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Biomedical subjects

A Torbicki

Publications and source records attributed to A Torbicki.

At least 55 records · Page 3Linked to original sources
PubMed1993

Haemodynamic effects of pressure support and PEEP ventilation by nasal route in patients with stable chronic obstructive pulmonary disease.

BACKGROUND: Intermittent positive pressure ventilation applied through a nasal mask has been shown to be useful in the treatment of chronic respiratory insufficiency. Pressure support ventilation is an assisted mode of ventilation which is being increasingly used. Invasive ventilation with intermittent positive pressure, with or without positive end expiratory pressure (PEEP), has been found to affect venous return and cardiac output. This study evaluated the acute haemodynamic support ventilation by nasal mask, with and without the application of PEEP, in patients with severe stable chronic obstructive pulmonary disease and hypercapnia. METHODS: Nine patients with severe stable chronic obstructive pulmonary disease performed sessions lasting 10 minutes each of pressure support ventilation by nasal mask while undergoing right heart catheterisation for clinical evaluation. In random order, four sessions of nasal pressure support ventilation were applied consisting of: (1) peak inspiratory pressure (PIP) 10 cm H2O, PEEP 0 cm H2O; (2) PIP 10 cm H2O, PEEP 5 cm H2O; (3) PIP 20 cm H2O, PEEP 0 cm H2O; (4) PIP 20 cm H2O, PEEP 5 cm H2O. RESULTS: Significant increases in arterial oxygen tension (Pao2) and saturation (Sao2) and significant reductions in arterial carbon dioxide tension (PaCO2) and changes in pH were observed with a PIP of 20 cm H2O. Statistical analysis showed that the addition of 5 cm H2O PEEP did not further improve arterial blood gas tensions. Comparison of baseline values with measurements performed after 10 minutes of each session of ventilation showed that all modes of ventilation except PIP 10 cm H2O without PEEP induced a small but significant increase in pulmonary capillary wedge pressure. In comparison with baseline values, a significant decrease in cardiac output and oxygen delivery was induced only by the addition of PEEP to both levels of PIP. CONCLUSIONS: In patients with severe stable chronic obstructive pulmonary disease and hypercapnia, pressure support ventilation with the addition of PEEP delivered by nasal mask may have short term acute haemodynamic effects in reducing oxygen delivery in spite of adequate levels of SaO2.

Aged↗
PubMed1993

A comparison between the automatized impedance cardiography and pulsed-wave Doppler echocardiography methods for measurements of stroke volume (SV) and systolic time intervals (STI).

Stroke volume (SV) and systolic time intervals (STI) were measured automatically using impedance cardiography signals (ICG) and compared with those obtained by pulsed-wave Doppler echocardiography using the apex approach. The comparison was made in 9 healthy male subjects, mean age 24.9 +/- 12.2 years, using recordings of 10 heart cycles simultaneously obtained by the two methods. During measurements the subjects rested in the supine position. There were no differences between mean values of SV determined by the two methods as well as between mean values of ejection time (ET) (p > 0.8 and p > 0.9, respectively). The pre-ejection period (PEP) estimated by ICG was 22 ms longer than that determined by echocardiography (p < 0.001). The relationship between SV values measured by impedance cardiography (SVA) vs those calculated by echocardiography (SVE) was found to be close to the line of identity in the range of measurements. The regression equation for SV was: SVA = 0.784.SVE + 15 (r = 0.69, p < 0.001, SEE = 10.7 ml). We conclude that automatic determination of SV and ET from ICG signals provides results comparable in absolute values with those obtained by the pulsed wave Doppler ultrasonocardiography using the apex approach for subjects remaining in the supine position.

Adult↗
PubMed1992

Role of echo/Doppler in the diagnosis of pulmonary embolism.

Echocardiography supplemented with pulsed and continuous wave Doppler facilities is a potent diagnostic tool in many cardiovascular disorders. Its potential role in the management of patients with suspected pulmonary embolism, though less extensively studied, deserves attention. Benefits of echo/Doppler in these patients are as follows: (1) Echo/Doppler is a noninvasive, relatively inexpensive technique, readily available and repeatable in critically ill patients at the bedside. (2) Echo/Doppler provides a number of independent parameters related to the pulmonary hemodynamics. These parameters include: (a) characteristics of blood flow velocity curves across the right heart valves as well as systolic and diastolic time intervals of the right ventricle (b) motion pattern of the interventricular septum (c) dimensions of the heart chambers and inferior vena cava (d) thickness of the right ventricular free wall (3) Echocardiography allows detection of thrombi within right heart chambers or in major branches of the pulmonary artery in some patients. (4) Echo/Doppler may disclose alternative abnormalities explaining symptoms found in a patient with suspected pulmonary embolism such as pericardial disease, myocardial infarction, aortic dissection, hypovolemic shock, etc.

Acute Disease↗
PubMed1992

[Natural history of pulmonary hypertension in chronic obstructive lung diseases and the usefulness of the simple noninvasive methods of its diagnosis].

In 47 patients with chronic obstructive pulmonary disease and 19 patients with idiopathic pulmonary fibrosis pulmonary haemodynamics were studied. Pulmonary arterial pressure was compared with non-invasive lung function tests, ecg and the chest X-ray. Correlations between pulmonary arterial pressure and some of those parameters were found. Investigations were repeated after 3 or 5 years depending on severity of pulmonary hypertension initially found. The progression of pulmonary hypertension was found. It was accompanied by intensification of non-invasive indices of pulmonary hypertension. More than half of patients with initially severe pulmonary hypertension (> or = 30 mmg Hg) did not survive 3 years.

Adult↗
PubMed1992

[Diagnosis of congenital anomaly of the inferior vena cava simulating aortic dissecting aneurysm by the method of transesophageal echo- cardiography].

A case of 59 year old woman with acute myocardial infarction is presented in whom chest X-ray film revealed double outlined aortic arch suggestive of dissection. Transesophageal echocardiography (TEE) disclosed presence of two vascular canals in the place of thoracic aorta. Atypical dissection of thoracic aorta or a vascular anomaly were suspected because the image of dissection of intima was not characteristic and no connection between the two canals was found. Computed tomography ruled out presence of aortic aneurysm but the image of inferior vena cava was difficult for interpretation. Final diagnosis of congenital anomaly of inferior vena cava, originating from two iliac veins, passing along left side of the spine and emptying to the right atrium at the level of aortic arch, was established by means of cavography. Familiarity with TEE image of this vascular anomaly may allow avoidance of diagnostic error in cases suspected of aortic dissection.

Aortic Dissection↗
PubMed1991

Doppler echocardiographic evaluation of pulmonary artery pressure in chronic obstructive pulmonary disease. A European multicentre study. Working Group on Noninvasive Evaluation of Pulmonary Artery Pressure. European Office of the World Health Organization, Copenhagen.

The feasibility, reproducibility and reliability of Doppler echocardiography in evaluation of pulmonary artery pressure in patients with chronic obstructive pulmonary disease (COPD) were determined in a multicentre study. In 100 COPD patients with mean pulmonary artery pressure ranging from 10 to 62 mmHg at cardiac catheterization, pulmonary pressure estimation was attempted by four Doppler echocardiographic methods. These methods comprised the calculation of transtricuspid and transpulmonary pressure gradients from Doppler-detected tricuspid or pulmonary regurgitation, the evaluation of right ventricular outflow tract velocity profiles with the measurement of right ventricular systolic time intervals and the measurement of the right ventricular isovolumic relaxation time. In 98 (98%) patients at least one of the methods could be employed. A tricuspid regurgitation jet was detected in 47 (47%) patients but its quality was adequate for measurement in 30 (30%). Pulmonary regurgitation jet velocity was measured only in five cases. The standard error of estimate in testing intra- and interobserver reproducibility of Doppler systolic time intervals was less than 5%. The predictive value of right ventricular outflow tract acceleration time less than 90 ms in the identification of patients with mean pulmonary artery pressure greater than 20 mmHg was 80%. Of Doppler echocardiographic data, best correlations with mean pulmonary artery pressure were found for the transtricupid gradient (r = 0.73, SEE = 7.4 mmHg), for the right ventricular acceleration time (r = 0.65, SEE = 8 mmHg) and right ventricular isovolumic relaxation time (r = 0.61, SEE = 8.5 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Treatment of primary pulmonary hypertension with high doses of nifedipine controlled by Doppler echocardiography].

In a 22 year old female with primary pulmonary hypertension Doppler echocardiography revealed a systolic gradient between the right atrium and ventricle of 11.3 kPa (85 mmHg). A trial of high dose nifedipine therapy was started. It's efficacy was assessed by monitoring the tricuspid gradient. During therapy variations of the gradient were seen but without a favorable, steady, decrease trend. Although nifedipine did not produce any improvement during the "acute trial"--nifedipine therapy was continued--initially 60 mg, followed by 80 mg and finally 100 mg per day. Efficacy of this therapy was also controlled by Doppler echocardiography. Nifedipine was discontinued after 8 months due to lack of improvement in the patient's state. The patient died 30 months from the initial symptoms. Pathomorphological examination confirmed the clinical diagnosis. The use of Doppler echocardiography in assessing the vasodilators in primary pulmonary hypertension is discussed.

Administration, Oral↗
PubMed1991

[Non-invasive methods for determining the pulmonary blood pressure using ultrasonics in patients with chronic respiratory diseases].

Ultrasound techniques and especially Doppler echocardiography offer several approaches to non-invasive assessment of pulmonary arterial pressure. The method based on the measurement of the velocity of the jets of tricuspid or pulmonary regurgitation is the most straightforward one, in most cases allowing for reliable quantitative assessment of pulmonary hypertension and thus should be applied as a method of choice whenever possible. Unfortunately, its application in patients with lung hyperinflation is limited by topographic factors. Short acceleration time of flow velocity in the right ventricular outflow tract (AcT less than 70-75 msec), especially accompanied by midsystolic deceleration occurring at end-expiration, is a strong evidence of severe pulmonary hypertension. Long AcT (above 115-120 msec) is virtually diagnostic of normal pulmonary arterial pressure. If high speed Doppler tracings of both pulmonary and tricuspid valve flow are available right ventricular isovolumic relaxation time may be used for estimation of pulmonary systolic pressure. However, the elaboration of the laboratory's own regression formula rather than application of Burstin nomogram seems more advisable in such cases. The future of non-invasive assessment of pulmonary hemodynamics will depend on the reliability to monitor acute and chronic changes not only in pulmonary arterial pressure, but also in flow and resistance. At present, echocardiography should be considered as a good screening test allowing also to stratify moderate and severe pulmonary hypertension. The exact assessment of pulmonary hemodynamics, especially in patients with chronic respiratory disease, when needed for important therapeutic decisions, should in most cases rely on right heart catheterization.

Blood Pressure Determination↗
PubMed1990

Hemodynamic effects of negative-pressure ventilation in patients with COPD.

In order to evaluate the hemodynamic effects of INPV, eight patients with COPD (FEV1/FVC, 54 +/- 6 percent; mean +/- SD), respiratory failure (PaO2, 52 +/- 6 mm Hg; PaCO2, 56 +/- 4 mm Hg), and clinical signs of inspiratory muscle fatigue underwent right cardiac catheterization while performing 20 minutes of INPV by a cuirass ventilator at a pressure (-20 to -40 cm H2O) able to reduce the diaphragmatic electromyographic activity. Patients showed a mild basal pulmonary artery hypertension. During INPV, no changes in the mean values of HR (from 79 +/- 20 to 80 +/- 18 beats per minute), systolic BP (141 +/- 19 to 139 +/- 16 mm Hg), CO (5.2 +/- 0.8 to 5.1 +/- 1.3 L/min), mean PAP (23.8 +/- 3.8 to 23.9 +/- 4.4 mm Hg), RAP (4.3 +/- 2.6 to 5.5 +/- 2.5 mm Hg), PWP (10.3 +/- 4.5 to 9.4 +/- 2.9 mm Hg), TPR (369 +/- 76 to 392 +/- 124 dynes.s.cm-5), and PVR (199 +/- 51 to 233 +/- 94 dynes.s.cm-5) were observed. Direct systemic BP monitoring could be performed in six patients. During INPV, three patients showed "pulsus paradoxus," as assessed by an inspiratory fall in systolic BP of 11, 13, and 20 mm Hg, respectively. We conclude that INPV by cuirass ventilator does not induce adverse hemodynamic effects in patients with COPD who have pulmonary artery hypertension.

Adult↗
PubMed1990

[Evaluation of 24-hour ambulatory ECG recording in patients with mitral valve prolapse].

Among 1150 ambulatory 24-hour ecg recordings, those taken from 67 persons no more than 40 years old, suffering from paroxysmal unconsciousness or maladies suggesting paroxysmal arrhythmias, without clinical signs of ischaemic heart disease, valve defects, cardiomyopathies or myocarditis, were chosen for further analysis. Echocardiographic signs of mitral valve prolapse (MVP) were found in 33 persons (23 females), whereas in the next 34 persons (20 females) no evidence of MVP was noted. There were no statistical differences between ages, mean heart rates and incidences of the ST segment depression greater than or equal to 2 mm in these two groups. Prolongation of the QT interval greater than 440 ms was found in 8 persons with MVP and in 3 without MVP. Appearance of the single ventricular extrasystoles, sporadic or frequent, was almost identical in both groups. Whereas polymorphic extrasystoles and/or ventricular couplets were significantly more frequent in the MVP group. Our study shows that MVP is present in about a half of persons no more than 40 years old referring to Holter ecg because of symptoms suggesting arrhythmias, without other signs of heart disease; and that complex ventricular arrhythmias in these patients with MVP are significantly more frequent than in persons with similar complaints without MVP.

Adolescent↗
PubMed1990

Simultaneous Doppler and thermodilution assessment of pulmonary artery flow during acute interventions in patients with chronic obstructive pulmonary disease.

Subcostal pulsed wave Doppler echocardiography of the right ventricular outflow tract was used to assess pulmonary arterial flow at basal conditions and during interventions in 20 patients with chronic obstructive pulmonary disease. The changes in the pulmonary flow induced by interventions ranged from -1.5 l/min to +4.18 l/min (73% to 183% of the basal value). When considered alone, heart rate changes induced by the interventions could explain 53% of the changes in pulmonary flow measured with thermodilution. When Doppler-assessed right ventricular stroke volume changes were also considered the coefficient of determination (R) increased to 77% (r = 0.88, p less than 0.001, SEE = 12%). Doppler echocardiography was less precise in predicting absolute basal values of pulmonary artery flow (r = 0.70, p less than 0.001, SEE = 1.00 l/min), probably indicating inaccurate assessment of the diameter of the right ventricular outflow tract.

Administration, Sublingual↗
PubMed1990

[Adaptation of the left ventricle to increased load in primary arterial hypertension].

Adaptational mechanisms of the left ventricle to increased afterload in essential hypertension were studied in a group of 53 males with essential hypertension and in 32 normotensive males of the control group. M-mode echocardiograms were performed in all patients. The degree of hypertrophy, contractility, end-systolic stress index were assessed. The group with essential hypertension had increased peripheral vascular resistance and normal LV out put. In this group there was also increase of LV contractility. Increased LV contractility and LV hypertrophy are adaptational mechanisms maintaining normal cardiac output in patients with hypertension through a decrease in end-systolic stress.

Adaptation, Physiological↗
PubMed1990

Transesophageal echocardiography in the definition of intracardiac sources of emboli in patients with recent ischemic stroke.

Using both transthoracic and transesophageal echocardiography we studied 13 consecutive patients with recent CT-proven ischemic stroke in which a carotid arteries high-resolution ultrasound study failed to detect thrombosis or other relevant atherosclerotic lesions in the pertinent arteries. The mean age was 53 years (range: 36-65). Two patients exhibited clinical signs of cardiac disease at physical examination i.e. absolute arrhythmia, mitral stenosis. Conventional transthoracic echocardiography allowed the detection of potential cardiac sources of emboli in 2/13 patients (15.4%): mitral stenosis in one patient and dilated cardiomyopathy in another. Transesophageal echocardiography was successfully performed without general sedation in all patients. Potential cardiac sources of emboli could be identified in 12/13 patients (92%). Left atrial thrombi were found in 3 patients: in two of them they were associated with rheumatic alterations of mitral valve leaflets; in the third patient a small thrombus was located inside a normal-sized, poorly contracting left atrial appendage. Left atrial appendage could be clearly visualized in all patients. A myxoid degeneration of a prolapsing mitral leaflet was found in 3 patients and an interatrial septum aneurysm in 2. Furthermore, at color-flow Doppler and contrast transesophageal echocardiography, 7 patients (54%) showed patency of the foramen ovale. In 5 of these patients paradoxical right to left shunting after cough or Valsalva manoeuvre could be evidenced. With reference to 11/13 patients with no clinical signs of cardiac disease at physical examination, subclinical potential cardiac sources of emboli could be detected at conventional transthoracic echocardiography in 1 and at transesophageal echocardiography in 10 patients (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Attempts at measuring pulmonary arterial pressure by means of Doppler echocardiography in patients with chronic lung disease.

In 72 patients with severe chronic pulmonary or pulmonary vascular disease pulmonary arterial pressure was measured by means of right heart catheterization. Forty three patients had pulmonary hypertension, (32 +/- 11 mmHg) and 27 patients had normal pressure (14 +/- 3 mmHg). These patients were examined with continuous wave (CW) and pulsed wave (PW) Doppler echocardiography. The retrograde systolic tricuspid valve pressure gradient assessed with CW Doppler correlated with systolic pulmonary pressure (r = 0.92, p less than 0.001, SEE 7.7 mmHg) but was measurable in only 17 of the 70 patients. The flow velocity pattern in the right ventricular outflow tract could be recorded in 68 of the 70 patients. Acceleration time (AcT) from systolic flow onset to peak velocity correlated with mean pulmonary artery pressure (r = 0.72, p less than 0.001, SEE 8.3 mmHg). An AcT less than 90 msec had an 84% positive predictive value for pulmonary hypertension. Right ventricular isovolumic relaxation time could be measured in 59 of the 70 patients and correlated with systolic pulmonary artery pressure (r = 0.69, p less than 0.001, SEE 12.4 mmHg). No single Doppler method is at the same time easily applicable and accurate in prediction of pulmonary arterial pressure in patients with chronic lung diseases.

Cardiac Catheterization↗
PubMed1988

Aortic root abscess--echocardiographic image.

Autopsy findings point to a high prevalence of perivalvular abscesses in patients with infective endocarditis. Diagnosis of this complication, which may have therapeutical implications, is difficult. The authors present echocardiographic image obtained in a patient with bacterial endocarditis in whom an aortic root abscess was subsequently found at operation.

Abscess↗