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PubMed1999

[Effect of lisinopril on progression of retinopathy and microalbuminuria in normotensive subjects with insulin-dependent diabetes mellitus].

Effect of lisinopril on progression of retinopathy and microalbuminuria in normotensive subjects with insulin-dependent diabetes mellitus. Retinopathy and nephropathy are the most important microvascular complications in diabetes with hyperglycaemia and hypertension as important risk factors. Antihypertensive treatment with angiotensin-converting enzyme inhibitors has been shown to delay progression of nephropathy, but the effect on retinopathy has not been established. We, therefore, performed a trial of the effect of the ACE-inhibitor lisinopril on retinopathy and nephropathy in normotensive patients with IDDM. We performed a two year randomized double-blind placebo-controlled trial of the ACE-inhibitor lisinopril on 530 normotensive IDDM patients within the age group 20-59 years from 18 European centres. Patients were either normo- or microalbuminuric. Retinopathy was classified from retinal photographs into five levels (none to proliferative). The primary endpoint of the trial was progression of albuminuria. Mean albumin excretion rate (AER) was 8.0 micrograms/min at baseline in both treatment groups. After two years AER was 2.2. micrograms/min lower in the lisinopril than in the placebo group, a difference of 18.8% (p = 0.03). The difference in AER was 38.5 micrograms/min between treatment groups in patients with microalbuminuria at baseline (p = 0.001), and 0.23 microgram/min in patients with normoalbuminuria at baseline (p = 0.6). Retinopathy was a secondary endpoint. Patients treated with lisinopril had significantly lower Hb-A1c at baseline than the placebo group (6.9%-7.3%). Retinopathy progressed with at least one level in 13.2% of lisinopril treated and 23.4% of placebo treated patients (odds ratio 0.50, p = 0.02). Progression by two levels or progression to proliferative retinopathy were also significantly reduced in the lisinopril group compared to the placebo group (odds ratio 0.27 and 0.18, respectively). In conclusion, lisinopril delays progression of retinopathy and nephropathy in normotensive IDDM patients with micro- or normoalbuminuria.

Adult↗
PubMed2000

Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations.

PURPOSE: Bacillus Calmette-Guerin (BCG) therapy is considered to be an effective prophylactic and therapeutic agent for high risk superficial transitional cell carcinoma of the bladder. Nevertheless, in a select uncommon population of stage Ta grade 3 superficial lamina-free tumors the results of this treatment have not yet been well established. We evaluated recurrence and progression rates, and the success of BCG therapy in a population with stage Ta grade 3 transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Of the 605 patients treated at our institution from 1982 to 1996 for the histopathological diagnosis of primary bladder cancer 32 (5.3%) with stage Ta grade 3 noninvasive primary bladder tumor were treated with intravesical instillations of 75 mg. Pasteur strain BCG in 50 ml. saline weekly for 6 weeks. At a followup of 2 to 13 years (mean 58.4 months) patients were evaluated with urinary cytology, cystoscopy, transurethral resection and random mucosal biopsies. Recurrence, grade and stage progression, death and causality were analyzed. RESULTS: Of the 32 patients 9 (28%) responded positively to BCG without recurrence, while disease recurred as stage Ta in 8 (25%) and T1 in 7 (22%), and progressed to muscle layer infiltration in 8 (25%). Four patients (12%) died of bladder cancer. The number of tumors at primary resection, gross examination, the mitotic index or an association with carcinoma in situ did not appear to be predictive factors of progression to muscle invasion. Urine cytology (I to II versus III to IV) appeared to correlate highly with progression and BCG response (p<0.001) with excellent sensitivity (1) but low specificity (0.67). CONCLUSIONS: Our study demonstrates the high progression potential of stage Ta grade 3 tumors, since nearly 50% recurred and 25% progressed to invasive disease. These results may be closely compared with the results of previous trials of stage T1 grade 3 disease. We suggest that recurrence should be detected at an early stage using long-term followup with strict observance of the surveillance protocols during a minimum 5-year tumor-free period.

Adjuvants, Immunologic↗
PubMed1975

Progression from minimal or focal to diffuse proliferative lupus nephritis.

Histologic classification of renal glomerular lesions in 46 patients with systemic lupus erythematosus revealed 17 as having either focal proliferative (10 patients) or minimal mesangial proliferative (7 patients) glomerulonephritis. Six of the 17 have progressed to a diffuse proliferative glomerular lesion on subsequent renal biopsies, 9 months to 5 years later. Five had clinical deterioration at the time of follow-up biopsies; currently one is undergoing hemodialysis and four others have decreased renal function. Although a comparison of those who progressed with those who are stable revealed greater proteinuria in some of those who progressed, no other clinical features of the initial illness were different in the two groups, nor were differences between the two groups noted on light microscopic examination of initial renal biopsies. However, ultrastructurally, electron-dense deposits, especially those subendothelial in location, were noted along glomerular capillary basement membranes more frequently and in greater number in those who progressed. These findings suggest that lupus patients with a mild proliferative glomerulonephritis may have clinical and histologic progression of the renal disease, and those who progress cannot be clearly defined by clinical or light microscopic features. Ultrastructural demonstration of subendotheial deposits suggests a greater likelihood of subsequent progressive disease.

Adolescent↗
PubMed2001

Verifying and evaluating progressive addition lenses in clinical practice.

BACKGROUND: Despite the fact that more than 50% of multifocal lenses dispensed in the United States are progressive addition lenses, adequate methods for clinical verification of these lenses have been lacking. Using automated lens meter techniques, the author describes a simplified method for verification of these complex lenses. METHODS: Thirty pairs of progressive lenses were measured in a modified method using a Humphrey 330 Lens Analyzer. Fifteen pairs were "premium-quality" progressive lenses: fifteen pairs were "non-premium-quality" progressives. Five criteria were assessed on each lens: Distance Zone Width (DZW). Intermediate Zone Width (IZW), Near Zone Width (NZW), Drop Distance (DD), and Maximum Astigmatic Distortion (MAD). RESULTS: "Premium-quality" progressive lenses failed to demonstrate clear-cut superiority over "non-premium-quality" progressive lenses in the five specified criteria. Individual measurements indicate considerable product inconsistency affected every brand tested. CONCLUSIONS: Premium- and non-premium-quality progressive lenses demonstrated similar performance characteristics in this study. Zone size variation in these lenses was found to be considerable, a characteristic that seemed to cut across brand lines. The AO Compact lens seemed to demonstrate a shorter drop distance than other lenses, which does enhance its suitability for use with small frames. A comparison of the Essilor Natural PAL to the Younger Image lens showed little difference in the categories measured, although peripheral distortions seemed closer to the reading zone in the image. A comparison of the MAD of lenses in this study to lenses tested in 1986 indicates a considerable improvement has been made in that important characteristic.

Eyeglasses↗
PubMed2001

The effectiveness of 0.5-lb increments in progressive resistance exercise.

A traditional progressive resistance exercise program consists of increasing the number of repetitions at a constant load until exceeding an established repetition range. Subsequently, the load is increased by 1.1 kg (2.5 lb) or more, and the lifter works at the new load until again exceeding the repetition range. This investigation examines the use of small incremental loads for 2 upper-body exercises (bench press and triceps press). Subjects were randomly assigned to traditional (TRAD) progressive resistance exercise (5 women, 5 men) and small increment (SI) progressive resistance exercise (5 women, 4 men) groups. Initially, both groups trained for 8 weeks using TRAD progressive resistance exercise. Subjects who achieved 7 repetitions on the final set of an exercise increased the load for the next session by 2.2 (bench press) or 1.1 kg (triceps press). Following the initial 8-week training period, the TRAD group continued for another 8 weeks following the same protocol, whereas the SI group trained for an additional 8 weeks, increasing the load by 0.22 kg (0.5 lb) when completing 7 or 8 repetitions and 0.44 kg (1 lb) when achieving 9 or more repetitions. All groups, except TRAD women, made significant increases in 1 repetition maximum (1RM) for the bench press. Both TRAD men and SI men significantly increased 1RM triceps press. Groups that did not significantly increase 1RM, in either the bench press or triceps press, demonstrated similar trends. For TRAD men and SI men, the number of repetitions to failure for the bench press at 60% 1RM decreased after training. Both regimens proved effective for increasing strength throughout 8 weeks. In conclusion, SI progressive resistance exercise appears to be as effective as TRAD progressive resistance exercise for increasing strength during 8 weeks in short-term pretrained college-aged men and women. However, preliminary data suggest that the TRAD progressive resistance exercise program might be a more effective method of increasing resistance during an extended period.

Adult↗
PubMed1975

[Heridity of progressive chronic polyarthritis - study of the course].

In an analytic epidemiological study 30 relations of patients with progressive chronic polyarthritis with positive rheumatoid factor and 127 relations with negative rheumatoid factor were after-examined concerning their clinical and serological behaviour 6 years after the primary recognition with the aim of an evidence concerning the hypothesis of an hereditary causal factor in progressive chronic polyarthritis. It was revealed that only in 14 of 30 persons with positive primary rheumatoid factor the rheumatoid factor could further be proved, on the other hand 14 relations who had at first a negative rheumatoid factor now, however, reacted with a positive rheumatoid factor. It could be confirmed, that the seropositive forms of the progressive chronic polyarthritis have a stronger hereditary trend to the formation of the rheumatoid factor than the seronegativeones and that after the 50th year of life there exists a significant persistence of the seropositivity. In the group of relations who were seropositive 6 years ago developed a definitive and probable progressive chronic polyarthritis each as well as a further probable progressive chronic polyarthritis in the group of relations who became seropositive only in the period of observation. On account of the changing seropositivity and the only rare appearance of a progressive chronic polyarthritis on the basis of this investigation of hypothesis of the rheumatoid factor as first (premorbid) symptom of a progressive chronic polyarthritis is to be refused.

Adult↗
PubMed1992

Effect of rapid glycemic control on progression of diabetic retinopathy.

The effect of the start of glycemic control on the progression of retinopathy was investigated by a case-control study. The changes in glycosylated hemoglobin (HbA1) were compared between a case group, diabetic cases showing progression of retinopathy (Group 1), and a control group, diabetic cases showing no progression of retinopathy (Groups 2-A and 2-B). Group 2-A was matched with Group 1 on the basis of the grade of retinopathy at the first examination and other clinical data. Group 2-B was matched with Group 1 in terms of HbA1 value and methods of control, but had no retinopathy or background retinopathy. The retrospective follow-up period for the three groups was 24 months. On the basis of the respective matching factors, Groups 1 and 2-A were divided into 9 blocks of homogeneous subjects, and Groups 1 and 2-B were similarly divided into 6 blocks. The resulting data was evaluated block by block, using the analysis of variance (ANOVA) and a conditional logistic regression analysis. In Group 1, the HbA1 value decreased rapidly 10-6 months before the progression of retinopathy, but the HbA1 value did not change in Groups 2-A and 2-B during the 24-month follow-up. The difference in the estimated mean HbA1 value between 10-9 months and 1-0 month before the progression of retinopathy was 2.46% greater in Group 1 than in Group 2-A, as determined by ANOVA. The relative risks of a 1, 2 and 3% increase in HbA1 value for 7-6 months were estimated as 1.6, 2.4 and 3.8, respectively, by conditional logistic regression analysis. These findings indicate that the decrease in HbA1 value during any 6-month period should be limited to less than 2% in order to prevent the progression of retinopathy. It is also evident that too rapid a decrease at the initiation of glycemic control could cause severe or transient exacerbation of the progression of retinopathy.

Analysis of Variance↗
PubMed1992

Flow-cytometric and histological progression to malignancy in Barrett's esophagus: prospective endoscopic surveillance of a cohort.

To determine whether or not flow-cytometric evidence of aneuploidy and increased G2/tetraploid fractions predispose to neoplastic progression in Barrett's esophagus, 62 patients with Barrett's esophagus were evaluated prospectively for a mean interval of 34 months. Nine of 13 patients who showed aneuploid or increased G2/tetraploid populations in their initial flow-cytometric analysis developed high-grade dysplasia or adenocarcinoma during follow-up; none of the 49 patients without these abnormalities progressed to high-grade dysplasia or cancer (P less than 0.0001). Neoplastic progression was characterized by progressive flow-cytometric and histological abnormalities. Patients who progressed to high-grade dysplasia and carcinoma frequently developed multiple aneuploid populations of cells that were detectable flow-cytometrically. Similarly, patients appeared to progress through a phenotypic sequence that could be recognized histologically by the successive appearance of Barrett's metaplasia negative for dysplasia, abnormalities in the indefinite/low-grade dysplasia range, high-grade dysplasia, and eventually adenocarcinoma. These and prior results suggest that neoplastic progression in Barrett's esophagus occurs in a subset of patients who have an acquired genomic instability that generates abnormal clones of cells, some of which have aneuploid or increased G2/tetraploid DNA contents. With continued genomic instability, multiple aneuploid subclones may evolve, one of which may ultimately acquire the ability to invade and become an early carcinoma. The combination of histology and flow cytometry can be used to identify a subset of patients with Barrett's esophagus who merit more frequent endoscopic surveillance for the early detection of high-grade dysplasia or carcinoma.

Aneuploidy↗
PubMed1992

Disease progression and early predictors of AIDS in HIV-seroconverted injecting drug users. The Italian Seroconversion Study.

OBJECTIVE: To evaluate the risk of developing AIDS and to identify early markers of disease progression in injecting drug users (IDU). DESIGN: Prospective study. SETTING: Sixteen centres throughout Italy. PATIENTS, PARTICIPANTS: Four hundred and sixty-eight IDU for whom it was possible to estimate the date of HIV seroconversion. MAIN OUTCOME MEASURES: Progression to AIDS. RESULTS: Twenty-six subjects developed AIDS during a median follow-up period of 42 months. The risk of developing AIDS was 21% within 7 years following seroconversion. Age greater than 25 years at seroconversion was associated with more rapid disease progression. Progression was similar for men and women. Continued drug injection did not accelerate progression to AIDS. Among the laboratory markers studied, CD4+ cell count at the first HIV-positive test was the best predictor of disease progression. Results were confirmed using multivariate analysis. CONCLUSIONS: Our findings indicate the importance of the role played by age in accelerated disease progression, which may be determined by a more rapid decline in CD4+ cell number in older HIV-infected IDU.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Factors predicting progression of IgA nephropathies.

The difficulties in defining the natural history of primary IgA nephropathy (IgAN) depend upon the pre-selection of patients for renal biopsy, a true individual variability - ranging from asymptomatic to rapidly progressive forms - as well as the use of different classifications of the renal lesions and statistical analyses sometimes carrying incorrect modalities. Long-term natural history studies have demonstrated that the rate of progression has an extremely wide range, from 5 to 25% after 10 years and 25-50% at 20 years, and complete remission is reported as well in 5 to 30% of cases. A geographic variability has been confirmed in a tri-continental study, explainable only partly by the earlier referral. Among the factors predicting progression, the more frequent in cohorts showing worse actuarial survival at 10 years are those associated with the advanced phases of renal damage, as increased creatinine level, arterial hypertension and nephrotic range proteinuria. A multivariate statistical approach showed the relevance of proteinuria during follow-up (percent duration of massive proteinuria or proteinuria at 1 year) more than proteinuria at the onset. Mean blood pressure value (MAP) and proteinuria during follow-up were independent predictors of end-stage CKD. Note the predictive value of severe microscopic hematuria in several studies. As far as histological features are concerned, strong independent predictors of progression at Cox multivariate analysis are the severity of glomerular sclerosis and interstitial fibrosis. The presence of crescents was a risk factor in almost all studies at univariate analysis, but did not maintain a significant predictor value at multivariate analysis. Conversely the association between crescents and tuft adhesions, possibly resulting from previous segmental necrosis, was found to be a significant risk factor. The extent of mesangial proliferation and parietal expansion of deposits was not significantly associated to unfavourable prognosis at multivariate analysis. The analysis of risk factors for progression of IgAN related to Henoch-Schoenlein purpura (HSP) failed to demonstrate any prognostic value for the presence and severity of extra-renal signs of vasculitis or presence of triggering factors. At multivariate Cox analysis, age and mean proteinuria during follow-up were powerful independent prognostic predictors. Proteinuria at baseline was not significantly related to renal progression, nor were hypertension or impaired renal function at onset. It is of interest that data at onset and at renal biopsy (renal function impairment, hypertension, nephrotic-range proteinuira) were not significantly related with renal detrimental progression. Neither had prognostic value the finding of crescents involving up to 75% of glomeruli.

Adult↗
PubMed1992

MYC rearrangements in histologically progressed follicular lymphomas.

Histologic transformation of low-grade follicular lymphoma to an aggressive-grade lymphoma occurs in 60% to 80% of patients during their clinical course. The events that drive the transformation process are poorly understood. Deregulation of the MYC gene has been implicated in a small number of cases. This observation led us to examine the molecular organization of the MYC oncogene in 38 cases of histologically transformed lymphomas that arose from follicular lymphomas, and in 18 of the initial pretransformation follicular lymphomas. In addition, we examined 58 "control" low-grade follicular lymphomas that had not yet shown evidence of histologic progression. Immunoglobulin heavy chain and light chain gene rearrangements were detected in all biopsies and rearrangements of the BCL-2 locus were seen in 36 of 38 of the transformed lymphomas (consistent with their origin from follicular lymphomas), in 18 of 18 of the pretransformation follicular lymphomas, and in 51 of 58 of the control follicular lymphomas. All 18 pretransformation follicular lymphoma specimens displayed at least one immunoglobulin gene and BCL-2 rearrangement in common with the corresponding histologically progressed lymphoma, indicating a clonal relationship between the original follicular lymphoma and the histologically transformed lymphoma. MYC rearrangements were detected in 3 of 38 (8%) transformed lymphomas and in 1 of 58 (2%) control follicular lymphomas. The latter MYC rearranged follicular lymphoma was clinically aggressive and transformed to a high-grade lymphoma that led to the death of the patient within 20 months. None of the 18 pretransformation follicular lymphomas showed MYC rearrangement, including two from patients who later demonstrated MYC rearrangement in the progressed aggressive lymphoma. PvuII mutational analysis failed to identify additional MYC gene abnormalities in the progressed lymphomas. Because the Epstein-Barr virus (EBV) is associated with a fraction of high-grade lymphomas and is known to upregulate BCL-2, we looked for a potential role for this agent in our progressed lymphomas. We did not detect viral sequences in any case indicating that EBV does not play a major role in progression. The presence of MYC rearrangements in a small fraction of progressed aggressive lymphomas, and not in the corresponding antecedent follicular lymphomas, suggests that acquisition of a MYC rearrangement is in some cases associated with the transformation event.

Chromosome Aberrations↗
PubMed1991

Correlation between progression of diabetic retinopathy and blood glucose control.

The relationship between the progression of diabetic retinopathy and consecutive blood glucose control evaluated by glycosylated hemoglobin (HbA1) values was statistically analyzed based on 422 eyes of 211 diabetic subjects who were followed up 2 years or more. The Cox regression model (proportional hazard model) with HbA1, as a time-dependent covariate was applied in the analysis. The cumulative effect and the relative risk of HbA1 affecting the progression of diabetic retinopathy was estimated. The effect of the moving average of HbA1 values for the previous 1-30 months on the progression of retinopathy was assessed to investigate the cumulative effect of HbA1. The cumulative effect of HbA1 on the progression of diabetic retinopathy was significant when the time span of the moving average was 6 months or more than 6 months. The moving average of HbA1 value for 7 months was most relevant to the retinopathy progression. The relative risk corresponding to the increase in the moving average of HbA1 values for 6 months by 1, 2 or 3% was 1.18, 1.39 or 1.63, respectively. When the HbA1 level was adjusted to its average value in the subjects (9.6%), the estimated cumulative retinopathy progression rate for 6, 12, 18 or 24 month follow-up was 3.6, 14.5, 22.5 or 30.5%, respectively. The differences in the cumulative retinopathy progression rate between a well-controlled group with a low moving average of HbA1 value (3% lower than the average) and a poorly-controlled group with a high moving average of HbA1 value (3% higher than the average) were estimated as 3% (6-month follow-up) and 23% (24 months).

Adult↗
PubMed1991

Progression and survival studies in early chronic lymphocytic leukemia.

To investigate the natural history of stage A chronic lymphocytic leukemia (CLL) we reviewed 84 such patients. Among 74 cases evaluable for disease progression, 22 (29.6%) progressed to more advanced clinical stages (9 to stage B, 13 to stage C); the actuarial estimation of such an event at 4 years was 30% (95% CI: 26.3% to 33.6%). Despite a linear trend toward an increasing risk (r = .92), the hazard function analysis showed a constant pattern of progression, suggesting a lack of correlation of such an event with time (r = .04). Furthermore, disease progression when analyzed as a time-dependent variable had a clear-cut impact on survival (P less than .001). With the aim of identifying a subgroup of patients with low probability of disease progression and death, we applied to our set of patients four different proposals for subclassifying stage A. All methods were similar in terms of sample size, 5-year survival rate, and disease progression risk, suggesting that the choice between different proposals is somewhat arbitrary. Whatever the criteria are for defining "smoldering" CLL, such patients (accounting in the present study for 20.5% of overall series and 46.7% of stage A patients) should not be treated until progression occurs.

Actuarial Analysis↗
PubMed1989

Cell cycle progression delay in conditioned medium does not play a role in the repair of X-ray damage in Chinese hamster V79 cells.

We tested our hypothesis that the lower survival of X-irradiated cells in growth medium (GM) relative to that in conditioned medium (CM) is due to differences in nutrient concentration levels rather than to differential effects on cell progression and growth. Chinese hamster V79 cells in log and unfed plateau phase, grown in Eagle's minimal essential medium (MEM) with 15% serum (100% GM), were irradiated. Before plating, cells were incubated in situ in various concentrations of MEM with serum (GM, normal cell progression) or MEM without serum or in CM (no cell progression). Cell survival was the lowest in 100% MEM with or without serum and increased with the decrease in MEM and serum concentrations, reaching a plateau in 40% MEM or 40% growth medium (40% MEM with 6% serum), similar to that in conditioned medium. Growth kinetics was the same in 40 and 100% growth medium, but the D0 of cells in 40% growth medium was higher than that of cells in 100% GM. Similarly, the D0 of cells in 40% MEM was higher than that of cells in 100% MEM, although cell progression was absent in both media. The radiation sensitivity of cells was the same in 40% GM with progression and in 40% MEM and CM with no progression. Cells in low-nutrient media were flatter than those in 100% MEM or GM. There was a correlation between the nutrient concentration in the medium postirradiation and the D0. This correlation was independent of the presence or absence of serum and thus independent of cell cycle progression. The cell morphology which is dependent on the nutrient concentration appears to influence the ability of a fraction of cells to repair their radiation damage.

Animals↗
PubMed1988

Renal pathology and proteinuria determine progression in untreated mild/moderate chronic renal failure.

The progression of renal failure was analyzed in 108 patients with mild to moderate renal impairment, none of whom had received any form of dietary protein, phosphate restriction or immunosuppressive treatment. The reciprocal of plasma creatinine was plotted against time using a minimum of six plasma creatinine values taken over at least six months (mean 13 values over 41 months). Plots indicated there was linear deterioration in 70 patients, non-linear deterioration in 15 and stable renal function in 24. Progressive renal failure was common in patients with glomerulonephritis, diabetic nephropathy, chronic pyelonephritis and polycystic kidney disease. Most patients with hypertensive nephrosclerosis, analgesic nephropathy and renal impairment following acute renal failure were stable. Among those with progressive impairment the mean rates of deterioration were significantly faster for patients with glomerulonephritis and diabetic nephropathy compared to those with chronic pyelonephritis, polycystic kidney disease and undiagnosed renal disease (p less than 0.01). Hence the underlying renal pathological changes appear to be important in determining progression of renal failure and also the subsequent rate of deterioration. For those with linear progression of renal failure there was a significant correlation between 24-h urinary protein excretion and the rate of deterioration. This relationship held for glomerulonephritis and chronic pyelonephritis as separate diagnostic groups only. Proteinuria, therefore, may be a useful prognostic index for the rate of progression of established renal failure. Calcium phosphate product correlated poorly with the rate of deterioration. We were unable to demonstrate a relationship between spontaneous protein intake and deterioration of renal function. However, patients prescribed high protein diets were not included in dietary analysis and we cannot, therefore, exclude the possibility that a high dietary protein intake may accelerate renal failure. Similarly we were unable to show a significant relationship between blood pressure and progression of renal failure although there were weak correlations between mean arterial pressure and rate of deterioration for chronic pyelonephritis and glomerulonephritis.

Blood Pressure↗
PubMed1988

[Progression of coronary artery stenosis and compensatory development of collaterals: analysis of data of 25 patients who developed complete occlusion].

The correlation between progression of atherosclerotic lesions and the compensatory development of collaterals which prevent ischemic events, particularly myocardial infarction, were examined in patients who underwent repeated coronary angiography (CAG) after medical therapy. Twenty-five patients with lesions in their coronary arteries perfusing the viable myocardium during the first study, which progressed to total occlusion in the second study, were evaluated. The subjects' mean age was 55.1 years, and the mean time interval between the two studies was 44.1 months. CAG was performed in the chronic stage of myocardial infarction or the stable phase of angina pectoris, but three patients underwent repeated CAG studies during the acute phase of myocardial infarction. The percent diameter of the narrowing in the lesion was assessed according to the AHA system. Concerning the sites of lesions with progression to complete occlusion, 14 (56%) were located in the proximal segment of the left anterior descending artery (segment 6 or 7), and six lesions were in the main trunk of the right coronary artery (segment 1, 2 or 3). In 11 patients with stable angina, associated lesions showed progression from 90 or 99% stenosis to complete occlusion. Seven patients with lesions exhibiting 99% stenosis had collaterals, and four patients with lesions exhibiting 90% stenosis had no collaterals during the first study. However, good collaterals were demonstrated in all patients in the second study. Seven patients had episodes of newly developed unstable angina. The lesions in five of the seven patients progressed from 75% or 90% stenosis to complete occlusion, and in one patient with triple vessel disease the lesion progressed from 99% stenosis to complete occlusion in the second study. The former five patients did not have collaterals in the first study, but development of collaterals was demonstrated in all seven patients in the second study. Seven patients had episodes of myocardial infarction, and in six of these, the lesions progressed from 75% or less stenosis to complete occlusion.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1985

Poor R wave progression in pure mitral stenosis. Correlation with hemodynamic data.

Poor R wave progression in the right precordial leads has frequently been reported in patients with pure mitral stenosis, but has never been investigated from clinical and hemodynamic points of view. In this work the clinical, electrocardiographic and hemodynamic data of 19 patients (mean age: 49 +/- 8.6 years), with pure mitral stenosis and poor R wave progression (study group) were compared with those of 19 subjects with pure mitral stenosis and normal R wave progression (control group). The age, sex distribution and duration of mitral valve disease were similar in the two groups; also clinical status, i.e. the distribution in the functional classes (NYHA), was similar in the two groups. Mitral valve area was similar in the two groups (1.3 +/- 0.5 vs 1.1 +/- 0.3 cm2), whereas wedge pressure, mean pulmonary artery pressure, systolic and diastolic right ventricle pressures and total pulmonary resistances showed significant lower values in patients with poor R wave progression compared to those with normal R wave progression (P less than 0.05). The hemodynamic variables of left ventricle and the cardiac index were similar in the two groups. In study group patients there was higher prevalence of vertical axis (P less than 0.05). These data indicate that in pure mitral stenosis, clinical status is similar in patients with poor R wave progression and in those with normal R wave progression, whereas in the former there is slighter hemodynamic involvement of the right ventricle.

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↗