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Biomedical subjects

R Tartini

Publications and source records attributed to R Tartini.

At least 19 recordsLinked to original sources
PubMed1998

[Physician referral versus self-referral for initial outpatient cardiological examination].

BACKGROUND AND OBJECTIVE: To compare the clinical characteristics of patients who referred themselves for specialist cardiological examination with those of patients referred by a general practitioner, to assess the usefulness of inserting a general practitioner or general physician before referral, and to project the likely cost effectiveness. PATIENTS AND METHODS: The data on 77 patients referred by a medical practitioner (group 1) were prospectively compared with those of a cohort of 65 patients who referred themselves for specialist cardiological examination (group 2). All patients fulfilling the inclusion criteria had been included consecutively over a period of one year. Excluded were patients with confirmed cardiological disease; those who had previously undergone specialist cardiological examination elsewhere; those who came for a second opinion; and those who had been referred as part of a medical insurance assessment or primarily for invasive tests. Comparisons were made regarding symptoms, investigations performed and the number of new cardiological diagnoses in each group. The assessments of the cardiologists regarding the presence or organic heart disease (before the performance of any diagnostic tests) was tested as to their sensitivity, specificity as well as their positive or negative predictive value. RESULTS: Symptoms and incidence of organic heart disease differed significantly between the two groups. A doctor's referral to a cardiologist seemed to have a greater diagnostic and therapeutic advantage (filtre function). The cost of establishing a diagnosis of organic heart disease for group 1 patients was only about 80% of that for group 2 patients. A large proportion of group 2 patients did not wish the results to be transmitted to their general practitioner. CONCLUSIONS: The relationship between patient and general practitioner needs improvement. Not included in this study were patients with organic heart disease who had not had any access to specialist cardiological investigation or only after a cardiac event.

Ambulatory Care Facilities↗
PubMed1996

[Cardiology 1995].

Rapid progress in the field of cardiology calls for an almost continuous update on latest developments. In particular, this is the case with respect to indications for diagnostic and therapeutic interventions. The present contribution deals with some topics in this area. The first article elaborates on the theme of which diagnostic test is indicated, under what circumstances, and for which patient. Technical improvements in the surgical practice of coronary revascularization are discussed in the light of better therapeutic results. Unsolved questions of percutaneous dilatation (PTCA) are critically reviewed in a third article. Current problems in surgical treatment of valvular heart disease are dealt with in the fourth report. Finally, the enormous progress in pacemaker medicine that has accumulated since the world-wide first implant in 1959 by A. Senning is summarized in the last contribution.

Aged↗
PubMed1995

[Acquired heart diseases and pregnancy].

Understanding of the mechanisms of cardiovascular and hemodynamic adaptation during pregnancy helps to prevent or manage complications in cardiac patients during gestation. Manifestations of coronary heart disease are exceptional during pregnancy and delivery. The same is true of disorders of the pericardium. Peripartal cardiomyopathy is a myocardial disorder of undetermined cause occurring shortly before, during or after delivery, which may take a fatal course. Hypertrophic obstructive or non-obstructive cardiomyopathy is compatible with gestation and delivery without serious complications in most cases. Rheumatic mitral stenosis was the most common cardiac disorder until the 1950s. Nowadays it is rarely seen in this country. Surgical and other interventional therapies have greatly changed the outlook in pregnant women with valvular heart disease. A highly controversial issue is heart valve replacement in young women and management of anticoagulation during pregnancy. Like any other drug therapy, anticoagulation during gestation requires careful weighing of the benefit for the mother against toxic and teratogenic effects for the fetus. In women with heart disease the management of pregnancy should start, if possible, before conception. Thorough counseling and proper planning of pregnancy and of therapeutic measures is essential in order to avoid or manage complications.

Abnormalities, Drug-Induced↗
PubMed1993

[Work load in occupations].

Fewer subjects return to work after acute myocardial infarction or a cardiac surgical procedure than one would expect from the results of their medical examinations and cardiac tests. To decide whether a patient is able to return to work, one has to assess his individual prognosis and measure his maximal physical working capacity without cardiac dysfunction. Psychological and socioeconomic aspects have also to be considered. Recommendations are presented for practical procedure in assessing the ability of a patient to return to work.

Adaptation, Psychological↗
PubMed1993

The internal mammary artery 'string phenomenon'. Analysis of 10 cases.

The internal mammary artery (IMA) string sign has been described as a narrowing of IMA grafts in the late course after coronary artery bypass grafting. It has been assumed that this phenomenon was due to competitive flow in grafts connected to only mildly stenosed coronary arteries. We analyzed 10 cases of IMA string sign operated on between March 1988 and June 1991. Bilateral IMA was used in six cases and unilateral IMA in four. The mean interval between operation and reangiography was 14 +/- 11 months. String sign of the whole length of the IMA was detected in nine cases, and of the distal part between two sequential anastomoses in one. In all cases, the stenosis of the vessel bypassed with the narrowed graft proved to be only mild (50% or less) at reangiography. In all six cases with bilateral IMA grafts, the contralateral IMA was widely patent. These were all connected to highly stenosed or occluded coronary arteries. With respect to this observation, there is a high index of suspicion that the string phenomenon occurs due to competitive flow in only mildly stenosed coronary arteries. We decided, for our strategy in coronary artery surgery, still to aim at complete revascularization using IMAs as much as possible, but to avoid connecting IMA grafts to only mildly or moderately stenosed coronary arteries.

Coronary Angiography↗
PubMed1991

[Developments in mitral valve surgery].

Between 1987 and 1990 we operated on 104 patients for mitral valve disease. If possible the valve was reconstructed according to CARPENTIER's technique: 8 of 28 stenotic, 43 of 57 regurgitant and 2 of 7 mixed lesions were repaired. Twelve patients underwent re-replacement of a previously inserted mitral prosthesis. Six patients died early (7.8% after replacement, 8% after isolated replacement, 3.7% after repair and 2% after isolated repair). Five of these six patients were in NYHA class IV preoperatively. Seven patients died late after a mean observation period of 18 months (5 after replacement, 1 after double valve replacement and 1 after repair and multiple coronary bypass surgery). Prognosis is best for patients whose valve can be repaired and who are not already in NYHA class IV. The postoperative NYHA class for surviving patients is excellent (1.3 in the replacement group and 1.2 after repair).

Adult↗
PubMed1991

[Emergency surgery for PTCA complications: tactics and results].

Incidence, risk and results of emergency coronary bypass surgery after failed percutaneous transluminal coronary angioplasty (PTCA) have been analyzed in a retrospective study. Failed PTCA has been defined as visible pathology (dissection, occlusion) of the dilated vessel associated with acute chest pain and ECG changes. From 3-1-1987 to 11-30-1990, 23 patients of 433 (5%) underwent emergency surgery for failed PTCA (19 male, 4 female, mean age 55 +/- 8 years). PTCA was performed in 16 cases of one-vessel-disease, 3 cases of two-vessel-disease and 4 cases of three-vessel-disease. All had an ejection fraction beyond 40%. 19 patients remained in stable hemodynamic condition. In average 2.1 vessels have been bypassed; in 13 cases the internal mammary artery (IMA) has been used, in 10 cases the saphenous vein (VSM) only. No early nor late death occurred. The perioperative infarction rate is 30%. Comparing the group with IMA and the group with VSM only, no difference could be found regarding the number of unstable hemodynamics, the use of catecholamines nor the perioperative infarction rate. After a mean follow-up period of 14.3 months, 21 patients are in NYHA class I, 2 in NYHA class II. Emergency coronary bypass surgery can be performed with low risk and favorable results, if the operation is timed without delay after the onset of acute chest pain and ECG changes in failed PTCA. The infarction rate is remarkably higher than in elective coronary surgery. The use of the IMA seems to be no additional risk factor.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Heart center surgery in the private hospital: heart surgery in the hospital with covering physicians].

Based upon the experiences at the "Herzzentrum Hirslanden" Zurich it is demonstrated that heart surgery and invasive cardiology, including cardiac catheterization and PTCA, can readily be performed by surgeons and cardiologists in private practice at a private hospital not receiving any government funds. The needs for additional heart surgical beds in the greater area of Zurich is confirmed. Manpower needed and necessary apparative infrastructure are discussed and present activities at the "Herzzentrum Hirslanden" illustrated. Finally problems with medical insurance companies covering the cost are dealt with.

Cardiac Surgical Procedures↗
PubMed1988

[Cardiogoniometry in coronary heart disease. A clinical study].

Maximal vectors of depolarization (QRS) and repolarization (ST/T), and the initial QRS-vector of CGM, were measured simultaneously with conventional ECG at rest and during exercise in a population of 85 patients with suspected coronary artery disease (CAD). Coronary angiography served as standard, luminal narrowing of at least 50% in a proximal segment of one or more major coronary arteries being taken to define CAD. CGM showed sensitivity of 0.89 and specificity of 0.64 (vs 0.76 and 0.18 for conventional stress ECG).

Adult↗
PubMed1987

[Percutaneous transluminal coronary angioplasty (PTCA): long-term results].

The authors report on the longterm follow-up after PTCA in 130/165 (79%) patients seen approximately 3 years after angioplasty. Primary success rate in the years 1980-84 was 79%. Emergency bypass surgery was necessary in 7%. In-hospital mortality was 0%. Recurrences of angina were seen in the first 6 months in 18 and after 1 year in 3 patients. 13 of 18 had a recurrence of the dilated lesion (10%). At 3 years there had been 4 cardiac deaths, 76% were asymptomatic, 8% were improved and 83% were working full time.

Aged↗
PubMed1986

Persisting myocardial sinusoids of both ventricles as an isolated anomaly: echocardiographic, angiographic, and pathologic anatomical findings.

The persistence of myocardial sinusoids in both ventricles as an isolated anomaly is described. A 21-year-old patient had progressive heart failure considered as cardiomyopathy of obscure etiology. Two-dimensional echocardiography demonstrated channel-like structures in the thickened myocardium of both hypokinetic ventricles. Angiography showed a honeycomblike inner contour in both ventricles. Autopsy proved the diagnosis of persistent sinusoids in a thickened myocardium.

Adult↗
PubMed1985

[The significance of ST elevation in the exercise ECG].

In contrast to ST-segment depression during exercise, the mechanism for ST-segment elevation - a more unusual finding - is controversial and poorly understood. Exercise induced ST-segment elevation of 2 mm and more was observed in 80 of 3000 consecutive patients (2.6%) undergoing bicycle exercise testing using 6 of 12 ECG leads. This abnormality was detected in 70 of 777 patients (9%) with documented previous myocardial infarction and in 10 of 2223 (0.5%) patients without a history of myocardial necrosis and with normal resting ECG. The substantial differences in exercise induced ST-segment elevation between these two groups are: patients with previous myocardial infarction and angiographically documented left ventricular aneurysm revealed progressive asymptomatic ST-segment elevation on an average of 3.4 +/- 1.2 mm persisting for a long time (greater than 3 minutes) during the recovery period. The extent of ST-segment elevation appears to correlate with LV EF and LV volume. These patients should be treated medically (as in 73% of our patients), and cardiac catheterization is indicated only in the presence of severe angina, congestive LV failure and arrhythmias. Patients with normal ECG at rest showed ST-elevation at maximal exercise. ST-segment elevation was associated with chest pain, which was more pronounced and shorter in duration than in the other group (9.1 +/- 2.8 mm, less than 30 sec). ST-elevation was abrupt and not preceded by ST-segment depression. 8 of 10 patients with anterior ST-segment elevation had a left anterior descending artery (LAD) lesion. Therefore, exercise testing in this group predicts significant proximal LAD obstruction accessible for PTCA.

Adult↗
PubMed1985

[Transluminal removal of intravascular foreign bodies].

Removal of catheter tip or guide wire emboli is needed for most cases with this complication. An alternative to surgery is transvenous retrieval. The authors present their experience with a simple self-made loop-catheter, which in 11 of 12 cases proved successful for extraction of 9 catheter tips and 3 guide wires located in the central venous system, the right ventricle and the pulmonary artery in 10 patients, and in the aorta in 2. No further complications were caused by this procedure. Due to the serious hazards of embolized foreign bodies there is a need to remove them, and the authors believe that the transluminal route, preferably with the loop catheter, should be the primary approach to this iatrogenic complication.

Adult↗
PubMed1985

Anomalous origin of the left thyrocervical trunk as a cause of residual pain after myocardial revascularization with internal mammary artery.

A patient with successful implantation of an internal mammary artery graft in the left anterior descending coronary artery complained of residual but different anginal pain after operation. Ischemia was demonstrated during a manual stress test. Angiography revealed anomalous origin of the thyrocervical trunk from the internal mammary artery. Angina and ischemia disappeared after the trunk was ligated.

Arteries↗
PubMed1984

[Ergometrically determined work capacity in chronic hemodialysis treatment].

To evaluate the degree of physical activity in hemodialysis patients, working capacity was assessed by bicycle ergometry in 16 hemodialysis patients (mean age 47 +/- 12 [SD] years). The mean length of dialysis treatment was 21 +/- 17 months. The laboratory and clinical findings were as follows (mean values +/- SD): urea 34 +/- 6 mmol/l; creatinine 1127 +/- 169 mumol/l; potassium 5.7 +/- 0.63 mmol/l; calcium 2.25 +/- 0.22 mmol/l; phosphate 1.76 +/- 0.54 mmol/l; hemoglobin 8.54 +/- 1.02 g/dl; hematocrit 26.1 +/- 2.9%; blood pressure 140 +/- 18/86 +/- 9 mm Hg; nerve conduction velocity 39.5 +/- 6.5 m/sec. Mean working capacity was 58 +/- 31 W (41 +/- 24% of normal values) and the specific working capacity (watts/kg body weight) was 0.79 +/- 0.54. The duration of exercise testing was 4.9 +/- 2 min. The ergometry had to be discontinued because of the following reasons: leg fatigue (10 patients); general fatigue (3); dyspnea (1); attainment of maximal heart rate (2). The maximal blood pressure during exercise testing was 149 +/- 21/86 +/- 14 mm Hg and the maximal increase in heart rate 117 +/- 34 beats/min. In patients treated with a beta-blocker agent for hypertension, maximal increase in blood pressure was comparable to normotensive patients. There was a negative correlation between working capacity and the age of the patients (r = 0.77; p less than 0.01). A positive correlation was found between working capacity and the serum creatinine level (r = 0.52; p less than 0.05).

Age Factors↗
PubMed1982

[Digitalization without saturation dose using methyldigoxin. Experiences with 29 patients].

The indications and performance of oral digitalization without saturation dose are evaluated on the basis of clinical parameters and plasma digitalis levels. A group of patients with evident cardiac insufficiency received a daily maintenance dosage of digitalis (2 tablets of 0.1 mg methyldigoxin) from the outset. After 7, 15 and 30 days the plasma concentration of methyldigoxin was measured. Objective and subjective signs of cardiac insufficiency were noted. In 28 of 29 patients the therapeutic plasma level (0.8-2.0 ng/ml) was achieved with a mean plasma digitalis concentration of 1.47 +/- 0.4 ng/ml. A clinical improvement was observed in 18 patients. On the 15th and 30th day of treatment the mean plasma level of methyldigoxin showed no significant difference: X15 = 1.51 +/- 0.57 ng/ml and X30 = 1.40 +/- 0.46 ng/ml. The measured plasma values were not influenced by the patient's weight or age. In 6 patients with renal insufficiency a clear correlation between the plasma level of methyldigoxin and the creatinine level was observed. The evaluation of ECG signs showed only minimal alterations of conduction and repolarisation. On the basis of these results conclusions are drawn with regard to the clinical value and use of this therapy.

Aged↗
PubMed1982

[Gradual coronary dilatation using double balloon catheters].

For the purpose of coronary angioplasty (PTCA) coronary stenoses over 80% usually can only be passed with very small catheters. We therefore developed an instrument with a very small tip-diameter and two balloons of different diameters arranged in line. In 9 cases primary success has been achieved and the degree of stenoses reduced from 89% to 22%. The gradient of 58 mm Hg was only 11 mm Hg after PTCA. When used with caution, the advantages of this catheter in high-degree coronary stenoses is obvious.

Angioplasty, Balloon↗