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Biomedical subjects

L Elbl

Publications and source records attributed to L Elbl.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Damage of left ventricular function after treatment with doxorubicin in patients with malignant lymphomas].

The authors evaluated using clinical and echocardiographic examination the effect of chemotherapy involving bolus administration of doxorubicin on the heart muscle in 90 patients with non-Hodgkin lymphoma and with Hodgkin lymphoma. In 18% of patients they found an asymptomatic decrease of the left ventricular ejection fraction during chemotherapy, chronic cardiotoxicity was recorded in 5% patients, in 2% of the patients one year after termination of chemotherapy a clinically latent myocardial infarction was found. The diastolic function was impaired (impaired relaxation) in 44% patients after terminated chemotherapy and in 50% after one year. Echocardiographic examination provided evidence that the impaired systolic and diastolic function persists even after one year following termination of chemotherapy. High-dose chemotherapy with administration of peripheral stem cells did not lead to marked deterioration of left ventricular function as compared with patients who did not undergo this treatment. The main clinical complications--death, cardiotoxicity, relapse of the malignant disease, cardiovascular complications--were present in the course of a 18.5-month follow up after establishment of the diagnosis in 32% of the patients.

Adolescent↗
PubMed1999

[Changes in left ventricular function during chemotherapy with doxorubicin].

The authors investigated by echocardiography changes of left ventricular function in 79 patients with non-Hodgkin lymphoma or Hodgkin's disease who were treated by chemotherapy containing doxorubicin. In 22% patients they diagnosed during treatment a significant gradual decline of the left ventricular ejection fraction (change > 10% or a drop of EF below 50%) after a cumulative dose of 185 +/- 52 mg/m2 doxorubicin (median 200 mg/m2). Changes of the ejection fraction were at the expense of an increasing endsystolic left ventricular volume. These changes correlated closely with the increase of endsystolic stress of the left ventricular wall (r = -0.87). After administration of a cumulative doxorubicin dose of 100 mg/m2 a significant deterioration of indicators of diastolic filling of the left ventricle occurred--of the isovolumic relaxation period (IRP) and deceleration time (DT). The contribution of these early changes of diastolic function of the left ventricle for assessment of the risk of development of systolic dysfunction is not unequivocal. Prolongation of IRP > 12% as compared with the baseline value and at the same time above 95 ms had a 50% sensitivity, 50% specificity, a 26% positive prediction value a 74% negative prediction value and 50% diagnostic accuracy, change of DT > 13%, and at the same time prolongation above 200 ms had a 47% sensitivity 55% specificity, a 22% positive prediction value, a 78% negative prediction value and a 53% diagnostic accuracy. The authors found a significant relationship between the assessed changes of left ventricular function and clinical and haemodynamic indicators. Only the patients' age correlated significantly with IRP and DT values. Changes of the left ventricular ejection fraction were not associated with clinical signs of cardiac failure, they did not call for cardiological intervention and did not affect the course of chemotherapy. Contrary to some statements in the literature, the authors did not consider the described functional changes as sufficient to justify interference with chemotherapy. On the other hand, their importance for the development of late sequelae of chemotherapy with anthracyclines in adult patients must be based on long-term prospective follow-up.

Adolescent↗
PubMed1999

[Involvement of the cardiac muscle in anemia].

Anemia is probably the most widespread syndrome associated with a very wide spectrum of pathological conditions with a different genesis. In malignities and their treatment it is one of the very serious complications the impact of which is manifested in particular in the state of the circulation. Thus anemia can cause deterioration of primary cardiac and cardiovascular complications which develop either as a result of the malignant disease or as a result of its treatment by cardiotoxic drugs. Thus risk conditions with the functional consequence of cardiovascular impairement are potentiated. This can complicate the disease or limit therapeutic possibilities. In the submitted work the authors tried to analyze the importance of anemia from the aspect of cardiovascular pathophysiology and outline results of their own observation supported by data from the literature concerned with this problem. From the observations ensues that in the group of patients studied by the authors who had careful substitution treatment with erythrocyte concentrates there were no serious drops of Hb which could be of fundamental importance from the aspect of cardiovascular damage. For this reason the cardiovascular status can be evaluated only from the aspect of primary toxicity of oncological treatment (if we omit direct damage by the disease) and it is not necessary to consider the consequences of hematological complications which must be taken into account when HB levels are lower than 70 g/l.

Anemia↗
PubMed1997

[Stress echocardiography in "non-ischemic myocardial disease"].

Stress echocardiography is nowadays an integral part of the diagnosis of ischaemic heart disease. In the submitted review the authors draw attention to the fact that ischaemic heart disease is no longer the domain of stress echocardiography. In recent years the interest of cardiologists in this method increased also in other cardiac diseases. Based on the appropriate pathophysiological mechanism of cardiac affection stress echocardiography is used to test left ventricular function after a dynamic or pharmacological stress, i.e. increased cardiac activity and cardiac minute volume in a number of heart diseases where we must know the extent of left ventricular affection and the functional reserve of the myocardium. These tests were also introduced to evaluate the impact of valvular disease and function of artificial grafts to evaluate left ventricular function in the transplanted heart. Stress echocardiograph holds its place also in paediatrics.

Dipyridamole↗
PubMed1996

[Analysis of adverse effects of dobutamine stress echocardiography].

Recently in various departments interest in dobutamine stress echocardiography is increasing. Originally this examination was meant for the diagnosis of suspected ischaemic heart disease in patients unable to tolerate a physical load. Clinical applications of this test are constantly expanding and comprise a number of risk patients. The purpose of the submitted paper is to discuss the safety of dobutamine stress echocardiography. The authors submit an analysis of 259 examinations of patients with suspected ischaemic heart disease (46%), after acute myocardial infection (42%) and patients with significant left ventricular dysfunction (12%). 231 examinations (89%) were made up to the defined maximum. The test was terminated prematurely in 12 patients on account of arrhythmia, in 10 because the test was positive, in two because of extracardiac effects, in three instances on account of hypotension and in one patient on account of pressure hyperreaction. Arrhythmias were recorded in 26%, discontinuous ventricular tachycardia was recorded only in two patients (0.7) with severe left ventricular dysfunction. Hypotension was found in 13%, pressure hyperreaction in 2%. Palpitations were noted in 15% of the examined patients and extracardiac side-effects in 31%. None of the side-effects called for therapeutic intervention. The authors consider dobutamine stress echocardiography a safe test which is well tolerated by the majority of patients and there is a minimum of side-effects. A higher risk must be foreseen in patients with reduced left ventricular function, hypertrophy of the left ventricle and those with an history of arrhythmias.

Cardiotonic Agents↗
PubMed1996

[Evaluation of the cardioprotective effect of bispiperazinedione ICRF-187 (Cardioxane) in patients treated with anthracyclines--an echocardiographic study].

The cardiotoxicity of anthracycline antibiotics is a serious complication of anti-tumourous treatment. One of the possible ways how to prevent it or at least restrict it substantially is to use cardioprotective substances. The latter include ICRF-187 bispiperazinedione (dexrazoxan) which is manufactured and supplied by CHIRON Cop. under the name Cardioxane. The authors investigated by echocardiography indicators of systolic and diastolic function of the left ventricle in patients where cumulative doses of 180-240 mg/sq.m of doxorubicin were achieved. In 10 patients to whom Cardioxane was administered no changes of left ventricular function were recorded. In 18 patients treated with boluses of doxorubicin significant deterioration of left ventricular diastolic function developed. The authors provided evidence that relatively small cumulative doses of doxorubicin administered as boluses lead to impaired left ventricular diastolic function. These changes were not recorded in patients who were given the cardioprotective substance ICRF-187 (Cardioxane).

Adult↗
PubMed1994

Treatment of refractory multiple myeloma with vincristine, adriamycin, dexamethasone, and with repeated application of cyclophosphamide (C-VAD).

The quick reduction of differentiated myeloma cells by VAD chemotherapy (vincristine, adriamycin, dexamethasone) causes, according to the investigation by Bell et al., the acceleration of the proliferation of myeloma stem cells. In 1990 Bell demonstrated that this proliferation could be stopped by administering 500 mg of cyclophosphamide in 1-week intervals. We therefore modified the classical VAD scheme to the following "C-VAD" scheme:vincristine 0.5 mg/day in continuous infusion on the first to the 4th day, adriamycin 9 mg/m2/day in continual infusion on the 1st to the 4th day, dexamethasone 40 mg p.o. or i.v. always on 4 days starting with the 1st, 10th and 20th days, cyclophosphamide 600 mg i.v. on the 5th, 10th and 20th days). A further cycle follows on the 28th day. In the present paper the effect and the tolerance of this C-VAD scheme is evaluated: In the group of 21 patients with refractory myeloma 9 remissions were achieved, 5 partial remissions, in 6 patients the disease progressed, 1 patient died after the 2nd cycle without the possibility of evaluating the therapeutic response. The mean remission length was 10.2 months. The tolerance of chemotherapy was satisfactory, C-VAD chemotherapy did not cause any serious drop in the number of leucocytes and thrombocytes. Echocardiographically lower adriamycin cardiotoxicity was demonstrated in continual administration in comparison with the bolus administration. The C-VAD scheme is considered to be suitable for comparison with the VAD chemotherapy in a randomized study.

Administration, Oral↗
PubMed1994

[Lower cardiotoxicity of adriamycin during continuous administration in patients with refractory multiple myeloma treated with cyclophosphamide, vincristine, adriamycin and dexamethasone (C-VAD)].

Standard treatment of refractory myeloma is combined VAD treatment (vincristine, adriamycin and dexamethasone). In recent years adriamycin was sometimes replaced by mitoxanthrone which caused greater myelotoxicity. As a positive feature of the exchange of adriamycin for mitoxanthrone, authors using it, report its lower cardiotoxicity. In the literature there are, however, occasional reports on a lower cardiotoxicity of adriamycin when administered in a continuous infusion. In the submitted work the authors sought answers to two questions. 1. Is the cardiotoxicity of adriamycin administered in a continuous infusion lower than the cardiotoxicity of adriamycin administered as a bolus? 2. Is it possible to add to VAD chemotherapy cyclophosphamide without increasing the toxicity excessively? After echocardiographic evaluation of the diastolic and systolic function following a cumulative dose of 200 mg the authors observed smaller changes of the above functions in the group treated with adriamycin a in a continuous infusion (patients with multiple myeloma) than in the group with bolus therapy (patients with non-Hodgkin lymphomas and acute leukaemia). Addition of 600 mg cyclophosphamide on the 5th, 10th and 20th day to the classical VAD pattern made treatment more intensive without causing a deteriorated tolerance of this treatment.

Aged↗
PubMed1994

[Difficulties in the therapy of primary amyloidosis].

The therapy of primary amyloidosis is still unsatisfactory. The response rate after the cytostatics, dimethylsulphoxide, colchicin and vitamin E is usually low. None of these treatment modalities prolongs significantly the survival in majority of treated patients. The success of interferon alpha in the maintenance therapy of follicular non-Hodgkin's lymphoma and in the remission of multiple myeloma, as well as successful treatment of primary cryoglobulinaemia, brought us to the idea to test interferon alpha in the therapy of primary amyloidosis. Interferon alpha-2b was administered to the patient with three years history of primary amyloidosis. Interferon alpha was used in the dose of 3 x 10(6) daily for the treatment period of 10 weeks. The evaluation of the response was based on the weekly assessment of the light chain lambda concentration in the morning spot of urine. No significant decrease of the light chain concentration during the course of the therapy was observed. The administration of interferon alpha-2b was interrupted in the 10th week of the therapy because of manic psychosis. The question is, whether a higher dose than 3 x 10(6) IU daily would be able to decrease the light chain production, or if this disease is resistant to interferon alpha therapy. Because of the low incidence of primary amyloidosis, the experiences will be collected on the base of small groups of case reports.

Amyloidosis↗
PubMed1993

[Experience with sulodexide (Vessel Due F) in diabetics with ischemic disease of the lower extremities].

A total of nine patients with diabetes type I and II and with claudications due to macro- and microangiopathies of the lower extremities took sulodexide (Vessel Due F) by the i.m. route for a period of 20 days and then as capsules for 90 days. In all a favourable therapeutic effect was recorded, in particular as regards delay of claudications. The authors recorded lower blood sugar values, lower levels of cholesterol, triglycerides, fibrinogen and plasma viscosity. In the authors' view sulodexide is an important advance in the treatment of diabetics with claudications.

Arteriosclerosis↗
PubMed1992

[Changes in hypertrophy and diastolic left ventricular function during hypertension therapy].

The authors examined a group of hitherto not treated patients with primary hypertension and hypertrophy of the left ventricle. By means of echocardiography and isometric loading they investigated the effect of treatment on the left ventricular morphology and function. Despite long-term normalization of casual and loading values of the blood pressure the authors did not observe a significant regression of LV hypertrophy. The authors did not find a relationship between the casual blood pressure and weight of the left ventricle with exception of the diastolic pressure after a load. The indicators of diastolic function did not correlate with the weight of the left ventricle but with changes of the end diastolic volume and blood pressure.

Adult↗
PubMed1990

[Segmental analysis of left ventricular wall mobility].

The authors present their experience with subjective and quantitative evaluation of the mobility of the left ventricular wall of the heart. The combination of computer technique and two-dimensional echocardiography makes it possible to evaluate quantitatively the function of the left ventricule of the heart by the method of segmental analysis of wall mobility. Segmental analysis has proved to be a suitable method for assessing the function of the left ventricle particularly in subjects with threshold or slightly decreased functional values. The authors use the method in studying the functional response of the left ventricle to diagnostic or therapeutic intervention. The method yields important information also on the development of left ventricular function after myocardial infarction in follow-up studies. Subjective assessment is a less demanding approach and when carried out expertly, the extent of muscular damage can satisfactorily be evaluated.

Cardiomyopathies↗
PubMed1990

[Stress echocardiography in clinical cardiology].

In their generally designed presentation the authors focus on practical problems concerning indication, different stress modalities and projections, evaluation and interpretation of findings, as well as on technical novelties and their use. Only dynamic exercise echocardiography is being discussed. Currently available knowledge is assessed in the light of the authors' own experience. Problems of evaluation and interpretation are considered to be most intricate. In the authors' opinion, many technical problems which have prevented the routine use of the method in practice will be eliminated by introducing technical novelties such as digitalization of the display with image loop. Other innovations will certainly be used to advantage and render the method less demanding and far more widespread.

Echocardiography↗
PubMed1990

[Long-term monitoring of changes in contractility of the left ventricular wall in patients with myocardial infarct].

Using two-dimensional echocardiography, the authors made a one-year investigation of left ventricular function in a group of patients after a first transmural myocardial infarction. They evaluated subjectively and quantitatively changes in the contractility and the development of the diastolic area of the left ventricle. They revealed a certain improvement of the contractility, probably as a result of the development of a collateral circulation and altered structure of the infarction focus associated with dilatation of the left ventricle by the Frank-Starling mechanism.

Adult↗
PubMed1989

[Comparison of changes in the mobility of the left ventricular wall with coronarographic findings in patients after myocardial infarct].

The authors examined by echocardiography at rest and after exertion a group of 55 patients after a clinically confirmed first transmural infarction. They compared the echocardiographic findings with coronarographic ones. The finding at rest, as regards impaired mobility of the left ventricular wall, corresponded to the clinical finding and the coronarographic finding. By diagnosis of the extended asynergy of contraction during an isometric load it was not possible to differentiate the functional and organic cause of impaired mobility and thus to assess the extent of the coronary affection. The impaired mobility of the left ventricular wall is associated above all with the state of the blood supply rather than with the finding on the coronary artery.

Adult↗