Serial angiographic observations after successful directional coronary atherectomy

This study focuses on the early and late angiographic evolution observed in 82 patients with coronary artery disease who were successfully treated by directional coronary atherectomy (DCA) without adjunctive balloon angioplasty. Qualitative inspections and quantitative measurements were obtained from a selected angled-view projection in the following conditions: (1) before treatment; (2) immediately after treatment; (3) the day after atherectomy; (4) 1 month after; and (5) 6 months after. The appearance of the treated segment 24 hours after the procedure did not differ in 79 patients from that observed immediately after DCA; silent total occlusion occurred in two patients, and one had an aneurysm at the site of resection (all three patients were excluded from the analysis). At the 1-month study restenosis developed in 3 (3.6%) patients; the remaining 76 had identical appearances, with no evidence of renarrowing of the lumen. However, from 1 to 6 months after the procedure restenosis developed in 35 of the remaining 76 (46%) patients, and 41 patients were free of restenosis and symptoms. These findings, which show that early elastic recoil does not occur after successful DCA, are different from the changes observed after balloon angioplasty. At the 1-month observation restenosis is an infrequent but possible phenomenon (3.8%). From this point the healing of the arterial wall leads to no or mild renarrowing (late success); an exaggerated proliferative response produces restenosis.

[Evolution of the microbiological parameters of cured ham]

The main microbiological and physico-chemical parameters in dry-salted ham previously selected were determined along the elaboration process. All determinations were performed at 2 levels: surface and internal. All bacterial groups showed a similar behaviour, increasing along the first stages up to the third month of drying, then decreasing to numbers similar to the initial ones. Only the halotolerants maintained fairly high numbers during last stages. Some groups were almost absent at internal levels. The hazardous bacteria showed different behaviour: whereas the faecal streptococci were fairly abundant during the whole study, coliforms almost disappeared at the final stages. During the elaboration process at different stages of ripening they were analysed in order to know the moulds population at surface level. Aspergillus and Penicillium were the dominant genera. The latter, mainly represented by 10 species, dominated during the first stages of elaboration. Aspergillus was present throughout the whole making process. The glaucus group was clearly dominant at the final stages due to the low aw values together with the high NaCl percentages. Aspergillus halophilicus was the most abundant species identified (18%) and the most frequently isolated at the final stages.

Intracoronary ultrasound assessment of directional coronary atherectomy: immediate and follow-up findings

OBJECTIVES

This study was conducted to assess the relations among intracoronary ultrasound, angiographic and histologic data obtained from patients with coronary artery disease successfully treated by directional coronary atherectomy. In addition, it was designed to elucidate whether some aspects of intravascular ultrasound or pathologic findings could predict a propensity to restenosis.

BACKGROUND

Intracoronary ultrasound is a useful technique in guiding and assessing atherectomy. However, there is little information about the characterization of the different types of coronary plaques and the changes observed in them after resection. Furthermore, the follow-up ultrasound appearance of previously treated lesions remains undepicted.

METHODS

Fifty-two patients (54 +/- 10 years old) were studied. All were successfully treated by atherectomy with the aid of intracoronary ultrasound guidance. Qualitative and quantitative ultrasound and angiographic variables were derived before and after resection. Quantitative histologic morphometric information was also obtained from the specimens. In 22 patients, a follow-up echoangiographic reevaluation was performed 6 +/- 4 months later.

RESULTS

Echogenic plaques had a higher collagen and calcium content, whereas echolucent plaques had an increased level of fibrin, nuclei and lipids. Ultrasound plaque reduction after atherectomy was greater in echolucent (76 +/- 21%) than in echogenic plaques (60 +/- 18%; p < 0.05). That reduction correlated with the weight of the resected material (r = 0.62; p < 0.01). At follow-up study, 13 of 22 patients had angiographic and ultrasound evidence of restenosis. Most recurrent lesions had a stenotic three-layer appearance. The incidence of restenosis of primary lesions treated with atherectomy was higher in echolucent (100%) than in echogenic (33%) plaques. Similarly, a higher proportion of nuclear content in the resected material was observed in patients who developed restenosis (2.1 +/- 0.7%) than in patients who had late success after atherectomy (1.2 +/- 0.6%).

CONCLUSIONS

Our findings suggest that echolucent plaques are easier to resect than are echogenic plaques but frequently develop restenosis. In contrast, the resection of echogenic plaques, although often incomplete, is associated with better long-term results.

Peripheral stent recovery after failed intracoronary delivery

The Palmaz-Schatz stent can be successfully deployed in most patients. However, in a small percentage of instances a systemic embolism of the stent has been reported. In the present article we describe an easy and fast method of stent capture when detachment from the balloon has happened (pulling back the stent-loaded balloon into the guiding catheter or femoral sheath). In this situation we propose the use of the coronary guide-wire "as a guide" to capture coaxially the lost stent. This method allows for continuing the procedure without removal of the femoral sheath.

Primary cardiac paraganglioma. Case report and review of surgically treated cases

A 58 year old man with an infiltrating non-resectable left atrial paraganglioma was diagnosed by sternotomy and open biopsy. The patient remains symptom free 16 months after the operation. No evidence of an increase in the size of the tumour has been detected by echocardiography. The literature regarding surgically treated patients with cardiac paragangliomas is reviewed.

[Follow-up study after percutaneous mitral valvuloplasty. The COR-PAL experience]

Mitral balloon valvulotomy has proven to be an effective method for the treatment of patients with mitral stenosis. Although several factors determining an optimal immediate result have been described, there is few information regarding the longterm follow-up as well as factors influencing late success after the procedure. In this article, we analyzed our series of 311 patients treated by mitral balloon valvulotomy who were clinically followed between 3 months and 5 years (mean 23 +/- 11 months). At least, one echo-Doppler follow-up study was obtained in 260 patients, 20 +/- 10 months after. Hemodynamic re-evaluations were performed in 63 patients after 20 +/- 11 months. Late success was defined as the patient being in functional class I-II and free of major events (death, restenosis or valve surgery). Restenosis was defined as the loss of 50% of initial gain in terms of valve area, confirmed always hemodynamically. Major events during follow-up period occurred in 19 patients (10 deaths, 8 restenosis and 11 mitral valve surgery). We performed a multivariate study using the Cox-regression model. In the analysis, all variables with or near statistic significance in the univariate analysis (Mantel-Haezel) were included. The only significant independent predictors of late success were the presence of sinus rhythm (p < 0.04) and the absence of calcium at the valve (p < 0.001). In conclusion, the best results 5 years after mitral balloon valvulotomy are observed in patients with non calcified valve and sinus rhythm.

Long-term beneficial effects of angiotensin-converting enzyme inhibition in patients with nephrotic proteinuria

Angiotensin-converting enzyme inhibitors (ACEI) can reduce proteinuria in diabetic and nondiabetic nephropathy. However, no studies have determined whether this antiproteinuric effect modifies the progression of renal insufficiency. We studied the evolution of 46 nondiabetic patients with nephrotic proteinuria treated with captopril for a minimum of 12 months. The follow-up period before captopril treatment was 12 to 18 months. At the end of follow-up, after captopril introduction (24.4 +/- 7.6 months), proteinuria had decreased from 6.3 +/- 2.5 to 3.9 +/- 3.1 g/24 h (P less than 0.001), with a mean decrease of 45% +/- 28%. The proteinuria decrease was higher in patients with reflux nephropathy, proteinuria associated with reduction of renal mass, inactive crescentic glomerulonephritis, nephroangiosclerosis, and IgA nephropathy, whereas patients with membranous glomerulonephritis and idiopathic focal glomerulosclerosis showed a poorer response. Patients were separated according to a proteinuria reduction greater (group A, 23 patients) or lower (group B, 23 patients) than 45% of the initial value. At the end of follow-up, renal function had not significantly changed in group A with respect to values at the start of treatment: serum creatinine (SCr) was 229 +/- 167 mumol/L (2.6 +/- 1.9 mg/dL) versus 203 +/- 97 mumol/L (2.3 +/- 1.1 mg/dL), and creatinine clearance (CrCl) was 0.80 +/- 0.52 mL/s (48 +/- 31 mL/min) versus 0.87 +/- 0.47 mL/s (52 +/- 28 mL/min). The slope of the reciprocal of Scr (1/SCr) showed a significantly beneficial change after captopril introduction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Drugs and porphyric crisis]

Life threatening crisis may accompany some varieties of porphyria like the acute intermittent form, coproporphyria, porphyria variegata and that associated to deficiency of porphobilinogen synthetase. Drugs are commonly involved as precipitating factors. A classification of drugs according to their proven or probable triggering effect is offered in this paper. Insufficient information precludes the classification of some drugs.

Cancer diagnosis disclosure in a Spanish hospital

At the Clinic Hospital in Barcelona, Spain, 167 cancer patients and 380 hospital health care workers were interviewed about cancer diagnosis disclosure. Only 25 patients (15%) were correctly informed of their diagnoses. Breast cancer patients were significantly more often informed than patients with other malignancies (p less than 0.05). Two hundred seventy-two of 380 hospital health workers interviewed (71%, p = 0.00) would want to know their own diagnoses should they suffer from cancer in the future, but only 19% (p = 0.00) would want such a diagnosis revealed to their similarly afflicted relatives. This information model, based on cancer taboo, is largely preferred by these healthy people and is followed by doctors, patients and family members. To inform our patients better, the mandatory uniform disclosure of the true diagnosis is not likely to be constructive at present. In our opinion a pragmatic approach is more realistic and humane. Nevertheless, we must hope that more modern cancer education will lead to the gradual elimination of this taboo in our society.

Effects of 3-hydroxy,3-ethyl,3-phenylpropionamide (HEPP) on rat models of generalized and focal epilepsy

The GABA withdrawal syndrome (GWS) is a new model of focal epilepsy in which paroxysmal activity is induced through the interruption of a chronic, intracortical infusion of GABA. Preliminary studies have shown extraordinary resistance of this epileptogenic activity to classic anticonvulsants including diazepam, the most effective agent for treating status epilepticus. However, GWS can be inhibited by GABA itself. The rat with petit mal-like seizures is a genetic model of generalized non-convulsive epilepsy (GNCE), with behavioral characteristics and electrical (spike-and-wave discharges) signs resembling absences. Moreover, GABAmimetics aggravate this type of seizure. Rats with GWS induced by cessation of a localized GABA infusion (50 micrograms/microliters/h for 24 h), and the rat model of GNCE, were treated with HEPP, a new anticonvulsant agent. In the case of GWS, the drug produced a significant decrease of focal spike activity in animals which started discharging at low frequencies while in rats with higher frequency discharge, HEPP was without effect. HEPP administered on the second day of the GWS in naive rats had no effect. In rats with GNCE, doses of 50 and 100 mg/kg i.p. blocked the spike-and-wave discharges. The higher dose produced sedation in this absence seizures model. Although the mechanism of action of HEPP is still unknown, its unique antiepileptic profile deserves further studies.

[The distribution of adipose tissue is related to the levels of insulin in the obese woman]

We studied 51 patients aged 20-35 years, with overweight or obesity evaluated by the body mass index (BMI = weight height2) when it was higher than 25 (normal 20-25), and a control group of six women with the same age and normal BMI. In all patients waist and hip circumferences were measured, to calculate the waist/hip ratio (WHR). Also serum insulin was measured in basal conditions and as response to 75 g oral glucose load, taking samples at 30, 60, 90, 120 and 180 minutes after. The test were performed 3 to 6 days following a spontaneous or induced genital bleeding with progestin. The WHR showed a normal distribution with the greatest frequency at 0.87. The patients were classified with predominance of adiposity in the upper body segment, when the WHR was equal or more than 0.85, and with adipose predominance in the lower body segment when it was equal or less than 0.84. The average insulin values in response to oral glucose load of patients with upper body segment obesity were significantly higher (Mann-Whitney's U = 0, p less than 0.02) than the corresponding cases with lower body segment obesity. Besides, there was a significant correlation between WHR and serum insulin values at 30 minutes after the oral glucose load (Pearson's r = 0.331, p less than 0.02). These results suggest a relation between the distribution of adiposity and insulin values, which were higher in patients with adipose predominance in the upper body segment.

[Transesophageal echocardiography in the selection of patients prior to percutaneous mitral valvuloplasty. Study of 71 consecutive patients]

We studied 71 consecutive patients with mitral stenosis candidates for mitral valvuloplasty by means of transthoracic (TTE) and transesophageal echocardiography (TEE). We compared the information obtained by the two methods with respect to: mitral valve morphology (echocardiographic score), severity of mitral regurgitation, prevalence of atrial thrombus and incidence of spontaneous contrast in the left atrium. The assessment of valvular thickening, mobility and calcification was similar by the two methods. The assessment of the subvalvular disease was significantly lower by TEE than the assessed by TTE (1.66 +/- 0.6 vs 2.12 +/- 0.5; p less than 0.001). The total "score" obtained by TEE was significantly lower than the "score" obtained by TTE (7.32 +/- 1.9 vs 7.88 +/- 1.8; p +/- 0.001), but when we classified the patients in groups according to the "score", there were no significant differences between the groups obtained by the two methods. We detected mitral regurgitation in 27 patients (38%) by TTE and in 36 (50%) by TEE. The difference in the quantification of the mitral regurgitation was no more than one grade in any case. Atrial thrombus were detected in 16 patients (22%) by TEE and in 2 patients by TTE. Spontaneous contrast was seen in 53 patients (75%) by TEE and in only 1 by TTE. We conclude that TEE is essential in detecting atrial thrombus, but does not provide any new information about mitral valve morphology and mitral regurgitation in the selection of patients for percutaneous mitral valvuloplasty.

Immediate and follow-up results of transluminal balloon dilation for discrete subaortic stenosis

This study presents the findings in 33 patients with discrete subaortic stenosis who were treated by percutaneous balloon dilation and were followed up for 2 months to 6.2 years (mean 34 +/- 21 months). The mean age was 13 +/- 11 years; 10 (30%) were female and 23 (70%) male. Associated malformations were observed in nine patients (27%). All patients underwent noninvasive studies and cardiac catheterization. The mean value to membrane distance was 4.5 +/- 2 mm/m2. After balloon dilation, the pressure gradient from the left ventricle to the aorta decreased from 68 +/- 30 to 20 +/- 13 mm Hg (p less than 0.00001); there were no significant changes in the degree of aortic regurgitation. A fluttering and widely mobile remaining membrane was clearly visualized after dilation. Better immediate results were obtained in patients with a smaller baseline gradient, a larger aortic anulus and a longer valve to membrane distance. Serial follow-up echographic studies were available in 30 patients, and 18 hemodynamic reevaluations were performed in 13 patients. However, seven patients who demonstrated restenosis underwent redilation at a mean of 29 +/- 17 months after the first dilation. Redilation in six of the seven patients obtained benefits similar to those observed at the first dilation. Only one patient with unsuccessful redilation required surgery. The mean value of the last explored residual gradient (on hemodynamic or Doppler study) in the remaining 32 patients was 21 +/- 10 mm Hg. No significant changes were observed in the angiographic evolution of aortic regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of the incubation conditions on the production of patulin by Penicillium griseofulvum isolated from wheat

Sixty-four wheat samples from Spanish flour factories were screened for patulin and patulin-producing moulds. None of them was found to contain any patulin, whereas samples experimentally contaminated with this toxin proved it to be highly unstable. On the other hand, Penicillium griseofulvum was the only in vitro patulin-producing species found (19 samples). Mould growth in the samples was investigated by using yeast-sucrose medium (YES) and high-performance liquid chromatography (HPLC) to measure the amounts of toxin produced during 40 day's incubation at 20 and 28 degrees C. The highest yield rate of patulin was obtained between the 20th and 30th day of incubation; such a rate, however, was very low throughout the vigorous growth phase, during the first 20 days of incubation. The more appropriate temperature for incubation and patulin production was 28 degrees C. We also investigated the influence of other incubation conditions in the yield and found stationary dark cultures to be more efficient that shaken or fermentation cultures in YES medium. The best patulin yield achieved was 11.9 mg in the culture broth and 6.3 mg in the mycelium from 100 ml of medium.

Mycotoxins and mycotoxigenic moulds in nuts and sunflower seeds for human consumption

A survey was carried out to obtain data on the occurrence of mycotoxins and the mycotoxin-producing potential of fungi isolated from nuts (almonds, peanuts, hazelnuts, pistachio nuts) and sunflower seeds in Spain. Thin-layer chromatography was used to separate the toxins. Aflatoxins were detected in one sample of almonds (95 ppb aflatoxin B1 and 15 ppb aflatoxin B2) and in one sample of peanuts at a level below 10 ppb of aflatoxin B1. 100% of samples showed variable incidence of fungal contamination. The predominant fungi present in samples were Penicillium spp, Aspergillus niger, A. flavus, A. glaucus and Rhizopus spp. The results showed that isolates of different species were able to produce aflatoxins B1, B2, G1, and G2, sterigmatocystin, ochratoxin A, patulin, citrinin, penicillic acid, zearalenone, and griseofulvin.

[Chagas disease in the Chilean altiplane. Epidemiological, parasitological, and clinical aspects]

Chagas' disease is endemo-enzootic in periurban and rural sections of the first seven (18 degrees 30'-34 degrees 36' South lat.), out of the thirteen political-administrative regions of Chile. Permanent inhabited localities situated at different altitudes over the sea level (OSL) are classified in: coastal settlement (0-1,499 m OSL), intermediate settlement (1,500-3,000 m OSL) and altiplano settlement (> 3,000 m OSL). A total of 1,558 dwellings and their occupants from regions I and II were surveyed in 1982-1984 for different epidemiological Trypanosoma cruzi infection parameters. Hence, 261 dwellings, 189 domestic mammals and 517 people (ages 5- > or = 60 years) from the Altiplano settlement were studied. The results obtained were: 4(1.5%) and 2(0.8%) of dwellings infested with Triatoma infestans, according to occupants information and by observation of direct evidences respectively; 8(4.2%) animals (1 dog, 4 goats and 3 sheep) with a positive hemagglutination test (IHAT) for Chagas' disease; 21 people (4.1%) with a positive IHAT; 4(19.0%) and 3(14.3%), out of the 21 IHAT positive individuals with all types of electrocardiogram (EKG) abnormalities and EKG abnormalities suggestive of a chagasic etiology respectively, whereas 65(13.1%) and 15(3.0%), out of the 496 IHAT negative ones presented the same kinds of EKG abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac rhabdomyoma and tuberous sclerosis. Survival after the surgical resection of the cardiac tumor]

A 3-month-old boy with tuberous sclerosis was diagnosed of biventricular heart tumor by means of 2D-echocardiogram. Three masses of tumor were excised from the right ventricle with the aid of cardiopulmonary bypass. Pathologic examination disclosed a cardiac rhabdomyoma. The boy is symptoms-free after 5 years of the operation. An echocardiogram taken at this time showed no-evidence of heart tumor. Pathology, diagnostic methods and surgical indications are commented. A review of selected surgically resected cases is also presented.

[Coronary permeability and left ventricular function following thrombolytic therapy]

We study 40 patients, 55 +/- 7 years old with acute myocardial infarction treated early by thrombolytic therapy (20 STK and 20 rt-PA). All patients were angiographically studied in the following conditions: 1) baseline, before initiating therapy. 2) Three hours after treatment. 3) Twenty four hours later. 4) Before discharge. The infarct related artery was patent 24 hours after treatment in 31 patients (78%); five of them were patent before treatment, and we observed an early reperfusion in 20 patients (57%) and late reperfusion in 6 patients (17%). The number of patients with angiographic evidence of intraluminal thrombus decreased progressively through conditions while the grade TIMI of coronary perfusion increased in the absence of reocclusion. Final regional wall motion of infarct related myocardial zones and their degree of recovery were significantly higher in recanalized patients, as compared with non-reperfused patients. Similarly, left ventricular functional recovery was higher in patients with antegrade of collateral flow to the infarct area, as compared with totally occluded patients.

[Valvulopathies (XIV). The role of percutaneous valvuloplasty in congenital valvular diseases]

The present article describes the cooperative experience Córdoba-Las Palmas since 1983 in 123 patients with congenital right or left ventricular outflow obstructions who were treated by percutaneous balloon dilatation. Seventy of them had pulmonary stenosis (63 valvular and seven supravalvular types); two had pulmonary atresia, 25 valvular aortic stenosis and 27 discrete subaortic stenosis. In patients with valvular pulmonic stenosis the gradient and the right ventricular pressure decreased significantly. No significant changes were observed in the degree of pulmonary regurgitation. One neonate died. No other major complications occurred. After a mean follow up of 3 +/- 2 years, we did not observe significant changes in the degree of pressure relief. The mean residual gradient is 26 +/- 19 mmHg. In our 21 patients out of the neonatal period with valvular aortic stenosis the gradient and the left ventricular pressure dropped significantly. Progression of aortic regurgitation in more than I grade was observed in 4 patients (19%), although only one (5%) progressed to grade III. There were no major complications in this group. After a mean follow up period of 24 +/- 17 months they persist with the obtained pressure relief and same degree of valvular competence. All 4 neonates with critical aortic stenosis had unsuccessful dilations and they died, wether after ulterior surgery or without it. In 27 patients with discrete subaortic stenosis the gradient and the left ventricular pressure decreased markedly, without significant changes in valve competence. There were no related major complications. After dilation, a broken and mobile membrane was frequently seen. At follow up (24 +/- 18 months), 6 patients (22%) had restenosis; five of them were successfully redilated. The remaining 21 patients persist with a reduced residual gradient (24 +/- 7 mmHg) and without significant changes in valve competence.

[Role of percutaneous valvuloplasty in rheumatic mitral valve stenosis. Córdoba-Las Palmas cooperative study]

This article describes our findings on a prospective and cooperative study (Córdoba-Las Palmas) in 203 patients with mitral stenosis who underwent balloon valvuloplasty using a retrograde transarterial technique. We analyzed the immediate and mid-term results, and studied the factors determining an optimal result and those related to the new appearance or worsening of mitral incompetence after the procedure. On the other hand, we analyzed the results of mitral valvuloplasty in patients with previous mitral surgery, mild mitral stenosis and patients dilated while having an acute pulmonary edema. We observed a marked decrease in mean mitral gradient (17 +/- 7 to 6 +/- 3 mmHg; p less than 0.001) as well as a significant increase in mitral valve area (1.02 +/- 0.4 to 2.04 +/- 0.7 cm2; p less than 0.001). Echo-Doppler follow-up did not show significant changes in the residual mitral valve gradient. Multivariate analysis selected, as independent predictors of an optimal result, the presence of a pliable valve and the absence of basal mitral regurgitation. On the other hand, the presence of a lower ejection fraction, an older age and a higher baseline left ventricular endiastolic volume were independent factors determining progression of mitral regurgitation. In patients with previous mitral surgery, the clinical, echo and hemodynamic profiles, as well as the immediate results, were similar to those observed in patients with unoperated mitral stenosis. In the subgroup of mild mitral stenosis, we observed and optimal result in all cases, without major complications. Mitral valvuloplasty was dramatically effective in 8 patients treated during acute pulmonary edema.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the degree of compliance in arterial hypertension protocol]

We report an evaluation of the hypertension protocol. Its aims were to assess the degree of compliance with its variables, the number, age and sex of hypertensives, and the rate in whom blood pressure levels were controlled in the patients included and not included in the protocol. The study was carried out in the Basauri Teaching Unit from January 1987 to June 1989. We reviewed all the parameters of the medical and nursing protocol of 1,429 patients diagnosed as hypertensive and the mean value of the three last blood pressure readings. A total of 67.2% of patients were included in the protocol. The compliance was higher than 80% in most of its items; 61.8% of the prescribed nursing controls were carried out. Blood pressure was less than or equal to 159/94 in 68.1% of patients. This rate was higher in the patients included in the protocol. The protocol was useful for the control of hypertension, although it should be modified directing it to primary care.

[Transesophageal Doppler color echocardiography in the evaluation of patients after percutaneous mitral valvuloplasty]

To determine the value of transesophageal ultrasound in the assessment of patients after percutaneous mitral valvuloplasty, 42 patients were studied by transthoracic (TTE) and transesophageal (TEE) two-dimensional and color Doppler echocardiography. All of them were studied as out-patients and without complications. We describe the technique, planes of examination and the advantages that this new acoustic window offers in patients after balloon valvuloplasty regarding to: detection of thrombus in the left atrium (LA), visualization of spontaneous echo contrast in the LA, evaluation of mitral regurgitation (MR), detection of small atrial septal defects (ASD) and evaluation of the stage of the commissures of the mitral valve. We detected thrombus by TEE, in 5/42 vs 1/42 by TTE approach. Spontaneous echo contrast was found in 35/42 by TEE and none by TTE. Small ASDs were visualized in 10/42 patients vs 2/42 by TTE. No differences were found in the evaluation of MR and mitral valve commissures either by TEE or TTE. We conclude that transesophageal echocardiography is a well-tolerated technique in outpatients which complements and improves the information obtained by the transthoracic approach in patients after balloon mitral valvuloplasty.

[Transesophageal echocardiographic diagnosis of a left atrial myxoma]

We report the case of a 65 year old woman with a left atrial myxoma. The only clinical manifestation were two transient ischemic attacks of cerebral origin. The diagnosis was established by transesophageal echocardiography because of poor definition of the transtoracic approach. We comment the clinical and diagnostic features of this type of tumors, with emphasize in the value of transesophageal echocardiography.

[The value of high dose steroid therapy in obstructive uropathy caused by a tumor]

The case of an 82-years old female patient with acute renal failure secondary to tumoral obstructive uropathy by neoplasic invasion of the trigone is described. The condition was treated with urinary deviation through percutaneous nephrostomy of the left kidney which achieved an improvement in the renal function. Later, the percutaneous nephrostomy was unintentionally moved not being possible to place a new one in none of the kidneys. The patient remained anuric for 24 hours, and therapy was then instaured with high doses of intravenous steroids (6 Metyl-Prednisolone 1.5 g I.V. in 24 hours), diuresis was recovered and renal function became normalized within a few days. The mechanism of action and therapeutic usefulness of high dosage steroids in tumoral obstructive pathology is discussed.

Characterization of the renal effects of an intravenous calcium gluconate infusion in normotensive volunteers

The effects on renal function of an intravenous infusion of calcium gluconate at subpressor doses have been investigated in a group of seven normotensive male volunteers. In the absence of changes in blood pressure, the calcium gluconate induced a significant increase in renal plasma flow and the glomerular filtration rate (P less than 0.01) with a significant fall in the filtration fraction (P less than 0.01). Both diuresis and natriuresis increased significantly (P less than 0.01), plasma renin activity fell (P less than 0.01) and the urinary excretion of 6-keto prostaglandin F1 alpha (PGF1 alpha) and prostaglandin E2 (PGE2) increased (P less than 0.01). These results indicate that calcium infusion at subpressor doses has renal vasodilating, diuretic and natriuretic properties that appear to be facilitated by an increase in the renal production of vasodilatory and natriuretic prostaglandins.

[Coronary transluminal angioplasty and determination of the intracoronary gradient with a new monorail system]

STUDY OBJECTIVE

To evaluate the results obtained in coronary angioplasty using the new very low profile monorail catheter.

DESIGN

A retrospective study to define the causes and frequency of successful and unsuccessful coronary angioplasty on proximal and distal lesions located in the three coronary vessels.

SETTING

Patients referred to the Hemodynamic Unit for coronary angioplasty.

PATIENTS

Coronary angioplasty was performed in 106 patients with cardiac ischemic disease (stable angina, unstable angina and myocardial infarction after thrombolytic therapy).

INTERVENTIONS

To perform coronary angioplasty using a monorail system, including dilatation of vessels (angioplasty) and to measure the intracoronary gradient.

RESULTS

A high success rate was achieved (92%) independent of vessel dilated or of the position of the stenosis. There was a lower success rate in complex lesions.

CONCLUSION

In this study, this newly modified system for coronary angioplasty with balloon catheter and monorail pressure catheter gave a very high performance.

[Aortic valvuloplasty using the transatrial route in aortic valve stenosis]

We describe a new technique for aortic valvuloplasty in four patients. The balloon catheter was inserted percutaneously from the right femoral vein over a long guidewire introduced into the right femoral vein and advanced transseptally to the left atrium and left ventricle and drawn out of the body through the left femoral artery using an intravascular retriever set. With both ends of the long guidewire under manual control outside the body, the balloon could be easily fixed during inflation. The procedure was easy to perform and caused no complications.

[Double mitral orifice associated with a bicuspid aortic valve detected using bidimensional echocardiography]

We present the case of a 16 year old girl with the rare association of double mitral orifice and bicuspid aortic valve. The patient was asymptomatic and the defect was noted in two-dimensional echocardiographic examination. The clinical and therapeutical implications are discussed.

[Isolation of imazalil and prochloraz resistant Penicillium variable strains from a commercial citrus warehouse]

"In vitro" sensitivity of two strains of Penicillium variabile to different concentrations of Imazalil and Prochloraz has been studied. Both strains were isolated from a citrus packing-house in which Imazalil was used. These strains were resistant to both compounds showing a ED50 higher than 100 ppm.