Isolation of Borrelia burgdorferi from the myocardium of a patient with longstanding cardiomyopathy.
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Antibodies, Bacterial↗
Biomedical subjects
D Glogar
Publications and source records attributed to D Glogar.
Diagnosis of a false left ventricular aneurysm with magnetic resonance imaging.
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Female↗
[Cine-MR for the quantification of regurgitation defects by a volume method].
We have examined 46 patients with angiographically confirmed regurgitant lesions (26 mitral insufficiency, 20 aortic insufficiency) using a 0.5 Tesla magnet. In each patient, multiplane and multiphase spin-echo sequences were obtained in a plane angled in the sagittal and coronal direction in the long axis of the heart; left and right ventricular volumes, ejection fractions and regurgitation fractions were calculated. In addition, a blood-flow sensitive gradient echo sequence was obtained in order to determine the direction and extent of the regurgitant jet. The data was compared with the results of angiography and echocardiography. By means of the gradient echo technique, MRI was able to show the regurgitant jet in every patient. There was a linear correlation between volumes determined by MRI and angiography. The best agreement was found for left ventricular contraction volume (R = 0.82, p is less than 0.0001). Comparison of the noninvasive and angiographic method showed a linear correlation for AI patients of R = 0.91 (p is less than 0.001), which is somewhat better than for patients with MI (R = 0.84, p less than 0.001). Semiquantitative grading of MI with a gradient echo technique showed a linear correlation with angiography of R = 0.73 (p less than 0.001), for AI there was agreement between both methods in 72% of cases. A comparison between MRI and colour Doppler sonography showed only moderately good correlation R = 0.69 (p less than 0.01).
Adult↗
[MRT using Gd-DTPA in the diagnosis of tumor and pseudotumor intracardiac masses].
Magnetic resonance examinations were performed in 15 patients suffering from echocardiographically detected intracardiac masses. All patients were examined with a 1.5 T superconducting machine, using spin echo technique, including Gd-DTPA, and gradient echo sequences. The MR findings were confirmed partially by histology and angiography, otherwise by good correlation to clinical findings. MR results were divided into three groups: 1. tumour, 2. thrombosis, 3. pseudotumorous mass, and corresponded well with the final diagnosis: in 8 patients tumour, in 5 patients thrombosis, and in two patients pseudotumorous masses, including one hydatid cyst and one case of lipomatosis. Tumours showed in contrast to thrombosis marked enhancement after gadolinium injection, whereas the hydatid cyst and the lipomatosis demonstrated characteristic signal behaviour. Problems existed in differentiation mass vs slow flow, in the detection of very small masses, and in the assessment of wall-fixation and motion of a mass during cardiac cycle. The results demonstrate that MRI with Gd-DTPA can give important additional information in the differential diagnosis of echocardiographically detected intracardiac masses.
Adolescent↗
Cardiac calcific deposits in patients with primary hyperparathyroidism: preliminary results of a prospective echocardiographic study.
To explain the incidence and significance of mitral and aortic valve calcification and calcific deposits in the myocardium, a prospective echocardiographic study was performed with 21 consecutive patients who had primary hyperparathyroidism (PHP) and with 21 age- and sex-matched control subjects with normocalcemia. Calcific deposits in the myocardium were seen in 13 patients (62%) with PHP, mainly in the interventicular septum, and in one control subject. Aortic valve calcification was observed in 12 patients (57%) with PHP and in one control subject. Calcification of the mitral valve was found in seven patients with PHP (33%) and three controls (14%). Calcification led to mild or moderate stenosis of the aortic valve in three patients with PHP and of the mitral valve in two patients with PHP. No stenosis was found in the subjects in the control group. Both calcification of the aortic and mitral valves and calcific deposits in the myocardium are common in patients with PHP and can be detected noninvasively by echocardiography. Because of the potential relationship of elevated calcium, calcification, and valvular heart disease, clinical evaluation of PHP should include echocardiographic studies before surgery is performed and during follow-up examination.
Adult↗
Humoral regulation during cold-induced coronary arterial spasm.
Previous attempts to define the etiology of coronary arterial spasm have been focused on mechanisms such as autonomic nervous dysfunction and/or enhanced platelet activation. In the present study, humoral regulation was investigated in patients with vasospastic angina and scintigraphically documented transient myocardial perfusion abnormalities after a peripheral cold pressor test. Serial changes in angiotensin II, epi- and norepinephrine as well as thromboxane B2 (the stable derivate of thromboxane A2), and malondialdehyde were determined at baseline (I), immediately after 5 minutes cold water hand immersion (II), and following 10 minutes recovery (III). Angiotensin II and epinephrine remained unchanged during observation (I vs II, II vs III: P = NS). Norepinephrine was elevated after cold (I vs II: P less than 0.001) and normalized after 10 minutes (I vs III: P = ns). Thromboxane B2 and malondialdehyde increased continuously (I vs III: P less than 0.05 and I vs III: P less than 0.002, respectively). Further radiothin-layer chromatography results indicate an activation of platelet function during myocardial ischemia. Our results do not establish a cause-effect relationship but, together with other evidence, they may suggest that thromboxane A2 is unlikely to be the cause of spasm. It might, however, play an important role in the maintenance of vasoconstriction.
Angiotensin II↗
Anomalous pulmonary venous drainage shown by duplex sonography, computed tomography, and plain radiography.
In a patient with the scimitar syndrome duplex Doppler sonography was used to show the point of entry of the abnormal pulmonary vein into the inferior vena cava to determine blood flow. Chest radiography and computed tomography also showed the vein descending to the diaphragm.
Aged↗
Cine-MR in dissection of the thoracic aorta.
Magnetic resonance imaging (MRI) of the thoracic aorta, including cine-MRI, was performed in 25 patients suspected of having dissection of the thoracic aorta. MRI was correlated with echocardiography, CT and angiography. The sensitivity of MRI (100%) was most closely followed by CT and angiography (83% and 77% respectively). The specificity of MRI and angiography was equally good, at 100% each. MRI was able to demonstrate the intimal flap in all 9 cases of aortic dissection, and there were no false-positive results. Differentiation of thrombosis and slow flow was possible on proton density images, gradient echo images permitted detection of the entry and re-entry sites. The nature of the dissection was determinated correctly in 8 out of 9 cases. MRI is capable of providing all the relevant parameters necessary to decide appropriate treatment of dissecting aneurysms of the thoracic aorta.
Adolescent↗
[Magnetic resonance tomography in the assessment of questionable aneurysm of the thoracic aorta with or without dissection of the intima].
To assess the value of MRI in the diagnosis of aneurysm of the thoracic aorta with suspected or known dissection 23 patients were imaged with cardiac gating. Seven patients (group 1) had known dissection of the thoracic aorta; in 16 patients (group 2) an aneurysm was suspected by chest x-ray or 2D-echocardiography. Reference methods were: x-ray, 2D-echocardiography, angiography, and computered tomography. In the first group MRI clearly identified the intimal flap, could differentiate between true and false lumen, slow flow, and thrombus, respectively. In the second group MRI could exclude a dissection of the ectatic part of the thoracic aorta in 11 patients and demonstrate paracardiac or mediastinal mass in five patients. MRI can serve as an important diagnostic tool in known or suspected aneurysm of the thoracic aorta.
Adolescent↗
Determination of triacylglycerols in serum by capillary gas chromatography with trinonadecanoylglycerol as internal standard.
An accurate capillary gas-chromatographic method with trinonadecanoylglycerol as internal standard for determining triacylglycerols in human serum and other biological sources is described. After serum extraction, total triacylglycerol and triacylglycerol species (differing in the number of carbon atoms in the acyl radicals) are directly determined without any further sample manipulation. In addition, from the same gas-chromatographic run the data obtained by the integrator record are compared with those of a computer data acquisition system. Evaluation of the triacylglycerol values resulted in a coefficient of variation (CV) of 2.08% (computer evaluation). Simultaneous evaluation of data obtained from tripalmitoylglycerol and tristearoylglycerol standards resulted in CV of 2.04 and 1.99%, respectively (computer evaluation), and 6.63 and 4.84%, respectively (integrator evaluation). Gas chromatography at lower elution temperature resulted in better separations but enhanced CV values up to about 4%. Triacylglycerol values were not influenced by storage of plasma at -20 degrees C up to 4 days prior to extraction.
Chromatography, Gas↗
Increase of pulmonary vascular resistance during cold provocation in patients with variant angina.
This study was performed to evaluate pulmonary vascular reactivity in patients with angiographically documented coronary vasospasm. Right heart catheterization was performed in 8 subjects with vasospastic angina without evidence of Raynaud's phenomenon: heart rate, systemic and pulmonary arterial pressure as well as cardiac output were determined at rest, during cold provocation and after 20 minutes recovery. Data were obtained both before and during treatment with nifedipine. During cold provocation pulmonary vascular resistance was elevated significantly (P less than 0.02 compared with baseline); systemic vascular resistance tended to increase; nifedipine blunted both vasoconstrictor effects. Our results indicate an abnormal vascular response of the pulmonary arteries to cold provocation in patients with symptomatic coronary artery spasm and suggest a primary vasospastic disorder with coronary and pulmonary manifestation.
Adult↗
Characteristics of transient ischaemic episodes in patients with silent and symptomatic exercise-induced myocardial ischaemia.
To evaluate transient ischaemic episodes during daily life in patients with coronary artery disease and exercise-induced myocardial ischaemia, 38 patients underwent ambulatory ST-segment monitoring over 48 h. Sixteen patients had painless ischaemia during exercise and occasional angina, and 12 patients had symptomatic ischaemia and frequent angina during daily life. Ten patients with proven coronary artery disease but normal exercise electrocardiograms served as controls. The extent of coronary artery lesions and the prevalence of myocardial infarction were similar in all groups. ST-segment monitoring revealed 817 min and 98 episodes of ST depression in 13/16 patients of the asymptomatic group and 111 min and 21 episodes in 5/12 patients of the symptomatic group (P less than 0.03). Subjective scores for physical activity during Holter monitoring were significantly higher in the first group than in the second. The majority of ischaemic episodes in both groups was asymptomatic. No ischaemic ST changes occurred in control patients. Results indicate a higher frequency of transient ischaemic episodes related to a higher level of physical activity in patients with silent ischaemia than in patients with symptomatic exercise-induced ischaemia.
Angina Pectoris↗
The effect of sotalol on exercise-induced ventricular arrhythmias.
Sotalol is a non-selective beta-adrenergic blocking agent with class III antiarrhythmic properties. Our study was intended to assess the efficacy of sotalol on exercise-inducible arrhythmias by oral administration to out patients. Thirty patients with exercise-inducible arrhythmias (80% coronary artery disease, 20% congestive cardiomyopathy) were studied after two baseline bicycle ergometric stress tests performed in upright position. Twenty-five patients (including nine crossover cases of the lower dose protocol) were given sotalol in a daily dose of 320 mg (group 1) and 14 patients in a dose of 160 mg (group 2). After 2 and 8 weeks, respectively, group 1 showed a mean reduction of the total number of inducible ventricular premature beats (VPBs) of 50% (P = 0.0042) and 61% (P = 0.0107), respectively and a significantly improved Lown score (P = 0.0002 and 0.0006, respectively). A significant antiarrhythmic response was not demonstrable for group-2 patients. Because of inefficacy, nine patients were changed from group 2 to group 1. Reduction of arrhythmias on the higher dose was significant (P = 0.0147) in this group. There was the same significant reduction of the heart rate pressure product with the low and high dosage indicating that the beta-blocker effect is achieved with the lower dosage. We conclude that sotalol is a powerful drug for reducing the number and complexity of ventricular arrhythmias in a dose of 320 mg daily. As the beta-blocking effect in both groups was the same, we assume that the reduction of arrhythmias is mainly due to class III action.
Adolescent↗
Acute vascular toxicity after combination chemotherapy with cisplatin, vinblastine, and bleomycin for testicular cancer.
Twenty-one consecutive patients with testicular cancer treated with bleomycin, vinblastine, and cisplatin (PVB) were evaluated for acute vascular ischaemic events during chemotherapy. Angina pectoris occurred in 8/21 (38%) patients, a median 5.6 weeks after initiation of chemotherapy and persisted for 2-7 days. Raynaud's phenomenon was detected in seven (33%) subjects, transient ischaemia of the toes was found in six (29%) patients, one patient complained of migraine, but none had major cerebrovascular accidents. Patients with and without angina pectoris and/or Raynaud's phenomenon did not differ in respect of age, histology of tumor or medication. Ischaemia occurred at any time during the course of chemotherapy. No correlation was found between dosage of drugs and time of onset of ischaemic reactions. However, arterial occlusive event is a frequent and common toxicity and a result of treatment with PVB.
Adult↗
Survival rate and causes of death in patients with pacemakers: dependence on symptoms leading to pacemaker implantation.
The survival rate of 2256 patients with pacemakers was analyzed. Patients paced for Adams-Stokes equivalents (e.g. dizziness) showed a significantly better survival rate than did patients with pacemakers implanted for Adam-Stokes attacks or heart failure (P less than 0.0001). The estimated survival of the latter two groups did not differ significantly. Of the deceased patients who had received a pacemaker for the treatment of heart failure, 54% died due to this condition despite pacemaker implantation. The relative percentage of cases of sudden death after pacemaker implantation was high in the groups with Adams-Stokes attacks (12%) and Adams-Stokes equivalents (13%). In patients paced for Adams-Stokes attacks, sudden death occurred more frequently in the first year after pacemaker implantation (P less than 0.015) than during the following years. Therefore, increased efforts should be made to monitor patients carefully after pacemaker implantation to enable prompt detection of malignant tachyarrhythmias, probably the cause of sudden death in a substantial number of patients with pacemakers.
Adams-Stokes Syndrome↗
Ventilation with the esophageal tracheal combitube in cardiopulmonary resuscitation. Promptness and effectiveness.
The success of cardiopulmonary resuscitation after cardiac arrest depends not only on the duration of the arrest, but also on the prompt establishment of a patent airway. In this study, we tested the safety and promptness of intubation with esophageal tracheal combitube (ETC) when compared to conventional endotracheal airway. Effectiveness of ventilation via the ETC as shown by blood gas analyses appeared to be comparable to endotracheal airway. Data suggest that the ETC might serve as a useful device during cardiopulmonary resuscitation.
Blood Gas Analysis↗
[Heavy metal and trace element deviations. A comparison of idiopathic dilated cardiomyopathy and coronary heart disease].
Blood, serum and urine (24-hour-samples) concentrations of cadmium, zinc, calcium and magnesium were determined by means of atomic absorption spectrophotometry in 60 patients, therefrom 30 patients with idiopathic dilated cardiomyopathy (IDC) and 30 patients with coronary heart disease (CHD). The data of heavy metal and trace element concentrations of IDC and CHD patients were compared with each other and furthermore, for each group separately, correlated with patients history data, laboratory evaluations and data from heart catherization protocol. IDC patients showed higher blood cadmium concentrations (p less than 0.001) and lower serum zinc concentrations (p less than 0.001) compared to CHD patients. Serum levels of calcium and magnesium were not different in both groups. In urine samples IDC patients had lower concentrations of calcium (p less than 0.01) and magnesium (p less than 0.01) compared to CHD patients. Urine concentrations of cadmium and zinc were in the same range in both groups. The comparison of heavy metal and trace element concentrations with clinical data did not reveal definite correlations, however, data from experimental studies pointing out interactions of heavy metals and trace elements, could serve as useful interpretations. Hypomagnesemia in both patient groups (IDC, CHD) requires clinical follow up and substitution treatment.
Aged↗
R-wave amplitude changes during exercise stress testing: patients with dilative cardiomyopathy compared to patients with coronary artery disease.
R-wave amplitude (RWA) depends to a large extent on the left ventricular filling volume. Changes of RWA are attributed to the Brody-effect. Exercise has been shown to induce a decrease of RWA in a healthy population and an increase in patients with coronary artery disease (CAD). No clear data exist for cardiomyopathy (CMP). Controls (n = 12), patients with CMP (n = 32) and CAD (n = 58) were compared. Alterations of RWA (Wilson lead V5) were correlated with parameters of a bicycle exercise test including resting and exercise hemodynamics and parameters of LV-function including EF, LVEDV and LVEDP. CMP compared to CAD had smaller RWA at rest (0.78 +/- 0.47 vs 1.32 +/- 0.72 mV, P less than 0.01). During comparable levels of exercise CMP (EF 35 +/- 14%) showed no significant changes of RWA. CAD (EF 57 +/- 16%) presented an increase of RWA by +0.11 +/- 0.23 mV (P less than 0.01), while controls showed a straight decline of RWA (-0.31 +/- 0.24 mV). In patients with CAD delta RWA (RWA max exercise - RWA rest) was a more sensitive parameter for detection of disease (assuming delta RWA greater than or equal to +0.1 mV, 36/58 patients) than maximal ST-segment changes (ST-segment-depression in lead V5 greater than or equal to 0.2 mV at 0.08 sec after J-point, 22/58 patients). Precordial leads V2, V4, V5 and V6 showed similar changes. This paper supports the theory that changes of wall thickness or changes in the amount of air respective to the amount of fluid in the lungs are responsible for RWA changes. These changes are clearly dependent on the severity of the disease and on left ventricular function. Therefore measurement of RWA changes during exercise may offer additional information in patients with CAD as well as in patients with CMP.
Adult↗