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Biomedical subjects

J Slany

Publications and source records attributed to J Slany.

At least 37 records · Page 2Linked to original sources
PubMed1997

Cardiac involvement in patients with myotonic dystrophy, Becker's muscular dystrophy and mitochondrial myopathy.

The aim of this prospective study was to classify cardiac involvement in myopathies by means of a comprehensive cardiac investigation, to determine the rate of cardiac involvement in myopathies according to this classification and to compare the validity of previously reported electro-cardiographic myopathy indices (QT/PQs, P/PQs, R/S) with that of the comprehensive cardiac investigation. We included 14 patients with myotonic dystrophy, 6 patients with Becker's muscular dystrophy and 10 patients with mitochondrial myopathy. Cardiac involvement was classified as either "definite", "equivocal" or "absent" by assessing cardiovascular history, physical examination, electrocardiography, echocardiography and 24-hour ambulatory electrocardiography. "Definite"/"equivocal"/"absent" cardiac involvement was found in 12/2/0 myotonic dystrophy, 3/3/0 Becker's muscular dystrophy and 6/3/1 mitochondrial myopathy patients. Electrocardiographic myopathy indices were pathologic in 3 Becker's muscular dystrophy, 6 mitochondrial myopathy but in none of the myotonic dystrophy patients. The proposed comprehensive cardiac investigation is simple, inexpensive and effective in assessing cardiac involvement in patients with myotonic dystrophy. Becker's muscular dystrophy and mitochondrial myopathy. In case of cardiac involvement, cardiac therapy might be one of the few therapeutic options for these patients.

Adolescent↗
PubMed1997

[Embolism in left-atrial thrombi (ELAT Study): are spontaneous echo contrast, thrombi in the left atrium/appendage and size of the left atrial appendage predictors of possible embolisms?].

Transesophageal echocardiography visualizes the left atrium, the left atrial appendage, thrombi and spontaneous echo contrast within them. The role of these findings as predictors for embolism in atrial fibrillation is unknown. We performed transesophageal echocardiography in 409 non-rheumatic atrial fibrillation outpatients (62 +/- 12 years, 36% female) with no recent (< 1 year) history of embolism. Patients with left atrial/appendage thrombi received oral anticoagulation, those without thrombi Aspirin. The patients were followed up over 2 years. Primary events were stroke, embolism and non stroke/embolism related deaths. Secondary events were initiation of anticoagulation in patients primarily assigned to Aspirin. Left atrial/appendage thrombi were diagnosed in 2.5%. They were associated with diabetes, heart failure and decreased left ventricular fractional shortening (p < 0.05 for each variable). Spontaneous echo contrast was diagnosed in 12%. It was associated with increased age, constant atrial fibrillation, hypertension, heart failure, valvular abnormalities and increased left atrial diameter (p < 0.05 for each variable). Increased left atrial appendage size was associated with constant atrial fibrillation, etiology of atrial fibrillation and valvular abnormalities (p < 0.05 for each variable). Follow-up was 25 +/- 7 months. 29 patients suffered a stroke, 33 further patients died of non stroke/embolism related causes. Secondary events occurred in 19 patients. Neither left atrial/appendage thrombi nor left atrial appendage size were predictors for embolism. Predictors for embolism were increased age (p = 0.003), hypertension (p = 0.01) and increased diastolic blood pressure (p = 0.04). In non-rheumatic atrial fibrillation outpatients with no recent history of embolism, transesophageal echocardiography is of limited value to assess embolic risk. Hypertension and increased diastolic blood pressure have been confirmed in their significance as clinical predictors for embolism.

Aged↗
PubMed1996

Influence of measurement inaccuracies on determination of left ventricular mass by M mode echocardiography.

OBJECTIVE: To determine to what extent inaccuracies in measuring the end diastolic diameter of the left ventricle, the interventricular septum, and the posterior wall, by M mode echocardiography influence the left ventricular mass calculated by the Devereux's formula. DESIGN: Mathematical model. RESULTS: Relatively small measurement inaccuracies such as 5%, which are known to be inherent in the echocardiographic method, will result in "changes" of left ventricular mass in the range of 8% to 15%. This is equivalent to expected changes in left ventricular mass seen during treatment. CONCLUSIONS: The use of Devereux's formula to calculate left ventricular mass is limited by measurement inaccuracies in individual patients.

Diastole↗
PubMed1996

Sex-related differences in acetazolamide-induced cerebral vasomotor reactivity.

BACKGROUND AND PURPOSE: Cerebral vasomotor reactivity can easily be assessed reliably by measuring vasodilatory response to acetazolamide by transcranial Doppler sonography. The aim of this study was to confirm the hypothesis that female sex is associated with an increased cerebrovascular flow reserve. METHODS: Blood flow velocity of the middle cerebral artery was measured by transcranial Doppler sonography in 36 healthy sex- and age-matched subjects. After the initial blood flow velocities were recorded, the subjects received 14.3 mg/kg body wt acetazolamide, ie, 1 g/70 kg, intravenously. The measurements were repeatedly performed at 5-minute intervals starting 10 minutes after injection and lasting for 30 minutes. The highest measured flow velocities were used for further analysis. RESULTS: In both groups mean blood flow velocity increased significantly after acetazolamide (women, from 60.2 +/- 12.5 to 89.9 +/- 14.4 cm/s, P < .006; men, from 54.5 +/- 18.8 to 75.7 +/- 24.5 cm/s, P < .02). The difference in mean blood flow velocity after acetazolamide between groups of women and men was statistically significant (P < .02). CONCLUSIONS: Female subjects show an increased vasodilatory response to the acetazolamide test compared with men.

Acceleration↗
PubMed1996

Aneurysm of the left sinus of Valsalva. An unusual source of cerebral embolism.

BACKGROUND: Aneurysm of the ascending aorta is rarely reported as the source of emboli. We report a patient with a minor stroke in whom a saccular aneurysm of the left sinus of Valsalva was diagnosed as the presumed source of cerebral embolism. CASE DESCRIPTION: A 49-year-old right-handed woman presented 10 days after sudden onset of right-sided hemiparesis. Her history was uneventful apart from an acute inflammation of the subcutaneous tissue in the right leg 20 years earlier. A diastolic murmur was heard best over the third left intercostal space. Results of duplex ultrasound investigation of the cerebral vessels, chest x-ray, and electrocardiography and biochemical and hematological variables were normal. CT of the brain showed a small hypodense area in the left frontal region. Transthoracic and transesophageal echocardiography detected moderate aortic regurgitation and a saccular aneurysm originating from the left sinus of Valsalva. The aneurysm had calcified walls and contained thrombotic material. Surgical closure of the aneurysm with a pericardial patch was performed to prevent recurrent embolism and rupture. Coaptation of the aortic valves was achieved, and no residual aortic regurgitation could be detected. CONCLUSIONS: We conclude that an unruptured sinus of Valsalva aneurysm should be included in the list of sources of embolism. Transthoracic echocardiography establishes the diagnosis. Transesophageal echocardiography provides additional information about the origin and size of the aneurysm and presence of thrombotic material. Surgical closure of the aneurysm prevents rupture and recurrent embolism and possibly corrects aortic regurgitation.

Aortic Aneurysm, Thoracic↗
PubMed1996

[Heart muscle involvement in myopathies].

By means of a comprehensive cardiologic examination "definite" cardiac involvement was found in 71% of patients with myotonic dystrophy (MD). In 50% of patients with Becker's muscular dystrophy (BMD) and in 70% of patients with mitochondrial myopathy (MMP). "Equivocal" cardiac involvement was found in 21% of patients with MD, in 50% of patients with BMD and in 20% of patients with MMP. The correlation between cardiac involvement and the neurological deficit was weak.

Adult↗
PubMed1995

Morphology of the left atrial appendage.

BACKGROUND: When examining the left atrial appendage by transesophageal echocardiography, differences in size and shape of the left atrial appendage are to be observed. The study was carried out with the aim of investigating the morphology of the left atrial appendage and to find associations with pathologic cardiac findings. METHODS AND RESULTS: In 220 cases (106 female, 114 male, mean age 72 +/- 13 years) a cast of the left atrial appendage was made after the post mortem examination by using synthetic resin. In 198 cases an ECG was available (sinus rhythm n = 143, atrial fibrillation n = 55). The casts were described in respect to course and ramifications of the principal axis. The casts were measured concerning orifice diameters, outline, and volume. Most frequently (42%) the course of the principal axis was angulated below 100 degrees. More than five ramifications of the principal axis were found in 56% of the casts. The volume ranged from 770-19,270 mm3 (mean 5,220 +/- 3,041). When comparing the clinical and autopsy-data of the patients with the morphology of the casts, associations could be found between the volume of the casts and atrial fibrillation (7,060 mm3 as compared to 4,645 mm3 in sinus rhythm, P < 0.01), left ventricular hypertrophy (5,740 mm3 as compared to 4,639 mm3 without hypertrophy, P < 0.01), myocardial scars (5,923 mm3 as compared to 4,891 mm3 without scars, P < 0.05), closed foramen ovale (5,515 mm3 as compared to 4,037 mm3 with patent foramen ovale, P < 0.01), and left atrial appendage thrombi (8,566 mm3 as compared to 5,027 mm3 without thrombi, P < 0.01). CONCLUSION: Left atrial appendages are formations greatly varying in volume and shape. This variability should be considered when interpreting images of the left atrial appendage, and in particular when diagnosing thrombi.

Adult↗
PubMed1995

Embolic stroke and transoesophageal echocardiography: can clinical parameters predict the diagnostic yield?

The study was performed to determine whether age, cardiovascular risk factors or the stroke syndrome might define patients with embolic stroke for whom transoesophageal echocardiography (TEE) would prove to be useful. Of 256 patients from the Klosterneuburg Stroke Data Bank, 105 (40%) were included because of suspected embolic stroke (59 female, 46 male, mean age 64 years). A positive TEE finding was defined as the presence of left heart thrombus, valvular vegetation, right to left shunting or spontaneous echo contrast. TEE detected potential sources for embolism in 35 of the 105 patients. These were left atrial/appendage thrombi (n = 18), valvular vegetations (n = 4), right to left shunting (n = 10), and spontaneous echo contrast (n = 5). Only the presence of atrial fibrillation showed a significant association with the presence of a cardiac source of embolism (18/35 versus 22/70, P < 0.02). Age, cardiac disease, cardiovascular risk factors and the stroke syndrome did not help in distinguishing stroke patients with and without a positive TEE finding.

Adult↗
PubMed1995

False diagnosis of myocardial infarction due to an extreme left sided cardiac rotation in two patients.

We present two patients with an extremely rare condition: abnormal cardiac levoposition. Alterations in the ECG caused by this congenital abnormality and additional chest symptoms led to the false diagnosis of previous myocardial infarction. Chest X-ray and echocardiography suggested cardiac malformation. Correct diagnosis of cardiac levoposition was established by magnetic resonance imaging.

Aged↗
PubMed1995

Interobserver variability in the detection of spontaneous echo contrast, left atrial thrombi, and left atrial appendage thrombi by transoesophageal echocardiography.

OBJECTIVE: To assess the interobserver variability between two observers from different echocardiographic laboratories. DESIGN: Two observers reviewed video recordings blinded to the other's diagnosis. In part I (n = 88), they determined interobserver variability for spontaneous echo contrast, left atrial thrombi, and appendage thrombi. No diagnostic criteria for thrombi were defined. In part II (n = 85), diagnostic criteria for thrombi were defined. RESULTS: Part I: Both observers agreed in diagnosing spontaneous echo contrast in 97%, left atrial thrombi in 90%, left atrial appendage thrombi in 94%. Part II: With predefined criteria no disagreement occurred in diagnosing left atrial thrombi. In the diagnosis of left atrial appendage thrombi both observers agreed in 89%. The mean diameters of the 10 thrombi on which the observers agreed were greater than of the nine appendage thrombi on which they disagreed. CONCLUSIONS: Interobserver variability in the diagnosis of spontaneous echo contrast is low. Defined criteria decrease interobserver variability for left atrial and appendage thrombi, although one third of the thrombi diagnosed by one observer were not confirmed by the other. Interobserver variability is high in the assessment of small structures (< 15 mm) within the left atrial appendage.

Adult↗
PubMed1994

[Syringomyelia as a rare cause of respiratory insufficiency requiring ventilation].

For 17 years a now 45-year-old man had suffered from progressively more severe flaccid paresis of the arms and thoracic muscles, spastic paralysis of the legs and kyphoscoliosis. Artificial ventilation was required when he contracted pneumonia. Although it was being treated with antibiotics, frequent bronchoalveolar lavage had to be done because of repeated atelectases. After 6 weeks clonuses developed in the legs, predominantly on the right, stretch synergisms and opisthotonos. The pupils were small with sluggish reaction to light, and there was a positive "doll's head" phenomenon. The level of consciousness alternated between somnolence and sleepiness. Magnetic resonance imaging demonstrated cavities in cervical and thoracic spinal cord, supporting the diagnosis of an abnormal cerebrospinal circulation due to gliosis in syringomyelia. To secure cerebrospinal fluid drainage, the cerebellar tonsils were resected, together with a duraplasty and partial resection of the atlas. Following this he became fully conscious and the spastic state improved. During the following 8 weeks it became possible gradually to wean him from the artificial ventilation and achieve satisfactory mobilization so that he could be discharged to domiciliary care.

Combined Modality Therapy↗
PubMed1994

Treatment of exudative fibrinous pericarditis with intrapericardial urokinase.

Three male patients with purulent pericarditis, in whom complete drainage could not be obtained by pericardiocentesis, were treated with transcatheter intrapericardial urokinase to prevent the development of chronic constrictive pericarditis. As shown by echocardiography, the intrapericardial fibrin layers disappeared in two cases and were reduced by more than half in the third. Effects on systemic coagulation indices and complications related to intrapericardial lysis were not observed.

Adult↗
PubMed1994

Bedside percutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients.

OBJECTIVE: To assess the value of endoscopic guidance in bedside percutaneous dilational tracheostomy. DESIGN: The medical critical care unit of a large community hospital. SETTING: 71 consecutive adult patients who required prolonged mechanical ventilation. INTERVENTIONS: 72 elective percutaneous dilational tracheostomies using the Ciaglia technique were performed under view of a flexible fiberoptic bronchoscope. MEASUREMENTS AND RESULTS: Patients were examined during tracheostomy and on days 2 and 7 after the procedure, at discharge and after half a year if they were still alive. A correct median puncture was observed by endoscopic control in 59 interventions. An initial paramedian puncture was detected in 13/72 (18%) procedures and was corrected by renewed insertion in all cases. No severe complications related to percutaneous dilational tracheostomy were noticed. Minor complications occurred in 4/71 (5.6%) patients including minor bleeding in 2, inflammatory infiltration in 1 and one superficial lesion of the posterior tracheal mucosa. Long-term follow-up revealed stomal granulation in 3 patients including one at the tracheal site. At the end of the observation period the tracheostomy still was in use in 14/71 (20%) patients and 12/71 (17%) patients were decannulated. Due to their severe underlying diseases 45/71 (63%) patients had died. To facilitate weaning from the tracheostomy a minitracheostomy tube was used in 3 patients. CONCLUSION: Percutaneous dilational tracheostomy is a simple bedside procedure associated with a low complication rate. We recommend the use of endoscopic guidance to increase the safety of tracheal puncture and dilation procedure.

Adult↗
PubMed1994

Initial experience with intravascular ultrasound imaging during carotid endarterectomy.

BACKGROUND AND PURPOSE: To assess the feasibility of intravascular ultrasound imaging during carotid endarterectomy. METHODS: Intravascular ultrasound imaging was performed during carotid endarterectomy in eight patients using an over-the-wire catheter system with a 30-MHz ultrasound probe. In vitro studies were carried out before the intraoperative application, paying special attention to visualization of the wall layers of normal carotid arteries, structures of more or less diseased vessels, and surgically placed materials such as patch, suture material, and fibrin glue. Although intravascular ultrasound failed to distinguish between intima and media in areas of normal intima, fibrotic and calcified plaques were detected clearly. Dacron patch as well as sutures were identified as highly reflective structures. RESULTS: In seven of the eight patients studied, intravascular ultrasound yielded cross-sectional images of good quality allowing identification of the vessel layers and the structures at the endarterectomy site. In all patients the three layers of the vessel wall were clearly differentiated and the transition zone between the site of endarterectomy and the genuine vessel appeared smooth without intimal flaps or residual arteriosclerotic plaques. In one patient severe eccentric thickening of the media was detected in the distal internal carotid artery. Neither damage of the vessel layers by the shunt nor thrombus formation in the operating area and the internal carotid artery were detected. CONCLUSIONS: Intravascular ultrasound lends itself as a potentially valuable method of quality control during carotid endarterectomy. The method seems to enable an accurate evaluation of the endarterectomy site and the search for residual plaques.

Adult↗
PubMed1994

Embolic stroke by compression maneuver during transcranial Doppler sonography.

BACKGROUND AND PURPOSE: Embolic complications during ultrasound examinations are a rare cause of neurological deficits. The present case documents the occurrence of embolism by a nonobstructive compression maneuver during transcranial Doppler examination, resulting in a minor stroke. CASE DESCRIPTION: A 63-year-old man suffered from recurrent transient ischemic attacks. Duplex sonography showed a small echogenic plaque at the right carotid bifurcation. During transcranial Doppler studies with a reverberating compression maneuver of the right common carotid artery low in the neck, multiple emboli signals were detected, and the patient developed a left-sided hemiparesis with slurred speech. Funduscopy revealed cholesterol emboli in the inferior temporal arteriole of the right eye. These findings suggested embolization as the cause of the stroke. CONCLUSIONS: Compression maneuvers should not be performed in patients with recent neurological symptoms, even in the case of only small lesions in the extracranial carotid territory.

Carotid Artery Diseases↗
PubMed1994

[Atrial fibrillation--from delirium cordis to therapeutic challenge].

Atrial fibrillation may develop in patients without (line atrial fibrillation) or with heart disease. Its prevalence raises with age. Medical or electrical cardioversion should be considered in view of the unfavourable hemodynamics and the increased risk of embolic events. Class-I antiarrhythmics given to sustain sinus rhythm after cardioversion are fraught with the risk of sudden death and should therefore be replaced by class-III antiarrhythmics. Control of heart rate in persisting atrial fibrillation is achieved best by digitalis glycosides at rest and by calcium channel blockers of the verapamil type or beta blockers during exercise. The risk of embolism in nonvalvular atrial fibrillation is reduced by mild oral anticoagulation and, probably to some extent, also by aspirin (300 mg daily). Ablation of the AV-node or an accessory pathway or heart surgery (maze procedure) may provide help in special cases.

Adult↗