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Biomedical subjects

J Slany

Publications and source records attributed to J Slany.

At least 91 records · Page 5Linked to original sources
PubMed1987

[Myxedema as a cause of QT syndrome and recurring ventricular tachycardia].

QT-prolongation and ventricular tachycardia of the "torsade de pointes" type are rare in hypothyroidism. We describe a woman with myxoedema coma secondary to hypopituitarism who initially presented a bizarre ECG. Predominant features were excessively prolonged QT intervals, ventricular bigeminy with extreme monophasic ST elevations and alternation of the isoelectric line. Repeated bouts of ventricular tachycardia needed rigorous therapy, including several DC shocks. It is suggested that the unusual ECG finding was due to large local differences in duration of myocardial action potentials.

Arrhythmias, Cardiac↗
PubMed1986

[Diagnosis and therapy of supravalvular aortic dissection (type A)--an interdisciplinary challenge].

Acute dissection of the ascending aorta is a life-threatening disease. Successful management requires close teamwork of internal medical specialist, radiologist and cardiovascular surgeon. The diagnostic and therapeutic approach is reviewed on the basis of 18 of our own cases - 15 men and 3 women aged from 42 to 88 years. Peculiarities of history, pain and ECG give valuable clues to the differentiation of aortic dissection from myocardial infarction and massive pulmonary embolism. As a non-invasive rapidly available diagnostic method echocardiography may yield decisive information about the aortic root and the presence of pericardial effusion. Definite confirmation of diagnosis is accomplished by aortography and/or computed tomography. Blood pressure and aortic flow must be decreased to the lowest level tolerated by the patient to prevent pericardial tamponade or rupture into the mediastinum. The urgency of surgical repair is underlined by a median survival time of 12 hours from onset of symptoms to death with conservative treatment. 7 of our patients were operated on. In 6 cases surgery was performed by means of extracorporeal circulation and the ascending aorta was replaced by a graft. 3 patients survived the operation (2 for over 2 years and three died in the postoperative period due to cerebral and pulmonary complications). In one case with inoperable dissection an axillo-femoral bypass was performed for relief of complete ischaemia of the left lower limb. Postoperatively, maintainance of the patient's blood pressure at the low normal level ist mandatory.

Adult↗
PubMed1986

[Acute occlusion in the vertebrobasilar circulatory system in children and young adults].

Within four years ten patients (six women and four men) under 50 years of age (13-49 years) were observed who presented occlusions of the vertebrobasilar artery. Eight patients were admitted from other hospitals, on an average 41 hours after the acute occlusion; only in one case had a correct first diagnosis been made. In all cases diagnosis was confirmed by means of selective angiography. Conservative treatment comprised in two patients low-molecular dextranes and heparin, in another two prostaglandin E1. In the remaining six patients local fibrinolysis was performed. In the group receiving conservative treatment a 33-year-old female patient survived and her neurological deficits subsided except for an organic psychosyndrome of minor degree. Local fibrinolysis yielded complete recanalization in three cases and partial recanalization in two. Three patients survived, in two patients near-complete recovery was achieved.

Acute Disease↗
PubMed1986

[Syncope as a misinterpreted leading symptom of pulmonary embolism].

One or several syncopes were the reason for hospitalization in 31 of 155 in-patients with proven pulmonary embolism. In all of them there were at least two further pointers to acute pulmonary embolism: all had tachypnoea, 28 had dyspnoea, 25 had sinus tachycardia (more than 100 beats/min), 24 had congested neck veins and 16 had deep leg-vein thrombosis. In 21 patients the ECG had signs of right heart strain, in 15 of 20 in whom it was measured the arterial oxygen partial pressure was below 70 mm Hg. In 23 patients the chest X-ray was largely unremarkable despite dyspnoea. In 23 patients there had been a massive embolus and 16 patients had died. Although syncope is only rarely caused by pulmonary embolism, its ominous significance in this connection should stimulate a search for further diagnostic pointers to such an occurrence.

Adult↗
PubMed1986

Coumarin induced acral skin necrosis associated with hereditary protein C deficiency.

Hemorrhagic skin necrosis of the toes was observed in a patient with heterozygous protein C deficiency (protein C:Ag 32% and protein C activity 30%) on the 4th day of coumarin treatment overlapping with effective intravenous anticoagulation with heparin. Family studies revealed protein C deficiency in two sisters of the proposita without a history of thromboembolic disease. Immunologic studies in the proposita at the time of coumarin necrosis revealed slight depression of complement factor C4 and the presence of immune complexes. The present case and review of the literature show that the pathogenetic mechanism leading to coumarin necrosis in patients with protein C deficiency seems not yet to be fully understood.

Adult↗
PubMed1985

[The state of thrombolytic therapy in acute myocardial infarct].

Current experience indicates that intravenous and intracoronary thrombolysis may prove promising in improving the prognosis of acute myocardial infarction. However, because of methodological shortcomings such as insufficient numbers of patients and retarded initiation of therapy no such improvement has been documented so far. According to findings in patients and corresponding results of experimental studies, a significant improvement in myocardial function and reduction in mortality can be achieved only when reperfusion occurs within 3 hours after onset of ischaemia. With later reperfusion the results are uncertain and benefit and damage may balance each other. Recanalization of occluded coronary arteries is achieved faster and more frequently with intracoronary than with intravenous administration of streptokinase but this advantage is often offset by the loss of time before intracoronary treatment is started. Methods, technique and complications of thrombolytic therapy, as well as further management of patients are discussed. Attention is drawn to newer activators of plasminogen which are claimed to be more effective despite lesser influence on coagulation.

Angina, Unstable↗
PubMed1985

Selective intracoronary thrombolysis in the coronary care unit without cineangiography.

Selective coronary artery visualization was performed in the CCU by means of a movable fluoroscopy device in 96 patients with suspected myocardial infarction within 6 hours after onset of symptoms. Intracoronary streptokinase (SK) was administered in a total dosage of 200 000 to 400 000 U within 30-60 min to 69 patients with complete (N = 57) or subtotal obstruction (N = 12) of the infarct-related vessel. Recanalization was achieved in 39 of the 57 patients (68%) with initially complete occlusion. Three of the 39 successfully treated patients died (7.7%) versus 8 of 33 subjects (24%) with persistent complete obstruction (chi-square 3.21, not significant). Selective cineangiography subsequently performed in 8 patients and postmortem examination of 12 subjects who had died, showed that all haemodynamically significant lesions had been recognized by the examination in the CCU with one exception. It is concluded that intracoronary thrombolysis performed in the CCU, by means of a standard mobile fluoroscopy equipment is effective, safe, inexpensive and may be started virtually without delay after admission.

Cineangiography↗
PubMed1984

[Measures in the prehospital phase of acute myocardial infarct].

The prehospital period of acute myocardial infarction is burdened by high mortality essentially caused by electrical instability. Delay in hospitalization is composed by decision time of the patient, arrival and decision time of the physician, transport, and admission period in the hospital. Marked shortening of these periods is urgent for control of ventricular fibrillation by DC-shock and is a prerequisite for early thrombolysis which possibly could reduce mortality further. Organizational and educational measures for that purpose are pointed out. Medical care during the prehospital period is discussed.

Arrhythmias, Cardiac↗
PubMed1984

[Acute myocardial infarct in the aged. Omissions in treatment].

The pre-hospital phase of acute myocardial infarction may be of crucial importance for the further fate of the subject. Mortality of old people seems to be twice that of middle aged persons during the pre-hospital phase of acute infarction. This may be due partially to the longer duration of latency between onset of symptoms and arrival at the hospital of older patients causing waste of time especially for resuscitation from lethal arrhythmias. The delay of therapy is promoted by difficulties in diagnosis due to lack of typical pain often veiled by other symptoms and failure of the electrocardiogram in old patients. Need of urgent hospitalization for reduction of pre-hospital mortality seems not to have been generally accepted among general practitioners. Standard management of emergency care of patients with suspected myocardial infarction is reviewed.

Aged↗
PubMed1984

[Regional lysis of acute basilar artery occlusion--case report].

Thrombosis of the basilar artery is not a rare disease, and the mortality is reported to be 60 to 80%. Present standard therapy with heparin infusions yields poor results. The high risk of intracerebral haemorrhage prohibits systemic fibrinolytic therapy. Due to these facts and good experience in our department with the use of local intracoronary lysis in acute myocardial infarction, the method of local thrombolysis was applied in a case of acute basilar artery thrombosis. Fibrinolytic therapy was started via an angiography catheter placed in the vertebral artery in a 28 year-old woman with hemiplegia and severe brain stem symptoms. The patient received 200,000 IU streptokinase within 2 hours and subsequently 300,000 IU urokinase within 10 hours. The vessel re-opened completely. The neurological symptoms decreased during the following weeks. Based on this experience and according to rare reports in the literature we believe local low-dose thrombolysis to be a causal therapy promising success for acute thrombosis of the basilar artery. This therapy can be carried out in every medical centre able to perform selective angiography and experienced in the administration of fibrinolytic drugs.

Adult↗
PubMed1984

Angiographic demonstration of tumor vascularity in left atrial myxoma: a case report.

We describe a 63-year-old woman with a large sessile left atrial myxoma and coexisting mitral valve stenosis and regurgitation. The diagnosis of a left atrial tumor was confirmed by echocardiography and coronary angiography. This case reveals the rare finding of tumor vascularity originating from both the right coronary artery and left circumflex artery.

Coronary Angiography↗
PubMed1984

Local thrombolysis in arterial occlusive disease.

In a series of 38 subjects intra-arterial catheters were used to infuse streptokinase (SK) or urokinase (UK) just proximal to an acute thromboembolic occlusion in 20 limbs or to perfuse SK directly into the obstructing material in 23 extremities with subacute or chronic occlusions by stepwise advancing the catheter until the distal open segment of the artery was reached. Dosage of SK varied between 50.000 U and 400.000 U and was administered during 1 to 4 hours. Patency could be achieved in 16 out of 20 acute occlusions and in 16 out of 23 chronically obstructed vessels within some hours. A systemic hyperlytic state of 12 to 24 hours duration was observed when total dosage of SK exceeded 80.000 U. In 9 patients thrombolysis was immediately followed by angioplasty. Advantage of the described technique is its rapid effectiveness, low cost, high success rate even in chronic femoro-popliteal occlusions and its applicability to patients in whom systemic thrombolysis would be considered contraindicated on account of old age or other causes.

Acute Disease↗
PubMed1983

[Giant cell arteritis: multiform disease of the elderly human].

Six biopsy proven cases of giant-cell arteritis in women beyond the age of 70 years are presented to illustrate the wide range of clinical manifestations of this disease. Besides polymyalgia rheumatica or cranial arteritis the illness may afflict various organs including eye, ear, skin, heart, cerebrum and liver or may mimic a chronic infectious or malignant disease. Diagnosis should be considered in any such cases, especially when laboratory data suggest a chronic infectious disease due to high sedimentation rate, anemia with low serum iron and normal total iron binding capacity and an increase in alpha 2-globulin. Diagnosis can be proven by temporal-artery biopsy or by prompt relief of all symptoms following cortisone treatment.

Aged↗
PubMed1983

[Internal medicine aspects in patients with operable carotid lesions].

Cerebral insufficiency with or without neurological deficits (n.d.) may be treated effectively surgically by carotid artery reconstruction or by extra-intracranial anastomoses. The low mortality of these operations and the favourable results including prevention of new n.d. and amelioration of long standing n.d. suggest consideration of operation in geriatric patients. Noninvasive screening methods for cranial artery pathology such as neck auscultation, direct and indirect Doppler ultrasonic investigations and dynamic and static cerebral scan therefore should be performed not only in all patients with overt cerebrovascular insufficiency whatever degree but also in patients with hypertension, diabetes mellitus, ischemic heart disease and occlusive disease of the extremities on account of the high incidence of multivascular disease in these patients. We compared 60 consecutive patients before and beyond the age of 70 respectively, treated surgically for cerebrovascular insufficiency. The only significant differences apart from age were a higher rate of pathologic findings of the heart on x-ray and on the ecg in the aged. Despite this mortality, major complications and favourable results were not different for both age groups. These results favour an active approach to diagnosis and indication to surgical treatment not only in young patients but also in the symptomatic geriatric patient.

Aged↗
PubMed1982

[Molsidomine, a coronary drug with platelet-aggregating inhibitory activity].

The influence of molsidomin (4 mg i.v.) on platelet function, on the plasma concentrations of 6-oxo-PGF1 alpha, the stable metabolite of prostaglandin I2, and thromboxane B2, the stable metabolite of thromboxine A2 was determined in ten patients with coronary heart disease. Prostaglandin I2 is generated in the vessel wall and is a potent vasodilator and inhibitor of platelet aggregation, whereas thromboxane A2 is a vasoconstrictor and a proaggregatory substance. In addition, in-vitro tests were performed, too. 60 min after bolus injection a decrease of systolic and diastolic blood pressure was observed, whereas heart rate remained nearly constant. Platelet aggregation decreased significantly; the addition of PGI2 in vitro had an additive effect. The plasma concentrations of 6-oxo-PGF1 alpha increased after 60 minutes, whereas thromboxane B2 concentrations remained unchanged. In vitro, SIN1, a metabolite of molsidomin generated in the liver, led to a dose-dependent inhibition of ADP-induced platelet aggregation, whereas molsidomin was nearly inactive. Thus molsidomin shows an inhibition of platelet function besides the known antianginal properties. The vasodilatatory and platelet inhibiting effects of this compound may be due partly to a stimulation of the prostaglandin I2 synthesis in the vessel wall.

Angina Pectoris↗