Biomedical subjects
Publications and source records attributed to B Martina.
We present two patients with exercise-induced bundle branch block (BBB), in which coronary heart disease could not be diagnosed by noninvasive techniques. Exercise-induced BBB (right BBB more than left BBB) is strongly associated with and requires intensive search for coronary heart disease.
We analyzed the postoperative longterm results after strumectomy for sporadic goiter in 26 patients. The follow-up time was 25.1 +/- 14.7 (7-58) years (x +/- SD, extremes). Actual goiter recurrence without need for surgery was observed and sonographically confirmed in 3 patients, and 1 patient without actual recurrence had had a second strumectomy for goiter recurrence in the past. Hence the overall frequency of goiter recurrence in this study is 15% (4/26 patients). The patients with a present recurrence (n = 3) were significantly younger at the time of operation (29 +/- 11, 14-41 years) than those without recurrence (n = 23; 45 +/- 11, 28-60 years; p < 0.001). No patient had clinical endocrine dysfunction. Only four patients had been treated with thyroxine and they all suppressed TSH in the presence of euthyroid FT4 and T3 levels without present recurrence of goiter. 22 patients had no thyroid hormone prophylaxis and in only four of them (18%) was observed a recurrence in the longterm follow-up without endemic iodine deficiency. Prophylaxis with thyroid hormones often is not required in low risk patients operated upon and carefully controlled after strumectomy from non-iodine-deficient regions. Patients at risk for recurrence (second strumectomy, family history, elevated TSH, clinical or sonographic evidence for thyroid growth) should be considered for thyroxine therapy with regular follow-up.
Carnitine, a quaternary amine (3-hydroxy-4-N-trimethylaminobutyric acid), plays an important physiologic role in fatty acid transport and metabolism as well as in energy production of the myocardial cell. L-carnitine in high doses has been postulated to have an antiarrhythmic effect and this has also been clinically proven. We studied 20 patients with acute myocardial infarction (AMI), 4-12 hours after onset of pain. The patients were randomized and treated double-blind with 5 g L-carnitine (n = 12) or placebo (n = 8) at hours 0, 12, 24, 36, and with 2 x 3 g on days 3 to 7 by intravenous infusion over 2 hours. The two groups were similar for age, sex, infarct site, maximum CPK and conventional antiarrhythmic therapy. 24-hour Holter-ECG was performed on days 1, 2 and 7 and showed no significant difference between the two groups with respect to incidence of ventricular premature beats (VPB) per hour. On the second day following AMI, however, only 4 of 12 carnitine-treated patients showed high-grade VPB (Lown IVa and IVb), in comparison with 7 of 8 patients in the placebo group. The difference is significant: p = 0.028 (Fisher's Exact Test). Carnitine was well tolerated and the efficacy demonstrated on the second day following AMI must be interpreted with caution.
A 43 year old man developed extensive supraventricular and ventricular extrasystoles (over 500 supraventricular extrasystoles per hour, VES class II) within 3 months after orthotopic heart transplantation because of dilatative cardiomyopathy. At the same time severe graft rejection (class III according to Billingham) was documented. After treatment of the rejection the following three controls by 24 hours Holter EKG showed only slight supraventricular extrasystoles of less than 10 per hour and in three consecutive myocardial biopsies no rejection process requiring additional treatment was found. In individual cases severe ventricular arrhythmia registered by the family doctor may be a first hint for early rejection. Since intervals for inpatient controls have been extended observation of extrasystoles may be helpful for initiation of a next inpatient control. Incidence of extrasystoles after heart transplantation in the cyclosporine-era is discussed.
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During a 15-year period (1973-1988) a consecutive series of papillary (n = 52) and follicular (n = 48) thyroid carcinomas was prospectively selected, on the basis of a clinico-pathologic and prognostic classification, for 1. non-total thyroidectomy, mostly hemithyroidectomy (n = 37), 2. total thyroidectomy (n = 19), or 3. total thyroidectomy and radioiodine (n = 44), together with exogenous suppressive thyroxine therapy in most patients. Patients with an occult or with an intrathyroidal, single papillary carcinoma without nodes, and microangioinvasive follicular carcinoma were often treated by non-total thyroidectomy or without radioiodine. During the follow-up period of 1-15 (7 +/- 4) years 5 recurrences (nodes n = 4, pulmonary n = 2) and 3 deaths occurred. Seven out of the 8 patients (age 58-76 years) had total thyroidectomy and radioiodine as initial treatment of an intrathyroidal papillary (n = 1), an extrathyroidal papillary (n = 3), and of an angioinvasive follicular (n = 4) carcinoma, respectively (no radioiodine in 1 patient). The study confirms that the outcome may be favourable in selected patients following hemithyroidectomy or without radioiodine treatment. Recurrences or death occurred in some biologically unfavourable tumors despite total thyroidectomy and radioiodine; the relatively frequent total thyroidectomy (73% of the patients) and radioiodine (51%) may have contributed to the disease-free course in the remaining patients.
A patient with an inflammatory fibrous tumor of the mesenteric fat tissue is reported. Clinical signs were epigastric pain, weight loss and palpable abdominal mass. diagnosis was by abdominal CT and surgical biopsy. The histological feature was diffuse fibrosis. Isolated mesenteric fibrosis is a rare variety of systemic idiopathic fibrosis, a disease entity including fibrosis of the retroperitoneum and other sites. Among possible etiological factors an autoimmune origin, drugs (methysergide) and lymphatic obstruction are discussed. Our patient had congenital hypoplasia of the lymphatic drainage system of the legs. She recovered rapidly and spontaneously and the tumor regressed on CT. Fatal courses are exceptional and medical therapy usually is not required.
Serum potassium in 20 patients with acute myocardial infarction (AMI) measured 2 to 6 hours after the beginning of chest pain was 3.8 +/- 0.4 mmol/l. This was lower than the value of 4.1 +/- 0.2 mmol/l of 29 controls admitted for elective evaluation of coronary heart disease. In patients with AMI there was a negative linear correlation between serum potassium and lymphocyte count. The hypothesis that AMI induces a decrease in potassium concentration by accompanying epinephrine secretion is supported by this correlation. In addition, respiratory alkalosis may play a role because it also induces hypokalemia and lymphocytosis. In view of the arrhythmogenic effect of hypokalemia, measures which reduce the epinephrine increase and hyperventilation, such as analgesic therapy and sedation, should be of potential antiarrhythmic value.
Operative treatment for rectal carcinoma has two aims, locoregional cure and sphincter preservation if possible. In a consecutive series, patients were selected for anterior resection, abdominoperineal excision, local tumor excision, and sphincter-preserving resection with anastomosis performed by a transsphincteric or transanal approach. Results with respect to local recurrence and survival rates were comparable to those obtained with conventional radical surgery.
In a consecutive personal series of rectal carcinoma treated for locoregional cure (n = 125) various surgical procedures were employed. 21 patients with a pT1 tumour remained without recurrence with local excision in 17, and with a major restorative excision in the remainder patients. Though only 7 (20%) of the pT2 tumours were selected for local excision, secondary amputation became necessary in 3 instances for nodal involvement. Nodal staging was successful in one third of the local excisions performed. Extension of low anterior (n = 54) to abdominotranssphincteric (n = 11) and abdominotransanal (n = 16) resections was useful for preservation of continence and for performing a major procedure instead of local excision, with satisfying results of locoregional cure. Abdominoperineal excision was the treatment of choice for large tumours lying below 6 cm (n = 15) or in patients with a patulous anus (n = 5).