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PubMedDate not supplied

Evidence based medicine and extradigestive manifestations of Helicobacter pylori.

A putative pathogenetic role has been ascribed to Helicobacter pylori in several extradigestive diseases, including vascular (atherosclerosis and ischaemic heart disease, primary Raynaud phenomenon, primary headache), autoimmune (Sjögren's syndrome, Henoch-Schönlein purpura, autoimmune thyroiditis, idiopathic arrythmias, Parkinson's disease, nonarterial anterior optic ischemic neuropathy), and skin diseases (chronic idiopathic urticaria, rosacea, alopecia areata), sideropenic anemia, growth retardation, late menarche, extragastric MALT lymphoma, diabetes mellitus, hepatic encephalopathy, sudden infant death syndrome, and anorexia of aging. We examine critically the strength of the evidence linking these diseases to Helicobacter pylori, using ischaemic heart disease as an example of epidemiological techniques, and skin diseases as an example of treatment studies. By the standards of evidence-based medicine, studies have been often of low quality. The best evidence usually is not indicative of a role for Helicobacter pylori in these diseases.

Evidence-Based Medicine↗
PubMed2001

[Proximal myotonial myopathy (PROMM): clinical and histology study].

We report 13 French patients with proximal myotonic myopathy. PROMM is a recently delineated multisystem disorder with dystrophic myopathy, myotonia and cataracts. This syndrome is genetically distinct from myotonic dystrophy (DM) by the absence of abnormal CTG repeat expansion. The geographical origin varies but 4 families originated from Poland. Of late onset, muscle weakness is diffuse and predominantly affected proximal and axial muscles. Facial involvement and myotonia were moderate or absent, but in all cases myotonic discharges were detected on EMG. 6 patients suffered from myalgia. Cataracts occurred in 11 patients, mainly indistinguishable from those in DM. Cardiac arrythmia occurred in 7 patients. Muscle biopsy revealed rare structural changes of the muscle fibers and selective type I atrophy, common in DM, could not be found on morphometric analysis. PROMM has a distinct clinical spectrum from DM which includes a predominantly proximal muscle weakness, with troubling pain, a more favourable prognosis and a different histopathological pattern.

Adult↗
PubMed1975

Hyperphosphatemia and hypocalcemia in Burkitt lymophoma. Complications of chemotherapy.

In two patients, metabolic complications, previously unreported to our knowledge, of severe hyperphosphatemia and hypocalcemia in addition to hyperkalemia nad hyperuricemia were demonstrated after treatment with cyclophosphamide. In one patient, elevated blood and ascites lactate levels were measured. The levels decreased rapidly to normal following chemotherapy. The hyperphosphatemia and hyperkalemia may have been due to rapid tumor lysis and the hypocalcemia may have been caused by the hyperphosphatemia. The reduction in blood and aseties lactate levels may reflect the lysis of anaerobically metabolising tumor cells. Renal dialysis was required in the management of both cases. Because of the potential for cardiac arrythmias related to electrolyte imbalance, it is recommended that whenever possible reanl dialysis be available before treating cases of Burkitt lymphoma with large tumor burden.

Abdominal Neoplasms↗
PubMed1975

[Changes in the ECG caused by electrolyte changes in primary hyperparathyroidism].

The development of cardiac arrhythmias in a case of primary hyperparathyreoidism is described. The arrythmias (sino-auricular block and ventricular ectopic beats) were observed preoperatively in the presence of a raised serum calcium. Postoperatively with a fall of serum calcium to subnormal values the arrhythmias ceased while serum magnesium was very low. The electrophysiological basis of these findings is discussed and the importance of serum calcium- and magnesium estimation in cases of unexplained arrhythmias is stressed.

Arrhythmias, Cardiac↗
PubMed2002

Non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy.

BACKGROUND: We hypothesized that neutralization of the gastric acidity by alkaline pancreatic secretion via a non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy (non-stented PPPD-PG) might provide protection against marginal or stress ulcer. Surgical risk of non-stented pancreaticogastrostomy was also assessed to clarify the importance of stenting in pancreatic anastomosis. METHODS: From January 1997 to December 2000, 54 patients with resectable periampullary lesions were included for non-stented PPPD-PG. Gastric pH and amylase levels were measured on the postoperative day 7. Surgical risks including pancreatic leakage, morbidity and mortality were also assessed. RESULTS: Patients undergoing the non-stented PPPD-PG presented significantly higher gastric levels of pH and amylase than healthy patients as controls (median pH 5.0 vs 2.8, p = 0.007; and median amylase 7,660 vs 21 IU/L, p = 0.031). Among the patients undergoing the non-stented PPPD-PG, low gastric pH and amylase levels were associated with high gastric drainage group > or = 600 c.c./day. However, only 1 of the 18 patients with low gastric amylase level (high gastric drainage group) developed significant steatorrhea and needed replacement of concentrated pancreatic enzymes. There were 18 (33.3%) complications and 1 (1.8%) mortality. The cause of death was cardiac arrythmia, not related to operation. Gastric atonia was the most common complication (18.5%), followed by wound infection, intraabdominal abscess, and intraabdominal bleeding in 2 patients (5.6%) individually. No pancreatic leakage or ulcer-related complication occurred after non-stented PPPD-PG. CONCLUSIONS: Experience of no pancreatic leakage in our 54 non-stented PPPD-PG implies that stenting of pancreaticogastrostomy might not be crucial in prevention of pancreatic leakage and ductal occlusion. Moreover, non-stented PPPD-PG can increase gastric pH and amylase levels, which might be beneficial in protection against marginal ulceration.

Adult↗
PubMedDate not supplied

Intravenous perfusion of adrenalin during enflurane (ethrane) anesthesia.

The effects of an IV perfusion of adrenaline were studied in three groups of patients. The first two groups were anesthestised with enflurane (Ethrane) and the perfusion of adrenaline was started either after stabilisation of cardiovascular parameters, or induction of anesthesia. The third group was anesthetised with halothane, and the perfusion of adrenaline was started after stabilisation of cardiovascular parameters. No significant statistical difference exists between the results obtained in the three groups, and particularly not concerning the incidence of arrythmias.

Adolescent↗
PubMed1975

[Treatment of heart-rhythm disorders in infancy and childhood].

According to own experiences and after a review of the literature a survey of therapy of cardiac arrhythmias in infancy and childhood is given. In this age group most of the occurring cardiac arrhythmias are harmless and pass without serious circulatory disturbances. Therefore in these cases no specific treatment is necessary, except of course the treatment and management of the disease which is causing the arrythmia. This report is concerned more detailed with the therapy of rhythm disturbances which are life threatening or will become fatal if they continue untreated for a longer period. In spite of the therapeutic recommendations given we are aware of the fact that it is impossible to predict the success of therapy. This turned out to be so especially in the case of tachycardias. The difficulties in long-term management of postoperative heart block are mentioned. Antiarrhythmic drugs, their indications, efficacy, side-effects and contraindications are listed in separate tables ("FdM-Tabellen für die Praxis" Nr. 30/1975, Fortschr. Med. 93, 30: 1447, 1975).

Age Factors↗
PubMed2002

[Prognostic value of results from clinical tests, echocardiographic, electrocardiographic and spiro-ergometric exercise test examinations in patients with heart failure].

UNLABELLED: The aim of this study was to assess the importance of the non invasive procedures in determinating prognosis of patients with heart failure (HF). MATERIAL AND METHODS: We investigated 110 patients with a mean age of 52.1 (65 patients--59%) with chronic (HF) due to coronary artery diseases and dilated cardiomyopathy (45 patients--41%). All the patients underwent baseline evaluations including a clinical status, echocardiography, Holter monitoring and a cardiopulmonary exercise test (CPX). After the mean follow-up period of 28.5 +/- 12 months, the patients were divided into 2 groups: Group I--in which 78 patients survived without heart transplantation (HTX) and Group II--in which 20 patients died and 12 underwent HTX. The relationship between the variables derived from noninvasive procedures was assessed using multivariate Cox proportional hazards models. RESULTS: Compared to group I, Group II had a significantly higher number of patients that were classified into NYHA class III. In addition, a third heart tone was identified more often in group II and an increased number of HF etiology was due to ischemia. Electrocardiographic recording showed an increased frequency of left bundle branch block and complex ventricular arrythmias. Markedly increased values of WSLK, OKSLK, WLP, OKRLK and FW were found in group II, as compared to group I. Cardiopulmonary exercise tests in group II revealed lower values of T, VO2AT, SBPpeak, VO2peak, VO2peak%N, PETCO2peak as well as VD/VTpeak, VE/VO2peak, and VE/VCO2peak. After multivariate analysis lope VE/VCO2peak (p = 0.009), peak oxygen uptake VO2peak-%N (p = 0.035), (p = 0.036), left ventricle end systolic volume (p = 0.045) and left bundle branch block (p = 0.046) were independent predictors of survival without heart transplantation. CONCLUSION: On multivariate analysis by the Cox proportional hazards method, the variables: VE/VCO2peak, VO2peak%N, etiology--CAD, OKSLK, and left bundle branch block were independent prognostic predictors. The echocardio-graphic evaluation play a significant role in the assessment of prognosis in patients, with HF. The ejection fraction of the left ventricle was not confirmed as an independent prognostic factor in HF.

Adult↗
PubMed2002

Is azithromycin treatment associated with prolongation of the Q-Tc interval?

OBJECTIVES: Prolongation of the corrected Q-T (Q-Tc) interval is associated with a risk of severe and even life-threatening arrythmias. It may occur as an adverse effect of various pharmacological agents including macrolides. We opted to study the influence of the azalide antibiotic azithromycin on the duration of Q-Tc interval as data on this subject are limited. METHODS: A prospective study was performed on 47 patients, 31 females and 16 males, aged 19-77 (median 52) years, treated with azithromycin (total dosage 3 g, divided over 5 days) for typical solitary erythema migrans. The patients were previously healthy and were not receiving any other medication. In all of them ECGs were performed before as well as 7 and 14 days after initiation of the azithromycin therapy. Thus, a total of 141 ECG tracings were analyzed. Q-T intervals were measured manually in a blinded manner and corrected for heart rate according to Bazzet's formula: Q-Tc = measured Q-T (ms)/square root of R-R (s). RESULTS: Comparison of the Q-Tc intervals before, 7 days, and 14 days after the initiation of azithromycin treatment revealed a mild, but not significant prolongation (median values 406, 412.5 and 419 ms with ranges of 339-488, 352-510, and 346-505 ms, respectively). Q-Tc intervals exceeding the upper normal value of 440 ms were found in the same proportion of patients prior to as after institution of treatment. None of the ECG tracings showed significant arrhythmias. CONCLUSION: In previously healthy persons, a modest statistically insignificant prolongation of the Q-Tc interval without clinical consequences was observed after completion of a course of 3 g of azithromycin administered over a period of 5 days for solitary erythema migrans.

Adult↗
PubMed1976

[Atrial dissociation].

A case of atrial dissociation with left-side atrial flutter is described in a patient with a transmural anterior myocardial infarction. A favourable outcome of this arrhythmia was achieved. Inviting the literature data the paper discusses the problems of impulse transmission from the right atrium to the left, the mechanism and causes of atrial dissociation, the electrocardiographic and differential diagnosis of this arrythmia, the prognosis in atrial dissociation.

Arrhythmias, Cardiac↗
PubMed2003

[Coronary angiography with sixteen-slice spiral CT: an initial study].

OBJECTIVE: To evaluate the scanning technique and primary clinical value of sixteen-slice spiral CT coronary angiography. METHODS: Plain and enhanced sixteen-slice spiral CT imaging was performed in 69 patients, including 64 cases of suspected coronary heart disease and 5 cases of coronary stent. Calcium scoring with plain scan images and MPR, MIP and VRT reconstruction with enhanced scan images were made in all cases, among which 10 underwent conventional coronary angiography. The demonstration and stenosis of coronary arteries were evaluated. The factors influencing the image quality were analyzed. Additional MPR and MIP reconstruction of slices perpendicular to the stent and virtual endoscopy of stent were made in 7 stents of the 5 cases of coronary stent. The patency of the stents was evaluated. RESULTS: A four-step scanning procedure was devised. Coronary calcium score could be got by plain scanning with sixteen-slice spiral CT angiography. All of the primary, most of the secondary and tertiary, and part of the fourth level branches of coronary artery could be shown isotropically with MPR, MIP and VRT reconstruction images of enhanced scanning. MPR and MIP were better than VRT in demonstrating small branches. Evaluated by VRT image, the image quality of 79.7% of the patients were first class, 10.1% second class, and 10.1% third class. The image quality was correlated to the contrast concentration in the root of aorta, heart rate, existence or absence of arrythmia, and the patient's breath-holding ability. Stenosis of coronary arteries was evaluated by sixteen-slice spiral CT imaging in 10 cases, with a result comparable to that by conventional coronary angiography. The stents were well shown, six stents being evaluated as patent, while one not. CONCLUSION: Sixteen-slice spiral CT coronary angiography is a noninvasive, simple and good method. Coronary calcium score and coronary artery stenosis can be evaluated with one study. The patency of stents can also be evaluated.

Adult↗
PubMed1976

Comparison of the bronchodilating effects of SCH 1000 with isoproterenol in patients with bronchial asthma.

The effect of SCH 1000 and isoproterenol was evaluated in 10 patients with extrinsic asthma. The onset of action for the SCH 1000 dose compared to the baseline response occurred at or before 15 minutes (FEV1 and MEFR). The onset of action for the isoproterenol dose occurred at or before one minute for all three pulmonary function variables. At the 1-, 3-, 6- and 15-minute intervals the response to the isoproterenol dose was significantly greater than the response to the SCH 1000 dose for FEV1, FVC and MEFR. At 30 and 60 minutes, however, the response to SCH 1000 was progressively increasing, whereas the response to isoproterenol was decreasing. The maximum improvement in FEV1 for isoproterenol was 49% at three and six minutes, whereas for SCH 1000 was 28% at 60 minutes. In patients with chronic bronchitis or bronchial asthma SCH 1000 may be considered as a therapeutic alternative to beta-adrenergic bronchodilators and in patients who also have cardiac arrythmias or angina pectoris and are adversely affected by sympathomimetic drugs.

Acetylcholine↗
PubMed1976

[Myocardiopathia gravidarum].

8 cases of the clinical syndrom known as cardiomyopathy of pregnancy have been presented. In 6 of them cardiac insufficiency during the last weeks of pregnancy was the prevailing symptomatology. In 2 the characteristic symptoms consisted of severe arrythmia at the beginning of the puerperium. Common symptoms were cardiomegaly and characteristic changes in the electrocardiogram. In all patients the disease subsided entirely some weeks after delivery.

Adult↗
PubMed1975

[Diagnostic characteristics of cardiac insufficiency under mountain conditions].

In patients with mitral lesions and prevalence of stenosis and insufficient circulation of the I, II A and B stages clinical and functional indicators of the cardiac work were studied at three different altitudes, viz. with a low-mountain relief (760 m), middle-mountain relief (1650-2020 m) and in highland (3600-4200 m). In highland decompensated mitral incompetence was found to be characterized by a much higher incidence of such manifestations of the disease as vertigo, syncopal attacks, fits of distressed respiration, epigastral pulsation, positive venous pulse, a significant expansion of the heart to the right, accentuation and splitting of the II tone on the pulmonary artery, overloading of the right ventricle and atrium (according to ECG findings), the absence of peripheral edematization and fibrillation arrythmia, the presence of arterial and venous hypotension, highly intensive hyperventilation, a drop of PAO2 and PACO2. In patients-residents of low- and middle-mountain regions the severity of clinical and hemodynamic disorders depended on the stage of cardiac insufficiency, whereby in residents of the second region the disclosed deviations on the level of circulation proved more marked. It is shown that the correlation links between individual physiological variables become greatly disrupted parallel with progressively increasing severity of cardiac incompetence. In conditions prevailing in the middle and, especially, high altitude areas there are evident links between individual functional indicators which are absent in low-mountain areas. The above data bear evidence not only to the fact that with progressive severity of cardiac insufficiency the disrupted regulation of the circulation system becomes still more aggravated, but also to the presence of other compensatory mechanisms that are operative in mountain areas.

Adolescent↗
PubMed1964

THE CARDIOMYOPATHY OF MUSCULAR DYSTROPHY: REPORT OF TWO CASES WITH A REVIEW OF THE LITERATURE.

About 50% of patients with progressive muscular dystrophy have a cardiomyopathy, manifested commonly by tachycardia, but also by arrythmias, refractory congestive heart failure and sudden death. Studies from the literature report manifold but nonspecific electrocardiographic changes in 41% to 85% of patients with progressive muscular dystrophy. The principal lesion is a diffuse myocardial fibrosis with minor degenerative changes in myocardial fibres unaccompanied by significant inflammation. The heart is enlarged and has a prominent deposit of epicardial fat. The myocardium is pale, coarse, flabby and friable, often showing gross evidence of scarring. The dilated chambers often contain mural thrombus.

Arrhythmias, Cardiac↗
PubMed1964

THE ARTIFICIAL CARDIAC PACEMAKER. INDICATIONS FOR IMPLANTATION.

Extensive clinical experience has demonstrated that implantable cardiac pacemakers are safe and effective mechanisms for controlling symptoms and preventing the hazards of third degree heart block with Stokes-Adams syncope. Medical management of this disease does not provide reliable protection and life expectancy averages about two years after diagnosis. Hence the negligible surgical morbidity and mortality associated with pacemaker implantation justifies broad indications to implant one of the four commercially available battery-powered units. ELECTIVE IMPLANTATION OF A PACEMAKER SHOULD BE CONSIDERED IN PATIENTS WITH PERSISTENT THIRD DEGREE HEART BLOCK WHO HAVE HAD: One or more episodes of Stokes-Adams syncope; surgical injury to the conduction system, regardless of syncopal attacks; evidence of low cardiac output with cardiomegaly secondary to bradycardia. Few if any other cardiac arrythmias are satisfactorily controlled by an electrical pacemaker. Emergency pacemaker control is obviously necessary for patients developing intractable or recurrent bouts of asystole. During the interval until an implantable unit can be obtained and sterilized, the patient may be controlled by intravenous isoproterenol or by an external pacemaker attached to a transvenous catheter electrode, a precordial skin electrode or a percutaneous myocardial wire electrode.

Adams-Stokes Syndrome↗
PubMed2003

Pregnancy following cardiac surgery.

OBJECTIVE: To determine the pregnancy outcome in women with cardiac disease who have undergone cardiac surgery. DESIGN AND SETTING: Prospective study in a tertiary care hospital. POPULATION: One hundred and thirteen pregnant women who had cardiac surgery due to valvular disease (commisurotomy as well as valve replacement), or other cardiac defects. These women were followed up in 170 pregnancies between January 1990 and December 1999. RESULTS: Rheumatic heart disease (91%) affecting the mitral valve, was the commonest indication for cardiac surgery (89%). Valve replacement with mechanical prostheses followed by anticoagulant therapy was carried out in 45%. There was no maternal death. Maternal morbidity from complications included pulmonary oedema (16%), cardiac arrythmias (4%), postpartum haemorrhage (3.5%). Other bleeding complications included epistaxis and haematoma at episiotomy site (2%). Impaired functioning of prosthesis (4%), severe pregnancy induced hypertension (2%) and thromboembolism (0.6%) were also observed. The abortion rate was 10.6%. There were 3 stillbirths (2%), another 6.7% babies were born preterm and 28% were lighter than appropriate for the period of gestation. There were no neonatal deaths. Coumarin derivatives were not associated with obvious foetal malformation. CONCLUSION: With appropriate care, the outcome of pregnancy in women who have had cardiac surgery is favourable, if their functional class is good.

Adolescent↗
PubMed2003

[Triiodothyronine intoxication. A clinical and phamacokinetic study].

A woman, thyroidectomised because of a thyroid papillary carcinoma, interrupted temporarily her levothyroxine intake in order to be subjected to an extension study five weeks later. To minimise her symptoms for the first three weeks, a treatment was prescribed consisting of one 25 micro g-capsule of triiodothyronine every 8 hours. Nine days later she complained of abdominal pain, nausea, vomiting, fever of 40 degrees C and chest discomfort. A serum total triiodothyronine of 575.2 nmol/l was measured by chemoluminiscent immunoassay eleven hours after the intake of the latest capsule (normal level: 1.1-2.9 nmol/l). Along the following ten days the patient suffered from delirium, agitation, tachycardia, hypertension, constipation and later diarrhoea, but neither arrythmias nor axillary temperature over 38 degrees C. Fifty-nine measurements of the serum total triiodothyronine were performed in order to determine the kinetics of elimination of this drug. We estimate that the maximal serum concentration after the intake of the latest capsule could be 794.3 nmol/l, i.e. 397 times higher than the mean normal value. The elimination half-life was 24 hours 40 minutes. The charcoal haemoperfusion had no impact on the velocity of elimination. The concentration of triiodothyronine became normal 200 hours after the intake of the latest capsule, but the clinical manifestations still lasted three days more. The pharmacokinetic data suggest that this intoxication could be due to the intake of capsules containing 5 mg of triiodothyronine, i.e. a dose 200 times higher than that prescribed by her physician.

Absorption↗