Both native coronary artery and coronary bypass grafts may develop vasospasm after coronary artery bypass grafting. We recommend that whenever there is a high suspicion of vasospasm in arterial grafts and the native c...
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Both native coronary artery and coronary bypass grafts may develop vasospasm after coronary artery bypass grafting. We recommend that whenever there is a high suspicion of vasospasm in arterial grafts and the native coronary artery unresponsive to or not suitable for usual vasodilator therapy, prompt selective graft arteriogram should be performed. Intraluminal injection of vasodilators such as calcium antagonists in combination with nitroglycerin may provide an effective antispastic therapy and this procedure could be lifesaving as demonstrated in the present report. (C) 2000 by The Society of Thoracic Surgeons.
Dipyridamole stress is the forerunner and prototype of pharmacological stress echo tests in the diagnosis of coronary artery disease. The safety of this test has been conclusively demonstrated as a result of extensive...
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Dipyridamole stress is the forerunner and prototype of pharmacological stress echo tests in the diagnosis of coronary artery disease. The safety of this test has been conclusively demonstrated as a result of extensive experience in large-scale multicenter projects. The diagnostic accuracy of dipyridamole stress echo is comparable to dobutamine and largely a function of the employed dose. Higher dosages (up to 0.84 mg/kg) are being required to achieve good sensitivity. The prognostic value has been shown to be independent and additive to clinical, exercise echocardiogram, and angiographic data. The test positive response should be titrated on the basis of severity, extent, and timing of induced dyssynergy with low positivity being associated to more anatomically and functionally severe forms of disease. Multicenter, randomized, prospective, international studies on cost- effectiveness directly comparing a noninvasive strategy centered on stress echo versus an invasive strategy centered on coronary angiography are currently ongoing.
Diseases of the thoracic aorta are serious conditions that require close observations. Impressive advances in imaging modalities such as magnetic resonance imaging, computed tomography sacs, and transesophageal echoca...
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Diseases of the thoracic aorta are serious conditions that require close observations. Impressive advances in imaging modalities such as magnetic resonance imaging, computed tomography sacs, and transesophageal echocardiography have aided diagnosis and provided insights into the pathogenesis and natural history of thoracic aortic aneurysms, dissection, and atherosclerosis. The current review highlights the etiology, epidemiology, and pathophysiology of these disorders and focuses on the diagnostic approach and suggested medical therapies in the current era.
Introduction and objectives: Intracavernosal injection (ICI) of vasoactive agents has been successfully used in the treatment of erectile dysfunction (ED). The authors' pharmacologic erection program, using a fixe...
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Introduction and objectives: Intracavernosal injection (ICI) of vasoactive agents has been successfully used in the treatment of erectile dysfunction (ED). The authors' pharmacologic erection program, using a fixed combination of prostaglandin E1 (PGE1) and papaverine, is notable for its simplicity and acceptance by patients who have suffered spinal cord injuries (SCIs). Methods: Patients undergo baseline questionnaire, physical examination, and hormone profile followed by instruction and injection of a fixed combination of PGE1 and papaverine. On successive visits, the patient injects himself and the dosage is titrated until a satisfactory erection is obtained. Patients who do not respond to injection of 1.0 cc are considered treatment failures. Patients return periodically for routine follow-up. Results: From May 1994 to March 1997, 37 patients with SCI underwent initial evaluation and 28 (76%) responded to injection therapy and were successfully using self-injection therapy at 3-month follow-up. Twenty-three patients are still on injection therapy. Five patients have dropped out for several reasons including a lack of a current sexual partner (60%) and pain with injection (40%). Patient age ranges from 24 to 72. The dosage range was 0.10 to 0.50 cc (mean = 0.29 cc). The average duration of erection was 43 minutes. At 3-month follow-up, 85% of the patients rated their erections as good or excellent. Forty-three percent of patients are using ICI 1 or more times per week. Seventy-seven percent of patients are moderately or extremely satisfied with their treatment and 89% said that they would recommend this program to a friend. Conclusions: This simplified pharmacologic erection program offers safe, well accepted, and effective therapy for ED to a SCI population with very high patient satisfaction.
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