Biomedical subjects
Publications and source records attributed to M Kupari.
Pulmonary hypertension due to tumor emboli is a rare complication of malignant diseases. We present a patient in whom symptoms and signs of acute cor pulmonale were caused by tumor cells and carcinomatous endarteritis occluding the pulmonary microvasculature. A concise review of the previous literature is also presented.
Pituitary function was investigated in 3 patients who developed hypothalamic-pituitary insufficiency after viral meningoencephalitis. In 2 patients the causative agents were probably Influenza-A-and Herpes simplex virus whereas in the third patient it was not identified. The pattern of hormonal deficiencies indicated that all the central regulatory areas - hypothalamus, pituitary stalk and pituitary gland - may be injured after viral meningoencephalitis. Usually, the hormonal deficiency is permanent but it can also be transient.
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In addition to regulating renal sodium resorption and, thus, intravascular volume, aldosterone may have direct effects on the cardiovascular system. We previously identified a polymorphism (-344C/T) in the promoter of the aldosterone synthase (CYP11B2) gene that affects binding of the SF-1 transcription factor and thus might influence gene expression. We found that, whereas this polymorphism has inconsistent associations with levels of aldosterone secretion and blood pressure, the -344C allele is strongly associated with increased left ventricular size and decreased baroreflex sensitivity in healthy individuals. These physiological parameters are cardiovascular risk factors. Indeed, preliminary studies suggest that the -344C allele is also associated with increased risk of myocardial infarction in high risk dyslipidemic males.
PURPOSE: Our goal was to assess the utility of different imaging directions in volumetric studies of the heart with MRI, in particular to identify the optimal imaging plane for studies of the right ventricle. METHOD: We examined 12 sets of human four-chamber cadaveric cardiac casts. Gradient echo MRI was performed in four imaging planes: (a) perpendicular to the right ventricular inflow tract; (b) perpendicular to the right ventricular outflow tract; (c) in the left ventricular short axis view; and (d) in the axial view. The volumes of the right ventricle and other cardiac cavities were determined with the method of discs. The true cast volumes were measured with the water displacement technique. The agreement between true and measured volumes and the repeatability of image analysis were determined using the Bland-Altman method. RESULTS: There were no statistically significant differences between the measured and true right ventricular volumes irrespective of the imaging plane. The axial plane gave the smallest mean absolute difference from the true right ventricular volume (3.2 +/-2.2 ml) and also the best repeatability of volume analysis (0.2+/-1.6 ml). However, the other imaging planes performed nearly as well, and the differences across the planes were not statistically significant (p > 0.05). Also, in studies of the left ventricle and left and right atrium, the axial view appeared to give the best results, but differences across the imaging planes remained small. CONCLUSION: The present studies of human cardiac casts suggest that gradient echo MRI is well applicable to right ventricular volume measurements. Imaging the right ventricle in axial planes covering the entire heart gives good agreement with true right ventricular volumes and excellent analysis reproducibility. However, other imaging directions perform nearly as well, and thus selection of the imaging plane may not be of major importance to the accuracy of cardiac volume measurements with MR.
The cardiovascular effects of ethanol ingestion after pretreatment with a new antialcohol drug, nitrefazole (2-methyl-4-nitro-1-(4-nitro-phenyl)imidazole, Altimol) were studied. Left ventricular function was examined by echocardiography and systolic time intervals in six healthy Finnish male volunteers who ingested 0.15-0.25 g of ethanol/kg, 24 hr after an 800 or 1600-mg peroral dose of nitrefazole. After ethanol ingestion, accumulation of acetaldehyde in blood (25-150 microM) was accompanied by a 1.5-2-fold increase in plasma noradrenaline, a 3-10-fold increase in plasma adrenaline, and a 0.5-2.0 degrees C rise in skin temperature. Heart rate increased by 70% and cardiac output by 107%. Diastolic blood pressure decreased by 30% and peripheral vascular resistance by 54%. Ejection fraction and maximum circumferential fiber-shortening velocity increased by 26 and 71%, respectively; the pre-ejection period/ejection time ratio decreased by 46%. An apparent vasovagal collapse was noticed in two nitrefazole-treated subjects after ethanol ingestion, and a third subject experienced a fainting attack shortly after the experiment. Thus, in subjects pretreated with nitrefazole, ingestion of rather small amounts of ethanol results in marked accumulation of acetaldehyde apparently due to aldehyde dehydrogenase inhibition. This causes elevation of plasma catecholamines and intense enhancement of cardiac performance. The marked cardiovascular changes demonstrate the potency of nitrefazole, suggesting that, particularly with alcoholics with occult myocardial diseases, its interaction with ethanol may be even more hazardous than that produced by other antialcohol drugs.
In addition to regulating renal sodium resorption and, thus, intravascular volume, aldosterone may have direct effects on the cardiovascular system. We previously identified a polymorphism (-344C/T) in the promoter of the aldosterone synthase (CYP11B2) gene that affects binding of the SF-1 transcription factor and thus might influence gene expression. We found that, whereas this polymorphism has inconsistent associations with levels of aldosterone secretion and blood pressure, the -344C allele is strongly associated with increased left ventricular size and decreased baroreflex sensitivity in healthy individuals. These physiological parameters are cardiovascular risk factors. Indeed, preliminary studies suggest that the -344C allele is also associated with increased risk of myocardial infarction in high risk dyslipidemic males.
Two cases of left ventricular (LV) pseudoaneurysm following mitral valve replacement (MVR) are presented. In one patient the false aneurysm developed after an initially successful correction of intraoperative left ventricular wall rupture while the other case resulted from an apparently uncomplicated MVR performed because of staphylococcal endocarditis. Both cases were detected by combined 2-dimensional and Doppler echocardiography. The operative treatment was similar in both patients. After extirpation of the old prosthesis, the orifice of the pseudoaneurysm was closed from inside the heart, either with a Dacron patch or using interrupted sutures supported by a teflon pledget. One of the patients died one month postoperatively but the other one recovered and is clinically well 6 months after repair. She has, however, a residual communication between the LV and the pseudoaneurysm.
To assess the risks and benefits attending the surgical repair of atrial septal defect in the elderly the case histories of all patients operated on at the age of 60 years or more were reviewed and follow-up study, including cardiac catheterization, was performed. A total of 17 patients (12 females and 5 males) were identified. The left-to-right shunt ratio averaged 2.7. Fifteen patients had abnormally high systolic (greater than 30 mmHg) or mean (greater than 20 mmHg) pulmonary artery pressure and the pulmonary arterial resistance was elevated (greater than 1.5 units) in eight. One patient died shortly after surgery (operative mortality, 6%) and major postoperative complications were found in four additional patients (24%). Three months after surgery the effort capacity had improved by at least one class in all survivors. After an average of 8.2 years follow-up 12 patients were alive. Ten of them felt better than preoperatively. Eight agreed to cardiac catheterization. The pulmonary blood flow was markedly decreased in all (means, 5.6 l/min postoperatively, vs 11.2 l/min preoperatively) even though a hemodynamically significant shunt persisted in two patients. The mean pulmonary artery pressure had decreased in all who were hypertensive before operation (mean, 25 mmHg vs 33 mmHg). It had slightly increased in patients who had normal pulmonary pressure preoperatively (mean, 27 mmHg vs 19 mmHg). The pulmonary arterial resistance was higher than before surgery in all except one patient (mean, 2.2 units vs 1.5 units).(ABSTRACT TRUNCATED AT 250 WORDS)
A 65-year-old male patient underwent two bypass operations because of coronary artery disease. After the second operation he developed congestive heart failure with breathlessness, ankle swelling, hepatomegaly and poor exercise tolerance. Echocardiographic and haemodynamic findings were characteristic of constrictive pericarditis. Pericardiectomy was performed three months after the second operation. The retrosternal space was replaced with fibrotic, patchy hyalinic tissue, and the pericardium was thick and rigid. Histologically, the thickened pericardium showed dense fibrosis and foreign-body granulomas with large multinuclear giant cells and irregular crystals. This report indicates that foreign body reaction following coronary artery bypass operation may result in constrictive pericarditis with severe heart failure.