Search PubMed⌕ Search

Biomedical subjects

T Paul

Publications and source records attributed to T Paul.

189 records · Page 11Linked to original sources
PubMedDate not supplied

Adenosine: an effective and safe antiarrhythmic drug in pediatrics.

Adenosine is an effective, safe drug for the diagnosis and treatment of paroxysmal tachycardias in adult and pediatric patients. A starting dose of 0.05-0.10 mg/kg as a rapid bolus injection is recommended for infants and children. An electrophysiologic effect can be expected within 20 seconds after injection. Dosage may be increased up to 0.3 mg/kg in steps of 0.05-0.10 mg/kg or until conversion to sinus rhythm is reached. Due to its basic electrophysiologic properties of slowing conduction in the atrioventricular (AV) node, which may result in transient AV block, adenosine is almost always effective in terminating supraventricular tachycardias in which the AV node forms a critical part of the reentrant circuit (i.e., AV nodal reentrant tachycardia and AV reciprocating tachycardia). Based on its properties, adenosine is also advocated as a useful diagnostic tool for unmasking primary atrial tachycardias by inducing transient high grade AV block. Advantages over other antiarrhythmic agents include the agent's short half-life (<2 seconds) and minimal or no negative influence on blood pressure. Because of its short half-life, however, early recurrence of the tachycardia is observed in up to one-third of patients treated. Based on rare but serious unwanted side effects, patients with known or suspected irritable airways and sinus node dysfunction and those who have undergone orthotopic cardiac transplantation should probably not be given adenosine. Adenosine may be recommended as the drug of choice for treatment of paroxysmal tachycardia in young patients. Primary success rates range between 85% and 100% of all the tachycardia episodes treated. Termination of the tachydysrhythmia, however, does not always mean that the underlying dysrhythmia was of supraventricular origin with the AV node as a critical part of the tachycardia mechanism. Rare but possible life-threatening side effects (prolonged sinus arrest and complete AV block, atrial fibrillation, acceleration of ventricular tachycardia, apnea) necessitate proper monitoring of the patients.

Adenosine↗
PubMedDate not supplied

[Systemic lupus erythematosus-associated endocarditis in a 7-years-old girl].

Systemic Lupus erythematosus (SLE) is a chronic inflammatory disease, caused by a fault of the immune regulation. The etiology of the SLE is still unknown, a possible virus infection is discussed. Libman Sacks endokarditis is the most important cardiac manifestation of this illness. Diagnosis, therapy and clinical course of a 7 years old so far healthy girl, which suffered from an acute Libman-Sacks-Endocarditis, are presented.

Child↗
PubMedDate not supplied

[Echocardiography diagnosis of total anomalous pulmonary venous drainage in the neonatal period].

A 20-days-old female newborn was referred to our hospital because of persistent respiratory distress and a mild central cyanosis. On echocardiography from the suprasternal notch all 4 pulmonary veins could be visualized entering a common chamber posterior to the left atrium. This chamber communicated with a left vertical vein which drained through a large innominate vein into the right superior vena cava. The diagnosis of supracardiac type of TAPVD was confirmed the following day by angiography. The child was successfully operated and the postoperative course was uneventful. Cardiac catheterization carries an increased risk in patients with TAPVD in case of pulmonary hypertension due to pulmonary-venous obstruction. In experienced centers echocardiography has become the definite diagnostic method with a high level of sensitivity and specificity in patients with atrial sitlus solitus, unifocal pulmonary venous connection, and no evidence of other major congenital cardiac defects. With continuously improving knowledge an increasing number of newborns will benefit from improved ability to perform surgical repair without prior cardiac catheterization.

Blood Flow Velocity↗
PubMedDate not supplied

Supraventricular tachycardia in infants, children and adolescents: diagnosis, and pharmacological and interventional therapy.

Supraventricular tachycardia is the most frequent form of symptomatic tachydysrhythmia in children. Neonates and infants with paroxysmal supraventricular tachycardias generally present with signs of acute congestive heart failure. In school-aged children and adolescents, palpitations are the leading symptom. Chronic-permanent tachycardia results in a secondary form of dilated cardiomyopathy. Therapy for episodes of tachycardia depends on the individual situation. In severe haemodynamic compromise, or if ventricular tachycardia is suspected, tachycardia should immediately be terminated by external cardioversion during deep sedation. Vagal manoeuvres are effective in patients with atrioventricular reentrant tachycardias. Adenosine is the drug of first choice in any age group for tachycardias involving the atrioventricular node; its advantages include short half-life and minimal or absent negative inotropic effects. Adenosine may also be used in patients with wide QRS complex tachycardia. Intravenous verapamil is contraindicated in neonates and infants because of the high risk of electromechanical dissociation. In older children (>5 years) and adolescents, verapamil may be administered with the same restrictions as in adult patients (wide QRS complex tachycardia, significant haemodynamic compromise). Spontaneous cessation of tachycardia can be expected in most neonates and infants during the first year of life. Prophylactic pharmacological treatment in this age group is advisable because recognition of tachycardia is often delayed until the occurrence of symptoms. Withdrawal of drug treatment should be attempted around the end of the first year. However, in older children, spontaneous cessation of tachycardia is rare. Prophylactic drug therapy is performed on an empirical basis. Digoxin may be administered in all forms of supraventricular tachycardia in which the atrioventricular node is involved, except in patients with pre-excitation syndrome aged >1 year. In patients with atrioventricular reentrant tachycardia, class IC drugs such as flecainide and propafenone are effective. Sotalol is also effective in atrioventricular reentrant tachycardia, as well as in primary atrial tachycardia. Although amiodarone has the highest antiarrhythmic potential, it should be used with caution because of its high rate of adverse effects. In school-aged children and adolescents, radiofrequency catheter ablation of the anatomical substrate is an attractive alternative to drug therapy, with a rate of permanent cessation of the tachycardia of up to 90%. Despite the clear advantages of this procedure, it should be performed only with unquestionable indication; the long term morphological and electrophysiological sequelae on the growing atrial and ventricular myocardium are still unknown.

Adolescent↗
PubMedDate not supplied

Upstream and total airway conductance in children and adolescents.

Static lung volumes, pressure-volume curves, airway conductance (Gaw) and maximum expiratory flow-volume curves were obtained in a group of healthy children and adolescents (age 6 to 17 years, body height 115 to 180 cm). Relating lung recoil pressure to maximum expiratory flow at the same lung volume level allowed the calculation of the conductance of the upstream segment (Gus). Gaw increased with increased body height and lung volume, so that specific Gaw did not change during growth. Gus also increased with body height, except at lower lung volume, but when corrected for simultaneous changes in lung volume it decreased. These physiological results suggest that the central airways grow proportionately to the changes in lung volume, whereas the growth of the peripheral airways is proportionately less marked. It is however not possible to draw definite conclusions on the isotropical or anisotropical growth of different parts of the lungs from these physiological observations.

Adolescent↗
PubMedDate not supplied

[A German version of the Eating Disorder Inventory EDI-2].

The paper presents a German version of the second revised edition of the Eating Disorder Inventory EDI-2 (Garner 1991). The EDI-2 is a self-rating inventory (self-report measure) with 91 items and 11 subscales designed for the assessment of attitudinal and behavioural dimensions relevant to anorexia and bulimia nervosa. It consists of the eight original subscales: drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoception and maturity fears, and the three new subscales: asceticism, impulse regulation and social insecurity. The German EDI-2 was given to 71 patients with anorexia or bulimia nervosa, 30 patients with binge eating disorder, a control group of 186 women and a further control group of 102 men. In comparison to the female control group, patient groups showed significantly elevated means on all subscales. Item analysis revealed sufficient internal consistencies for all subscales except subscale 9 (asceticism) with Cronbachs alpha ranging from 0.58 to 0.90. Twelve of the 91 items showed poor item total scale correlations below 0.40. Factor analysis supported a six-factor-structure. Hence, the reliability and validity of the three new subscales was confirmed only partially. The use of the EDI-2 in therapy research and clinical practice is critically discussed.

Adult↗
PubMedDate not supplied

Periodontal diseases of children and adolescents. An update.

Plaque related periodontal diseases in children and adolescents have long been recognized, but recent studies have highlighted their prevalence and presentation. The aim of this article is to highlight the current classification of periodontal diseases of children and adolescents and to review the diagnosis and treatment of these diseases. This will help dental practitioners to diagnose and treat their juvenile and young adult patients suffering from different types of periodontal diseases.

Adolescent↗
PubMedDate not supplied

Early and late atrial dysrhythmias after modified Fontan operation.

UNLABELLED: Occurrence of supraventricular tachycardia and sinus node dysfunction was investigated pre- and postoperatively by serial ECG and Holter monitors in 63 consecutive patients with univentricular circulation after modified Fontan operation (total cavopulmonary connection 39 patients, atriopulmonary connection 24 patients). Mean age at operation was 7.2 (0.1-20.3) years. Of the 63 patients, 14 (22%) had early (< 14 d) supraventricular tachycardia or sinus node dysfunction, which was not related to the type of operation. None of 9 patients with a preoperative mean right atrial pressure < or = 2.5 mm Hg had early supraventricular tachycardia or sinus node dysfunction in contrast to 16/54 patients (30%) with a preoperative mean right atrial pressure > 2.5 mm Hg. 6/63 patients died during the early (< 14 d) postoperative period. In only 1 child, death was related to a dysrhythmia (junctional ectopic tachycardia). During a mean follow-up of 2.5 years, 15/57 long-term survivors (21%) had late supraventricular tachycardia or sinus node dysfunction. Early supraventricular tachycardia/sinus node dysfunction was a predictor or late atrial dysrhythmias, as it occurred in 8 of the surviving 14 patients with early dysrhythmias in contrast to 4 children without early atrial dysrhythmias (p < or = 0.001). After creation of an atriopulmonary connection, 10/22 patients (45%) had late supraventricular tachycardia/sinus node dysfunction, but only 2/35 patients (6%) with a total cavopulmonary connection had late atrial dysrhythmias (p < 0.001). CONCLUSIONS: Early atrial dysrhythmias after the Fontan operation were related to preoperative hemodynamics. Early supraventricular tachycardia/sinus node dysfunction and the atriopulmonary type of Fontan connection were significant risk factors for late atrial dysrhythmias.

Child↗