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Biomedical subjects

N G Kounis

Publications and source records attributed to N G Kounis.

At least 19 recordsLinked to original sources
PubMed2003

Electrocardiographic changes in elderly patients during endoscopic retrograde cholangiopancreatography.

BACKGROUND: Cardiorespiratory complications may occur during gastrointestinal endoscopy, and elderly people seem to be more vulnerable to these complications during endoscopic procedures involving the manipulation of abdominal viscera. OBJECTIVES: To determine the incidence of cardiac arrhythmias, changes in oxygen saturation, heart rate and blood pressure during endoscopic retrograde cholangiopancreatography (ERCP) via Holter monitoring in elderly patients older than 70 years of age. METHODS: Holter monitoring and 12-lead electrocardiograms were performed in 30 elderly patients undergoing ERCP and in 30 control subjects undergoing routine chest, abdomen, bone and upper gastrointestinal small bowel follow-through studies. A computerized nontriggered template system was used to analyze the electrocardiograms qualitatively and quantitatively. Arrhythmias, cardiac axis, conduction defects, pauses, ST segment changes, ectopic beats, oxygen desaturation and changes in blood pressure and rate-pressure product were evaluated. RESULTS: Increased heart rate, ST segment changes resulting from myocardial ischemia, oxygen desaturation and transient atrial and ventricular ectopic beats were frequent during ERCP compared with the control group. In one patient, transient left bundle branch block developed and this was attributed to pre-existing hypertension with cardiomegaly. One patient developed ventricular tachycardia and one other sinus bradycardia, but this was attributed to sick sinus syndrome. CONCLUSIONS: Transient myocardial ischemia and various cardiac arrhythmias are frequent in elderly patients undergoing ERCP. Appropriate noninvasive monitoring seems to be justified during this procedure.

Aged↗
PubMed1996

Dose-dependent appearance and disappearance of amiodarone-induced skin pigmentation.

A 66-year-old man suffering from atrial flutter developed cutaneous blue-gray pigmentation while receiving 600 mg of amiodarone daily for 15 months. With reduction of the dose to 100 mg, skin discoloration disappeared within 16 months, to reappear within 7 months after increasing the dose to 400 mg. Finally, the discoloration disappeared within 13 months with a dose reduction to 200 mg daily. It seems that a tissue threshold level for amiodarone exists in this patient, above which skin discoloration appears and below which it fades. Dose, duration, metabolism, macrophage transfer, and spillover saturation-excretion may be relevant in amiodarone-induced skin pigmentation.

Aged↗
PubMed1996

Electrocardiographic changes in elderly patients during small bowel enema.

RATIONALE AND OBJECTIVES: Enteroclysis (small-bowel enema) involves the introduction of a large amount of fluid into the small bowel, through a tube, producing small bowel distention. A study was done to determine the incidence of any electrocardiographic changes during enteroclysis with Holter monitoring. METHODS: Continuous electrocardiographic monitoring and 12-lead electrocardiograms were performed in 30 elderly patients undergoing enteroclysis and in 30 control subjects undergoing routine chest, bone, and upper gastrointestinal small bowel follow-up studies. Two channel qualitative and quantitative electrocardiographic analysis was performed by a computerized nontriggered template system. Arrhythmias, change in cardiac axis, conduction defects, pauses, ST segment changes, and ectopics were sought. RESULTS: Increased sympathetic tone resulting in increased heart rate and transient atrial and ventricular ectopics was frequent during enteroclysis compared with the control group. In one patient ventricular tachycardia developed, and two patients had diminished heart rate, but this was attributed to preexisting heart disease and concurrent medication. CONCLUSION: Transient, nonhazardous cardiac arrhythmias are encountered during enteroclysis in elderly patients. These arrhythmias may be attributed to the preexisting heart disease, fear, and anxiety during intubation, or increased sympathetic tone from the enteric loop distention.

Aged↗
PubMed1996

Brainstem auditory evoked potentials in patients with ischemic heart disease.

The authors of this study used the method of increased stimulus rate on brainstem auditory evoked potentials (BAEPs) in 30 patients with ischemic heart disease (IHD) and in an equal number of healthy age-matched control subjects. The BAEPs were recorded using 100- to 3000-Hz alternating polarity clicks at a rate of 22.6 per second. Measurements included the absolute latencies of waves I through V, the interpeak latencies I-III, III-V, and I-V, and the peak amplitudes of peaks I, III, and V. The measured absolute latencies and interpeak latencies were found to be significantly increased, and the peak amplitudes were found to be diminished. The audiometric tests revealed no significant hearing loss in IHD patients. This study is the first to demonstrate prolongation of BAEPs in IHD patients. BAEP recording may become an additional noninvasive tool for detecting IHD patients with impaired microcirculation.

Adult↗
PubMed1996

Allergic reactions to local glyceryl trinitrate administration.

To assess the exact cause and extent of transdermal glyceryl trinitrate (GTN)-induced allergic reactions, a study of continuous and intermittent use of GTN patches was conducted in 320 patients with New York Heart Association (NYHA) class II and III angina pectoris. Three commercially available GTN patch systems were used. Twenty-one patients (6.5%) developed cutaneous reactions. In 17 patients (5.3%), the reactions were confined to the area of application and were characterised as irritant reactions. Four patients (1.2%) developed both localised and remote from the area of application lesions and one patient developed a generalised anaphylactic reaction. The rate of discontinuation of therapy was 3.4%. The irritant skin reactions were mainly due to contaminants and additives. Changing to a different transdermal system reduced the incidence of local reactions--a particularly desirable effect in patients who respond well to GTN therapy.

Adhesives↗
PubMed1995

Pregnancy-induced increase of supraventricular arrhythmias in Wolff-Parkinson-White syndrome.

Six women suffering from Wolff-Parkinson-White syndrome and who were previously asymptomatic or nearly asymptomatic, were followed prospectively during and after their subsequent pregnancies. Three women experienced several attacks of supraventricular tachycardia (SVT) for the first time and the rest experienced an increase in their attacks. It seems that there is an increased tendency for SVT in pregnancy. Increased adrenergic sensitivity by estrogens, increased plasma volume, stress, and anxiety during pregnancy may be some of the causative factors.

Adult↗
PubMed1993

A modified per os double contrast examination of the colon in the elderly.

A modified per os double contrast examination of the colon was used in 62 elderly patients in whom conventional barium enema had been unsuccessful. We created endogenous gas generation instead of air insufflation by per os administration of a special mixture containing barium sulfate, lactulose and gastrografin. Good quality double contrast images of the colon were obtained after 12 hours in 59 of the 62 patients. The sensitivity of the method was 100% in 6 patients suffering from carcinoma and in 15 patients suffering from diverticular disease. However, the method failed to demonstrate small solitary polyps in 5 patients and it was also negative in another 27 patients. 7 of these had negative endoscopy and in the remaining a definite diagnosis was not established by any other method. It seems that this method may become an alternative for investigation of suspected colonic pathology in the elderly patients with difficulty in retaining the barium enema.

Administration, Oral↗
PubMed1992

Anticoagulant-induced shoulder hematoma producing brachial plexus neuropathy--case reports.

Hemorrhagic complications from anticoagulants are common and may manifest in any part of the human body. Skin discoloration, pain, tenderness, and soft-tissue swelling may be the main clinical features. The authors present 3 extraordinary cases of brachial plexus neuropathy associated with anticoagulant-induced hemorrhage. The signs, symptoms, important differentials, and clinical treatment are described with regard to the pathologic anatomy.

Aged↗
PubMed1991

Histamine-induced coronary artery spasm: the concept of allergic angina.

Histamine, the main amine released during allergic reactions, can provoke coronary arterial spasm manifested as angina pectoris. This has been shown during clinical and laboratory studies. The effects of histamine on cardiac function are mediated via H1- and H2- receptors situated on the four cardiac chambers and coronary arteries. Coronary arteries of cardiac patients are hyperactive and contain stores of histamine which can initiate coronary artery spasm. Clinical observations indicate that angina pectoris or acute myocardial infarction can be provoked by acute allergic reaction. The coincidental occurrence of chest pain and allergic reaction accompanied by clinical and laboratory findings of classical angina pectoris seems to constitute the syndrome of allergic angina. The clinical symptoms of allergic angina include chest discomfort, dyspnoea, faintness, nausea, pruritus and urticaria. They are accompanied by signs such as hypotension, diaphoresis, pallor and bradycardia. There are also electrocardiographic findings indicating myocardial ischaemia, arrhythmias and conduction defects. Thus, in patients undergoing acute allergic reaction, the development of chest pain could be explained by the mechanism of coronary arterial spasm provoked by the release of histamine, which constitutes the syndrome of allergic angina.

Angina Pectoris↗
PubMed1990

Endocarditis, pyrexia of unknown origin and occult abdominal malignancy.

Two patients who presented with pyrexia of unknown origin were found to have carcinoma of the caecum without gastrointestinal symptoms. Blood cultures were positive for Escherichia coli, and in one patient the diagnosis of endocarditis was confirmed by echocardiography. This rare association may be fortuitous, but a common pathogenetic basis cannot be excluded.

Aged↗
PubMed1989

Systolic and diastolic septal and posterior wall echocardiographic measurements in normal subjects.

M-mode echocardiographic measurement of septal and left ventricular excursions and velocities was attempted in 109 subjects. Seventy subjects had adequate echocardiograms enabling detailed measurement. Two groups of subjects were studied: a group of normal adults aged nineteen to seventy-eight years and a group of normal juveniles aged nine to eighteen years. The posterior wall excursion (PWE), systolic septal excursion (SSE), diastolic septal excursion (DSE), and diastolic septal velocity (DSV) did not differ in these groups. There were significant differences in the posterior wall excursion during isovolumetric contraction (B-Ce, p less than 0.002), mean posterior wall velocity (PWV mean, p less than 0.002), and systolic septal velocity (SSV, p = 0.05) between the two groups. The measurements were obtained by using the recently published method of the specific points for labeling and description of the wall motion.

Adolescent↗
PubMed1989

Effects of nitroglycerin on myocardial excursions and velocities in the early hours of acute myocardial infarction.

The effects of sublingual nitroglycerin on septal and left ventricular wall motion were determined by echocardiography in the early hours of acute myocardial infarction (MI) in 20 patients admitted via a mobile coronary care unit. Left ventricular and septal echoes were obtained in 11 patients with acute anterior MI and in 9 with acute inferior MI before and after administration of 500 micrograms sublingual nitroglycerin. In the group with acute anterior MI, nitroglycerin did not significantly affect the B-C excursion, posterior wall excursion, and mean posterior wall velocity. Nitroglycerin significantly increased (P less than 0.01), however, the systolic septal excursion, systolic septal velocity, diastolic septal excursion, and diastolic septal velocity. In the group with acute inferior MI, nitroglycerin significantly increased the B-C excursion (P less than 0.01); posterior wall excursion (P less than 0.01); mean posterior wall velocity (P less than 0.01); systolic septal excursion (P less than 0.01); diastolic septal excursion (P less than 0.05), and diastolic septal velocity (P = 0.01) but did not affect the systolic septal velocity. All measurements were obtained by use of a method of labeling and describing specific points of the wall motion that has been described recently.

Administration, Sublingual↗