Search PubMed⌕ Search

Biomedical subjects

R Pifarre

Publications and source records attributed to R Pifarre.

At least 73 records · Page 4Linked to original sources
PubMed1987

Successful reversal of acute cardiac allograft rejection with OKT*3 monoclonal antibody.

The efficacy of OKT*3 monoclonal antibody in reversing acute cardiac allograft rejection was investigated in 10 cardiac transplant recipients aged 5 to 57 years (mean 34 +/- 18) and treated with the same induction and maintenance immunosuppression. Serial endomyocardial biopsies, right heart catheterization, and echocardiograms were performed for rejection surveillance. After intensified immunosuppression with equine antithymocyte globulins and steroids, nine patients showed persistent rejection (lymphocytic infiltration and myocyte necrosis). Conventional immunosuppression was contraindicated in one patient. OKT*3 (5 mg by intravenous push daily for 14 days) resulted in complete resolution of rejection in nine of 10 patients (90%). After therapy with OKT*3 mean right atrial and pulmonary arterial wedge pressure were significantly lower (9.1 +/- 4.0 vs 4.8 +/- 2.0 mm Hg and 13.4 +/- 4.3 vs 8.0 +/- 3.3 mm Hg, respectively; p less than .05). Cardiac index was doubled in two patients with rejection-induced cardiac dysfunction (1.5 vs 3.2 and 1.6 vs 2.7 liters/min/m2). Only two patients developed antibodies to OKT*3. Fever, nausea and headache occurred with the first three doses of OKT*3 and did not recur. One patient developed aseptic meningitis. OKT*3 effectively reverses refractory cardiac allograft rejection before the development of irreversible graft dysfunction. Patients who do not develop antibodies to OKT*3 can be retreated with this drug. Adverse reactions to OKT*3 are self-limited.

Acute Disease↗
PubMed1986

Diagnosis of intrapericardial tumor in an infant by two-dimensional echocardiography.

Two-dimensional echocardiography is a useful noninvasive tool for diagnosing intrapericardial tumors as a cause of respiratory distress or abnormal cardiomediastinal shadow on chest x-ray. Early recognition of these tumors within the pericardium is important since surgical removal is often curative. Cardiac cineangiography is unnecessary to delineate further the tumor and should be reserved for those in which associated intracardiac defects are suspected.

Cysts↗
PubMed1986

Qualitative evaluation of coronary flow during anesthetic induction using thallium-201 perfusion scans.

Qualitative distribution of coronary flow using thallium-201 perfusion scans immediately postintubation was studied in 22 patients scheduled for elective coronary artery bypass surgery. Ten patients received a thiopental (4 mg/kg) and halothane induction. Twelve patients received a fentanyl (100 micrograms/kg) induction. Baseline thallium-201 perfusion scans were performed 24 h prior to surgery. These scans were compared with the scans performed postintubation. A thallium-positive scan was accepted as evidence of relative hypoperfusion. Baseline hemodynamic and ECG data were obtained prior to induction of anesthesia. These data were compared with the data obtained postintubation. Ten patients developed postintubation thallium-perfusion scan defects (thallium-positive scan), even though there was no statistical difference between their baseline hemodynamics and hemodynamics at the time of intubation. There was no difference in the incidence of thallium-positive scans between those patients anesthetized by fentanyl and those patients anesthetized with thiopental-halothane. The authors conclude that relative hypoperfusion, and possibly ischemia, occurred in 45% of patients studied, despite stable hemodynamics, and that the incidence of these events was the same with two different anesthetic techniques.

Anesthesia↗
PubMed1985

A database management system for cardiovascular disease.

The Loyola Open-Heart Registry is a fully operational database that has hundreds of programs designed to input, modify, verify, maintain, update and analyze its raw data. It contains retrospectively collected data on approximately 4000 patients who underwent coronary bypass (CABG) or cardiac valve replacement (CVR) from January 1970 to May 1981. Since 1981 we have collected detailed information on approximately 1300 patients per year. The system is described in clinical and technical terms. The means of data acquisition and input are described and a flow chart for the collection of data is provided. The system's hardware is described briefly, and the nature and limitations of the software are discussed. Specific datasheets are described, and examples of output retrievals are provided. A few comments are made regarding the administrative aspects of database management. The entire paper is summarized, and our future plans and areas of development are described.

Cardiovascular Diseases↗
PubMed1985

Urgent surgery for ventricular septal rupture complicating acute myocardial infarction.

Medical treatment of postinfarction ventricular septal rupture carries a high mortality. Delayed surgery can be done with good results but many patients die awaiting operation. In 1978 we decided that all such patients presenting to us should undergo urgent cardiac catheterization and surgery. Since then we have seen 22 such patients. Two decided against surgery and died in the hospital. Twenty agreed to surgery; in 15 of these an intra-aortic balloon pump was inserted before catheterization and in another four at the time of operation. Catheterization was performed without complication, and surgery was performed within 2 days of septal rupture in all 20 patients. Twelve patients (60%) survived hospitalization. Three patients died of pump failure shortly after surgery; five died after a second operation for free wall rupture (n = 2) or persistent or recurrent septal defect (n = 3). Two other patients survived reoperation. Survivors were significantly younger than nonsurvivors and had a higher cardiac index and a lower shunt ratio. At a mean follow-up of 47.9 months, there has been one late noncardiac death. Eleven patients survive, all in class I or II. We conclude that in patients with septal rupture urgent surgery results in improved near-term survival compared with known survival rates in medically treated patients. Early recurrent rupture is common and often disastrous and requires refinement in operative technique. Age, cardiac index, and shunt volume are related to surgical outcome. Hospital survivors do very well on a long-term basis. We recommend continuation of this aggressive approach.

Age Factors↗
PubMed1984

The reasons for gastrointestinal consultation after cardiac surgery.

Sixty-two (1.10%) of 5719 patients undergoing cardiac surgery between 1976 and 1982 required postoperative gastro-intestinal consultation, and 24 (0.4%) required operation. The major complications were gastrointestinal bleeding due to gastritis in 15, peptic ulcer in ten, and acute cholecystitis in 12. Acute diverticulitis was diagnosed in eight patients. Three patients had massive bowel necrosis, while eight patients had painless jaundice. Six patients had miscellaneous problems requiring consultation. Operative mortality was 10/25 (40%). Most complications occurred within 7 days of cardiac surgery. Seventeen of 62 patients required an intra-aortic balloon pump, and 29/62 had a hypotensive episode during cardiac surgery. Gastro-intestinal complications following cardiac surgery are rare but carry significant mortality. Patients with circulatory compromise and those requiring intra-aortic balloon pump are most likely to develop gastrointestinal complications. Careful monitoring and physical examination of these high-risk patients following cardiac surgery is required for early detection and effective treatment.

Acute Disease↗
PubMed1982

Transient bundle branch block following use of hypothermic cardioplegia in coronary artery bypass surgery: high incidence without perioperative myocardial infarction.

Hypothermic cardioplegia (HCP) is a method commonly used for myocardial preservation at the time of aortic cross-clamping during coronary artery bypass grafting (CABG). This study assessed the frequency and significance of transient bundle branch block (BBB) in 50 patients undergoing CABG using HCP compared to 61 controls. All patients had normal QRS complexes on preoperative ECG. CLinical, hemodynamic, and operative data were similar in both groups. Seventeen (34%) of the HCP group and four (6%) of the controls developed postoperative BBB (p less than 0.001). These changes were transient in all but three patients in the HCP group. None of the HCP patients with transient BBB had evidence of perioperative myocardial infarction. Clinical and operative parameters did not provide prediction of development of transient BBB. This study demonstrates that transient BBB in the immediate post-CABG period occurs commonly with the use of HCP and does not indicate myocardial necrosis.

Aged↗
PubMed1982

Hemodynamic response to changes in ventilatory patterns in patients with normal and poor left ventricular reserve.

Hemodynamic effects of controlled mechanical ventilation (CMV), intermittent mandatory ventilation (IMV), and intermittent mandatory ventilation with 5 cm H20 PEEP (IMV 5 peep) were studied in 20 patients after aortocoronary bypass surgery. Significant increases in cardiac index (CI) and stroke volume index (SI) (p less than 0.01) resulted in patients with normal left ventricular end-diastolic pressure (LVEDP) and ejection fraction (EF) changing from CMV to IMV. With a change from IMV to IMV 5 peep, the CI and SI returned to CMV values. However, in patients with increased LVEDP with an EF of less than 0.6, suggesting poor ventricular function and reserve, when the mode of ventilation was changed from CMV to IMV, right atrial pressure (RAP) and pulmonary artery occlusion pressure (PAOP) significantly increased (p less than 0.01) with an associated significant decrease in mean arterial pressure (MAP), CI, SI (p less than 0.01). When these patients were placed on IMV 5 peep, the hemodynamic variables returned to the values obtained during CMV. We conclude that changing from CMV to IMV has salutory effects on the patient's hemodynamic values with normal left ventricular function. But in patients with failing left ventricle, volume overload of right ventricle which occurs with the institution of spontaneous respiration during IMV has deleterious effects on the hemodynamic variables. These deleterious effects can be effectively negated by the application of IMV 5 peep.

Blood Pressure↗
PubMed1982

Risk factors related to progressive narrowing in aortocoronary vein grafts studied 1 and 5 years after surgery.

Factors related to late narrowing of aortocoronary vein grafts are poorly understood. Repeat aortocoronary bypass graft angiography was performed in 34 patients at 13 +/- 5 months and 61 +/- 13 months after surgery. In these patients, 61 of 65 grafts (94%) were patent at 1 year; at 5 years, 39 of these patent grafts (64%) remained unchanged, 21 (34%) had become progressively narrowed and one (2%) was totally occluded. There appeared to be no predilection for progression to occur at specific segments or in particular grafts: Eight of 28 left anterior descending (29%), seven of 17 right coronary artery (41%) and seven of 16 circumflex artery grafts (44%) (NS) showed further narrowing. Progressive graft narrowing occurred in 15 of 34 patients (44%). Risk factors (incidence of smoking, diabetes mellitus, hypertension, and triglyceride and cholesterol levels) in these 15 patients were compared with those in the 19 patients whose grafts were unchanged between 1 and 5 years. The incidence of smoking, diabetes mellitus (fasting blood sugar greater than or equal to 110 mg % or 2-hour postprandial sugar greater than or equal to 140 mg %) and hypertension (systolic blood pressure greater than 140 mm Hg or diastolic pressure greater than or equal to 95 mm Hg) were 46%, 27% and 33%, respectively, in the patients with progressive graft narrowing and 68%, 16%, 26% in the patients whose grafts were unchanged (NS). The average mean triglyceride levels were 617 +/- 785 mg % (+/- SD) and 195 +/- 86 mg %, respectively (p less than 0.05). The average mean cholesterol levels were 279 +/- 53 mg % and 234 +/- 35 mg %, respectively (p less than 0.01). In patients who have had aortocoronary bypass surgery, total graft occlusion is rare between 1 and 5 years after surgery. Progressive narrowing of grafts is common and appears to be associated with elevated blood lipids.

Cholesterol↗
PubMed1981

Diagnosis of dissecting aortic aneurysm by computed tomography.

Computed tomography (CT) of the torso combined with simultaneous intravenous bolus injection of contrast media was used in sixteen patients suspected of having dissected their aorta. All patients had subsequent correlative percutaneous aortography within 24 h of the CT examination. Four patients proved to be normal, one had an aneurysm of the thoracic aorta, and eleven had aortic dissection (five type I, six type III dissection). All eleven patients with aortic dissections were diagnosed by CT and angiography; nine had spontaneous dissections and two had iatrogenic injuries to the aorta. Limitations of this imaging procedure include; inability to detect aortic valvular dysfunction and failure to provide an adequate perspective of aortic branch involvement. Potential benefits include: avoidance of aortogram in some cases, relative non-invasiveness, rapidity and ease of procedure, and less expense, radiation, contrast media, and discomfort to the patient. Early experience with CT-enhancement technique has reliably demonstrated normal as well as abnormal aortic wall morphology. It may have a place as an alternative to the conventional aortogram.

Adult↗
PubMed1981

Progression of coronary artery disease in medically and surgically treated patients 5 years after randomization.

Repeat angiography was performed at 63 +/- 9 months in 26 medically treated patients and at 66 +/- 10 months in 32 surgically treated patients with chronic angina. The native coronary arteries were divided into three major trunk vessels and 15 angiographic segments. Progression of disease was defined as the appearance of new (greater than 50%) obstruction or significant worsening of existing lesions in a segment or vessel. The incidence of progression was similar in medical and surgical patients, comparing individual segments (69 of 312 [22%] and 91 of [23%], respectively) or vessels (49 of 78 [63%] and 60 of 96 [63%], respectively). In both medical and surgical patients, segments initially free of disease showed a 14% incidence of developing new lesions, compared with the 37% progression in segments initially diseased (p less than 0.001). In the surgical patients, progression occurred in 48 of 219 (22%) nongrafted and 43 of 177 (24%) grafted segments (NS). When analyzed by major trunk vessel, progression occurred in 40 of 57 grafted arteries (70%) and 20 of 39 nongrafted arteries (51%) (NS). The incidence of new total occlusions was similar in medical and surgical patients (6% and 8%, respectively); new total occlusions occurred predominantly in diseases segments (15% and 22%, respectively). In patients with stable angina pectoris who have medical or surgical treatment assigned by randomization, progression of coronary disease at 5 years is not influenced by which mode of therapy was received. Vessels initially free of disease are at relatively low risk for development of disease within 5 years. In surgical patients, grafted and nongrafted vessels show similar rates of progression.

Angiography↗
PubMed1980

Treatment of uremic pericardial effusion by local steroid instillation via subxiphoid pericardiotomy.

Seven maintenance hemodialysis patients suffering from intractable uremic pericardial effusion were treated with instillation of a non-absorbable steroid, triamcinolone hexacetonide, into the pericardial sac via a large-bore catheter. The latter was placed under direct vision by subxiphoid pericardiotomy. All patients responded to the treatment while complications of the procedure were few and minor.

Drainage↗