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Biomedical subjects

T Pop

Publications and source records attributed to T Pop.

At least 19 recordsLinked to original sources
PubMed2001

Early MR changes in vertebral bone marrow for patients following radiotherapy.

Our study aimed to evaluate the vertebral marrow changes in patients following radiotherapy (RT) by measuring the T2 relaxation times before and during RT. We were mostly interested in evaluating early MR marrow changes during RT. Fifteen patients treated by RT for cervical cancer were submitted to MR examination before and during RT (5-23 days of RT). T2 values were calculated for irradiated and non-irradiated tissues (lumbar and sacral vertebral bone marrow, symphysis pubis marrow, and regional muscle). Fourteen patients presented increased T2 values for irradiated vertebral bone marrow (VBM), and 3 patients showed increased T2 values even for non-irradiated VBM. We found T2 variations for VBM as early as in the fifth day of RT for an absorbed dose as small as 9 Gy. Calculated T2 values in irradiated and also in non-irradiated tissues prove very early tissue alterations.

Adult↗
PubMed1996

[Long term course over 10 years after balloon dilatation in stable and unstable angina pectoris].

OBJECTIVE: To assess the cardiac status of patients ten years after percutaneous transluminal coronary artery angioplasty (PTCA). PATIENTS AND METHODS: Data of 534 patients (436 men, 98 women; mean age 53.2 +/- 8 years) in whom a PTCA had been performed between 1983 and 1986 were analysed, based on a questionnaire answered 121 +/- 11 months after the initial procedure. At the time of PTCA 184 patients (35%) had unstable angina, 350 (65%) stable angina. RESULTS: 116 patients (63%) with unstable angina and 164 (47%) with stable angina had at least one cardiac event after the initial PTCA (repeat PTCA, bypass operation, myocardial infarction, death). None of these events occurred in 68 patients (37%) with unstable or in 186 (53%) with stable angina (P < 0.001). After 10 years 196 of the 302 surviving patients with stable angina (65%) and 104 of the 153 surviving patients with unstable angina (68%) were symptom-free. CONCLUSIONS: Ten-year follow-up after PTCA has shown that cardiac events are significantly more frequent in patients who had had unstable angina than in those with stable angina. This difference already develops in the first year post-PTCA, with no increase later. Symptoms are lastingly improved after 10 years in both groups of patients.

Angina Pectoris↗
PubMed1993

Long-term follow-up of global and regional left ventricular function by two-dimensional echocardiography after thrombolytic therapy in acute myocardial infarction.

In order to evaluate changes in left ventricular volumes and regional left ventricular function after thrombolytic therapy in acute myocardial infarction serial two-dimensional echocardiography was performed during a follow-up of 2 years in 206 consecutive patients treated with streptokinase and adjunctive angioplasty in a randomized group of patients. Unexpected progressive left ventricular enlargement was detected both with and without angioplasty. In anterior wall infarction, end-diastolic volume index increased from 55 +/- 14 to 91 +/- 28 ml/m2 (+65%, P < 0.01) and end-systolic volume index increased from 31 +/- 11 to 55 +/- 23 ml/m2 (+79%, P < 0.01), whereas ejection fraction decreased from 45 +/- 9 to 41 +/- 7% (-9%, P = NS). Averaged regional anterior wall motion improved during the first 4 weeks (11 +/- 10 to 16 +/- 12%), but subsequently deteriorated (16 +/- 12 to 10 +/- 6, P < 0.05). The number of segments with pathological wall motion increased. Similar volumetric and regional wall motion data were demonstrated in inferior wall infarction. We believe this reflects a chronic ventricular remodelling phenomenon. This process takes place predominantly during the first 3 months, but continues over the whole follow-up period. Forty percent of the patients suffered symptoms of heart failure on long-term follow-up. Attenuation of progressive ventricular enlargement remains a therapeutic challenge in the long-term care of these patients. Angiotensin-converting enzyme inhibitors are promising agents in this regard.

Adult↗
PubMed1992

[Long-term follow-up of thrombolytic treatment of acute infarct in combination with acute and elective revascularization].

From March 1983 to June 1986 in 206 patients with acute transmural myocardial infarction, combined intravenous and intracoronary therapy with streptokinase was initiated. After intravenous thrombolysis and randomization in two groups we performed a coronary angiography with selective intracoronary lysis. Infarct related vessels still occluded after intracoronary streptokinase application were opened mechanically in group I. In group II we performed additionally a percutaneous transluminal coronary angioplasty (PTCA) after mechanical recanalisation (occluded vessels) or after thrombolysis (open vessels). In 85 of 87 cases in group II, PTCA could be performed in the acute phase. Elective PTCA was performed in 22 patients of group I (21%) and in nine patients of group II (9%). Up to five years after myocardial infarction, coronary artery bypass grafting (CABG) was necessary in 22 patients (21%) of group I and in 23 patients (22%) of group II. Within four weeks after infarction CABG was performed in 32% and 17% of group I and II respectively. The six-year survival rate was 78% in group I and 82% in group II. Taken all patients together, the six-year survival rate was significantly higher (p = 0.002) for those with early reperfusion (less than or equal to 3.5 h). The survival rates of CABG-patients, PTCA-patients and patients without reperfusion were 91%, 74% and 65% respectively. Streptokinase thrombolysis results, combined with acute or elective PTCA and/or coronary bypass surgery, in a high six-year survival rate after acute transmural myocardial infarction. This rate is about 20% higher than ten years ago.

Angioplasty, Balloon, Coronary↗
PubMed1992

[Use of biological vicarious biofeedback in the rehabilitation of patients with brain damage].

The mechanisms of feedback not controlled by our consciousness play an essential role in the functions of the central nervous system in the process of programming of activities, behaviour and control of these functions. In case of deviations or errors of activities the possibility of their immediate correction exists. Brain damage after trauma or caused by tumour disturbs these normal feedback mechanisms producing very varying symptom complexes. In such cases it is advantageous to introduce vicarious feedback based mainly on visual and auditory afferentation. The authors present own original methods used in the rehabilitation of such patients using vicarious feedback with elbow crutch with light and sound signalling in walk learning, and platform for attitude stability exercises. The earlier obtained results of rehabilitation by this method in a large group of patients after stroke, and preliminary observations of patients after trauma and after tumour operations justify recommendation of the method.

Adult↗
PubMed1991

Sudden cardiac death while wearing a Holter monitor.

The Holter tapes of 61 patients (46 men, mean age +/- standard deviation 65 +/- 11 years) with sudden cardiac death while being monitored were analyzed. Thirty-eight patients were known to have coronary artery disease, 5 had cardiomyopathy, and 7 had aortic valve disease. Etiology remained unknown in 11 patients. Mean New York Heart Association functional class was 2.5 +/- 0.7. Thirty patients had received antiarrhythmic drugs and 32 had received digitalis. Sudden death occurred at rest in 73%. In the hours before death, repetitive ventricular arrhythmias were found in 50 patients (82%), with atrial fibrillation in 34%. Patients with bradyarrhythmic death (18%) had less complex ventricular activity compared to patients with tachyarrhythmic death (p less than 0.01). Lethal arrhythmias--monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, torsades de pointes, primary ventricular fibrillation, and 1:1 conducting atrial tachycardia--were found in 26 (43%), 15 (25%), 5 (8%), 3 (5%), and 1 patient, respectively. The coupling interval of the final ventricular tachycardia correlated inversely with the initial frequency of ventricular tachycardia (p less than 0.05). For patients with tachyarrhythmic death, an increase of heart rate within the last 3 hours was noted (83 vs 89 beats/min, p less than 0.05). Ventricular premature complexes and the proportion of patients with greater than 2 couplets and greater than 2 triplets increased significantly only within the last hour before death.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

PTCA of the left main stem following protective coronary artery bypass grafting.

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 14 patients with significant left main stem stenosis following protective coronary artery bypass grafting (CABG). The procedure was successful in 13/14 patients (93%), achieving a decrease in mean diameter stenosis from 74% +/- 7% to 31% +/- 12% (P less than 0.01). Accordingly, the absolute stenosis diameter increased from 0.9 mm +/- 0.3 mm to 2.4 mm +/- 0.5 mm (P less than 0.01). Dissection of the left main stem artery and a transient significant fall of blood pressure each occurred in one patient. No other serious complications were noted. Eight of 13 patients (62%) with successful PTCA underwent control angiography. Restenosis had occurred in 3 of 8 patients (38%) with total occlusion of the left main stem in 1 patient. All bypass grafts were found to be patent at follow-up. Clinical evaluation in all 14 patients revealed no serious events (death, myocardial infarction, repeat revascularization procedure) during a mean follow-up period of 27 months (range 6-39 months). PTCA of the left main stem following CABG can be considered a relatively safe and effective procedure with a marked restenosis-rate but beyond that, an uncomplicated long-term follow-up.

Adult↗
PubMed1991

[Modification of thrombocyte function in diagnostic and therapeutic interventions in cardiology].

In patients with coronary heart disease platelet activity may be pathologically increased. Administration of platelet inhibitor drugs is an established treatment principle. The interactions between platelet activation, platelet inhibitor drugs like acetylsalicylic acid (ASA) or molsidomine and the endogenous fibrinolysis were studied in three trials. Platelet aggregation and thromboxane synthesis are dose- dependently inhibited after oral intake of ASA (0, 10, 30, 100 or 500 mg/d) Additional intake of the antianginal agent and nitric oxide donator Molsidomine (8 mg) results in a synergistic platelet inhibitor effect characterized by a significantly delayed aggregation response. In a group of patients with coronary artery stenoses platelet activity was markedly enhanced, when compared to healthy individuals. During physical exercise platelet activity was even further enhanced and plasma t-PA-activity was increased by a factor of 2.2. The stimulation of the endogenous fibrinolytic system was markedly reduced when compared to healthy subjects. Following successful coronary angioplasty 393 patients were randomized to receive either molsidomine (2 x 8 mg/d) or ASA (1 x 500 mg/d) plus nifedipine (3 x 20 mg/d). Coronary angiography performed after the 6 month treatment period revealed a restenosis rate of 29% in the molsidomine group and of 33% in patients treated with ASA + nifedipine. This difference was not statistically significant.

Angioplasty, Balloon, Coronary↗
PubMed1990

Analysis of risk factors for restenosis after PTCA.

To identify risk factors for restenosis, we evaluated data in 473 patients with single-vessel percutaneous transluminal coronary angioplasty (PTCA) and control angiography after 6 months. Restenosis, defined as (1) loss greater than 50% of the initial gain, and (2) stenosis greater than 50% was found in 138 patients (29.2%). Univariate analysis revealed eight factors related to restenosis: (1) duration of symptoms less than 1 month (P = 0.005), (2) unstable angina (P = 0.004), (3) high-grade stenosis before PTCA (P = 0.014), (4) large residual stenosis after PTCA (P = 0.001), (5) insufficient improvement of stenosis (P = 0.042), (6) prolonged single inflation time (P = 0.017), (7) prolonged total inflation time (P = 0.055), and (8) low inflation pressure (P = 0.028). Multivariate analysis revealed four factors significantly related to restenosis: (1) large residual stenosis after PTCA (P = 0.0001), (2) prolonged single inflation time (P = 0.0047), (3) unstable angina (P = 0.0127), and (4) high-grade stenosis before PTCA (P = 0.0179). Modification of procedural factors might be helpful to reduce the risk of restenosis after successful PTCA.

Aged↗
PubMed1990

Enoximone.

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Arrhythmias, Cardiac↗
PubMed1990

Short- and long-term outcome after PTCA in patients with stable and unstable angina.

Acute results and follow-up data over a period of 36 months after attempted PTCA in 406 patients with stable angina and 202 patients with unstable angina are reported. The rate of acute complications (death, myocardial infarction and bypass grafting (CABG) amounted to 1.5% in stable and 6.4% in unstable patients (P less than 0.005). Within the first week after PTCA a significantly lower percentage (1.7% vs 10.4%) of cardiac events (death, myocardial infarction, CABG and repeat PTCA) was observed in the stable group (P less than 0.001). During a 12-month follow-up period, another 16.3% of the patients in the stable group and 30.7% of unstable patients suffered a new cardiac event (P less than 0.001). The long-term follow-up of 36 months revealed no significant difference in the event rate between stable and unstable patients (5.4% in both groups). The cumulative rate of myocardial infarction within 3 years after PTCA was significantly lower (3.7% vs 9.4%) in the stable group (P less than 0.005). The cumulative mortality amounted to 3.0% in stable and 6.4% in unstable patients (P less than 0.05) and the incidence of repeated PTCA was 8.1% and 19.3% respectively (P less than 0.001). The crossover rate to CABG was 10.1% in stable and 17.8% in unstable patients (P less than 0.01). The total rate of any cardiac event thus amounted to 24.9% in stable and 53.0% in unstable patients (P less than 0.001) within a 3-year follow-up period. At the end of follow-up, 74% of the stable patients were asymptomatic, compared with 60% of unstable patients (P less than 0.01). 45% of the stable group patients and 28% of the unstable patients were not on antianginal treatment (P less than 0.01). We conclude that PTCA in unstable angina carries a markedly enhanced risk of acute complications and cardiac events in the early phase after PTCA. In the long run, patients with stable angina have a better quality of life with regard to medical treatment and angina symptoms.

Adult↗
PubMed1990

Detection of dissection of the aortic intima and media after angioplasty of coarctation of the aorta. An angiographic, computer tomographic, and echocardiographic comparative study.

Balloon coarctation angioplasty (BCA) was performed in eight patients (five male and three female) who were 14-49 years old (mean, 27.3 years) with isolated discrete unoperated coarctation of the aorta (n = 7) and postoperative recoarctation (n = 1). BCA was successful in seven of eight patients, resulting in a decrease in the gradient (64 +/- 19 to 16 +/- 13 mm Hg, p less than 0.01), an increase in the diameter at the coarctation site (0.9 +/- 0.4 to 1.6 +/- 0.4 mm, p less than 0.01). Follow-up (6 months) has demonstrated continued gradient relief (6 +/- 9 mm Hg) and diameter increase (1.6 +/- 0.2 cm). Monitoring was performed by transesophageal echocardiography (TEE) during BCA, and before and after BCA angiography and after BCA computed tomography. In three of seven patients, immediately distal to the BCA site, intimal flaps (1-2 cm) could be detected by TEE but not by angiography or computed tomography. Follow-up TEE showed spontaneous healing in two and persistence in one patient. By TEE and computed tomography in one of eight patients during follow-up, intima and media dissection was found with pleural effusion and spontaneous healing. In one female patient, aortic dissection occurred after successful uneventful BCA, detected by TEE at the 6-month follow-up study and subsequently confirmed by biplane angiography, not detected by computed tomography and previous monoplane angiography. Because of the significant morbidity of BCA in this group of patients, its role in the management of adults with coarctation has yet to be determined. Further long-term follow-up studies will demonstrate whether the observed intima and media dissection by TEE after BCA are related to aneurysm formation.

Adult↗
PubMed1990

[Acute and chronic effects of molsidomine in therapeutic coronary angioplasty].

The effects of the molsidomine metabolite SIN-I (0.5 mg) on tolerance to ischemia were studied in twelve patients during coronary angioplasty of the LAD. SIN-I resulted in a significant prolongation of time to ST-segment alteration one, five and ten minutes after intracoronary injection. Beside hemodynamic reasons the effects of SIN-I on circulating blood cells and collateral perfusion are discussed as mechanisms of action. The effects of molsidomine (2 X 8 mg/d) on restenosis rate after initially successful coronary angioplasty were studied in 393 patients in a prospective, randomized and controlled trial. 29% of patients treated with molsidomine experienced restenosis at control coronary angiography at six months. The control group receiving nifedipine (3 X 20 mg/d) and acetylsalicylic acid (1 X 500 mg/d) showed a restenosis in 33% of patients. Therefore, molsidomine seems as effective as nifedipine and acetylsalicylic acid in treating patients after coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Cardiopulmonary stress: control of the function of frequency variable pacemaker systems].

Based on the linear relationship between cardiac output and oxygen uptake direct breath-to-breath gas exchange measurements during exercise allow accurate determinations of cardiopulmonary function. We used cardiopulmonary exercise testing to assess the physiologic benefit of rate response VVIR pacing in 17 patients with chronotropic incompetence. 13 patients had an activity-rate-response pacemaker, two patients had a temperature-controlled pacemaker and two patients a respiratory-dependent system. Exercise testing was performed with the pacemaker, either programmed to fixed rate VVI or to rate variable VVIR pacing. All patients were exercised on a bicycle using a ramp protocol with 10 to 20 watts/min increments. Maximal oxygen uptake and the anaerobic threshold were determined. Compared with findings in the VVI mode, rate response VVIR pacing increased maximal exercise heart rate from 74 +/- 10 to 118 +/- 21 bpm (p less than 0.001). This increase in heart rate was associated with an increase of maximal oxygen uptake from 14.3 +/- 5 to 18.3 +/- 6 ml/kg per min (p less than 0.04) and a delay of the anaerobic threshold to a higher oxygen consumption of 14.6 +/- 5 vs 10.6 +/- 5 ml/kg per min (p less than 0.04). The individual increase in oxygen uptake was a direct function of the change in exercise heart rate independent of the implanted pacing device. The improved aerobic capacity resulted in a 17% increase in exercise tolerance and a 19% increase of exercise time. Cardiopulmonary exercise testing appears to be a useful noninvasive technique to quantify the cardiopulmonary benefit of rate response pacing.

Adult↗