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Biomedical subjects

R Kornowski

Publications and source records attributed to R Kornowski.

104 records · Page 6Linked to original sources
PubMed1994

[Neuroleptic malignant syndrome in elderly hospital patients].

Neuroleptic malignant syndrome (NMS) has gained increasing attention over the past decade. Diagnostic features include exposure to major tranquilizers, acute onset of high fever, extrapyramidal symptoms and markedly elevated CPK. Other common signs include changes in mental status, tachycardia and leukocytosis. It usually runs its course within 10 days. Greater awareness and improved treatment have resulted in markedly decreased mortality. However, failure to diagnose and treat properly results in a significant risk of death. Most cases of NMS reported have been in those with psychiatric illness. Few cases have been reported in elderly patients without a psychiatric history. We describe an 85-year-old man, without previous psychiatric illness, who developed NMS while hospitalized on a general medical ward.

Aged↗
PubMed1993

Predictors and long-term prognostic significance of recurrent infarction in the year after a first myocardial infarction. SPRINT Study Group.

This study was undertaken to examine whether clinical factors predict reinfarction within 1 year of a first acute myocardial infarction (AMI) and to quantify the subsequent influence of reinfarction on long-term mortality. Data from 3,695 patients with a first AMI included in the Secondary Prevention Reinfarction Israeli Nifedipine Trial Registry were analyzed. The 1-year reinfarction incidence was 6.0% (220 of 3,695) and in-hospital mortality during reinfarction was 31%. Patients with reinfarction were older (63.0 vs 60.8 years) at entry. The independent clinical predictors for 1-year reinfarction were (adjusted relative odds): peripheral vascular disease (2.12), anterior location of the first AMI (1.62), angina before the first AMI (1.53), congestive heart failure on admission (1.34), diabetes (1.33), systemic hypertension (1.28) and age increment (1.13). One-year reinfarction rate increased from 4.0% in patients with 0 or 1 risk factor to 23.3% in patients with 5 to 6 risk factors (p < 0.0001). Patients with reinfarction had significantly increased 1- and 5-year mortality compared with those who had no reinfarction (11.8 vs 5.3% and 40.1 vs 20.3%, respectively, p < 0.001). Recurrent AMI within 1 year was the most powerful predictor of long-term (mean 5.5 years) total mortality (adjusted relative risk = 4.76).

Age Factors↗
PubMed1993

Persistent activation of thrombocytes in neurosurgical patients operated for primary brain tumours.

A prospective study was designed to investigate whether platelet hyperactivity exists following neurosurgical removal of primary brain tumours. The level of beta-thromboglobulin (beta TG), a protein released by platelets during the activation process, was measured in the plasma of 13 consecutive patients prior to surgery (T 1) and on the first (T 2) and seventh (T 3) post-operative days. A significant and sustained increase in beta TG levels from a baseline of 20.7 +/- 1.7 ng/ml (mean +/- sem) at T 1 to 37.0 +/- 5.2 ng/ml (p < 0.005) at T 2 and 35.9 +/- 3.7 at T 3 (p < 0.005) occurred. When patients were grouped according to tumour malignancy, significantly higher beta TG levels were found in the malignant group at T 2 (51.8 +/- 6.3 ng/ml) when compared to the benign group (30.6 +/- 6.0 ng/ml) (p = 0.025). Postoperative T 3 levels were linearly correlated to T 1 levels (r = 0.58, p = 0.04). This significant and sustained platelet activation that occurs following brain surgery may be part of the biochemical sequel leading to a hypercoagulable state and thrombo-embolic phenomena (TEP) in these patients.

Adolescent↗
PubMed1993

Activated protein C and antithrombin-III activity during arterial thrombolysis with recombinant tissue-type plasminogen activator in rabbits.

BACKGROUND: Protein C and antithrombin III (AT-III) are endogenous anticoagulants that regulate thrombotic processes. This experimental study examined the effect of recombinant tissue-type plasminogen activator (rt-PA) thrombolysis on the activity of these natural anticoagulants. METHODS: Blood clots were produced in the femoral artery segments of six rabbits with endothelial damage and stenosis (group A). Five rabbits with only surgical dissection served as controls (group B). Both groups received an infusion of rt-PA at 30 micrograms/kg/min for 60 min. The plasma activity of activated protein C (APC) and AT-III was determined using chromogenic assays. Blood samples were taken at baseline (t1), after surgical dissection with (group A) or without (group B) thrombosis induction (t2), after rt-PA infusion (t3), and 1 h later (t4). RESULTS: In group A rabbits, the mean (+/- SEM) APC activity rose significantly (P = 0.02) from 2.2 +/- 0.3 and 3.7 +/- 1.5 mOD units/min at t1 and t2, respectively, to 59.3 +/- 17.8 mOD units/min at t3 and decreased to 8.0 +/- 3.4 mOD units/min at t4. In group B rabbits, the mean (+/- SEM) APC activity rose (P = 0.01) from 1.1 +/- 0.1 and 1.2 +/- 0.1 mOD units/min at t1 and t2 to 17.1 +/- 3.2 mOD units/min at t3 and decreased to 2.4 +/- 0.2 at t4, (P = 0.011 for comparison between groups using two-way analysis of variance). The mean APC value at t3 was higher for group A than for group B (P = 0.06). A slight but statistically significant decrease (P < 0.01) in AT-III activity was noted in both groups, from 92 +/- 3% and 96 +/- 2% at t1 in groups A and B, respectively, to 79 +/- 3% and 86 +/- 2% at t4 (P = 0.028 for comparison between groups). CONCLUSION: These data show a transient rise in APC and a slight decrease in AT-III activity during rt-PA thrombolysis. Whether these changes influence thrombolysis outcome remains to be determined.

Animals↗
PubMed1992

Combined effect of captopril and aspirin in renal hemodynamics in elderly patients with congestive heart failure.

Captopril and aspirin have been claimed to adversely affect renal function. This study was designed to evaluate the safety of concomitant administration of both drugs in patients with moderate to severe congestive heart failure (CHF). The study group consisted of 10 patients with a mean age of 77.6 +/- 4.4 years and a mean New York Heart Association functional class of 2.6 +/- 0.5. Captopril was administered in a rapidly escalating dose regimen over a 4-day period to a maximum dose of 75 mg/day. Aspirin 0.25 g/day was added from day 5 on. Renal plasma flow (RPF) was measured by iodohippurate scan and the creatinine clearance test (Ccr) was used as an index of glomerular filtration rate (GFR). Both Ccr and RPF remained unchanged throughout the study period; 48.9 +/- 16; 48.2 +/- 16.5; 49.4 +/- 16, and 222 +/- 67, 241 +/- 97, 237 +/- 88 ml/min, for days 0, 4, 9, respectively. Only 1 patient developed a significant decrease in Ccr following the administration of captopril. This patient had a further decrease when aspirin was added. The decrease in Ccr was accompanied by a marked reduction in filtration fraction and in mean arterial pressure. Our data suggest that the administration of aspirin to elderly patients with moderate CHF treated with captopril is relatively safe and is not associated with further deterioration in renal function.

Aged↗
PubMed1992

Erythropoietin therapy obviates the need for recurrent transfusions in a patient with severe hemolysis due to prosthetic valves.

Erythropoietin has been proved extremely effective in ameliorating the anemia of chronic renal failure and is currently under intensive investigation. We describe a patient with severe anemia and secondary hemochromatosis due to prosthetic valves, who has been successfully treated with erythropoietin. During 12 months' follow-up, an acceptable hemoglobin level was maintained without any need for blood transfusions; in addition, there was evidence indicating regression of hemochromatosis. This patient illustrates that erythropoietin therapy might prove beneficial for similar cases.

Anemia, Hemolytic↗
PubMed1991

[Sedural toxicity].

Phenazopyridine (Sedural) is widely used in the treatment of dysuria. It is considered a benign drug and most physicians are unaware of its potential toxicity. A 24-year-old woman who developed methemoglobinemia, acute renal failure and hemolytic anemia following a single 1 g dose of the drug is presented.

Acute Kidney Injury↗
PubMed1991

Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumors.

A retrospective study was designed to evaluate clinical thromboembolic phenomena (TEP) in patients operated upon for brain tumours. Among 492 patients treated surgically in the supratentorial area, the overall incidence of clinical TEP was 7%. There were 5% with deep vein thrombosis (DVT) and 4% with clinical pulmonary embolism (PE). Seven patients (1%) died from massive PE. Among 141 patients treated surgically in the infratentorial area there were no episodes of TEP. Significant risk factors for TEP development were operations in the supratentorial area, malignant gliomas (compared to meningiomas) and para- or hemiparesis. Age, sex and the specific location in the supratentorial area were not found to be statistically significant risk factors. Among 12 patients who presented initially with DVT two developed PE despite full heparinization. 7/19 patients with PE died within minutes to hours of the clinical episode despite full conservative measures. In 2/26 patients who were treated with full heparinization complications occurred. There was one case of diffuse subcutaneous bleeding and one case of tumour bed haematoma. The identification of risk factors for the development of TEP will allow the implementation of prophylactic measures in appropriate patients undergoing elective brain tumour surgery.

Adult↗
PubMed1991

Renal toxicity of enalapril in very elderly patients with progressive, severe congestive heart failure.

We evaluated the safety of enalapril administration in 20 very old (76 +/- 7 years) patients with rapidly progressive congestive heart failure (deteriorating from New York Heart Association class 2 to class 4 on admission). They were all given increasing doses of enalapril regardless of concomitant diuretic therapy and state of hydration. Renal function deteriorated in four patients (group A) and remained unchanged in 16 (group B). The mean pretreatment serum creatinine level in group A was significantly higher than that in group B (2.4 vs 1.3 mg/dl, p less than 0.001). No patient with a serum creatinine level less than 1.9 mg/dl on admission had further impairment of renal function. Groups A and B did not differ by age, concomitant diseases (including hypertension and diabetes mellitus), or medications (including diuretics) or by in-hospital serum electrolyte concentrations and blood pressure. Renal damage was noted during the initial four days of the study and was reversible following discontinuation of enalapril. Our data suggest that enalapril can be safely administered to very old patients with rapidly progressive congestive heart failure provided that the initial serum creatinine level is below 1.9 mg/dl. In patients with a higher serum creatinine level, careful monitoring and prompt discontinuation of enalapril administration can prevent irreversible renal damage.

Age Factors↗
PubMedDate not supplied

Anaerobic bacteremia: a retrospective four-year analysis in general medicine and cancer patients.

Anaerobic bacteremia was studied in 32 medical patients (mean age 72 years) in a four-year retrospective analysis. Malignancy was the most common underlying disease and probable portal of entry. The gastrointestinal tract was affected most often, followed by the respiratory and urinary tracts. Bacteremia occurred either following invasive (non surgical) procedures or spontaneously. The clinical course ranged from asymptomatic bacteremia, to mild febrile illness, to sepsis and septic shock (two, 12, 16 and two patients, respectively). The case fatality rate was 25%. The causative organisms were Clostridium and Bacteroides species. All organisms isolated were susceptible to chloramphenicol. Early diagnosis and prompt treatment may reduce mortality in cases of anaerobic sepsis.

Adult↗
PubMedDate not supplied

Augmentation of the expression of proangiogenic genes in cardiomyocytes with low dose laser irradiation in vitro.

BACKGROUND AND OBJECTIVE: Several reports suggest that low power red laser light (LPRLL) is capable of affecting cellular processes in the absence of significant thermal effect. The objective of the present study was to determine the effect of LPRLL on proliferation of fetal cardiomyocytes in vitro and on the expression of proangiogenic genes, transforming growth factor-beta (TGF-beta), and vascular endothelial growth factor (VEGF). STUDY DESIGN/MATERIALS AND METHODS: All cell cultures were irradiated with single-dose LPRLL using a He-Ne continuous wave laser (632 nm) with different doses. The effect of LPRLL on new DNA synthesis was studied by 3H thymidine-incorporation assay. VEGF and TGF-beta expression by cardiomyocytes was studied by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: We observed that a dose-dependent increase in cardiomyocytes proliferation can be obtained with LPRLL and that there is a significant increase in VEGF and TGF-beta mRNA expression by cardiomyocytes. CONCLUSIONS: These data may have significant importance leading to the establishment of new methods for myocardial photoangiogenesis and photoregeneration as well as in vitro proliferation of cardiac myocytes.

Base Sequence↗
PubMedDate not supplied

Prognostic significance of infarction location in patients with recurrent myocardial infarction. SPRINT Study Group. Secondary Prevention Reinfarction Israel Nifedipine Trial.

This study assesses the impact of infarct location on immediate (in-hospital) and 1- and 5-year mortality among patients with reinfarction during the year following discharge from the initial episode of myocardial infarction. The analysis included 192 patients with a second myocardial infarction who were compared in four infarction location groups. The in-hospital mortality associated with reinfarction was higher in patients with a second anterior (32%) than with a second inferior (18%) location, irrespective of the first infarction location (p = 0.03). At 5 years of follow-up, the mortality (65%) tended to be higher in patients with a first anterior-second anterior infarction as compared with patients with all other combinations of location.

Age Factors↗
PubMedDate not supplied

The "hybrid" approach for revascularisation: direct myocardial revascularisation and coronary angioplasty.

We report the cases of two patients where catheter-based laser direct myocardial revascularisation has been coupled with conventional coronary angioplasty at the same sitting using the Biosense left ventricular electromechanically guided laser procedure. In both the cases, the non-revascularizable ischaemic target zone was identified using left ventricular electromechanical mapping signals, and Ho: YAG laser channels were placed at the designated target lesion following successful coronary stenting. The results did not show any procedural complications. This preliminary report suggests the feasibility and safety of this "hybrid" percutaneous approach for myocardial revascularisation.

Adult↗