RESUMEN
Disruption of the posterior mitral anulus is a rare complication of mitral valve replacement that may result in subvalvular left ventricular pseudoaneurysm formation. Such pseudoaneurysm formation was easily recognized by two-dimensional echocardiography in a 54 year old man 3 years after his second mitral valve replacement. The finding was confirmed by cineangiography and direct surgical inspection. Recognition of this rare complication of mitral valve replacement has therapeutic importance because surgical correction is necessary.
Asunto(s)
Ecocardiografía , Aneurisma Cardíaco/diagnóstico , Prótesis Valvulares Cardíacas , Válvula Mitral/cirugía , Cineangiografía , Ecocardiografía/métodos , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , ReoperaciónRESUMEN
The immediate effects of successful percutaneous transluminal coronary angioplasty on global and regional left ventricular function were assessed by comparing 30 degrees right anterior oblique left ventricular angiograms performed immediately before and after angioplasty on 39 patients undergoing 42 successful procedures. Mean (+/- SD) lesion stenosis decreased from 88 +/- 10% to 35 +/- 11% (p less than or equal to 0.001), whereas left ventricular ejection fraction increased from 57 +/- 11% to 64 +/- 10% (p less than or equal to 0.001) for the entire group. Left ventricular functional changes were further subgrouped according to stability of angina. Eighteen procedures were performed on 17 patients with stable angina: 24 procedures were performed on 22 patients with unstable angina defined as angina at rest or on minimal activity or recently accelerated angina. There were no significant subgroup differences in mean age, gender ratio, vessel anatomy, drug therapy or extent of coronary stenosis before or after angioplasty. Global ejection fraction increased significantly for the unstable group (from 54 +/- 11% to 66 +/- 9%, p less than or equal to 0.001) but was unchanged for the stable group (from 61 +/- 9% to 61 +/- 11%, p = NS). In unstable angina, regional ejection fraction (segmental area method) increased for both jeopardized (from 37 +/- 11% to 52 +/- 9%, p less than or equal to 0.001) and nonjeopardized myocardial segments (from 43 +/- 13% to 51 +/- 13%, p less than or equal to 0.001), but improvement was significantly (p less than or equal to 0.02) greater in jeopardized segments.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Angina de Pecho/terapia , Angioplastia de Balón , Volumen Sistólico , Adulto , Anciano , Angina de Pecho/fisiopatología , Angina Inestable/fisiopatología , Angina Inestable/terapia , Vasos Coronarios , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
One year survival and event-free survival rates were analyzed in 342 patients with acute myocardial infarction who were consecutively enrolled in a treatment protocol of early intravenous thrombolytic therapy followed by emergency coronary angioplasty. Ninety-four percent of the patients achieved successful reperfusion, including 4% with failed angioplasty whose perfusion was maintained by means of a reperfusion catheter before emergency bypass surgery. The procedural mortality rate was 1.2% and the total in-hospital mortality rate was 11%. Ninety-two percent of surviving nonsurgical patients who underwent repeat cardiac catheterization were discharged from the hospital with an open infarct-related artery. The related cumulative 1 year survival rate for all patients managed with this treatment strategy was 87%, and the cardiac event-free survival rate was 84%. The 1 year survival for hospital survivors was 98% and the infarct-free survival rate was 94%. Multivariable analysis identified the following factors as independent predictors of subsequent cardiovascular death: cardiogenic shock, greater age, lower ejection fraction, female gender and a closed infarct-related vessel on the initial coronary angiogram. Among patients with cardiogenic shock, despite a 42% in-hospital mortality rate, only 4% died during the first year after hospital discharge. Similarly, the in-hospital and 1 year postdischarge mortality rates were 19 and 4%, respectively, for patients with an initial ejection fraction less than 40, and 25 and 3%, respectively, for patients greater than 65 years. An aggressive treatment strategy including early thrombolytic therapy, emergency cardiac catheterization, coronary angioplasty and, when necessary, bypass surgery resulted in a high rate of infarct vessel patency.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Angioplastia de Balón , Infarto del Miocardio/mortalidad , Grado de Desobstrucción Vascular , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Puente de Arteria Coronaria , Urgencias Médicas , Femenino , Fibrinolíticos/uso terapéutico , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Choque Cardiogénico/mortalidad , Volumen SistólicoRESUMEN
OBJECTIVE: The authors' goal was to determine the levels of trauma and psychiatric symptoms in a randomly selected group of Cambodian refugees and to determine the relationship between the amount of trauma experienced and subsequent psychiatric symptoms. METHOD: Data on traumatic experiences and symptoms of posttraumatic stress, dissociation, depression, and anxiety were collected on 50 randomly selected Cambodian refugees who had resettled in the United States. RESULTS: Subjects experienced multiple and severe traumas and showed high levels of all symptoms measured. Forty-three (86%) of the subjects met DSM-III-R criteria for posttraumatic stress disorder, 48 (96%) had high dissociation scores, and 40 (80%) could be classified as suffering from clinical depression. Correlations between trauma scores and symptom scores and among symptom scores were moderate to large. CONCLUSIONS: These results indicate that a high proportion of Cambodian refugees who are not psychiatric patients suffer from severe psychiatric symptoms and that there is a relationship between the amount of trauma they experienced and the severity of these symptoms.
Asunto(s)
Trastorno Depresivo/diagnóstico , Trastornos Disociativos/diagnóstico , Acontecimientos que Cambian la Vida , Refugiados/psicología , Trastornos por Estrés Postraumático/diagnóstico , Adulto , Anciano , Cambodia/etnología , Trastorno Depresivo/psicología , Trastornos Disociativos/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inventario de Personalidad , Trastornos por Estrés Postraumático/psicologíaRESUMEN
OBJECTIVE: The Dissociative Experiences Scale has proved a reliable and valid instrument to measure dissociation in many groups, but its capacity to distinguish patients with multiple personality disorder from patients with other psychiatric disorders has not yet been conclusively tested. METHOD: A discriminant analysis was performed to classify 1,051 subjects as having or not having multiple personality disorder. Another discriminant analysis was performed on a subgroup of 883 subjects more closely representing patients in a typical psychiatric facility in terms of base rates of dissociative disorders. A cutoff score of 30 was also used to classify subjects, and Bayes's theorem, which allows for the calculation of the positive predictive value and the negative predictive value of a screening test, was applied. RESULTS: According to discriminant analysis of the total study group, the scale's sensitivity was 76% and its specificity was also 76%; according to discriminant analysis of the more representative subgroup, the scale's sensitivity was 76% and its specificity was 85%. Use of the cutoff score of 30 produced similar results. Results of the application of Bayes's theorem showed that 17% of the subjects scoring 30 or higher would actually have multiple personality disorder and 99% of those scoring less than 30 would not have multiple personality disorder. CONCLUSIONS: These results indicate that the Dissociative Experiences Scale performs quite well as a screening instrument to identify subjects with multiple personality disorder. In addition, the consistency of responses to scale items across centers indicates that the symptoms reported by patients with multiple personality disorder are highly similar across diverse geographic centers. This consistency supports the reliability and validity of the diagnosis of multiple personality disorder across centers.
Asunto(s)
Trastornos Disociativos/diagnóstico , Trastorno Disociativo de Identidad/diagnóstico , Inventario de Personalidad/normas , Adulto , Teorema de Bayes , Diagnóstico Diferencial , Análisis Discriminante , Trastornos Disociativos/psicología , Trastorno Disociativo de Identidad/clasificación , Trastorno Disociativo de Identidad/psicología , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Trastornos del Humor/clasificación , Trastornos del Humor/diagnóstico , Inventario de Personalidad/estadística & datos numéricos , Psicometría , Curva ROC , Reproducibilidad de los Resultados , Esquizofrenia/clasificación , Esquizofrenia/diagnóstico , Trastornos por Estrés Postraumático/clasificación , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicologíaRESUMEN
Recovery of global and regional systolic and global diastolic left ventricular (LV) function was examined after 60 seconds of coronary arterial occlusion in 9 men without myocardial infarction undergoing elective percutaneous transluminal coronary angioplasty. Hemodynamic and electrocardiographic recordings and a simultaneous digital subtraction LV angiogram in the 30 degree right anterior oblique view were performed before coronary occlusion, after 60 seconds of the first 2 occlusions and at 20, 40, 60 and 90 seconds of reperfusion. Diastolic pressure-volume relations paired the digital volumes to corresponding high-fidelity analog pressures. Similar and significant depression of global ejection fraction, percent radial shortening in the jeopardized region, maximal positive dP/dt and significant elevation of LV end-diastolic pressure and ST segments occurred with each 60-second coronary occlusion. All of these variables except LV end-diastolic pressure returned to control levels within 40 seconds of reperfusion. Significant elevation of the diastolic pressure-volume relation occurred with each coronary occlusion and progressively diminished to control values with 60 seconds of reperfusion. No statistically significant difference in any measurement occurred between the 2 occlusions and reperfusions at any point. This study shows that similar and significant depression and time course of recovery of global and regional systolic and global diastolic LV function accompanied each 60-second coronary occlusion with recovery of systolic function preceding recovery of diastolic function.
Asunto(s)
Angina de Pecho/terapia , Angioplastia de Balón , Contracción Miocárdica , Angina de Pecho/fisiopatología , Circulación Coronaria , Vasos Coronarios/fisiología , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico , Factores de TiempoRESUMEN
The ability of bedside auscultation, echophonocardiography and cinefluoroscopy to detect prosthetic valve malfunction was compared in 81 patients with a Bjork-Shiley aortic or mitral valve prosthesis or a Beall mitral valve prosthesis. In 32 patients with an abnormal mitral valve prosthesis proved by cardiac catheterization, the sensitivities of auscultation, echophonocardiography and cinefluoroscopy were 94, 78 and 88 percent, respectively. In 25 patients with a normal mitral valve prosthesis, the specificities were 96, 64 and 89 percent, respectively. Twelve patients had an abnormal aortic valve prosthesis; the sensitivities of auscultation, echophonocardiography and cinefluoroscopy were 92, 58 and 33 percent, respectively. In 12 patients with a normal aortic valve prosthesis, the specificities were 100, 75 and 92 percent, respectively. Auscultation can detect almost all cases of malfunction of nontissue prosthetic valves. Echophonocardiography and cinefluoroscopy can detect most cases of malfunction of mitral valve prostheses, but false positive studies are common; both procedures are less useful in detecting malfunction of aortic valve prostheses.
Asunto(s)
Cinerradiografía , Ecocardiografía , Auscultación Cardíaca , Prótesis Valvulares Cardíacas , Válvula Aórtica , Cateterismo Cardíaco , Humanos , Válvula Mitral , FonocardiografíaRESUMEN
This report describes a digital subtraction angiographic technique used to simultaneously display the proximal and distal segments of three totally occluded coronary arteries in two patients undergoing percutaneous transluminal coronary angioplasty (PTCA). The advantage of this technique over routine cineangiography for PTCA of total occlusions is illustrated.
Asunto(s)
Angiografía/métodos , Angioplastia de Balón , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Intensificación de Imagen Radiográfica , Adulto , Enfermedad Coronaria/terapia , Humanos , Persona de Mediana Edad , Técnica de SustracciónRESUMEN
Right ventricular infarction is usually associated with coronary artery disease and concomitant left ventricular infarction. Isolated right ventricular subendocardial necrosis was discovered at autopsy in a 52-year-old woman with pulmonary hypertension, right ventricular hypertrophy, and normal coronary arteries, who died with septicemia 41 days after mitral valve replacement. This represents the first well-documented report of isolated right ventricular subendocardial infarction associated with normal coronary arteries.
Asunto(s)
Cardiomegalia/patología , Vasos Coronarios/patología , Hipertensión Pulmonar/complicaciones , Insuficiencia de la Válvula Mitral/complicaciones , Infarto del Miocardio/patología , Bioprótesis , Endocardio/patología , Enterobacter , Infecciones por Enterobacteriaceae/patología , Femenino , Prótesis Valvulares Cardíacas , Ventrículos Cardíacos/patología , Humanos , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/cirugía , Miocardio/patología , Necrosis , Complicaciones Posoperatorias/patología , Sepsis/patologíaRESUMEN
Most measures of posttraumatic stress disorder (PTSD) symptoms are limited in that they focus on a single traumatic event and cannot be used to assess symptoms in persons who report no traumatic events. The utility of the brief PTSD measures that do not key to a single trauma is limited by lengthiness and high reading levels. The Screen for Posttraumatic Stress Symptoms (SPTSS) is a brief, self-report screening instrument for PTSD symptoms that overcomes these limitations by assessing PTSD symptoms using a low reading level and without keying them to a specific traumatic event. In a sample of 136 psychiatric inpatients, the SPTSS showed good internal consistency, a high sensitivity rate, and a moderate specificity rate. The concurrent and construct validity of the SPTSS were supported by strong correlations with symptom and trauma experience measures and by comparisons of SPTSS scores of groups with different trauma histories.
Asunto(s)
Acontecimientos que Cambian la Vida , Trastornos por Estrés Postraumático/diagnóstico , Adulto , Ansiedad/diagnóstico , Ansiedad/psicología , Trastornos Disociativos/diagnóstico , Trastornos Disociativos/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Violación/diagnóstico , Violación/psicología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Trastornos por Estrés Postraumático/psicologíaRESUMEN
The mental health status of a general population sample of Cambodian refugees living in the United States was assessed ten years after they had left their homes in Cambodia. Subjects were found to be experiencing extremely high levels of post-traumatic stress disorder, dissociation, depression, and anxiety. Ninety percent of these refugees exhibited marked symptomatology in one or more of these categories.
Asunto(s)
Aculturación , Asiático/psicología , Trastornos Mentales/psicología , Refugiados/psicología , Adulto , Anciano , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Cambodia/etnología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Trastornos Disociativos/diagnóstico , Trastornos Disociativos/psicología , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicologíaAsunto(s)
Angioplastia de Balón/tendencias , Cateterismo Cardíaco/tendencias , Enfermedad Coronaria/terapia , Angioplastia de Balón/instrumentación , Animales , Cateterismo Cardíaco/instrumentación , Perros , Humanos , Infarto del Miocardio/tratamiento farmacológico , Estreptoquinasa/uso terapéuticoAsunto(s)
Prestación Integrada de Atención de Salud/economía , Administración Financiera de Hospitales/tendencias , Relaciones Comunidad-Institución , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/normas , Hospitales Filantrópicos/economía , Hospitales Filantrópicos/organización & administración , Michigan , Garantía de la Calidad de Atención de SaludRESUMEN
Despite a growing literature of cross-cultural research on mental illness, little is known about the universality of most psychiatric disorders. This study was designed to determine whether people from a very different culture have the same symptoms in response to traumatic experiences as do trauma survivors in the United States. We were also interested to find out if the severity of the current symptoms is related to the amount of trauma experienced. Furthermore, we gathered information about the perceived severity of traumatic experiences among refugees. Fifty Cambodian refugees living in the U.S. were asked about their traumatic experiences and their current symptoms of posttraumatic stress, dissociation, depression, and anxiety. High levels of all symptoms were found along with statistically significant relationships between each symptom measure and the amount of trauma experienced. We conclude that the basic symptom picture in this group was similar to that observed in U.S. trauma survivors.
Asunto(s)
Comparación Transcultural , Refugiados/psicología , Trastornos por Estrés Postraumático/diagnóstico , Aculturación , Adaptación Psicológica , Adulto , Anciano , Cambodia/etnología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/etnología , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Recuerdo Mental , Persona de Mediana Edad , North Carolina , Trastornos por Estrés Postraumático/etnología , Trastornos por Estrés Postraumático/psicologíaRESUMEN
The effect of intracoronary papaverine administration on epicardial coronary arterial diameter was examined in 18 male patients. Coronary-artery cineangiograms were acquired with a power injector before intervention, 20 sec after intracoronary saline (control), and 20 sec after administration of papaverine into either the left (12 mg) or right (8 mg) coronary artery. Absolute coronary arterial diameter of a normal-appearing segment was quantified using a previously validated, fully automated digital edge detection program with an ADAC digital radiographic unit. Baseline coronary arterial diameter of 3.1 +/- 0.8 mm did not significantly change after saline administration (3.1 +/- 0.9 mm) but did significantly increase (p less than .001) to 3.4 +/- 0.9 mm after papaverine administration. No significant percent change in diameter occurred in either the left anterior descending (-.5 +/- 1.7%), left circumflex (-.2 +/- 1.1%), or right (-3.0 +/- 3.8%) coronary arteries with saline, but significant (p less than .001) increases occurred with papaverine (7.2 +/- 4.1%, 7.0 +/- 4.5%, 6.8 +/- 2.7%, respectively). The response of 7 coronary arteries examined immediately proximal to a significant lesion was not significantly different from the response of the remaining 11 coronary arteries. In conclusion, intracoronary papaverine causes a significant increase in coronary arterial diameter. This has clinical implications for assessing coronary flow reserve with devices that defect flow velocity.
Asunto(s)
Vasos Coronarios/patología , Papaverina/farmacología , Pericardio/efectos de los fármacos , Anciano , Humanos , Masculino , Persona de Mediana Edad , Papaverina/administración & dosificaciónRESUMEN
Thirty-eight patients with a Beall mitral valve prosthesis were studied by cinefluoroscopy and cardiac catheterization to determine which characteristic of disc morphology and which patterns of disc motion predict significant valve malfunction. Eleven patients with a Beall 105/106 prosthesis served as a control group. There were two normal patterns of disc motion: (a) disc moving either entirely parallel to the suture ring or (b) disc having an intermediate nonparallel position but normal systolic and diastolic seating. Twenty-seven patients had a Beall 104 prosthesis. Fourteen of these had normal disc motion, only one showing significant mitral insufficiency. Thirteen of the 27 patients had abnormal disc motion with systolic cocking of the disc; 12 of these had significant mitral insufficiency, and all 13 showed severe disc wear at surgery.
Asunto(s)
Prótesis Valvulares Cardíacas , Hemodinámica , Cateterismo Cardíaco , Fluoroscopía , Humanos , Válvula Mitral , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiologíaRESUMEN
Based on a conceptual framework for the long-term effects of childhood abuse, this study examined the capacity of childhood family environment (caretaker dysfunction, neglect, perceived social support), violent abuse (physical and sexual), and individual variables (other abuse) to predict adult psychiatric symptoms of PTSD, dissociation, and depression. Complete interview data were obtained from 178 psychiatric in patients who varied greatly on abuse status and severity. Results of multiple regressions of predictor variables onto the three outcome variables showed that the predictor variables accounted for 15% (for depression) to 42% (for PTSD) of the variance in these symptoms and that violent abuse uniquely accounted for a significant proportion of the variance in outcomes for all three of the symptom groups studied.
Asunto(s)
Trastorno Depresivo/psicología , Trastornos Disociativos/psicología , Trastornos por Estrés Postraumático/diagnóstico , Adulto , Niño , Maltrato a los Niños/psicología , Trastorno Depresivo/complicaciones , Trastornos Disociativos/complicaciones , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Análisis de Regresión , Apoyo Social , Trastornos por Estrés Postraumático/complicaciones , Encuestas y CuestionariosRESUMEN
We introduce the 'Fragebogen zu Dissoziativen Symptomen' (FDS), a German adaptation of the Dissociative Experience Scale (DES) which was developed to screen for dissociation within an ICD-10 framework. In addition to the original 28 DES items, the FDS contains 16 items covering dissociative phenomena included in the ICD-10, particularly pseudoneurological conversion symptoms. The psychometric properties of the FDS were studied in 927 clinical and nonclinical subjects from different diagnostic groups and compared to results of American studies. The scale had good test-retest reliability of .88, high internal consistency (split-half = .90, Cronbach's alpha = .94) and good construct validity. These results indicate that the FDS may be a valuable screen for dissociative psychopathology in German-speaking countries.