22 research outputs found
Pulmonary Embolism: Clinical Features and Diagnosis
Pulmonary embolism is a lethal yet treatable disease. Given the significant overlap of symptoms and signs between the presentation of pulmonary embolism and acute coronary syndromes, it becomes clear that emergency room physicians must be familiar with the diagnosis of pulmonary embolism. A critical issue is always to consider pulmonary embolism in the differential diagnosis of chest pain. However, the clinical diagnosis of pulmonary embolism remains problematic due to the nonspecific presenting symptoms, signs, electrocardiographic abnormalities, arterial blood gas and chest X-ray findings. D-dimers are becoming a widely available useful laboratory tool in the diagnosis of suspected pulmonary embolism. In this concise overview, the diagnostic value of clinical assessment in patients with possible pulmonary embolism will be explored
Low-dose adenosine stress echocardiography: Detection of myocardial viability
OBJECTIVE: The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability. BACKGROUND: Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine. METHODS: Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals) echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of ≥ 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 ± 2 months) were available in 24 revascularized patients. RESULTS: Wall motion score index improved from rest 1.55 ± 0.30 to 1.33 ± 0.26 at low-dose adenosine (p < 0.001). Of the 257 segments with baseline dyssynergy, adenosine echocardiography identified 122 segments as positive for viability, and 135 as necrotic since no improvement of systolic thickening was observed. Follow-up wall motion score index was 1.31 ± 0.30 (p < 0.001 vs. rest). The sensitivity of adenosine echo test for identification of viable segments was 87%, while specificity was 95%, and diagnostic accuracy 90%. Positive and negative predictive values were 97% and 80%, respectively. CONCLUSION: Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability
The contribution of cavernous body biopsy in the diagnosis and treatment of male impotence
This study concerns the results of penile
biopsies in 50 patients aged 27 to 80, with secondary
impotence removed with a biopty gun or during penile
surgery. The biopty gun specimens were equally
representative as the open biopsy ones. The cause and
the degree of erectile dysfunction were determined by
clinical and laboratorial investigation. The histological
study of the cavernous bodies in the patients with
psychogenic impotence revealed normal erectile tissue.
In patients with organic impotence, histological lesions
were graded as mild, moderate or severe. The most
severe lesions were observed in the erectile tissue and in
particular in the smooth muscle of the trabeculae and the
helicine arteries, which had been reduced and replaced
by connective tissue. Histological lesions were found not
only in the arterial but also in the venous leak cases.
There was a correlation between their severity and the
degree of impotence, although of no statistical
significance. The penile biopsy determines the condition
(state) of the functional cavernous smooth muscle tissue,
the integrity of which is essential for the erectile
mechanism as well as for the action of the vasoactive
drugs and the results of vascular surgery. Its important
role is evident as it contributes not only to the diagnosis
of the cause, but also to the choice of treatment of male
impotence
Comparison of the extent and severity of coronary artery disease inpatients with acute myocardial infarction with and without microalbuminuria
The extent and severity of coronary atherosclerosis were compared
between 43 microalbuminuric and 87 normoalbuminuric nondiabetic patients
with acute myocardial infarction. Patients with microalbuminuria had
significantly greater scores of the severity (Gensini score) and extent
(Hamsten score) of coronary artery disease (p < 0.001). (C) 2004 by
Excerpta Medica, Inc
Coronary microcirculation evaluation with transesophageal echocardiography Doppler in type II diabetics
Evaluation of coronary microvascular function can be obtained through
coronary flow reserve measurements. The aim of this study was to
evaluate the coronary microvascular function by using
transesophageal-Doppler echocardiographic assessment of coronary flow
reserve. The study included 32 normotensive patients with type II
diabetes mellitus (group A) of short duration (6.1+/-3.8 years) aged
55.4+/-9.4 years and 14 healthy volunteers matched for age, gender and
BMI (group B). No patients had clinical evidence of coronary artery
disease and all of them produced a negative recent stress ECG test.
Excluded from the study were patients with anemia, left ventricular
hypertrophy, arrhythmia, congenital, or acquired structural heart
disease. All subjects underwent transesophageal-Doppler
echocardiography. Satisfactory coronary blood flow velocity recordings
could be obtained from the initial segment of the left anterior
descending coronary artery in healthy volunteers and in 27 patients at
baseline and 2 min after dipyridamole infusion (0.56 mg/kg, for 4 min).
In the remaining 5 patients no satisfactory recordings were available.
The indexes of coronary flow reserve, i.e. the ratios of dipyridamole
over basal maximum and mean diastolic velocities were calculated.
Dipyridamole/rest maximal coronary reserve (Table 3) was 1.946+/-0.743,
while this ratio for the mean diastolic velocity was 1.969+/-0.805 in
group A. The respective values for group B, were 2.811+/-0.345 (P=0.000
vs. group A) and 2.914+/-0.303 (P=0.000 vs. group A). Thus, the increase
in coronary flow reserve although present in both groups, it was more
impressive in the normal group. Multiple regression logistic analysis
of: age, sex, smoking, glucosylated hemoglobin, duration of diabetes and
type of therapy, did not show any correlation of these parameters with
the above ratios. This study shows that coronary flow reserve, as
measured with transesophageal echocardiography-Doppler, is severely
impaired in normotensive patients with type II diabetes, with relatively
short duration of the disease. (C) 1997 Elsevier Science Ireland Ltd
Microalbuminuria: A strong predictor of 3-year adverse prognosis in nondiabetic patients with acute myocardial infarction
Background The aim of this study is to evaluate the significance of
microalbuminuria (MA) as a 3-year prognostic index in nondiabetic
patients with acute myocardial infarction (AMI).
Methods One hundred seventy-five patients with AMI were followed
prospectively for 3 years. The study end point was cardiac death or
rehospitalization for an acute coronary event.
Results Forty-two patients (24%) developed a new cardiac event during
the follow-up. Microalbuminuria (P < .001), pulmonary edema during
initial hospitalization (P < .001) and postinfarction angina (P =
.0364), advanced age (P = .001), severe atherosclerosis (high Gensini
score) (P = .036), ejection fraction <50% (P = .0013), history of
bypass surgery (P = .0265), and early conservative management (P = .021
A) were all associated with adverse prognosis. Cox proportional hazards
regression analysis showed that MA was an independent predictor of
3-year adverse prognosis in all the models tested, with an adjusted
relative risk for the development of a cardiac event ranging from 2.1 to
4.3.
Conclusions In nondiabetic patients with AMI, MA is a strong and
independent predictor of an adverse cardiac event within the next 3
years