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Biomedical subjects

A Reikvam

Publications and source records attributed to A Reikvam.

At least 19 recordsLinked to original sources
PubMed1992

[Torsades de pointes ventricular tachycardia induced by disopyramide at therapeutic serum concentration].

We describe a patient who developed torsades de pointes ventricular tachycardia after several years of treatment with disopyramide. The case demonstrates that measuring disopyramide serum concentration provides limited information about correct dosages. Life-threatening arrhythmias may arise even at recommended doses and therapeutic serum concentration. Clinical trials have shown that class Ic antiarrhythmic drugs, and perhaps all class I antiarrhythmics, may increase the risk of serious arrhythmias and sudden death in certain groups of patients. Aspects of the pharmacology of disopyramide are discussed, with particular emphasis on the variable plasma protein binding and the narrow therapeutic specter. This complexity seems to be the most important reason for the limited reliability of serum concentration measurements for predicting the best dosage for the individual patient.

Aged↗
PubMed1990

[Lung shock in connection with acute myocardial infarction. Adult respiratory distress syndrome, ARDS].

We describe the case of 42 year-old male patient who developed adult respiratory distress syndrome (ARDS) during an acute myocardial infarction. He was treated with positive pressure ventilation for 23 days. Chest X-ray showed multiple, bilateral infiltrates for several weeks. ARDS is accompanied by serious and progressive hypoxemia. Early diagnosis is important. The therapeutic consequences involve positive pressure ventilation with increased inspired oxygen concentration and positive end-expiratory pressure. ARDS in patients with impaired myocardial function can be difficult to recognize. It is an alternative diagnosis to pneumonia and ordinary heart failure when patients are seen to be suffering serious hypoxemia.

Adult↗
PubMed1990

Diagnostic efficiency of lactate dehydrogenase isoenzymes in serum after acute myocardial infarction.

Diagnostic efficiency of lactate dehydrogenase isoenzymes were studied in 117 consecutive patients admitted with some symptoms of acute myocardial infarction. The results of lactate dehydrogenase isoenzyme tests were not available to the physicians, who diagnosed the patients according to criteria based on clinical symptoms, electrocardiographic findings and changes in three serum enzymes. Acute myocardial infarction was diagnosed in 41 patients. The diagnostic efficiency of lactate dehydrogenase isoenzyme 1 and the various ratios between this and the other isoenzymes were compared using receiver operating characteristic curves and logistic discriminant analysis. Lactate dehydrogenase isoenzyme 1 was the best parameter on the second day after admission. On that day, calculating the various ratios between isoenzyme 1 and the other isoenzymes did not improve discrimination.

Adult↗
PubMed1987

Blood donor selection can prevent cytomegalovirus infection after open heart surgery.

Thirty-four patients without IgG antibodies against cytomegalovirus (CMV) prior to open heart surgery were studied. The patients were randomized to receive blood either from unselected donors, or from donors without detectable CMV antibodies. Fresh whole blood was mainly used. Eleven patients received CMV seronegative blood only. All had an uneventful convalescence period and remained seronegative. Ten of the 23 patients who received blood from unselected donors had typical CMV disease with the onset of symptoms in the third or fourth postoperative week, and fever lasting for two to three weeks. They all had liver enzyme release and later seroconversion against CMV. Four patients were hospitalized during this period. The incidence of symptomatic CMV infection after open heart surgery was higher than usually reported among the CMV seronegative patients. Selection of blood donors who lack antibodies against CMV may be an adequate protective measure. Avoidance of fresh blood and reduced use of blood products are presumably also of importance.

Antibodies, Viral↗
PubMed1985

Primary cytomegalovirus infection following open heart surgery.

Among 674 patients undergoing open heart surgery in 1981-82, 86 (13%) were cytomegalovirus (CMV) antibody-negative when tested by an enzyme-linked immunosorbent assay prior to operation. At follow-up, 54 (67%) of 80 patients restudied had seroconverted after the operation, and 35 of the 54 seroconvertants had been ill with fever and elevated liver enzymes. Among the latter 35 patients, 26 demonstrated a significant rise in CMV antibody titre, most often detected in the third week following the onset of illness. The older patients were more susceptible to illness and seroconversion, and there was a positive correlation between age and the number of blood units given. Thus, at least one third of the seronegative patients developed symptomatic CMV illness after open heart surgery. This is a much higher incidence than earlier reported.

Adolescent↗
PubMed1985

Identification of patients at risk of symptomatic cytomegalovirus infection after open-heart surgery.

In a prospective study, 58 consecutive patients submitted to open-heart surgery were followed from the preoperative period up to 3 months postoperatively with regard to clinical status, cytomegalovirus (CMV) antibodies and signs of enzymatic liver damage. Forty-eight patients (83%) were seropositive prior to operation. Of the ten (17%) preoperatively seronegative patients, five became CMV-seropositive during follow-up. Of the 48 initially seropositive patients, nine showed heightened CMV-antibody titers after the operation. Significant symptomatic CMV illness with protracted fever developed in four patients, all from the group of five with seroconversion. All five of these patients had enzymatic liver damage. The incidence of symptomatic CMV infection after open-heart surgery in CMV-negative patients probably is higher than previously assumed, while CMV-positive patients seem to have complete protection against CMV morbidity.

Cardiac Surgical Procedures↗
PubMed1982

Myocardial protection during aortocoronary bypass operations. Comparison of two different operative procedures: cold chemical cardioplegia versus intermittent cross-clamping of the aorta.

Myocardial injury was studied in 40 randomized coronary patients operated on electively with coronary bypass grafting using two different techniques, (A) cardioplegic arrest and continuous cross-clamping of aorta, and (B) ischaemic arrest and intermittent cross-clamping of aorta. The released quantity of the MB isoenzyme of creatine kinase was used as an indicator of myocardial injury. Of the whole group, 3 patients (8%) suffered a myocardial infarction as judged by ECG. The CK-MB release was not significantly different in the two groups. The total period of aortic cross-clamping was markedly longer in the cardioplegic group than in the intermittent clamping group. A significant correlation between the duration of aortic clamping and the amount of CK-MB release was found in the cardioplegic group. Our results indicate that the beneficial effects of cardioplegic arrest are outweighed by an unavoidable longer period of total aortic clamping as compared with the intermittent clamping technique.

Aorta↗
PubMed1981

The origin of creatine kanase BB occurring in serum during aortocoronary bypass surgery.

The serum concentration of creatine kinase (CK)-BB during and after coronary bypass surgery was measured by a sensitive and highly specific radioimmunoassay technique. All patients showed a distinct and temporary increase in CK-BB concentration shortly after the start of operation. Our results indicate that this increase has no connection with damage of the heart or the brain. Most probably the BB isoenzyme is liberated mainly from the saphenous vein as a consequence of the surgical manipulations during the heart operation.

Aged↗
PubMed1979

Hyperthermia and rhabdomyolysis in self-poisoning with paracetamol and salicylates. Report of a case.

A young women ingested large amounts of different analgesics, mainly salicylate and paracetamol. On admission about 17 hours later, clearly toxic serum levels of both drugs were demonstrated. She was comatose with respiratory failure for 5 days. During the first day there was a period of several hours of therapy-resistant hyperthermia. A severe bleeding tendency was probably related to profound coagulation defects. Persistingly elevated serum levels of ASAT and ALAT for two weeks were presumably caused by a toxic effect of paracetamol on the liver. When consciousness was regained, widespread pareses of skeletal muscles, predominantly of the lower limbs, were demonstrated. These were related to extensive rhabdomyolysis as evidenced by extremely elevated serums levels of CPK for 6 weeks, and by muscle necrosis in biopsy specimens. There was a gradual improvement, but walking disturbances were still present after one year. The hyperthermia was probably related to the cerebral effects of salicylates or the combination of multiple drugs. The rhabdomyolysis might be related to a deleterious effect of hyperthermia on the muscles or to an effect of paracetamol on the skeletal muscles similar to that which might occur in the myocardium, or to a combination of these mechanisms.

Acetaminophen↗
PubMed1977

Hydroxyurea (HU) in experimental hematology. I. Characterization of in vitro and in vivo effects on progenitor and transit cells.

The lethal effect of hydroxyurea (HU) on normal and regenerating mouse bone marrow was examined in vivo and in vitro. Progenitor cells (DCPC) were assayed by their capacity to form granulocytes and macrophages in 7-day diffusion chamber (DC) cultures. Dose-response experiments showed that a plateau effect was obtained in vitro for HU concentrations above 1 mM, killing about 40% of regenerating progenitor cells or normal proliferative granulocytes. Similarly, a plateau effect was found for doses exceeding about 15 mg i.p., when lethal effects on 3-4 day DC cultures were measured. Time-response studies in vitro showed that about 60% of maximum killing was achieved after only 10 min, with a levelling off of the effect for exposure times between 1 and 3 h. Total depression of 3H-thymidine incorporation in DC cultures was achieved in less than 0.5 h, and subsided within 4-6 h, after one i.p. injection of 23 mg HU. HU had no appreciable effect on DCPC of adult normal marrow, but killed 15% of agar colony-forming cells.

Animals↗