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Biomedical subjects

T Paul

Publications and source records attributed to T Paul.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Definitive therapy of supraventricular tachycardia using high frequency current catheter ablation].

BACKGROUND: Catheter ablation using radiofrequency current has been proven to be an effective and save tool for the treatment of adult patients with accessory atrioventricular pathways and with atrioventricular nodal reentry tachycardia. This study was designed to analyse the efficacy of this method in children and adolescents. PATIENTS AND METHODS: Using radiofrequency current, catheter ablation of an accessory pathway or of AV nodal reentry tachycardia was performed in 13 patients (mean age 12.7 years) with drug-refractory supraventricular tachycardia. Radiofrequency current was applied through a 6 French steerable catheter positioned against the mitral or tricuspid anulus. Criteria for radiofrequency current application (at 70 degrees C or with 30 W) were the recording of an accessory pathway potential or a local atrioventricular interval < 40 ms. In the patient with atrioventricular nodal reentry tachycardia, a potential of the slow pathway was recorded. RESULTS: In 6 of 7 patients with left-sided accessory pathways and in 4 of 5 patients with right-sided connections, conduction over these pathways was permanently interrupted. In the patient with atrioventricular nodal reentry tachycardia, radiofrequency current eliminated the tachycardia without affecting normal atrioventricular nodal conduction. In a patient with an anteroseptal pathway, induction of atrioventricular block was inevitable. No other complications were noted. CONCLUSION: Catheter ablation using radiofrequency current is a highly effective method for definite treatment of supraventricular tachycardia in children and adolescents.

Adolescent↗
PubMed1992

Efficacy and safety of propafenone in congenital junctional ectopic tachycardia.

OBJECTIVES: Class IC antiarrhythmic drugs have recently been shown to be effective in some patients with atrial ectopic tachycardia. We therefore studied the efficacy of these drugs in patients with congenital junctional ectopic tachycardia. BACKGROUND: Follow-up data on patients with junctional ectopic tachycardia suggest that this potentially lethal arrhythmia may cease spontaneously in a significant proportion of affected children. Therefore, temporary antiarrhythmic treatment appears to be the therapy of choice. METHODS: The efficacy of propafenone was prospectively assessed in four infants with junctional ectopic tachycardia (ventricular rate 180, 185, 210 and 320 beats/min, respectively). The diagnosis of junctional ectopic tachycardia was established before the age of 2 months in all four infants. Propafenone was given orally in a mean dose of 350 (300 to 500) mg/m2 body surface area per day. Success of therapy was determined by serial electrocardiograms (ECGs) and Holter ambulatory ECG monitoring. RESULTS: In two patients, junctional ectopic tachycardia was completely suppressed. In the remaining two patients, the tachycardia rate decreased to less than 150 beats/min. Serum propafenone levels did not correlate with efficacy of treatment. The mean duration of therapy was 18 months (range 3 to 36). No chemical or clinical side effects were noted. CONCLUSIONS: Because of its effectiveness, safety and lack of side effects, propafenone appears to be a valuable drug in the treatment of junctional ectopic tachycardia in newborns and infants.

Drug Evaluation↗
PubMed1992

Histological and immunopathological analysis of recovered encapsulated allogeneic islets from transplanted diabetic BB/W rats.

Allogeneic islets encapsulated in an alginate/poly-L-lysine membrane and transplanted into diabetic BB/W rats resulted in graft failure within 2 weeks of transplantation. Graft failure was associated with a dense pericapsular infiltrate (PCI) that resulted in necrosis of the encapsulated islets. The PCI could be inhibited by immunosuppressive agents, including cyclosporine and dexamethasone, and this resulted in a significant increase in graft survival. Immunopathological characterization of the PCI indicated that there was a predominance of macrophages. T helper cells also appeared to be present in this PCI. Empty capsules were also found to induce a similar PCI that was identical in composition to that found around encapsulated islets. Thus alginate/poly-L-lysine capsules do not appear to be biocompatible and may account for the variable results in islet graft survival found with these capsules.

Animals↗
PubMed1992

Molecular genetic study of the frequency of monosomy 22q11 in DiGeorge syndrome.

It is well established that DiGeorge syndrome (DGS) may be associated with monosomy of 22q11-pter. More recently, DNA probes have been used to detect hemizygosity for this region in patients with no visible karyotypic abnormality. However, DGS has also been described in cases where the cytogenetic abnormality does not involve 22q11; for instance, four cases of 10p- have been reported. In this study we have prospectively analyzed patients, by using DNA markers from 22q11, to assess the frequency of 22q11 rearrangements in DGS. Twenty-one of 22 cases had demonstrable hemizygosity for 22q11. Cytogenetic analysis had identified interstitial deletion in 6 of 16 cases tested; in 6 other cases no karyotype was available. When these results are combined with those from our previous studies, 33 of 35 DGS patients had chromosome 22q11 deletions detectable by DNA probes.

Chromosome Deletion↗
PubMed1992

[Experiences with triple antibiotic combination in neonatal infection].

BACKGROUND: In-vitro and clinical efficacy of a combination therapy consisting of 3 antibiotic agents was to be assessed in neonatal septicemia. METHODS: From 1980 to 1987, 152 newborns with septicemia as proven by blood culture were treated with an initial antibiotic regimen consisting of azlocillin (150 mg/kg bw), cefotaxime (100 mg/kg bw), and tobramycin (5 mg/kg bw). RESULTS: According to the microbiologic testing, antimicrobic therapy was effective in each of the 152 organisms: 101/152 bacteria were susceptible to all 3 agents; resistance to 1 or 2 of the antibiotics was evident in 33/152 and in 18/152 organisms, respectively. Mortality due to septicemia was 7.2%. CONCLUSION: As no difference was observed in the frequency in which one of the three antibiotic substances was the only effective drug, each of the 3 agents seemed to be necessary for clinical effectiveness of this antibiotic combination.

Azlocillin↗
PubMed1992

[Effectiveness of propafenone in congenital ectopic junctional tachycardia--a case report].

Junctional ectopic tachycardia is associated with a poor prognosis when it occurs in newborns and young infants. Like other automatic tachyarrhythmias, junctional ectopic tachycardia has been shown to be very resistant to medical treatment. Successful therapy with propafenone in a newborn with congenital junctional ectopic tachycardia is presented. Due to its high effectiveness, safety, and lack of side-effects, propafenone appears to be a valuable drug in the treatment of young patients with congenital junctional ectopic tachycardia.

Child, Preschool↗
PubMed1991

Efficacy and safety of intravenous and oral propafenone in pediatric cardiac dysrhythmias.

Propafenone was administered to 58 patients with a mean age of 3.2 years (range 0.1 to 16). Mean intravenous dose was 1.2 mg/kg body weight (range 0.3 to 1.5 mg). The final mean oral maintenance dose was 308 mg/m2 body surface area (range 200 to 600 mg/m2, 16.8 mg/kg body weight). After intravenous application, propafenone was effective in 21 of 36 patients; atrial flutter was converted in 1 of 5 patients, and reentry supraventricular tachycardia was controlled in 15 of 25 patients. Propafenone was partially or completely effective in 3 of 4 patients with chaotic atrial tachycardia. Junctional ectopic tachycardia was suppressed in 2 infants. Thirty-seven patients had oral treatment with a mean follow-up of 2.2 years. Propafenone was effective in 33 of 37 patients (89%); atrial flutter was controlled in 2 patients, ventricular ectopy was suppressed in 1 of 2 patients. In reentry supraventricular tachycardia, propafenone was effective in 25 of 28 patients. Chaotic atrial tachycardia (n = 3) and junctional ectopic tachycardia (n = 2) were controlled after successful intravenous therapy. Systemic side effects were rare. Two patients developed a proarrhythmic effect, and 1 patient with ventricular ectopy after repair of tetralogy of Fallot died suddenly during propafenone maintenance therapy.

Administration, Oral↗
PubMed1991

[Complex cyanotic heart defect in a newborn infant with cat eye syndrome].

In a cyanotic newborn with characteristic features of Cat-Eye-Syndrome, cytogenetic examination disclosed a supernumerary small bisatellited chromosome. Angiography showed Tetralogy of Fallot with pulmonary atresia and a narrow patent ductus arteriosus with additional stenosis of the bifurcation of the pulmonary artery. At an age of 14 weeks, the patient died after the attempt of corrective cardiac surgery. Congenital cardiac malformation is present in more than one third of patients with cat-eye-syndrome and is usually the lifelimiting malformation in this syndrome.

Abnormalities, Multiple↗
PubMed1990

Relation of syncope in young patients with Wolff-Parkinson-White syndrome to rapid ventricular response during atrial fibrillation.

Syncope in patients due to Wolff-Parkinson-White (WPW) syndrome may be related either to a rapid rate of supraventricular tachycardia or to rapid ventricular response over the accessory pathway during atrial fibrillation (AF). From 1982 to 1987, 74 patients less than or equal to 25 years old (mean age 12.6 years) with WPW syndrome on electrocardiogram underwent electrophysiologic study. Of the 74 patients, 14 (19%) had a history of syncope. During electrophysiologic study 9 of 14 patients with syncope had sustained (greater than 5 minutes or requiring termination due to hypotension) AF. Of the remaining 5 patients, 3 had inducible nonsustained AF and 2 had no AF. None of the 60 patients without syncope developed sustained AF; 34 had nonsustained and 26 had no AF. Occurrence of sustained AF had a sensitivity of 64% and specificity of 100% for history of syncope. All patients with syncope and AF (12) had a short RR interval between 2 consecutive preexcited QRS complexes during AF at less than or equal to 220 ms, in contrast to 9 of 34 patients without syncope (p less than 0.001, sensitivity 100%, specificity 74%). No patient with a short RR interval between 2 consecutive preexcited QRS complexes during AF of greater than 220 ms had a history of syncope. Thus, in these young patients with WPW syndrome, occurrence of AF with a rapid ventricular response during electrophysiologic study correlated well with a history of syncope and may be the cause of syncope in most patients. Electrophysiologic study may be helpful in identification of young patients with WPW at risk for syncope.

Adolescent↗
PubMed1990

Long-term follow-up of amiodarone therapy in the young: continued efficacy, unimpaired growth, moderate side effects.

Long-term follow-up data on young patients receiving amiodarone is lacking, especially in relation to growth and late side effects. The records of 95 young patients (mean age 12.4 years; range 3 weeks to 31.5 years) who received amiodarone were reviewed. Minimal follow-up time for those continuing to take amiodarone was 1.5 years; the mean duration of therapy was 2.3 years (maximal 6.5). The mean maintenance dosage was 7.7 (1.5 to 25) mg/kg body weight per day. Initial success (based on symptoms and 24 h electrocardiogram) was achieved in 23 of 34 patients with ventricular tachycardia, in 32 of 33 with atrial flutter and in 21 of 28 patients with supraventricular tachycardia. However, in 7 of 33 patients with atrial flutter, the arrhythmia returned after 6 months. Patient growth continued in the same percentiles achieved before amiodarone in all but eight patients, improving in six and worsening in two with severe underlying disease. Proarrhythmia occurred in three patients: one had torsade de pointes that disappeared when amiodarone administration was stopped; two with severe anatomic heart disease died suddenly during the loading period (one with atrial flutter and one with ventricular tachycardia). Side effects occurred in 28 (29%) of the 95 patients: keratopathy (in 11), abnormal thyroid function test (in 6), chemical hepatitis (in 3), rash (in 3), peripheral neuropathy (in 2), hypertension (in 1) and vomiting (in 1). All side effects disappeared when amiodarone was discontinued or the dose was reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Ventricular couplets in the young: prognosis related to underlying substrate.

Ventricular couplets may be a risk factor for sudden death in adults, but their prognosis in children is unknown. From 1981 to 1987 104 patients, mean age 13.2 years (0.2 to 37 years), had ventricular couplets on a 24-hour electrocardiogram (ECG) (Holter monitor) and on follow-up with a second Holter (mean, 2.5 years). Of the 104 patients, 22 had a normal heart and 82 had an abnormal heart. Patients with a normal or an abnormal heart did not differ in incidence or severity of symptoms (patients with a normal heart had 17 instances of palpitations and none of syncope; patients with an abnormal heart had 49 instances of palpitations, six of dizziness, and none of syncope). Number of ventricular couplets was higher in patients with a normal heart (33 +/- 50/day: mean +/- 1 SD) than in those with an abnormal heart (17 +/- 15/day; p less than 0.05). Of the 22 patients with a normal heart, 11 underwent an electrophysiologic study (EPS); none had inducible ventricular tachycardia. After mean follow-up of 29.7 months, all 22 patients with a normal heart were alive without ventricular tachycardia; 6 of 22 were treated for palpitations, with complete suppression of couplets in two. In 11 of 16 untreated patients with a normal heart, ventricular couplets disappeared spontaneously. Of the 82 patients with an abnormal heart, 32 had an EPS: nine (28%) had sustained ventricular tachycardia, 16 (50%) had nonsustained ventricular tachycardia, and seven (22%) had no inducible ventricular tachycardia. ECG criteria and hemodynamic status were of limited value in predicting inducibility of ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Epicardial mapping: how to measure local activation?

UNLABELLED: Epicardial ventricular mapping was performed in 5 dogs during sinus rhythm with a sock array containing 41 electrodes. Maps were generated with a computer-assisted mapping system using four different definitions of local epicardial activation: (1) maximal negative slope (intrinsic deflection) of the unipolar electrogram, (2) maximal slope of the bipolar electrogram, (3) maximal amplitude of the bipolar electrogram, and (4) first onset by 45 degrees from the baseline of the bipolar electrogram. The site of earliest and latest epicardial activation was identical with maximal negative slope in the unipolar electrogram and maximal slope and maximal amplitude of the bipolar electrogram in all five animals. Times of earliest and latest epicardial activation calculated with maximal amplitude of the bipolar electrogram were most similar to those evaluated with maximal negative slope of the unipolar electrogram. Using onset of the bipolar electrogram, activation times were measured 10 to 12 msec earlier than with each of the other three definitions of local activation, and in two of the five animals, first epicardial breakthrough was mapped to a different site than with the three other methods. CONCLUSIONS: (1) Maximal amplitude of the bipolar electrogram coincided with maximal negative slope of the unipolar electrogram; (2) Using onset of the bipolar electrogram, timing and location of earliest epicardial activation may be misinterpreted.

Animals↗
PubMed1989

Epicardial mapping: ventricular epicardial activation is unaffected by heart position.

Epicardial ventricular mapping was performed in five dogs during sinus rhythm with a sock array containing 41 bipolar electrodes. Maps were generated with a computer-assisted mapping system when the heart was in situ and when the heart was lifted by 44 degrees out of the chest. Times of earliest and latest epicardial activation in these two states did not differ. Despite a different frontal plane QRS axis, location of earliest activation was not affected by lifting the heart. In two of the five animals, the site of latest epicardial activation was minimally different from the heart in situ, but the general pattern of epicardial activation was unchanged. Therefore, the change in frontal plane QRS axis with lifting the heart was due to a change in heart position rather than a general change of heart activation.

Animals↗
PubMed1988

The effect of small increases in dietary iodine on thyroid function in euthyroid subjects.

Dietary iodine intake in the United States is greater than that considered necessary for the maintenance of normal thyroid function. The administration of pharmacologic quantities of iodine (10 to 1,000 mg daily) to euthyroid subjects results in small decreases in the serum T4 and T3 concentrations and a compensatory increase in the basal and TRH-stimulated serum TSH concentrations. Studies were carried out to determine whether a far smaller increase in iodine intake would also affect thyroid function. Normal volunteers received 1,500, 500, or 250 micrograms supplemental iodine daily for 14 days. Following the administration of 1500 micrograms iodine daily, there were small but significant decreases in the serum T4 and T3 concentrations and a small compensatory increase in the serum TSH concentration and the serum TSH response to TRH. In contrast, no changes in pituitary-thyroid function occurred during the administration of 500 or 250 micrograms iodine daily. These findings indicate that a small increase in dietary iodine can induce subtle changes (all values remaining within the normal range) in pituitary-thyroid function, probably by inhibiting thyroid hormone release. The smaller iodine supplements of 500 and 250 micrograms daily, quantities that may easily be achieved under normal conditions, did not, however, affect thyroid function.

Adult↗
PubMed1988

Sleep apnea and sleep-related periodic leg movements in community resident seniors.

The elderly have a high incidence of sleep complaints. A high incidence of sleep apnea (SA) and sleep-related periodic leg movements (PLMs) is also suspected. The relationship between the incidence and severity of SA and PLMs and sleep complaints has not, however, been determined in terms of symptomatology and physiologic abnormality. In a group of 46 community resident seniors (60 to 95 years old), the incidence of SA and PLMs was correlated with subjective sleep-wake complaints. Sixty-one percent of subjects had SA and/or PLMs. Apneas/hypopneas were associated with an average oxygen desaturation of less than 5% and an average change in heart rate of less than 10 beats per minute. While subjects with SA or PLMs had clear evidence of objective sleep disturbance, only one quarter of them admitted to any subjective sleep complaints or daytime sleepiness. Furthermore, severity of SA or PLMs failed to predict sleep-wake complaints, and vice versa. This study confirms that typically mild SA and PLMs are widespread in the elderly but tend not to be manifested in sleep-wake complaints and probably go untreated as a result. Further research is needed to determine any long-term medical significance.

Aged↗
PubMed1988

Industrial marketing perspectives for health care providers.

Hospitals and other providers have begun to market services directly to employers and other organizations. This paper describes employers' purchasing process for health care services, explains why changes have been limited so far, and suggests how the perspective of industrial marketing can be applied by providers to serve their own needs and those of employers more effectively.

Data Collection↗