ischemic and valve related complications at five years was 95% and 71.2% respectively. 58.2% of the hospital survivors were in functional class I or II and free of any valve related or ischemic complications at the end of the fifth follow up year.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Transluminal coronary balloon angioplasty: a useful therapeutic modality in octogenarian patients with severe angina.

In this study, the immediate and short-term outcome of 9 consecutive patients aged 80 years or older undergoing percutaneous transluminal coronary angioplasty (PTCA) are reported. Of these 9 patients, 8, despite optimal medical therapy, had unstable Class IV anginal symptoms and 6 had multivessel coronary artery disease. Primary success at PTCA (successful dilation of all attempted lesions without any complications) was achieved in 8 of the 9 (89%) patients. The one patient with unsuccessful PTCA had subsequent successful elective coronary bypass graft surgery. The 8 patients with primary success at PTCA have been followed up for a mean of 27 +/- 15 (range: 6 to 45) months. During follow-up, no patient died, required a further revascularization procedure or had a myocardial infarction. Indeed, 7 of these 8 patients have, following PTCA, remained entirely asymptomatic with no decrease in their activity level. Angina has recurred in 1 patient but it is mild and does not restrict his activities. Based on our encouraging experience we suggest that PTCA should be considered favourably in the treatment of selected octogenarian patients with severe angina poorly controlled by medical therapy.

Aged↗
PubMed1992

Time course of serum lipid and lipoprotein levels after coronary bypass surgery: modification by pravastatin.

The time course of the changes in serum lipid and lipoprotein levels have been studied in 100 patients undergoing coronary artery bypass surgery. Marked decreases occur in the levels of cholesterol (-45%), HDL-cholesterol (-35%), LDL-cholesterol (-53%), Apo A1 (-43%) and Apo B (-43%) on the third day after the operation. In the control group the values gradually returned to preoperative levels which are reached after three months. Three months after the intervention, in the pravastatin-treated group (20 mg/day) the values of total cholesterol (-20%), LDL-cholesterol (-28%) and Apo B (-22%), remained significantly lower than in the control group (p 0.0001) and were lower over the whole duration of the study. The postoperative time course of HDL-cholesterol and Apo A1, however, was not significantly influenced by the administration of pravastatin.

Aged↗
PubMed1992

Time course of serum Lp(a) in men after coronary artery bypass grafting.

The serum Lp(a) time course was studied in 100 male patients who underwent coronary artery bypass grafting (CABG). The patients were randomized in a placebo (N = 50) and pravastatin treated (N = 50) group. The pravastatin regimen was 10 mg daily from the third postoperative day on and 20 mg daily after 1 week during 11 weeks. Lp(a) levels and serum lipids were analyzed at baseline, at 3 and 10 days, and at 4 and 12 weeks post-CABG. A decrease of serum Lp(a) levels at the third postoperative day was seen which parallels the changes noted with the other serum lipids when using extracorporeal circulation. In contrast with the other serum lipids, a slight but significant Lp(a) overshooting was noticed at day 10 followed by a decrease of the serum Lp(a) levels to preoperative levels 1 month after the acute event. The study clearly depicts that there is a significant time-dependent effect on the serum Lp(a) levels post-CABG and that there is no effect of treatment (pravastatin). The data also reveal that reliable postoperative Lp(a) measurements can be made at earliest 1 month post-CABG.

Adult↗
PubMed1992

Surgery for massive pulmonary embolism.

Pulmonary embolectomies were performed in 30 patients from January 1973 until December 1991 in the University Hospital of Leuven. There was an 80% hospital survival. The late follow-up showed no recurrent pulmonary emboli. The preoperative haemodynamic status was the most important predictor for survival. Patients, under cardiopulmonary resuscitation or in profound cardiogenic shock before surgery, had a survival of only 50% while all other patients survived. Angiography, performed in only 23% of the cases, remained the most important diagnostic tool until the advent of transthoracic and transoesophageal echocardiography. Thrombolysis is an acceptable alternative in the stable patient, but pulmonary embolectomy is life-saving in the haemodynamically unstable patient and when thrombolysis is contraindicated.

Adult↗
PubMed1992

Early venous coronary bypass graft occlusion in a patient with non-specific aortitis: a case report.

A 58-year-old woman with aortic valve regurgitation and bilateral ostial coronary artery stenosis due to non-specific aortitis is presented. Four months after aortic valve surgery and venous bypass surgery, orificial occlusion or high grade stenosis of the bypass grafts occurred. Repeat coronary arteriography was followed by cardiac arrest and emergency surgery but patient did not survive. The etiology, pathological findings and surgical approach are discussed.

Aorta↗
PubMed1991

The return of clinically evident ischemia after coronary artery bypass grafting.

Although survival after coronary artery bypass grafting (CABG) is the most serious outcome information, the quality of life in living patients is largely determined by the freedom from ischemic events. The return of angina, acute myocardial infarct and sudden death were studied in a large (n = 5880) population of patients undergoing CABG between 1971 and 1987. The freedom from angina pectoris was 95%, 83% and 63% at 1, 5 and 10 years, respectively, after surgery. Early return of angina was related to both procedure incremental risk factors (incomplete revascularization and non-use of the internal mammary (thoracic) artery (IMA) as a conduit) and patient incremental risk factors (aggressiveness of the atherosclerotic process and severity of preCABG symptoms). Late angina return was related to patient risk factors including coexisting factors (hyperlipidemia and hypertension), preCABG symptom severity and gender (female). The freedom from an acute fatal or non-fatal postCABG myocardial infarct was 99%, 96% and 85% at 1, 5 and 10 years after surgery. The incremental risk factors for early infarction were related to incomplete revascularization, but late infarction was related to lipid levels, coexisting diseases (diabetes, positive family history) and non-use of IMA to LAD. The freedom from sudden death was 99.8%, 99% and 97% at 1, 5 and 10 years, respectively, after surgery. The incremental risk factors were dominated by the severity of the left ventricular dysfunction. The freedom from any ischemic event (any of the previous three) was 93%, 79% and 54% at 1, 5 and 10 years, respectively, after surgery. The incremental risk factors included all those cited above for the specific components. Patient-specific predictions validate the influences of these risk factors. They demonstrate that unlike the profound influence of the use of the IMA on survival, there is little benefit of the use of the IMA on return of ischemic events over and above the effect of revascularization per se. The study demonstrates that most patients will experience return of ischemic symptoms within a period of 15-20 years after surgery, but that this is most likely to be return of angina and rarely sudden death.

Adult↗