Biomedical subjects
Publications and source records attributed to J Górny.
On the basis of own material, the authors discuss the epidemiology, clinical picture, and results of treatment of newborns with polycythaemia. An analysis shows that the blood hyperviscosity syndrome is an underestimated cause of many pathological signs in newborns.
Modern views on the pathological mechanism, clinical symptoms and therapeutic management of neonatal myasthenia gravis are reviewed on the basis of literature reports and own experiences. Particular attention is given to intensive medical care in this condition.
We present a case of the rare coincidence of three mechanisms leading to development of congenital heart disease in intrauterine life: intrinsic defect of the development of the cardiac loop (dextrocardia), failure of normal expansion of the subpulmonary infundibulum (Fallot syndrome) and endocardial cushion defect (common atrium and common atrioventricular valve ). It was associated with partial viscera inversion. A 31-year old man with congenital cyanotic heart disease, and Blalock-Taussig anastomosis was admitted to the hospital due to symptoms of severe cardiac failure. On physical examination: systolic murmur, hepatomegaly, ascites, leg's edema and cyanosis were found. In ECG--atrial fibrillation with 3-d degree a-v block. Standard echocardiography revealed: dextrocardia, a large single atrium with ostia of pulmonary and systemic veins, single atrio-ventricular valve , large ventricular, Fallot-like septal defect. The papillary muscles were not visible in the left ventricle. Aorta and pulmonary trunk arose from morphological right ventricle. The patient died on the 3-rd day of hospitalization in the course of cardiac and respiratory insufficiency. Postmorten examination confirmed the diagnosis.
43 patients with end-stage renal failure maintained on hemodialysis were studied by echocardiography before and after hemodialysis. Considering possibility, that left ventricule can be enlarged due to intrinsic factors impairing their performance, like myocardial fibres damage in coronary disease or inflammation and extrinsic factors like hypertension, overhydration, anemia, arteriovenous shunt and humoral changes (electrolyte imbalance, uremic toxins, acidosis) three groups of patients were chosen: A--with normal left ventricular diameter, B--with enlarged left ventricule before and after dialysis, C--with enlarged left ventricule only before dialysis. Mean velocity of circumferential fibre shortening (mVcf) and ejection fraction (EF) as left ventricular contractility indexes and end-systolic meridional wall stress as afterload index were determined. Stress-shortening relations before and after hemodialysis were compared in groups, to determine possible intrinsic contractility impairment of the left ventricule. No differences in groups were found in preload reduction (weight loss) and humoral changes (BUN, creatinine, pH, potassium, calcium, hematocrit), also blood pressure was not significantly different in all groups. Hemodialysis improved contractility only in patients with normal left ventricular diameter and significant reduction of afterload. In group A and C stress-shortening relation increased after dialysis. In group B decreased probably because of the lack of mVcf improvement despite reduction of stress in two patients. It is possible that these two patients had impaired contractility and enlarged left ventricle due to intrinsic factors.
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