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Biomedical subjects

J Slany

Publications and source records attributed to J Slany.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1994

[Complications of routine intensive care interventions].

The frequent use of invasive procedures for diagnosis, monitoring, and treatment in intensive care units engenders often underestimated dangers due to human error or complications which are to some extent inherent. A brief survey is given of adverse events in connection with central venous catheters, Swan-Ganz catheters, arterial lines, endotracheal intubation, gastric tubes, and cardiopulmonary resuscitation. Strategies to reduce the risks are outlined. Documentation of adverse events and near misses, along with an analysis of their causes constitute indispensable elements of quality control in intensive care medicine. Policies to avoid adverse events, as well as guidelines to recognize and treat them promptly should be regularly scrutinized.

Cardiopulmonary Resuscitation↗
PubMed1993

The prevalence of deep venous thrombosis in patients with suspected paradoxical embolism.

OBJECTIVE: To determine the prevalence of venous thrombosis in patients with suspected paradoxical embolism. DESIGN: Observational study. PATIENTS: Two hundred sixty-four patients with clinically suspected embolic events underwent contrast transesophageal echocardiographic evaluation. Forty-nine patients (24 women, 25 men) had a patent foramen ovale. Forty-one patients had acute stroke, and 8 had acute limb ischemia. SETTING: Echocardiography laboratory of a community hospital. MEASUREMENTS: The presence of a patent foramen ovale was assessed by transesophageal contrast echocardiography. Forty-two patients had venographic evaluation of the lower-extremity venous system. RESULTS: Venous thrombosis was clinically suspected in 6 patients and documented in 24 of the 42 patients with patent foramen ovale who underwent venographic study (57%; 95% Cl, 41% to 72%). Venous thrombosis was confined to calf or popliteal veins in 15 cases. Fifteen of 17 patients who had venographic evaluation within 7 days of the index event had thrombosis compared with 9 of 25 patients who had later evaluations (P = 0.001). More patients with venous thrombosis than without venous thrombosis had a history of previous thromboembolism (13 of 24 compared with 1 of 18 [corrected], respectively; P = 0.001). CONCLUSION: When a patent foramen ovale is detected in a patient with embolism, occult leg vein thrombosis is frequently present.

Adult↗
PubMed1993

Duplex sonographic detection of internal jugular venous thrombosis after removal of central venous catheters.

Venous thrombosis is a very common complication of central venous catheters inserted via the jugular or subclavian vein. The aim of this prospective study is to test the suitability of duplex sonography in detecting thrombi in the internal jugular vein after catheter removal and to analyze the number and extent of such thrombus formations. The study group comprised 64 consecutive patients with an average age of 59 +/- 16 years admitted to an internal intensive care unit. In 54 cases the catheters were removed under sonographic control. In 10 cases duplex sonography was carried out within 24 h after removal of the catheters. The data of 63 patients were evaluated. In 40 patients (63.5%), thrombi of varying extent were present in the jugular vein. No significant correlations were found between thrombus formation and the basic disease, duration of cannulation, the type of catheters used, and the mode of heparinization (therapeutic vs. low-dose). Local inflammation signs and local hematoma showed a significantly higher incidence (p < 0.01) in patients with thrombus formation. Duplex sonography lends itself as a valuable diagnostic tool in the diagnosis of thrombus formation in the internal jugular vein after removal of central venous catheters. Sonographic examinations should be carried out in all long-stay patients at an intensive care unit, in whom central venous catheters are inserted repeatedly via the internal jugular vein.

Adult↗
PubMed1993

Intra-operative transluminal angioplasty of the supra-aortic vessels.

Intra-operative transluminal angioplasty of supra-aortic vessels was performed in 9 patients. All subjects had lesions which were considered difficult or impossible to operate upon. In 2 patients a proximal occlusion of the left subclavian artery was dilated. Seven subjects showed severe stenoses of the supra-aortic vessels: common carotid artery: 1, internal carotid artery: 2, external carotid artery: 1, external carotid artery prosthetic graft: 1, brachiocephalic trunk: 1, vertebral artery: 1. All patients suffered from symptoms which corresponded to the site of the lesions in question. Intra-operative angioplasty was primarily successful in all 9 patients. Re-occlusion occurred within a few days in both patients who underwent angioplasty of the subclavian artery. Six of the seven subjects with stenotic lesions remained free of symptoms and of restenosis. In the case of dilatation of a prosthetic graft of the external carotid artery asymptomatic occlusion developed within 8 weeks. In selected cases intra-operative angioplasty is a potentially valuable alternative in the treatment of surgically inaccessible lesions of the supra-aortic vessels.

Adult↗
PubMed1993

[Aortocoronary bypass operation or percutaneous transluminal coronary dilatation in patients over 70 years of age?].

On account of improved outcome an increasing number of patients more than 70 years old have undergone aortocoronary bypass grafting or percutaneous transluminal coronary angioplasty over the past years. Elective coronary bypass surgery carries a risk in the range of 5 to 10% hospital mortality among this age group. However, excellent long term results are in favour of surgery in carefully selected patients. Major indications are patients with extended areas of myocardial ischemia due to left main stem or proximal triple vessel disease. Overall results of PTCA are, likewise, somewhat less satisfactory in geriatric patients than in younger ones. With careful selection of patients, however, morbidity and mortality of this intervention is low. Excellent indications for PTCA are short, concentric, non calcified single or multiple vessel lesions in symptomatic patients with good ventricular function. In patients with angina refractory to medical treatment who carry an increased risk of surgery, PTCA may be worthwhile even if the coronary morphology is less promising (type B or C lesion).

Aged↗
PubMed1993

[Aortic valve stenosis in the aged--replacement or dilatation?].

In patients with severe symptomatic aortic stenosis the prognosis is very poor (1 year mortality rate 54%). Percutaneous transluminal aortic valvuloplasty shows a primary success rate of 86% and an in hospital mortality rate of 7%. However, within 6 to 12 months in almost all patients restenosis occurred. 23% of the patients died within this time range. 13 subjects with restenosis underwent redilatation or valve surgery. Aortic valve surgery is the treatment of choice in this setting. The method demonstrates also in elderly patients a relatively low early mortality rate and excellent long term results. Patients in NYHA stage IV, with severe coronary heart disease and with impaired left ventricular function (LVEF < 50%) show a 2.5 to 3.6 times increased early postoperative mortality rate. In these patients valvuloplasty may be performed as a palliative therapy or as a bridging procedure to aortic surgery. Aortic valvuloplasty may be indicated further in patients with reduced general conditions or severe secondary diseases.

Aged↗
PubMed1992

Transcranial Doppler sonography monitoring of local intra-arterial thrombolysis in acute occlusion of the middle cerebral artery.

BACKGROUND AND PURPOSE: The aim of this study is to report on the use of transcranial Doppler ultrasonography as a noninvasive diagnostic monitoring tool during local intra-arterial thrombolysis in a patient with acute embolic occlusion of the middle cerebral artery. CASE DESCRIPTION: We describe a 41-year-old woman with mitral valve stenosis suffering from embolism of the middle cerebral artery. Local thrombolysis was performed with tissue plasminogen activator at a dosage of 0.05 mg/kg/hr. Progress of the thrombolysis was monitored by transcranial Doppler. The steps of recanalization could be ascertained by transcranial ultrasound showing a hemodynamically relevant residual stenosis after the first 120 minutes and complete patency of the M1 segment of the middle cerebral artery 180 minutes later. One branch of the middle cerebral artery still showed a filling defect. CONCLUSIONS: Our report demonstrates the potential usefulness of transcranial Doppler monitoring during thrombolysis of a proximal occlusion of the middle cerebral artery for guiding the treatment by assessing the reperfusion of the obstructed artery.

Acute Disease↗
PubMed1992

Evaluation of vasomotor reactivity by transcranial Doppler and acetazolamide test before and after extracranial-intracranial bypass in patients with internal carotid artery occlusion.

BACKGROUND AND PURPOSE: The aim of this trial was to evaluate the effectiveness of extracranial-intracranial bypass with respect to vasomotor reactivity in patients with internal carotid artery occlusions and absent vasomotor reactivity, comparing them with a control group treated conservatively. METHODS: To test vasomotor reactivity in 104 patients with unilateral occlusion of the internal carotid artery, we measured blood flow velocity in the middle cerebral artery by transcranial Doppler sonography both at rest and after injection of acetazolamide. Among the 39 patients who failed to show increased mean blood flow velocity after the acetazolamide test distal to an occluded internal carotid artery by greater than or equal to 10%, 14 subjects subsequently underwent extracranial-intracranial bypass surgery (group A) and 14 age- and sex-matched subjects in whom no such procedure was done composed the control group (group B). Follow-up examinations were performed 3-6 months postoperatively and in the control group 3-6 months after initial examination. RESULTS: Baseline values of the mean blood flow velocity at rest on the affected side were reduced in both groups compared with the contralateral healthy side (group A, 46.0 +/- 15.1 cm/sec; group B, 48.1 +/- 16.7 cm/sec) and revealed only a marginal increase after acetazolamide. The contralateral side showed a normal blood flow velocity at rest and an adequate response to acetazolamide in both groups. On the follow-up examination group A demonstrated a normalized vasodilatory capacity. Blood flow velocity increased significantly after acetazolamide from 41.9 +/- 13.1 cm/sec to 53.5 +/- 16.0 cm/sec (p less than 0.002). In group B, the compromised vasomotor reactivity remained unchanged. CONCLUSIONS: Our results demonstrate that transcranial Doppler sonography together with the acetazolamide test can identify subjects with reduced vasomotor reactivity distal to an occluded internal carotid artery, who may improve hemodynamically by an extracranial-intracranial bypass.

Acetazolamide↗
PubMed1992

[Transcranial Doppler ultrasound in intensive care medicine].

Transcranial Doppler sonography (TCD) enables measurement of blood flow velocities in the basal intracerebral vessels. The most important applications of TCD in the ICU are the diagnosis and monitoring of vasospasms caused by subarachnoid hemorrhage after rupture of an aneurysm. Further indications are the non invasive diagnosis of critical decreases of cerebral perfusion pressure, the evaluation of brain death and the monitoring of thrombolysis of occlusions of the middle cerebral artery. TCD lends itself as a valuable non invasive bedside-monitoring tool, which enables continuous or intermittent monitoring of intracerebral hemodynamics without strain for the patients. Disadvantages to be mentioned are the dependence of experienced examiners and the long lasting training phase required to achieve the requisite experience.

Blood Flow Velocity↗
PubMed1992

Value of echocardiography in atrial fibrillation.

In patients with non-valvular atrial fibrillation one must differentiate between those without a clinically suspected embolic event and those who have sustained embolism or stroke of uncertain origin. All of the latter should undergo echocardiography as part of a comprehensive search for a possible source of embolism. A positive finding will enhance the probability that the ischaemic event was indeed caused by a cardiac embolus. It must be kept in mind, especially in stroke patients, that long-term anticoagulation will expose many of them to a far higher risk of haemorrhage [26] due to multimorbidity, propensity to repeated falls and difficulties in compliance than it did to the carefully selected cohorts of the recent warfarin studies. Whenever transthoracic echocardiography (TTE) fails to disclose an unequivocal cardiac source of embolism, transesophageal echocardiography (TEE) should be performed. In persons with atrial fibrillation but no history of systemic embolisation the only rationale for performing echocardiography is to rule out heart disease in clinically suspected lone atrial fibrillation. For the rest of this group TEE remains an investigative tool.

Atrial Fibrillation↗
PubMed1992

[Intensive care of cerebral hemorrhage].

Critically ill patients with intracerebral hemorrhage require immediate treatment in an intensive care unit. In the acute phase of the disease the patients are endangered from increased intracerebral pressure, respiratory disorders (aspiration!) and hypertension. An adequate intensive care management consisting of sedation, analgesia, intubation and mechanical ventilation, correct body positioning and treatment of hypertension is of decisive importance for the prognosis of these patients. The aim of this report is to discuss the most important therapeutic strategies and arising problems in the course of intracerebral hemorrhage.

Brain Damage, Chronic↗
PubMed1991

[Multiple cerebrovascular lesions as fatal late sequelae of syphilis].

A previously healthy man, aged 33 years, suddenly developed a hemiparesis and right facial paresis, as well as anisocoria and motor aphasia, preceded by recurrent attacks of dizziness. On admission he was somnolent. A flow murmur was heard over both carotid arteries; the blood pressure was 160/80 mm Hg. Cerebral computed tomography demonstrated multiple hypodense areas in the area supplied by several cerebral arteries, and marked cerebral oedema. Angiography of the aortic arch and the supra-aortic branches showed an occlusion of the left common carotid artery and a stenosis of the brachiocephalic trunk. The cerebral oedema, caused by ischaemia, did not respond to treatment. The patient died on the fourth hospital day from brainstem "strangulation". At autopsy syphilitic mesaortitis with characteristic lymphoplasmacellular endangiitis of the vasa vasorum of the aortic arch was demonstrated as the cause of the "aortic arch syndrome". Serology confirmed the diagnosis of an untreated tertiary syphilis. (VDRL titre 1:256; TPHA reactive; IgM-SPHA titre 1:64). Although a very rare cause, a late stage of syphilis should be considered in the differential diagnosis of cerebrovascular lesions in youngish patients.

Adult↗
PubMed1990

[Steroid therapy in subarachnoid hemorrhage].

Increase in intracranial pressure due to brain oedema is one of the most frequent complications of subarachnoid hemorrhage (SAH), apart from vasospasm and hydrocephalus. Up to now the administration of corticosteroids at various dosages has been the standard therapy for brain oedema. With this retrospective study we tried to answer the question whether the administration of dexamethasone at high dosage in patients with SAH bears an increased risk of medical complications such as infections, gastrointestinal bleeding and diabetes mellitus. 171 consecutive patients of our intensive care unit, 51 men and 120 women (average age 52.4 +/- 13.6 years) were included in the study. 107 patients received dexamethasone in high doses according to Gobiet's scheme. 64 patients who were not given any steroids formed the control group. Almost the same frequency of gastrointestinal bleeding was registered in the steroid group (2.8%) and in the control group (3.1%). No increase in diabetic problems was found in the steroid group, either. The steroid group showed an increase in infections (38.3% compared with 28.1% in the control group; p less than 0.001). The increase, however, was entirely due to the more frequent occurrence of urinary tract infections (14.0% vs. 4.7%). Dexamethasone therapy at high dosage bears no increased risk of medical problems in patients with SAH, except for a greater number of urinary tract infections. However, stomach ulcer prophylaxis and monitoring of blood sugar levels and electrolytes are deemed necessary.

Adolescent↗
PubMed1990

Transcranial Doppler monitoring during percutaneous transluminal aortic valvuloplasty.

Cerebral blood flow was studied in 12 elderly patients with severe calcific aortic stenosis by means of transcranial Doppler sonography (TCD) during percutaneous transluminal aortic valvuloplasty (PTAV). In 8 of these 12 patients duplex sonography revealed a stenosis of the internal carotid artery (ICA) exceeding 50%. Frequency spectra of 10 patients showed a satisfactory quality and were analyzed. In 7 subjects balloon inflation was well tolerated and systolic blood pressure did not drop below 75 mmHg. In these patients, whether they had a stenosis of the ICA or not, blood flow velocity in the middle cerebral artery (MCA) did not decrease to a critical level. The authors defined "critical" as a reduction of mean blood flow velocity in the MCA exceeding 50% or a decrease below 35 cm/sec. Three patients showed a rapid decrease of systolic aortic pressure below 75 mmHg. In these subjects mean blood flow velocity in the MCA dropped to levels below 35 cm/sec. Deflation and retraction of the balloon resulted in a rapid increase of systemic blood pressure and flow velocity in the MCA. This report demonstrates TCD to be a useful monitoring method of determining residual perfusion in patients with aortic stenosis during PTAV.

Aged↗