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Biomedical subjects

A Marek

Publications and source records attributed to A Marek.

At least 19 recordsLinked to original sources
PubMed1992

[Complications of liver biopsy in ultrasonic evaluation].

Ultrasound of the right upper quadrant was performed in 261 patients just before and 2-4 h after liver biopsy (Menghini needle 1.4 mm). Serious complications were not seen. 9 patients had ultrasound-detected small hepatic hematomas (1 x 1 cm - 4 x 3 cm) 2-4 h after liver puncture, clinically however irrelevant. Follow-up ultrasound at 24 h and 48 h showed complete resolution of hematomas that had been detected previously (5 patients and 4 patients resp.). The results of our study indicate that intrahepatic hematomas are uncommon after liver biopsy; lesions disappear spontaneously within 24-48 h and that is why ultrasound detection of all post-biopsy intrahepatic hematomas should be performed at 2-4 h. If major complications are not seen a 4 h length of post-biopsy bed rest seems us as sufficiently for all the patients.

Adolescent↗
PubMed1992

[Value and limits of the determination of aortic output by Doppler echocardiography in the quantification of aortic valve insufficiencies].

The aim of this study was to assess the value and limitations of Doppler echocardiographic measurement of aortic flow in the quantification of aortic regurgitation. Sixty-one patients were examined by Doppler echocardiography within 48 hours of cardiac catheterisation. There were 9 Grade I, 18 Grade II, 18 Grade III and 16 Grade IV angiographic aortic regurgitations. The mean aortic blood flow in angiographic Grades I and II (p less than 0.01). A correlation was observed between Doppler aortic flow and the angiographic grade of regurgitation (r = 0.66, p less than 0.001) and between aortic flow and regurgitant fraction (r = 0.68, p less than 0.001). Aortic flow greater than 10 l/mn identified angiographic Grades III or IV regurgitation with a sensitivity and specificity of 73.5% and 92.5% respectively and a positive and negative predictive values of 92.5% and 73.5% respectively. Aortic regurgitation with a regurgitant fraction greater than 40% was identified by a pulsed Doppler aortic blood flow greater than 10 l/mn with a sensitivity and specificity of 70% and 93% respectively, and positive and negative predictive values of 95% and 61% respectively. The sensitivity of this criterion is relatively poor as some severe aortic regurgitations have aortic flows of less than 10 l/mn: these patients have low outputs because of left ventricular dysfunction which is apparent from measurement of left ventricular fractional shortening.

Adolescent↗
PubMed1991

Non-invasive measurement of the regurgitant fraction by pulsed Doppler echocardiography in isolated pure mitral regurgitation.

OBJECTIVE: To assess the usefulness of pulsed Doppler echocardiography as a method of measuring the regurgitant fraction in patients with mitral regurgitation. PATIENTS AND METHODS: Twenty controls and 27 patients with isolated mitral regurgitation underwent Doppler studies. In the patients the study was performed within 48 hours of cardiac catheterisation. Aortic outflow was measured in the centre of the aortic annulus, and mitral inflow was derived from the flow velocity at the tip of the leaflets and the area of the elliptical mitral opening. The regurgitant fraction was calculated as the difference between the two flows divided by the mtiral inflow. RESULTS: In the 20 controls the two flows were almost identical (mitral inflow, 4.44 (SD 0.88) l/min; aortic outflow, 4.58 (SD 0.84) l/min), with a mean regurgitant fraction of 4.2 (SD 8.4)%. In patients with mitral regurgitation, the mitral inflow was significantly higher than the aortic outflow (8.8 (3.6) v 4.3 (1.1) l/min). In most patients the Doppler-derived regurgitant fraction (45.8 (19.2)%) accorded closely with the regurgitant fraction (41.3 (SD 17.8)%) determined by the haemodynamic technique. CONCLUSION: Pulsed Doppler echocardiography, with an instantaneous velocity-valve area method for calculating mitral inflow, reliably measured the severity of regurgitation in patients with mitral regurgitation.

Adult↗
PubMed1991

[Determination of cardiac output by Doppler ultrasonics. Principle, techniques and limitations].

The development of quantitative applications of Doppler ultrasound for the measurement of cardiac output was a lengthy and difficult process. These applications call for rigor of the part of the ultrasound cardiographer and a sufficiently echoic patient. Numerous studies have demonstrated the reliability of Doppler ultrasound in determining aortic flow. A high degree of consensus has emerged for measuring aortic areas and velocities at the ring. Doppler ultrasound quantification of the pulmonary flow has been validated in children. In adults, measurement of the pulmonary ring is often difficult and may lead to major errors in the estimation of the flow rates. The determination of mitral flow is also possible, either at the ring or at the tip of the mitral funnel. A few publications highlight the value of Doppler ultrasound in evaluation of tricuspid flow, however, these results require confirmation.

Aorta↗
PubMed1991

[Quantification of mitral valve diseases by Doppler].

Echo Doppler makes a fundamental contribution to the non-invasive quantification of mitral valve disease. It enables calculation of gradients and of orifice surface area in mitral stenosis. The quantification of mitral insufficiency is also possible though more difficult: it is based upon the combination of semi-quantitative and quantitative methods, in particular the calculation of regurgitation fraction obtained by comparison of flow rates at different orifices in cases of pure regurgitation. Finally, the calculation of pulmonary artery pressures from a Doppler record in tricuspid and pulmonary insufficiency can be used to assess the effects of mitral valve disease on the pulmonary circulation. Echo Doppler thus provides a reliable non-invasive hemodynamic assessment of mitral valve disease and should lead to a reduction in the number of invasive investigations in this type of valve disease.

Blood Pressure↗
PubMed1991

[Myocardial infarction caused by closed thoracic injury: pathogenic and angiocoronarographic aspects. Apropos of 4 cases and review of the literature].

The 4 cases of transmural myocardial infarction by closed chest trauma reported by the authors bring the number of angiographically documented and published cases to 52. This group serves as a basis for a detailed review of coronary and myocardial anatomical lesions and their pathophysiological mechanism is suggested. Long controversial, direct traumatic coronary damage has been confirmed by coronary angiography and is the essential mechanism of transmural infarctions. Myocardial contusion, much commoner, is responsible for non transmural lesions which remain difficult to diagnose. The authors stress the twin value of coronary arteriography: pathophysiological with its medicolegal consequences, and also therapeutic since a revascularisation procedure may be particularly beneficial in situations where thrombolysis is generally contraindicated.

Adolescent↗
PubMed1991

[Postoperative iatrogenic left coronaroventricular fistula. Demonstration by color two-dimensional Doppler].

The authors report the case of an asymptomatic 67 year old patient, in whom, 6 years after aortic valve replacement, Doppler color flow mapping showed the presence of a coronary artery--left ventricular fistula. The normality of preoperative coronary angiography suggested that this fistula was created during peroperative left ventricular purging: the implantation of a needle through the right ventricle and interventricular septum. A iatrogenic lesion of a septal branch probably caused the communication between the left anterior descending artery and the left ventricle. Postoperative normalisation of the left ventricular end diastolic dimension, the absence of dilatation of the left main coronary on 2D echocardiography, the narrowness of the Doppler color jet and the absence of a significant end diastolic Doppler signal in the aortic isthmus indicated a fistula of small size and simple Doppler echocardiographic follow-up was decided upon.

Aged↗
PubMed1990

[Doppler echocardiographic study of hemodynamic changes of double stimulation mode and atrial detection in patients with dual chamber pacemaker. Value of hysteresis of the atrioventricular delay].

This Doppler echocardiographic study of patients with a dual chamber pacemaker was undertaken to assess the changes in mitral and aortic flow induced by passing from the double stimulation to the atrial detection mode. Thirteen patients totally dependent on ventricular pacing were examined and mitral and aortic blood flow recorded by pulsed wave Doppler. The chronology of left atrial contraction as assessed by the Doppler mitral A wave was measured with respect to the ventricular stimulation. The A wave was recorded on average 177 ms after the right atrial stimulation artefact. For an average AV delay of 168.8 ms and an identical pacing frequency, the passage from the double stimulation to the atrial detection mode led to left atrial contraction occurring on average 70 ms earlier with respect to ventricular stimulation, reflecting prolongation of the programmed AV delay related to the delay in detection of the sinus atrial wave. This earlier atrial systole shortened the total duration of mitral flow from 363 to 317 ms, decreased the early diastolic mitral flow and increased the atrial end diastolic flow; the stroke volume and cardiac output calculated from the aortic velocity time integral decreased significantly from 73 +/- 11 ml to 67 +/- 10 ml and 5.4 +/- 1.11/mn to 4.9 +/- 1.01/mn respectively. The initial parameters were restored (average 74 +/- 9 ml and 5.5 +/- 1.11/mn respectively) when the AV delay in the atrial detection mode was reduced by a value close to that of the calculated increase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Doppler echocardiographic study of mitral and aortic flow at various rates and atrioventricular intervals in patients with dual chamber pacemakers].

The aim of this study was to measure the changes in mitral and aortic blood flow induced by rate changes and different atrioventricular intervals in dual chamber pacemaker patients. Ten totally pacemaker dependant patients were studied under basal conditions, in double atrial and ventricular stimulation mode, by pulsed Doppler recordings of mitral and aortic flow, at three different pacing rates (80, 100 and 120/mn) and with three different atrioventricular intervals at each rate (short, 90 or 115 ms; medium, 165 or 190 ms; and long, 240 ms). The increase in pacing rate and prolongation of the atrioventricular interval significantly shortened the duration of mitral flow. Increasing the pacing rate induced a significant fall in stroke volume measured from the aortic flow. The optimal atrioventricular interval tended to shorten when the pacing rate was increased; a long atrioventricular interval had a deleterious effect on stroke volume compared with medium and short atrioventricular intervals; however, the difference between the short and medium atrioventricular intervals was not statistically significant even at 120 mn. These observations emphasise the hemodynamic advantages of shortening of the atrioventricular interval of dual chamber pacemakers when the pacing rate increases.

Aged↗
PubMed1989

[Demonstration by Doppler echocardiography of multiple valvular involvement in carcinoid cardiopathy].

We report a case of carcinoid heart disease which was remarkable on three scores: --the value of echocardiography which enabled us to diagnose the disease; --the usefulness of cardiac doppler examination which provided non-invasive haemodynamic evaluation of lesions of the four valves; --the presence of moderate involvement of the right heart, which is classical from the point of view of anatomopathology but is often missed clinically and was ascertained in that case by doppler-echocardiography.

Carcinoid Heart Disease↗
PubMed1989

[Infarction with angiographically normal coronary vessels. (20 cases)].

Over 8 years, 20 cases of infarction with normal coronary angiography have been reported, representing 0.9% of the patients who underwent a coronary angiography after a myocardial infarction. The main characteristics of these patients are compared with those taken from the literature. The occurrence of this disease mainly depends on the age: especially higher when the patients are younger, ranging between 1 and 4% in major series, but it may reach 25% in case of infarction occurring before the age of 30. Therefore, this entity mainly affects young patients (mean age in the literature: 34.3 years), with a large proportion of women (27%). The main risk factor is smoking, found in 3 out of 4 men an more than half of the women; on the contrary, hypercholesterolemia and arterial hypertension are only seldom found. In women, administration of estro-progestative medications in mentioned in almost every other case. Coronary heredity is mentioned in one out of 3 cases. In 68% of the cases, the infarction is the original manifestation and frequently occurs during stress: 60 p. cent of the cases. The site of the necrosis is insignificant. Mortality is low: 2 p. cent but in 5 p. cent of the cases, the course may be complicated by recurrence or heart failure. According to recent findings on coronary angiography during the acute phase, the pathogenesis could involve an arterial coronary thrombosis, perhaps developing on minimal coronary lesions, caused by a spasm and/or a platelets hyperaggregation; then this coronary thrombosis is revascularized.

Age Factors↗
PubMed1989

[Auricular flutter preceding by several years the discovery of Steinert's disease. 3 cases].

The large frequency of arrhythmias and conduction disorders in the course of Steinert's myotonic dystrophy is well known; most of the time, the muscle disease is already known when the heart disease is discovered. The authors report three cases of young subjects (2, 31 and 35 years) in whom an atrial flutter without obvious etiology preceded by several years (14, 2.5 and 2 years) the diagnosis of muscular disease. On this occasion, the characteristics of the heart involvement in Steinert's disease are reminded: large frequency of atrial and also ventricular rhythm disorders, distalic conduction disorders. Our cases emphasize the importance of diagnosing Steinert's disease by clinical examination, electromyography and neuro-muscular biopsy in front of a rhythm disorder--especially atrial flutter--or an interventricular conduction disorders occurring, without obvious etiology, in a young subject.

Adult↗
PubMed1988

[Echocardiographic aspects of pericardial metastases. Apropos of 7 cases].

Modern two-dimensional imaging is of such quality that echocardiography is now capable of detecting intrapericardial formations. Three morphological types of abnormal intrapericardial echoes have been described: round masses, mattresses and linear echoes. These have been observed in effusions of various origin and seem to be lacking in aetiological specificity. In order to determine more precisely the echocardiographic signs of pericardial metastases, the authors have analyzed 7 cases of intrapericardial masses visualized in a series of 10 patients with metastatic pericardial effusion and examined in two-dimensional mode. These were echogenic and dense masses implanted on the pericardium and subject to cyclic movements linked with those of that membrane. Morphologically, they fell into two categories: round and sessile masses (6 cases) 8 to 23 mm high and 22 to 48 mm wide at their implantation; they were found mostly opposite the cardiac apex (4 cases) and/or in the lateral wall of the right ventricle (3 cases), oval formations (2 cases) which were 70 mm long and 17 mm wide in one case and 50 mm long and 15 mm wide in the other. One patient had two masses of different shapes. A review of the literature showed that these two echocardiographic images corresponded to two macroscopic types of pericardial invasion: either tumoral nodules or infiltration plaques betraying a diffuse invasion of the pericardium. All masses observed by the authors were located on the visceral leaflet of the pericardium. This predominantly epicardial location might be due to the visceral leaflet being selectively invaded by retrograde lymphatic embolization from the mediastinal lymph nodes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Metastatic pericardial effusions. Apropos of 12 cases. Review of the literature].

The authors report 12 cases of metastatic pericardial effusions with clinical manifestations. Primary bronchial cancer is the most frequent with 7 cases; in 3 of these patients, the original manifestation is a tamponade. The contributions of sonocardiography to the diagnosis are analyzed: evaluation of hemodynamic tolerance and visualization within the effusion, in 4 out of 7 patients undergoing bidimensional sonocardiography, of dense masses, implanted on the visceral layer of the pericardium; the frequent epicardic location of these metastases may be explained by preferential invasion of the visceral layer by retrograde lymphatic route. The advantage of pericardial cytology is discussed. From the therapeutic standpoint, a pleuro-pericardial window or tetracycline instillation tend to prevent a recurrence of the effusion and the risk of tamponade; the neoplastic process is controlled with local and/or general chemotherapy and radiotherapy; therapeutic strategy depends on the sensitivity of the primary tumor. The prognosis remains very dim with a mean survival of 3.7 months in our series.

Adult↗
PubMed1987

[The esophagus in patients with coronary disease. A sensitive area not to be neglected].

The authors report the case of a 35 year-old man, suffering from Prinzmetal's angor and stress angor associated to a complicated esophago-gastric reflux. Coronary angiography demonstrates a capillary network well dilated under Trinitrin. The Methergin test is explosive. After failure of calcium inhibitors, the sole treatment of the reflux alleviates the spontaneous pain. From this report, the place of esophageal pathology in coronary patients, the means to recognize it, the role of the reflux in the definition of myocardial ischemia, are discussed.

Adult↗