Biomedical subjects
Publications and source records attributed to D Stajer.
In a sixty-one-year-old patient with chronic polyarthritis, two life-threatening septic events were observed over a period of 6 months. The patient also had a selective IgG3 deficiency. The susceptibility to infection and chronic polyarthritis observed in this patient were very likely a consequence of the selective IgG3 deficiency.
Spectral components of heart rate variability (HRV) are determined in the time-frequency domain using a wavelet transform. Based on the finer estimation of low-frequency content enabled by the logarithmic resolution of the wavelet transform, corrections of spectral intervals, already defined by Fourier and model based methods, are proposed. The characteristic peaks between 0.0095 and 0.6 Hz are traced in time and four spectral intervals are defined, I (0.0095-0.021 Hz), II (0.021-0.052 Hz), III (0.052-0.145 Hz) and IV (0.145-0.6 Hz), within which peaks are located for all subjects included. These intervals are shown to be invariant regardless of the age and the state of the system. We also show that the frequency and power of the spectral components are related to age, AMI and particularly to type II diabetes mellitus.
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We observed a patient with ventricular septal rupture occurring 33 days after a blunt chest trauma. The presumed mechanism was interventricular septal dissection and formation of a pseudoaneurysm that ruptured after a delay. Echocardiography enabled a non-invasive diagnosis and follow-up of the patient.
QTc interval and left ventricular regional wall motion abnormality score (WMS) were assessed in 61 consecutive patients with 4-day-old acute myocardial infarction (AMI). There were 45 men and 16 women, aged 60.6 +/- 8.7 years; 24 had anterior wall AMI and 37 had inferior wall AMI. Twenty-nine patients received thrombolytic treatment, which was presumably successful in 19. The longest QTc interval from a standard 12-lead electrocardiogram, corrected by Bazett's formula, was considered for the study. The WMS was evaluated echocardiographically. The authors found a statistically significant correlation between WMS and QTc interval duration; the correlation was stronger in patients with anterior AMI (r = .9, P < .001) than in those with inferior AMI (r = .66, P < .001). The WMS and QTc values were significantly lower in patients with successful thrombolytic treatment compared to those with unsuccessful thrombolysis (P < .003 and P < .002, respectively). The authors could demonstrate no significant correlation between serum potassium concentration and the QTc interval. In patients with anterior AMI, QTc interval duration might represent an additional marker of left ventricular systolic dysfunction. It could also be used as an additional noninvasive criterion of coronary artery reperfusion in patients with AMI.
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In 60 patients with acute myocardial infarction (AMI) treated with brief i.v. infusion of streptokinase, signal averaged surface ECG as well as 24-hour ECG were recorded within the first 6 hours after admission and 5 to 10 days later. Results obtained from a group with presumed reperfusion (early plasma creatine kinase activity peak, cessation of pain, decrease in ST segment elevations, the appearance of "reperfusion arrhythmias"), were compared to those from patients with no reperfusion. The first recording showed a higher incidence of ventricular late potentials (VLP) in the group with reperfusion (77% vs. 44%, p less than 0.01), and a smaller difference in the incidence of complex ventricular arrhythmias (89% vs. 68%, p = 0.06). In the period between the two recordings, the incidence of VLP decreased in higher proportion in the same group (p less than 0.025). The incidence of complex ventricular arrhythmias was similar in both groups in the second recording. The authors conclude that complex ventricular arrhythmias following successful thrombolytic therapy occur together with "reperfusion VLPs", which are a better marker for successful thrombolysis in patients with AMI than a high grade of ventricular ectopic activity.
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A family with the Romano-Ward syndrome is described. A 28-year-old woman had episodes of syncope due to self-terminating ventricular tachycardia torsades de pointes. During lidocaine treatment she developed a sustained ventricular tachycardia and cardiopulmonary resuscitation was necessary. Propranolol reduced ventricular ectopic activity, but the QTc interval remained prolonged. A "threshold" in QT duration for the generation of complex ventricular arrhythmias was observed in the patient. There were no late ventricular potentials noted in the signal averaged ECG in the patient and in members of her family.
Cardiogenic shock and apnoea appeared in a 78-year-old woman with a history of biventricular heart failure, following ingestion of a single 80 mg verapamil tablet. She was resuscitated with artificial ventilation, dobutamine, norepinephrine and calcium gluconate. Toxicological analysis revealed unexpectedly high plasma verapamil concentration, which was attributed to the patient's liver failure. In patients with advanced heart failure a single oral therapeutic dose of verapamil may have a severe toxic effect.