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Alarcón E, Sansosti A, Navarro B, Claver A, Botey E, Cisteró-Bahima A, Bartra J. Amoxicillin-Induced Aseptic Meningitis: 2 Case Reports and Appraisal of the Literature. J Investig Allergol Clin Immunol 2019; 29:248-250. [DOI: 10.18176/jiaci.0380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Turner NC, Alarcón E, Armstrong AC, Philco M, López Chuken YA, Sablin MP, Tamura K, Gómez Villanueva A, Pérez-Fidalgo JA, Cheung SYA, Corcoran C, Cullberg M, Davies BR, de Bruin EC, Foxley A, Lindemann JPO, Maudsley R, Moschetta M, Outhwaite E, Pass M, Rugman P, Schiavon G, Oliveira M. BEECH: a dose-finding run-in followed by a randomised phase II study assessing the efficacy of AKT inhibitor capivasertib (AZD5363) combined with paclitaxel in patients with estrogen receptor-positive advanced or metastatic breast cancer, and in a PIK3CA mutant sub-population. Ann Oncol 2019; 30:774-780. [PMID: 30860570 PMCID: PMC6551452 DOI: 10.1093/annonc/mdz086] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND BEECH investigated the efficacy of capivasertib (AZD5363), an oral inhibitor of AKT isoforms 1-3, in combination with the first-line weekly paclitaxel for advanced or metastatic estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer, and in a phosphoinositide 3-kinase, catalytic, alpha polypeptide mutation sub-population (PIK3CA+). PATIENTS AND METHODS BEECH consisted of an open-label, phase Ib safety run-in (part A) in 38 patients with advanced breast cancer, and a randomised, placebo-controlled, double-blind, phase II expansion (part B) in 110 women with ER+/HER2- metastatic breast cancer. In part A, patients received paclitaxel 90 mg/m2 (days 1, 8 and 15 of a 28-day cycle) with capivasertib taken twice daily (b.i.d.) at two intermittent ascending dosing schedules. In part B, patients were randomly assigned, stratified by PIK3CA mutation status, to receive paclitaxel with either capivasertib or placebo. The primary end point for part A was safety to recommend a dose and schedule for part B; primary end points for part B were progression-free survival (PFS) in the overall and PIK3CA+ sub-population. RESULTS Capivasertib was well tolerated, with a 400 mg b.i.d. 4 days on/3 days off treatment schedule selected in part A. In part B, median PFS in the overall population was 10.9 months with capivasertib versus 8.4 months with placebo [hazard ratio (HR) 0.80; P = 0.308]. In the PIK3CA+ sub-population, median PFS was 10.9 months with capivasertib versus 10.8 months with placebo (HR 1.11; P = 0.760). Based on the Common Terminology Criteria for Adverse Event v4.0, the most common grade ≥3 adverse events in the capivasertib group were diarrhoea, hyperglycaemia, neutropoenia and maculopapular rash. Dose intensity of paclitaxel was similar in both groups. CONCLUSIONS Capivasertib had no apparent impact on the tolerability and dose intensity of paclitaxel. Adding capivasertib to weekly paclitaxel did not prolong PFS in the overall population or PIK3CA+ sub-population of ER+/HER2- advanced/metastatic breast cancer patients.ClinicalTrials.gov: NCT01625286.
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Affiliation(s)
- N C Turner
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK; Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK.
| | - E Alarcón
- Clinical Oncology Department, British American Hospital, Lima, Peru
| | - A C Armstrong
- Department of Medical Oncology, Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M Philco
- Peruvian Institute of Oncology Radiotherapy, Lima, Peru
| | | | - M-P Sablin
- Department of Drug Development and Innovation (D3i), Curie Institute, Paris, France
| | - K Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - J A Pérez-Fidalgo
- Medical Oncology Unit, INCLIVA Biomedical Research Institute, University Clinical Hospital of Valencia, Valencia; CIBERONC, Health Institute Carlos III, Madrid, Spain
| | | | - C Corcoran
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge
| | - M Cullberg
- IMED Biotech Unit, AstraZeneca, Cambridge
| | - B R Davies
- IMED Biotech Unit, AstraZeneca, Cambridge
| | | | - A Foxley
- IMED Biotech Unit, AstraZeneca, Cambridge
| | | | - R Maudsley
- IMED Biotech Unit, AstraZeneca, Cambridge
| | | | | | - M Pass
- IMED Biotech Unit, AstraZeneca, Cambridge
| | - P Rugman
- IMED Biotech Unit, AstraZeneca, Cambridge
| | - G Schiavon
- IMED Biotech Unit, AstraZeneca, Cambridge
| | - M Oliveira
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Turner N, Alarcón E, Armstrong A, Philco M, López Chuken Y, Sablin MP, Tamura K, Gomez Villanueva A, Pérez-Fidalgo J, Foxley A, Lindemann J, Maudsley R, Outhwaite E, Pass M, Rugman P, Schiavon G, Oliveira M. BEECH: A randomised Phase 2 study assessing the efficacy of AKT inhibitor AZD5363 combined with paclitaxel in patients with ER+ve advanced or metastatic breast cancer, and in a PIK3CA mutant sub-population. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mendoza-Ticona A, Alarcón E, Alarcón V, Bissell K, Castillo E, Sabogal I, Mora J, Moore D, Harries AD. Effect of universal MODS access on pulmonary tuberculosis treatment outcomes in new patients in Peru. Public Health Action 2012; 2:162-167. [PMID: 24579063 DOI: 10.5588/pha.12.0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Primary health care centres in Callao, Peru. OBJECTIVES To evaluate the effect of universal access to the microscopic-observation drug susceptibility (MODS) assay on treatment outcomes in new and primary multidrug-resistant tuberculosis (MDR-TB) patients and on the process of drug susceptibility testing (DST). DESIGN Retrospective review of tuberculosis (TB) registers and clinical records before (2007) and after (2009) the introduction of MODS in 2008. RESULTS There were 281 patients in each cohort. Favourable treatment outcomes for 2007 (81%) and 2009 (77%) cohorts were similar. There was an increase in loss to follow-up (from 6% to 10%, P = 0.04) and a reduction in failure rates (from 4% to 0.4%, P = 0.01) in the 2009 compared with the 2007 cohort. In new MDR-TB cases (n = 22), a favourable treatment outcome was improved (from 46% to 82%, P = 0.183) in the 2009 cohort. DST coverage improved (from 24% to 74%, P < 0.001), and a significant reduction in time to diagnosis of drug-susceptible (from 118 to 33 days, P < 0.001) and MDR-TB (from 158 to 52 days, P =30.003) was observed in the 2009 cohort. CONCLUSION Universal access to MODS increased DST coverage, reduced the time required to obtain DST results and was associated with reduced failure rates. MODS can make an important contribution to TB management and control in Peru.
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Affiliation(s)
| | - E Alarcón
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - V Alarcón
- Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud, Lima, Peru
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France ; The University of Auckland, Auckland, New Zealand
| | - E Castillo
- Dirección Regional de Salud de Callao, Callao, Peru
| | - I Sabogal
- Instituto de Medicina Tropical 'Daniel A. Carrión', Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - J Mora
- Dirección Regional de Salud de Callao, Callao, Peru
| | - D Moore
- London School of Hygiene & Tropical Medicine, London, UK
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Alarcón E, del Pozo MD, Bartolomé B, Navarro B, Escudero R, Gonzalez I, Blasco A, Lobera T. Urticaria and angioedema due to ingestion of carob gum: a case report. J Investig Allergol Clin Immunol 2011; 21:77-78. [PMID: 21370730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- E Alarcón
- Allergy Section, Hospital San Pedro, Logroño, La Rioja, Spain.
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Mandiola E, Alarcón E, Oñate JC, del Sol M, Olave E. Arterias Comunicantes del Círculo Arterial del Cerebro: Características Biométricas y Relación con el Índice Cefálico. INT J MORPHOL 2010. [DOI: 10.4067/s0717-95022010000300048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Alarcón E, Aspée A, González-Béjar M, Edwards AM, Lissi E, Scaiano JC. Photobehavior of merocyanine 540 bound to human serum albumin. Photochem Photobiol Sci 2010; 9:861-9. [DOI: 10.1039/c0pp00079e] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lobera T, Audícana MT, Alarcón E, Longo N, Navarro B, Muñoz D. Allergy to quinolones: low cross-reactivity to levofloxacin. J Investig Allergol Clin Immunol 2010; 20:607-611. [PMID: 21314003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Immediate-type hypersensitivity reactions to quinolones are rare. Some reports describe the presence of cross-reactivity among different members of the group, although no predictive pattern has been established. No previous studies confirm or rule out cross-reactivity between levofloxacin and other quinolones.Therefore, a joint study was designed between 2 allergy departments to assess cross-reactivity between levofloxacin and other quinolones. MATERIAL AND METHODS We studied 12 patients who had experienced an immediate-type reaction (4 anaphylaxis and 8 urticaria/angioedema) after oral administration of quinolones. The culprit drugs were as follows: ciprofloxacin (5), levofloxacin (4), levofloxacin plus moxifloxacin (1), moxifloxacin (1), and norfloxacin (1). Allergy was confirmed by skin tests and controlled oral challenge tests with different quinolones. The basophil activation test (BAT) was applied in 6 patients. RESULTS The skin tests were positive in 5 patients with levofloxacin (2), moxifloxacin (2), and ofloxacin (2). BAT was negative in all patients (6/6). Most of the ciprofloxacin-reactive patients (4/5) tolerated levofloxacin. Similarly, 3 of 4 levofloxacin-reactive patients tolerated ciprofloxacin. Patients who reacted to moxifloxacin and norfloxacin tolerated ciprofloxacin and levofloxacin. CONCLUSIONS Our results suggest that skin testing and BAT do not help to identify the culprit drug or predict cross-reactivity. Oral challenge testing is the only way to confirm tolerance to a quinolone before prescribing it as a safe alternative. Levofloxacin could be a safer alternative in cases of reaction to first-, second-, or fourth-generation quinolones.
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Affiliation(s)
- T Lobera
- Department of Allergy, Hospital San Pedro/San Millán, Logroño, Spain.
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Lobera T, Navarro B, Del Pozo MD, González I, Blasco A, Escudero R, Venturini M, Alarcón E. Nine cases of omeprazole allergy: cross-reactivity between proton pump inhibitors. J Investig Allergol Clin Immunol 2009; 19:57-60. [PMID: 19274931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Although rare, anaphylactic reactions induced by proton pump inhibitors have been reported. The presence of cross-reactivity between different members of the group is not clear. We studied 9 patients with adverse reactions to omeprazole. Clinical symptoms appeared immediately in 8 patients and after 4 hours in 1. Symptoms ranged from urticaria/angioedema in 7 cases to anaphylaxis in 2 cases. Skin prick tests and oral controlled challenge tests with omeprazole, lansoprazole, and pantoprazole were performed. Skin prick or intradermal tests with omeprazole were positive in 8 patients. Four were also positive to pantoprazole. Prick tests with lansoprazole were always negative. Lansoprazole was administered to all 9 patients, with good tolerance in 8. Only 3 patients were challenged with pantoprazole and developed widespread urticaria. We present 9 patients with immunoglobulin E-mediated allergy to omeprazole. In most of our cases, lansoprazole proved to be a good alternative treatment.
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Affiliation(s)
- T Lobera
- Department of Allergy, Hospital San Pedro/San Millán, Logroño, Spain.
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Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick CD, Riekstina V, Zarovska E, Rich ML, Fraser HSF, Alarcón E, Cegielski JP, Grzemska M, Gupta R, Espinal M. Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2005; 9:640-5. [PMID: 15971391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
SETTING Globally it is estimated that 273000 new cases of multidrug-resistant tuberculosis (MDR-TB, resistance to isoniazid and rifampicin) occurred in 2000. To address MDR-TB management in the context of the DOTS strategy, the World Health Organization and partners have been promoting an expanded treatment strategy called DOTS-Plus. However, standard definitions for MDR-TB patient registration and treatment outcomes do not exist. OBJECTIVE To propose a standardized set of case registration groups and treatment outcome definitions for MDR-TB and procedures for conducting cohort analyses under the DOTS-Plus strategy. DESIGN Using published definitions for drug-susceptible TB as a guide, a 2-year-long series of meetings, conferences, and correspondence was undertaken to review published literature and country-specific program experience, and to develop international agreement. RESULTS Definitions were designed for MDR-TB patient categorization, smear and culture conversion, and treatment outcomes (cure, treatment completion, death, default, failure, transfer out). Standards for conducting outcome analyses were developed to ensure comparability between programs. CONCLUSION Optimal management strategies for MDR-TB have not been evaluated in controlled clinical trials. Standardized definitions and cohort analyses will facilitate assessment and comparison of program performance. These data will contribute to the evidence base to inform decision makers on approaches to MDR-TB control.
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Affiliation(s)
- K F Laserson
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Oñate JC, Sanhueza P, Alarcón E, López R, Montero C, Mandiola E. Presencia del Apéndice Fibroso Hepático: Estudio de Correlaciones Bioantropológicas y su Estructura. INT J MORPHOL 2005. [DOI: 10.4067/s0717-95022005000300004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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López F, Hernández-Palazón J, López R, Alarcón E, Martínez-Lage JF. [Activity of copper-zinc superoxide dismutase in a global ischemic brain lesion model without arterial hypotension]. Neurocirugia (Astur) 2004; 15:151-8. [PMID: 15159793 DOI: 10.1016/s1130-1473(04)70495-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the behavior of the copper-zinc superoxide dismutase enzyme (SOD/Cu/Zn) in tissue homogenates of rat brains with ischemic lesions produced following the model of global cerebral ischemia without arterial hypotension. MATERIAL AND METHODS Thirty rats were randomly assigned to five groups of six animals each. Bilateral carotid occlusion was temporarily produced in 24 rats (4 groups) during periods of 5, 15, 30 and 60 minutes, respectively. All the animals were then submitted to reperfusion for 30 minutes and after that, they were sacrificed. A control group of 6 rats was not exposed to arterial occlusion. Cerebral homogenates of the rats' brain were obtained and submitted to spectrophotometer analysis. RESULT The control group showed the lowest mean values in SOD/Cu/Zn activity (40.60+/-11.42 U/mg of protein), while the highest mean values (60.34+/- 13.52 U/mg of protein) corresponded to the rats submitted to ischemia for 60 minutes, what indicates a statistically significant difference (p = 0.016) between the two groups. CONCLUSIONS SOD/Cu/Zn activity in rats increases during the production of ischemic cerebral lesions. The analysis of SOD/Cu/Zn activity showed an important tendency to rise from the 30 minutes period of ischemic lesion and reached statistically significant values at 60 minutes from the beginning of the ischemic injury. The experimental model of global brain ischemia without arterial hypotension used in this study constitutes a reliable method for researching cerebral ischemia.
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Affiliation(s)
- F López
- Servicio Regional de Neurocirugía y Laboratorio de Cirugía Experimental, Hospital Universitario Virgen de la Arrixaca, Murcia
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Mandiola E, del Sol M, Olave E, Alarcón E, Montero C, Sanhueza P, Oñate JC. ANÁLISIS BIOMÉTRICO ENTRE MEDICIONES BIOANTROPOLÓGICAS CEFÁLICAS Y LA ARTERIA BASILAR. INT J MORPHOL 2004. [DOI: 10.4067/s0717-95022004000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Suárez PG, Watt CJ, Alarcón E, Portocarrero J, Zavala D, Canales R, Luelmo F, Espinal MA, Dye C. The dynamics of tuberculosis in response to 10 years of intensive control effort in Peru. J Infect Dis 2001; 184:473-8. [PMID: 11471105 DOI: 10.1086/322777] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2001] [Revised: 05/08/2001] [Indexed: 11/04/2022] Open
Abstract
Improved tuberculosis (TB) case detection and cure rates are expected to accelerate the decline in incidence of TB and to reduce TB-associated deaths. Time series analyses of case reports in Peru showed that the per capita TB incidence rate was probably steady before 1991. Case reports increased between 1990 and 1992 as a result of improved case detection. Although diagnostic efforts have continued to increase since 1993, the incidence of new pulmonary TB cases has declined in every department of the country, with a national rate of decline > or =5.8% per year (range, 1.9%-9.7%). This elevated rate of decline suggests that 27% (19%-34%) of cases (158,000) and 70% (63%-77%) of deaths (91,000) among smear-positive patients were averted between 1991 and 2000. This is the first demonstration that a significant number of TB cases can be prevented through intensive short-course chemotherapy in a high-burden country.
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Affiliation(s)
- P G Suárez
- Ministerio de Salud, Enfermedades Transmisibles, Av. Salaverry s/n Jesus Maria, Lima, Peru.
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Olmos A, Seguel I, Gajardo J, Ghyra A, Santander C, Alarcón E, Saldaña A, Piana ME, Palacios S, Lama A. [Percutaneous mitral valvuloplasty and open mitral commissurotomy: comparison of 2 techniques in immediate results]. Rev Med Chil 1994; 122:274-82. [PMID: 7809517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this study was to assess the real usefulness of percutaneous mitral balloon valvuloplasty (PMV). Eighty patients aged less than 56 years old, with symptomatic pure mitral stenosis, with an hemodynamic and echocardiographic area < 1.5 cm2, without associated valvular or coronary lesions and without surgical contraindications were studied. These were randomized in two groups of similar age, sex, symptomatology, cardiac rhythm, severity of stenosis and valve anatomy, that were subjected to PMV (n = 38) using a double balloon technique or to mitral commissurotomy (n = 42) with extracorporeal circulation (MC). Mitral areas (calculated using modified Gorlin's formula) increased in 1.15 +/- 0.28 and 1.72 +/- 0.34 cm2 in patients subjected to PMV and MC respectively. No patient died, there was one technical failure with PMV and two patients subjected to MC had a surgical wound infection. Mitral regurgitation increased in more than one degree in two patients treated with PMV (5%) and in 6 patients treated with MC (15%). It is concluded that PMV and MC are highly effective and safe procedures for the treatment of mitral stenosis. Mitral areas obtained with MC are higher than with PMV, however a significant improvement of the disease is achieved with both procedures and MC produces mitral regurgitation with a higher frequency.
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Affiliation(s)
- A Olmos
- Seccione de Cardiología, Facultad de Medicina Universidad de Concepción, Chile
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Burgos C, Doblaré M, Alarcón E. Automatic mesh generation processor for 3-D parabolic boundary discretization. ACTA ACUST UNITED AC 1983. [DOI: 10.1016/0141-1195(83)90109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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