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Biomedical subjects

J Kaliman

Publications and source records attributed to J Kaliman.

At least 73 records · Page 4Linked to original sources
PubMed1984

[Causes of death in patients with pacemakers - with respect to the indication for implantation].

We compared the life expectancy of 1559 patients with an implanted pacemaker (PM) with a normal age-matched population and found a significantly reduced survival rate in paced patients. Patients paced for heart failure have the lowest survival rate, whilst those paced for Adams-Stokes attacks do slightly better. Patients with Adams-Stokes equivalents do not differ significantly from our normal population. 54% of patients with PM implanted for heart failure died due to heart failure despite PM implantation. The relative percentage of sudden death after PM implantation is high in groups with Adams-Stokes attacks (16%) and Adams-Stokes equivalents (20%). In both of these groups sudden death occurred especially during the first two years after PM implantation. The high risk of sudden death after PM implantation should increase our efforts to monitor patients carefully after PM implantation for the occurrence of malignant tachyarrhythmias.

Adams-Stokes Syndrome↗
PubMed1984

Plasma factor and platelet sensitivity to prostacyclin in patients with peripheral vascular disease before and after treatment with a combination of a cyclooxygenase and a phosphodiesterase inhibitor.

According to a pathogenetic concept originally presented by Moncada in 1977 a therapeutic combination of a low-dose cyclooxygenase inhibitor with a phosphodiesterase inhibitor might help in restoring a disturbed hemostatic balance, as thromboxane synthesis in the platelets should be inhibited to a greater extent than the prostacyclin synthesis of the endothelium. Therefore, we evaluated the influence of a therapeutic combination of cyclooxygenase inhibitors in different dosages (sulfinpyrazone, acetylsalicylic acid) with a phosphodiesterase inhibitor (dipyridamole) on platelet sensitivity and plasma factor in comparison to placebo treatment. We examined 76 males with peripheral vascular disease (PVD) stage IIa according to Fontaine in a double-blind randomized study over a 3 months period. Patients were divided into 4 groups and the different drugs were randomized as follows: I. 75 mg sulfinpyrazone and 75 mg dipyridamole, II. 150 mg ASA and 75 mg dipyridamole, III. 330 mg ASA and 75 mg dipyridamole, IV. placebo. Clinical symptoms as well as the plasma factor and the diminished platelet sensitivity to prostacyclin in patients with PVD remained unchanged throughout the whole observation period. Our findings suggest that no improvement in hemostatic dysregulation can be obtained by this combined treatment.

Aspirin↗
PubMed1984

Reversible end-of-life indicator leading to erroneous pacemaker replacement-pitfalls of telemetry.

In several modern pacemakers, end-of-life (EOL) is indicated by a single-step rate drop, which is initiated by a voltage-sensitive electronic switch. This switch may also be activated by other causes, such as very short voltage drops, low temperatures, and electrocautery. We report a case in which a Cordis 233 F Sequicor II pulse generator was operating at 51.6 bpm in VOO mode at the time of implantation. As telemetry seemed to indicate that back-up pacing (the EOL indicator in this model) was "off," it was erroneously assumed that the pacemaker was not working properly. The unit was replaced by another impulse generator. At laboratory testing, the pacemaker was within specifications, when back-up pacing was separately programmed off. In conclusion, physicians should be aware of the new phenomenon of reversible EOL indicators, and that they may not rely on telemetry in this respect. Future pacemakers should incorporate a telemetry message which prevents similar misunderstandings.

Equipment Design↗
PubMed1984

[Diagnosis of syncopes in suspected arrhythmias].

Several mechanisms lead to attacks with unsuspected sudden and intermittent loss of consciousness. A major cause for such syncopes are arrhythmias. Only in rare cases it is possible to register an ECG during a typical attack despite many newer methods as long-term ECG (LT-ECG), exercise stress test and electrophysiologic investigations. LT-ECG does not record the ECG only during symptomatic periods (syncopes, dizziness, palpitations etc), but also registers asymptomatic AR, which can be precursors of SY. Carotid sinus massage is a valuable tool for the detection of a cardio-inhibitory Carotid-Sinus-Syndrome, which can be treated with PM-implantation. Exercise stress testing induces ventricular arrhythmias, which also indicates AR as underlying cause for SY. Using the invasive electrophysiologic investigation methods the importance measuring supraventricular parameters (SNRT, SA-, AH-interval) or parameters of the AV-nodal conduction (AH-, HV-interval) decreased in contrast to the ventricular stimulation techniques. With these invasive procedures ventricular tachycardias, ventricular flutter or fibrillation can be induced in selected patients, which indicates also a possible arrhythmogenic substrate for SY. In a suspected arrhythmogenic genesis of SY it has to be recommended to perform LT-ECG, carotid sinus massage, exercise stress testing and -- in selected patients -- electrophysiological investigations in addition to the routine-ECG to exclude or confirm arrhythmias as possible substrate for SY.

Arrhythmias, Cardiac↗
PubMed1984

Arachidonic acid metabolites of human lymphatics.

Human lymphatics convert exogenously added 14C-arachidonic acid into PGE2, PGF2 alpha and the main metabolite 6-keto-PGF1 alpha. Thromboxane formation is undetectable either by radiothinlayer-chromatography or by radioimmunology. These data confirm and extend our earlier findings indicating an important PGI2-synthetic mechanism in human lymphatics. Assuming that lymphatic contractility is regulated at least in part by thromboxane A2, we propose that this derivative of arachidonic acid derives from extralymphatic sources.

6-Ketoprostaglandin F1 alpha↗
PubMed1984

Is gamma-camera imaging of platelet deposition useful to assess the effectiveness of prostacyclin treatment?

Platelet labeling with 111-In-oxinesulfate allows visualization of platelet deposition in the vascular bed. Scintigraphic studies were performed in 6 patients with "active" (PUR greater than 1.20) and 8 patients with "inactive" (PUR less than 1.20) atherosclerotic lesions of the femoral artery. Platelet deposition was also studied in 11 patients with implanted prosthetic vascular grafts and in 21 patients with an abnormal aneurysm of the aorta. Infusing 5 ng/kg/min PGI2 during 6 hours for 5 days into patients with "active"-atherosclerosis and aneurysms of the aorta resulted in a significant decrease of platelet deposition even after having stopped the infusion. There was no influence of PGI2 on PUR in patients with "inactive" lesions. The group of patients with implanted prosthetic grafts demonstrated also a significant decrease of PUR values during the PGI2-infusion, but reached baseline values soon after stopping the infusion. When platelet deposition is increased gamma-camera imaging provides valuable date on the influence of any kind of therapy on the in-vivo platelet function.

Aorta, Abdominal↗
PubMed1984

[Diagnosis and effective therapy with plasmapheresis in a patient with homozygous familial hypercholesterolemia].

The case of a 17-year-old boy with the homozygous form of familial hypercholesterolaemia is reported. The patient presented tuberous and tendinous xanthomas, arcus lipoides, complete occlusion of the LAD of the coronary arteries, a characteristic family history, and total cholesterol levels greater than 600 mg/dl. Among the available therapeutic regimens we decided to perform plasma exchange treatment, which was introduced by Thompson in 1973 as therapy of this metabolic disorder. After each plasmapheresis, performed so far 7 times, the cholesterol and LDL-cholesterol concentrations dropped to normal levels; they increased again within the next 3 weeks, without, however, reaching the pretreatment levels. Undergoing this treatment, the xanthomas decreased markedly; there are reasons to assume that atherosclerotic lesions might also decrease during this treatment.

Adolescent↗
PubMed1983

[Thrombocyte migration test--method, value and reproducibility].

A method for platelet migration testing is presented. The results are comparable using sodium citrate and acid citrate dextrose as anticoagulants, whereas other anticoagulants lead to lower absolute migration. The day-to-day variability of the method is higher than the intra-day variability. The variability between the patients is higher than that between measurements carried out on the same patient. There is no correlation to ADP-induced platelet aggregation.

Adult↗
PubMed1983

[What does the Doppler ultrasonic technic accomplish in angiology?].

Doppler ultrasound was the most important diagnostic improvement in angiology during the last twenty years. This technique has been used answering the following clinical questions: severity of peripheral vascular disease; diagnostic of cerebro-vascular disease and diagnostic of deep vein thrombosis. Doppler ultrasound provides a clinical useful and objective evaluation of peripheral artery disease. Mönckeberg's sclerosis and leg oedema give false results only. The sensitivity of carotid Doppler investigations is over 90%. Deep vein thrombosis of the leg and pelvis can be diagnosed correctly in about 90% of cases. Ultrasonic methods are not only reliable but have also the advantages of being non-invasive, repeatable and inexpensive.

Arterial Occlusive Diseases↗
PubMed1983

[Venous prostacycline synthesis and plasma thromboxane B2 after low-dose aspirin].

It has been reported that low-dose aspirin inhibits prostaglandin synthesis of platelets, but not of endothelial cells. Whereas platelet prostaglandin synthesis is irreversibly inhibited by acetylation of cyclooxygenase, the nuclei-containing vascular wall cells are able to resynthesize this enzyme. The optimal optimal dosage in influencing vascular haemostatic regulation is still an open question in the literature. Hence, we examined the effect of a single dose of aspirin (50-500 mg), given to patients undergoing surgery for varicose veins, on venous wall PGI2 synthesis in a biopsy specimen and on plasma thromboxane B2 levels monitored continuously for up to 96 hours. Our findings demonstrate that a dose as low as 50 mg per day is able to inhibit thromboxane formation significantly. On the other hand, this dose does not influence vascular wall PGI2 synthesis. Based upon these data it is concluded that the optimal dosage to achieve a beneficial effect on haemostatic balance should not exceed 50 mg aspirin per day.

Adult↗
PubMed1983

Reversible EOL-indicator: a new cause for low pacemaker rate.

A case is presented in which a new cause for decrease in pacemaker rate was encountered: six months after implantation of a Medtronic 5967 pacemaker, the first routine check-up revealed a rate of 62.5 ppm instead of 70 ppm. After application of a magnet, all measurements returned to normal. The cause for this phenomenon, which could not be attributed to battery depletion or oversensing, was probably a change of state of the flip-flop which is responsible for the sudden rate drop of 10% which serves as the end-of-life (EOL)-indicator in this pacemaker. This change of state may result from a very short decrease of power supply voltage during shipment or at the time of implant, and is fully and permanently reversible by performance of the magnet test. In order to prevent unnecessary pacemaker explants, future pacemaker circuits should be redesigned to eliminate the effect of very short voltage changes. Meanwhile, a routine magnet test should be performed immediately after implantation.

Electric Power Supplies↗
PubMed1983

Electrophysiologic findings in carotid sinus massage.

Thirty patients with carotid sinus syndrome were electrophysiologically studied. In 14 patients carotid sinus massage was performed during atrial and ventricular stimulation, and the conduction times were measured. The AH-time was prolonged by more than 120 ms in 6 patients (20%); the HV-time was prolonged in 6 patients by more than 55 ms (20%); 5 patients had bundle branch block (16.7%); The sinus node recovery time was prolonged in 7 out of 27 patients (26%). Ten patients (33%) did not have additional electrophysiologic abnormalities. There was a predominance of carotid sinus syndrome on the right side. During carotid sinus massage there was a significant increase of the AH-time, but there were no significant changes of the HV-time or the width of the QRS-complexes. Twenty-one patients developed an atrial asystole and 9 patients an atrial bradycardia and an additional AV-block. There was a longer AH-time and a longer prolongation of the AH-time in the patients who developed an AV-block. Twelve out of 14 patients (85.7%) developed an AV-block during carotid sinus massage and atrial pacing. During ventricular pacing 5 of 14 patients (35.7%) revealed a complete retrograde block before carotid sinus massage and 5 of the remaining 9 patients developed a total retrograde block during carotid sinus massage. Consequently, in 71.4% of the patients with carotid sinus syndrome complete retrograde conduction block and atrial asystole can be expected during attacks of ventricular asystole and simultaneous ventricular pacing. In conclusion, there is a high incidence of additional disturbances of the sinus node function and AV-conduction in patients with carotid sinus syndrome. AAI pacemakers are contraindicated due to the common development of additional AV-block during carotid sinus massage. Physiologic pacing might contribute to better hemodynamics, particularly in patients with the mixed type of carotid sinus syndrome.

Adult↗
PubMed1982

[Platelet half-life in patients with primary hyperlipoproteinemia type IIa, IIb, and IV according to Fredrickson with and without clinical signs of atherosclerosis].

It is generally accepted that platelet half-life is shortened in atherosclerotic vascular disease. Concerning changes due to hyperlipoproteinemia (HLP), however, there exist only few data. Therefore, we examined the platelet-half life in 60 patients with recently discovered HLP type IIa, IIb and IV according to Fredrickson before treatment in comparison to 60 controls. 33 of the HLP-patients had no clinical symptoms of angiopathy, 27 patients suffered from peripheral vascular disease or from coronary heart disease as verified by angiography. The labelling of autologous platelets was performed with 100 microCi of 111Indium-oxine-sulfate at 37 degrees C for 5 minutes. The mean labelling efficiency was 90%, the recovery after 2 hours about 70%. Serum lipoproteins were estimated by means of ultracentrifugation and polyanionprecipitation according to Lipid Research Clinic Methods. In the patients with HLP platelet half-life was significantly shortened in comparison to the control group (p less than 0.01). These changes were most pronounced in patients with HLP-type IIa and with atherosclerotic lesions, respectively. In patients with HLP-type IIa a very close correlation could be demonstrated between platelet half-life and LDL-cholesterol (r = -0.72; p less than 0.001) as well as total cholesterol (r = -0.73; p less than 0.001). These data prove that in HLP in-vivo platelet function as measured by platelet survival is significantly influenced even before the occurrence of clinically relevant symptoms of atherosclerosis.

Adult↗