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Biomedical subjects

J Kvasnicka

Publications and source records attributed to J Kvasnicka.

At least 109 records · Page 6Linked to original sources
PubMed1994

Clinical results of coronary excimer laser angioplasty: report from the European Coronary Excimer Laser Angioplasty Registry.

From January 1991 to January 1993 the clinical and angiographic data of 470 patients were included in the European Coronary Excimer Laser Angioplasty Registry. Symptoms were CCS class 3 in 23% and CCS class 4 in 14.7%; unstable angina was present in 14.7% and 6.6% of patients had acute myocardial infarction. Of 477 treated lesions, 60% were type B2, and 19% type C. The lesion was located in the LAD in 61%, in the LCX in 16%, in the RCA in 20%, in a protected left main stem in 1.3% and in a saphenous vein graft in 2.5%, respectively. Failure of laser angioplasty occurred in 56 (12%) interventions. By multivariate analysis failure was associated with the intention to treat long segmental lesions (risk ratio (RR) 3.6, confidence interval (CI) 2.9 to 4.4; P = 0.0005), segments with severe prestenotic tortuosity (RR 3.5, CI 2.4 to 4.6; P = 0.02) and total occlusions (RR 2.1; CI 1.4 to 2.8; P = 0.05). Complications included vasospasm (13.4%), dissection (14.7%), flow limiting dissection (4%), reclosure (7.8%), and perforation (1.9%). Myocardial infarction occurred in 2.1%, CABG was requested in 1.9%, and the mortality was 1.5%. Procedural success was achieved in 89%. Individual morphological criteria for a reduced procedural success were the presence of a thrombus (RR 6.4; CI 5.0 to 7.7; P = 0.007) and vessel calcification (RR 2.6; CI 1.9 to 3.2; P = 0.005). Procedural success was slightly lower in type C lesions (86%) than in type B2 (88%) type B1 (95%), and type A lesions (92%), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1994

Percutaneous angioscopy in patients with restenosis after excimer laser coronary angioplasty.

Coronary angioscopy was performed in two patients with restenosis after excimer laser coronary angioplasty to improve our knowledge of restenosis after excimer laser angioplasty. The characteristics of the angioscopic findings in restenosis after excimer laser angioplasty consisted of smooth white plaques, which were distinctly different from the yellow plaques commonly observed in primary lesions. These findings indicate that restenosis in these patients after excimer laser angioplasty may be associated with smooth muscle cell proliferation and fibrosis.

Angioplasty, Laser↗
PubMed1994

Treatment of hypertension in the presence of coexisting medical conditions.

Treating hypertension reduces morbidity and mortality. Unfortunately, hypertension often exists in patients with other medical conditions. In these patients, the selection of an antihypertensive agent is often influenced by the presence of the coexisting condition. Conversely, the treatment of the coexisting medical condition may be influenced by the presence of hypertension. Given the vast array of antihypertensive medications available today, appropriate treatment of both hypertension and coexisting conditions can be achieved with careful selection of medications. This review discusses factors to consider when treating elderly patients with hypertension with the following coexisting conditions: dyslipidaemia, glucose intolerance, sexual dysfunction, cardiovascular disease, pulmonary disease, renal disease and neuropsychiatric disorders. Hypothyroidism, hyperthyroidism and various states of high cardiac output may cause hypertension. These conditions should be identified, since they are often treatable with subsequent resolution of the hypertension.

Aged↗
PubMed1994

[Implantation of Strecker's endocoronary prosthesis. Apropos of 21 cases].

The aim of this study was to assess the safety and efficacy of implantation of Strecker coronary stents. The implantation was performed in 21 patients during elective angioplasty (N = 18) or in emergency situations (N = 3). The indications were acute occlusion after angioplasty (N = 3), restenosis (N = 12), incomplete balloon angioplasty results (N = 4) and implantation of first intent (N = 2). The site of implantation was a venous bypass graft in 9 cases, the left anterior descending artery in 5 cases, the right coronary artery in 4 cases and the left circumflex in 3 cases. The average length of the lesions was 8.4 +/- 4.1 mm, including 15 short (< 10 mm) and 6 long (> 10 mm) lesions. Four lesions were located at an acute angle (> 45 degrees) and 4 at the site of origin of a side branch. The diameter of the normal segment of the treated artery was < 3 mm in 12 cases and > 3 mm in 9 cases. Seven 3 mm, five 3.5 mm, six 4 mm and three 4.5 mm diameter stents were implanted. There were no failures to position or implant the stents. After the implantation, the minimal lernen diameter of the artery at the angioplasty site was greater than that obtained with balloon (2.87 +/- 0.67 mm versus 1.83 +/- 1.11 mm, p < 0.001). There was no early restenosis at control angiography at 24 hours (2.78 +/- 0.20 mm versus 2.87 +/- 0.67 mm NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Actilyse (a recombinant tissue-type plasminogen activator] in the treatment of acute myocardial infarct. Comparison of the effects of Actilyse and streptokinase].

The preparation Actilyse--a tissue plasminogen activator prepared by recombination--is an effective fibrinolytic drug. The authors recorded in a group of 33 patients reperfusion in 91%, evaluated on the basis of indirect criteria. In a group of 18 patients treated with streptokinase reperfusion was achieved in 74%. Based on changes of CK and CK-MB values--an earlier rise of values following Actilyse administration and conversely their more marked increase during subsequent sampling after streptokinase administration--it may be assumed that earlier dissolution of the thrombus in the coronary artery occurs after Actilyse administration, as compared with streptokinase. It may be thus assumed that there is also a smaller necrotic focus after Actilyse treatment, as compared with streptokinase. Early re-occlusion--according to indirect indicators--occurred in 8.6% in the Actilyse treated groups, as compared with 5.9% in the streptokinase treated group. The fibrinogen values decline in the Actilyse group to 40% and in the streptokinase group to 28%. Later enhanced new formation of fibrinogen occurs and the fibrinogen values rise to 160% in the Actilyse treated group and to 250% of the initial value in the streptokinase treated group. The elevated fibrinogen value, as compared with the baseline value, persists for the 12 days of the follow-up. No severe spontaneous haemorrhage was recorded, haemorrhagic manifestations were associated with blood sampling and i.v. administration of drugs only. The necessity to administer blood was due to a complication during puncture of the subclavian vein in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Ratios of surface markers (CD) on peripheral blood lymphocytes in the working-age Czech population].

The authors present an account of lymphocytic CD signs in adult men (mean age 34 years) and women (mean age 29 years) of the Czech population. Mean values and standard deviations (s.d.) are given for men/women: CD2: 79.6% (6.6)/86.4% (5.3), CD 3: 71.5% (7.4)/81.1% (7.4), CD4: 42.4% (6.3)/48.4% (8.5), %CD45RA+ v CD4+: 41.7% (14.1)/47.3% (13.9), CD5: 69.5% (7.0)/76.00% (6.5), CD8: 33.9% (9.3)/29.8% (6.8). CD10: 1.9% (1.3)/2.5% (1.6), CD11c: 8.3% (4.7)/10.9% (4.4), CD16: 8.3% (3.8)/4.4% (2.3), CD19: 11.5% (4.0)/8.8% (3.2), CD20: 14.7% (4.7)/11.3%, CD22: 10.6% (9.2)/8.9% (3.5), CD45RA: 56.7% (7.6)/61.7% (7.8), CD56: 15.1% (5.7)/16.0% (6.5), CD57: 13.7% (7.9)/8.5% (6.3), CD71: 1.9% (1.3)/3.5% (1.7) a HLA DR: 22.1% (6.4)/19.6% (7.1), DP: 16.3% (7.1)/13.5% (4.9), DQ: 10.9% (5.8)/7.2% (3.2), BJK: 2.6% (2.2)/2.1% (1.1), BJL: 1.8% (1.2)/2.1% (1.3), ratio CD4/CD8 1.35 (0.49)/1.75 (0.69). The examination were made on an apparatus FACScan (Becton Dickinson).

Adult↗
PubMed1993

Effects of pulsed lasers on agar model simulation of the arterial wall.

Coronary laser angioplasty is limited by a high rate of dissection and the occurrence of abrupt closure and perforation. The aim of this study was to visualize the mechanical effects of pulsed lasers on two chamber in vitro models. These models consisted of 1 or 2 agar layers and calcium carbonate inclusions (1-layer model) or lipid (2-layer model) simulating lipid or calcified tissue. The inclusions were irradiated with a holmium-yttrium-aluminum-garnet (Ho-YAG) laser or a xenon chloride excimer laser. The Ho-YAG laser demonstrated dissection-like expansions of the target and perforation-like cracks. The size of dissection was obtained using an the empirical formula of energy (E) and the maximal expansion distance (Dmax) of the targets, Dmax = 0.15E0,87-1,17. The excimer laser showed rare and short perforation-like cracks and little dissection-like expansion of the gaseous products originating from the ablation of material. Ho-YAG laser ablation is likely to induce target tissue dissections and/or perforations. Excimer laser-ablates targets with less traumatic effects than Ho-YAG laser.

Agar↗
PubMed1993

Acute response of the arterial wall to pulsed laser irradiation.

This study was designed to examine the acute response of normal arterial wall to pulsed laser irradiation. Irradiation with an Excimer or a Holmium YAG laser was performed in 15 normal iliac sites of 8 male New Zealand white rabbits. The excimer laser was operated at 308 nm, 25 Hz, 50 mJ/mm2/pulse, and 135 nsec/pulse and the Ho:YAG laser was operated at 2.1 microns, 3.5 Hz, 400 mJ/pulse, 250 microseconds/pulse. The excimer and Ho:YAG laser were coupled into a multifiber wire-guided catheter of 1.4 and 1.5 mm diameter, respectively. The mean luminal diameter increased similarly from 2.01 +/- 0.29 to 2.46 +/- 0.27 mm (P < 0.0005) and from 2.09 +/- 0.53 to 2.45 +/- 0.30 mm (P < 0.005) after excimer and Ho:YAG laser irradiation, respectively. Perforation occurred in 3 of 15 Ho:YAG irradiated sites and 0 of 15 excimer laser irradiated sites. The sites irradiated with excimer or Ho:YAG laser had similar histologic features, consisting of shedding of the endothelium, disorganization of internal elastic lamina, localized necrosis of vascular smooth muscle cells, and fissures in the medial layer. However, the sites irradiated with excimer laser had lower grading scores than those irradiated with the Ho:YAG laser (P < 0.05). Irradiation with excimer or Ho:YAG laser of normal arteries results in: (1) vasodilation of the irradiated artery; (2) localized mechanical vascular injury, and (3) Ho:YAG laser induces more severe damage to the arterial wall than excimer.

Angioplasty, Laser↗
PubMed1993

Temporal and regional trends of cancer mortality in West Germany.

Age-specific and cumulative mortality rates are presented for different cancer sites from 1970 until 1988 for the 11 individual federal states of West Germany (FRG). Sex- and age-specific evaluations are performed and temporal and regional trends in mortality from different cancer sites are revealed. In the FRG there is no comprehensive cancer registry with national coverage for recording cancer patients of all ages (nationwide incidence rates are available only for childhood cancers). Therefore, in view of the lack of a nationwide cancer registry the importance of long-term cancer mortality studies for health policy is emphasized. Methodological aspects of certification regulations and classification of cancer sites are discussed.

Age Factors↗
PubMed1993

Excimer and holmium yttrium aluminum garnet laser coronary angioplasty.

Recently access to the coronary arteries became available to laser angioplasty because of a new technique utilizes a pulsed laser source and multifiber, "over-the-wire" guided catheters. The aim of this study was to evaluate the early and long-term results and the side effects of coronary angioplasty with an excimer or a Ho-YAG laser. Forty consecutive patients were treated with the Ho-YAG laser (group I) and 46 consecutive patients were treated with the excimer laser (group II). The primary laser angioplasty success rate was 55% and 72% (NS) for groups I and II, respectively. This success rate was highest in saphenous vein grafts. It was similar in calcified and noncalcified lesions and in total occlusions and stenoses. It tended to be lower in long lesions than in short ones (40% vs 60%; p < 0.05 and 44% vs 78%; NS for groups I and II, respectively). Laser stand-alone therapy was performed in 5% of patients in group I compared with 22% in group II (p < 0.05). Failures were due to the inability of the laser catheter tip to reach the lesion, to cross the obstruction, or to obtain a significant reduction in stenosis. They were more frequent in patients in group I than in those in group II (45% vs 28%). There were no deaths, no myocardial infarctions, and no need for emergency coronary artery bypass grafting because most patients had total occlusions or a well-protected coronary artery. Complications included acute closure in 8% of patients in group I and in 17% of patients in group II and spasm in 10% and 13% of patients in groups I and II, respectively. Dissection occurred more frequently in patients in group II than in those in group I (28% vs 7%; p < 0.04). The angiographic patency rate at 6-month follow-up was 33% and 29% for patients groups I and II, respectively. Multifiber, wire-guided catheters provide easy access to the coronary arteries. Excimer laser angioplasty is effective but induces a high rate of dissections. Technical improvements are required to ablate more tissue to possibly reduce the restenosis rate. Further studies are needed to elucidate the mechanism of side effects and to reduce the restenosis rate.

Adult↗
PubMed1993

Iatrogenic clubbing of the fingers.

We report on a 39-year-old female who had been operated on for an atrial septal defect at the age of 14 years. On operation the inferior vena cava was iatrogenically misdirected into the left atrium. The cyanotic patient, in functional group IV of the NYHA classification, with polyglobulia and clubbing of the fingers was successfully reoperated after 25 years.

Adult↗
PubMed1993

Increase in fibrinogenemia in the postoperative period of open-heart surgery.

Postoperative thromboses, with no effective prevention currently available, are a serious complication of open-heart surgery. Conventionally, anticoagulants (heparin, coumarine derivatives) are used after prosthetic heart valvular surgery (PHVS), and antiplatelet drugs (ASA) are administered after coronary artery by-pass graft operation (CABG)). Postoperative thrombophilia may be enhanced by an increase in plasma fibrinogen (FBG) levels, from 2.6 +/- 0.4 to 6.0 +/- 1.8 g/l, p < 0.01, as observed following open-heart surgery in CABG pts (n = 19), and from 2.8 +/- 0.5 to 4.2 +/- 1.0 g/l, p < 0.01) in PHVS pts (n = 12) during postoperative days 6 to 10. This increase in FBG in both groups of pts on different antithrombotic regimens significantly correlated with an increase in others plasma proteins alpha-1-antitrypsin A1AT (r = 0.43, p < 0.01), coeruloplasmin, CRPL (r = 0.53, p < 0.01), orosomucoid, ORM (r = 0.37, p < 0.02), and with prolongation of euglobulin clot lysis time (r = 0.42, p < 0.01) during the 21-day postoperative period. A negative correlation was demonstrated between FBG and the plasma levels of transferrin, TRF (r = -0.389, p < 0.02). Whereas FBG, ORM, A1AT, and CRPL are referred to as "positive" acute phase proteins, TRF is a "negative" acute phase protein. It follows from multivariate factor analysis that the reactive increase in these acute phase proteins (incl.FBG) is due to one "common" stimulating factor during the postoperative period. The "common" stimulating factor also raised thrombocyte count.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute-Phase Proteins↗
PubMed1993

Neurohumoral relations in neurological and psychiatric patients.

Sixteen patients-epileptics, alcoholics, psychotics and post-contusion cases-were subjected to neurological, psychiatric, psychological, morphological (X-ray, CT, NMR), physiological (EEG, polysomnography, evoked potentials), immunological and SPECT examination. Most had CT and SPECT signs of focal brain damage. The results were but exceptionally due to injury, most were of unknown etiology. This tallied with EEG focal abnormalities, mainly sleep disorders, sometimes subjective ones, but invariably detectable objectively. In each case there was REM, in some also NONREM sleep deficiency. Half of the cases were tested immunologically, each time with positive results: increased levels of acute-phase protein and stress-reaction proteins. As copious literature and our experience show, the above pathological condition, rather than being accidental, constitute regardless of etiology, an integrated entity which could be called "programme cerebropathy". The primary role is played there by the epileptic focus and its properties, in particular, the speed of discharge and localization and brain stem humoroergic systems, i.e., their performance and mutual balance. There is a program sequence of events, first, and epileptic focus acting on the neighborhood, the rise of secondary and tertiary foci, and influence over the thalamocortical system. Soon afterwards, epileptic activity begins to act on brain-stem structures. This results in changes in sleep, mood, psychic output, immunity, endosecretion, and in paroxysms.

Adult↗
PubMed1993

[Regional distribution and temporal development of infant mortality in West Germany 1973-1988].

Infant mortality was documented for the Federal Republic of Germany as well as for the individual Federal Laender (before German unification) during 1973 and 1988. 31 Cause-of-Death groups, 5 Age-of-Death groups, and both sexes were considered. During the observation period the infant mortality rate decreased to 1/3 of the value of 1973 and is now well below 1%. The temporal decrease of infant mortality is different with regard to causes of death, age of death, sex, and Federal Land: Infant mortality due to congenital malformations decreased to about one half within the observation period, but its relative contribution to all natural causes of death increased from about 20% in 1973 to about 30% in 1988.

Cause of Death↗
PubMed1993

[Percutaneous coronary angioplasty by ultraviolet and infrared laser].

Laser angioplasty can now be performed on the coronary arteries as sources of pulsed laser and steerable multifibre catheters have become available. The aim of this study was to analyse the immediate results, the outcome and secondary effects of coronary angioplasty with excimer and holmium YAG laser. The homium-YAG laser was used in 40 patients (Group I) and the excimer laser in 46 patients (Group II). The immediate success rates were 55% in Group I and 71.7% in Group II. The highest success rates were obtained in lesions of saphenous vein grafts. The primary success rate was remarkably high in calcific lesions and complete occlusions. It was less impressive in long than in short stenoses in Group I. Treatment by laser coronary angioplasty alone was successful in 21.7% of patients in Group II and 5.0% of patients in Group I (p < 0.05). The failures were related to difficulty in reading the lesion, in passing the stenosis or in obtaining a reduction of its severity. The failures were more common in Group I (45%) than in Group II (28.3%). In this preliminary series there were no deaths, myocardial infarcts or emergency coronary bypass procedures. The following complications were observed: acute occlusions in 17.1% of patients in Group I and 7.5% of patients in Group II; spasm (10-13%); coronary dissection was commoner in Group II (28.3%) than in Group I (7.5%, p < 0.04). Angiographic and clinical follow-up at 6 months showed a restenosis rate of 46% in Group I and 43% in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Comparison of the effects and safety of atenolol and nifedipine in the treatment of angina pectoris].

The effects of atenolol (100 mg/day) and nifedipine (60 mg/day) on angina symptoms and exercise tolerance were compared in an open, randomized study. Twelve-week treatment period was compared with two weeks of placebo treatment in 51 patients with chronic stable angina pectoris. Mean frequency of angina attacks decreased significantly from 8.3 to 1.6 attacks per week after atenolol treatment (p < or = 0.05). Both drugs increased exercise tolerance to development of signs of ischemia on electrocardiogram (p < or = 0.05) and increased maximal exercise tolerance as well (p < or = 0.05). Mean ST segment depressions at peak exercise were significantly decreased after treatment with atenolol and nifedipine (p < or = 0.05). Both drugs also increased total exercise capacity in comparison with placebo period, stated as 100%:192% after atenolol and to 191% after nifedipine. No significant changes of heart rate and blood pressure were noted during treatment period. Twelve patients did not finished study, two of them suffered myocardial infarction with death in one of them (atenolol group, other one nifedipine group). Thus, atenolol in one daily dose is as effective as nifedipine in chronic stable angina patients when administered as single therapy.

Adult↗
PubMed1993

[Detection of cerebropathy in neurologic and psychiatric diseases].

The authors made a comprehensive examination of 16 patients--epileptics, alcoholics, psychotic subjects and patients after cerebral contusion. The patients were subjected to a neurological, psychiatric, psychological examination as well as to a morphological examination (X-ray, CT, NMR), physiological examination (EEG, polysomnography, evoked potentials), immunological examination and SPECT. The majority of patients had positive CT and SPECT findings suggesting focal brain damage. These results could be explained only in exceptional cases by injury, the majority was of unknown aetiology. With this corresponded focal EEG abnormalities and in particular sleep disorders, sometimes subjective but always detectable by objective methods. There was always a shortage of REM, sometimes also NONREM sleep. Half the patients were subjected to an immunological examination which was always positive and comprised elevated acute stage proteins and proteins associated with the stress reaction. Numerous data in the literature and the authors' experience indicate that the mentioned pathological findings are not incidental and form, independently on the aetiology, an integrated unit for which the term cerebropathy can be used. A primary role is played by the epileptic focus and its quality, i.e. above all the rate of discharge and site and humoroergic systems of the brain stem, in particular their efficiency and mutual balance. The events have a programmed sequence. At the beginning an epileptic focus develops which influences the surrounding area, secondary and tertiary foci are formed and the thalamo-cortical system is affected. Soon this is followed by an apparent influence of the epileptic activity on structures of the brain-stem. The consequence are changes affecting sleep, mood, mental performance, immunity, endosecretion and paroxysms. Subsequently individual symptoms are already prepared but have a different latency of manifestation and the latter depends also on external provoking influences. The thalamo-cortical reaction is characterized by the manifestation of epileptic paroxysms and sets in after a different interindividual incubation following injury. The same applies to the hippocampal reaction manifested by the organic psychosyndrome. Some symptoms such as changes of immunity, sleep or endosecretory function are not necessarily manifested if the influence of the focus on structures of the brain-stem is not sufficiently intense. Conversely if the effect on the brain-stem and limbic structures is greater and the effect on the thalamo-cortical system smaller, psychotiform behaviour develops. Then there are marked changes of phoria, dynamogeny, rate, affectivity, sleep and hormonal secretion and its equilibrium.

Adult↗