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Biomedical subjects

J H Thomsen

Publications and source records attributed to J H Thomsen.

At least 19 recordsLinked to original sources
PubMed1987

Catheter drainage of the pericardium. Practical method to maintain long-term patency.

Pericardiocentesis with catheter insertion and drainage is widely used in management of large pericardial effusions and cardiac tamponade. Two potential problems with an indwelling pericardial catheter system are catheter blockage and infection. We have utilized slow infusion of heparinized saline solution (3 ml/hr) via a continuous flush device to maintain catheter patency for up to seven days (mean 3.6) in 16 patients. Pericardial effusions were secondary to malignancy, uremia, and cardiac surgery. This article describes practical aspects of the technique. Most pericardial effusions can be successfully treated with pericardiocentesis and catheter drainage, provided the drainage is continued reliably and safely for several days. Surgical treatment such as subxiphoid pericardiostomy or partial pericardiectomy should be reserved for loculated effusions, clotted blood, subacute effusive-constrictive pericarditis, or significant recurrences after initial drainage.

Adult↗
PubMed1983

Detection and estimation of rheumatic mitral regurgitation in the presence of mitral stenosis by pulsed Doppler echocardiography.

The sensitivity and specificity of pulsed Doppler echocardiography (PDE) in diagnosis and estimation of the severity of mitral regurgitation in the presence of rheumatic mitral stenosis was studied in 34 patients (18 women and 16 men) ranging in age from 33 to 70 years (mean 55). Definitive diagnosis of mitral regurgitation was confirmed in all patients by angiography and in 20 patients also by indicator dilution technique. Mitral regurgitation was detected by PDE in all patients with angiographically proven severe mitral regurgitation and in 7 of 8 patients with moderate mitral regurgitation. In patients with trace to mild mitral regurgitation, PDE was positive in only 7 of 13 patients. When subdivided for mild, moderate and severe mitral regurgitation, PDE sensitivity for diagnosis was 54, 88, and 100%, respectively; overall accuracy was 79% and specificity was 100%. Average systolic dispersion on time-interval histogram was 59% for mild, 89% for moderate, and 100% for severe mitral regurgitation. Groups of patients with mild mitral regurgitation could be differentiated from those with moderate (p less than 0.05) and severe (p less than 0.01) mitral regurgitation. A significant overlap of individual values, however, occurred. In 7 of 11 patients with moderate to severe mitral regurgitation, systolic turbulence also was detected in the left atrium. PDE was sensitive and specific in diagnosing moderate to severe mitral regurgitation in the presence of mitral stenosis. Assessment of precise severity of mitral regurgitation is still a problem in individual patients.

Adult↗
PubMed1983

Multiple calcified thrombi (rocks) in the right ventricle.

Large, organized right ventricular thrombi are rare. This report describes a 51 year old man with a history of recurrent pulmonary emboli treated with inferior vena cava ligation who subsequently developed multiple mobile calcified thrombi in the right ventricle. He was treated successfully by surgical resection. Unusual clinical presentation on admission consisted of a two component friction rub secondary to calcified masses rubbing against each other in systole and diastole. Cardiac catheterization showed a constrictive-restrictive pattern that persisted after surgery. The role of noninvasive studies in the diagnosis and long-term follow-up of the patient is emphasized.

Calcinosis↗
PubMed1983

Estimation of absolute left ventricular volume from gated radionuclide ventriculograms. A method using phase image assisted automated edge detection and two-dimensional echocardiography.

Twenty-four patients underwent gated cardiac blood pool (GBP) imaging, two-dimensional echocardiography (2-D echo), and single-plane contrast ventriculography (within 24 hours). Variable left ventricular (LV) regions of interest on GBP images were identified by an automated threshold radial search. To avoid excluding LV counts we indexed the search threshold to the threshold identified by a phase image generated by Fourier analysis. LV depth calculated by 2-D echo was used for attenuation correction of LV counts. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were calculated by dividing attenuation, background and deadtime corrected LV count rates by the background corrected count rate/ml of venous blood drawn during the study. Correlations between radionuclide and contrast volumes were good (EDV + ESV r = 0.97, EDV r = 0.94, ESV r = 0.95). Regression lines were close to the lines of identity. This method, in which GBP imaging and automated LV edge finding are complemented by 2-D echo for count attenuation correction, demonstrated reliable and reproducible noninvasive estimates of absolute LV volume.

Adult↗
PubMed1981

Cardiac arrhythmias due to oral aminophylline in patients with chronic obstructive pulmonary disease.

The effect of orally-administered aminophylline on cardiac arrhythmias was studied in 15 patients with stable chronic obstructive pulmonary disease by continuous 24-hour ambulatory electrocardiographic recordings. During the control period, the mean frequency of ventricular ectopic beats (VEBs) per hour was 43 +/- 26 (range 0.3 to 401), and heart rate was 80 +/- 3 beats per minute. All grades of ventricular arrhythmias were seen with occasional VEBs in five patients, frequent in three, multifocal in four, coupled beats in two, and short runs of ventricular tachycardia in one patient. Seven patients had occasional atrial premature contractions, six paroxysmal atrial tachycardia, and one patient had stable atrial fibrillation. Mean frequency of VEBs per hour and heart rate were statistically similar in patients undergoing two 24-hour control recordings. Mean grade of atrial and ventricular arrhythmias also remained similar on two control recordings. After oral aminophylline, the mean frequency of VEBs per hour increased to 72 +/- 41 (P = 0.006). Heart rate increased to 88 +/- 4 beats per minutes (P = less than 0.01). The mean grade of ventricular or atrial arrhythmias remained unchanged. We conclude that orally-administered aminophylline has both arrhythmogenic and chronotropic effects, but does not change the grade of arrhythmia.

Administration, Oral↗
PubMed1979

Improved pacing tolerance of the ischemic human myocardium after administration of carnitine.

The possibility that DL-carnitine has a protective effect during myocardial ischemia was evaluated by performing two rapid coronary sinus pacing studies 15 minutes apart in 21 patients with coronary artery disease. Eleven patients received DL-carnitine (20 or 40 mg/kg) before the second pacing study. The treated group had a significant increase in mean heart rate (12.5 beats/min, P less than 0.001), pressure-rate product (1,912 units, P less than 0.01) and pacing duration (3.2 minutes, P less than 0.001) after the administration of carnitine. The treated group also had improvements in percent myocardial lactate extraction (8.8 percent increase, P less than 0.001) and left ventricular end-diastolic pressure (a decrease of 5.3 mm Hg, P less than 0.05). There was significantly less S-T segment depression during the second pacing period in both the untreated and treated groups. The results of this study suggest that in ischemic human hearts with reasonably well preserved left ventricular function, DL-carnitine may improve the tolerance for stress associated with an increase in heart rate and pressure-rate product.

Carbon Dioxide↗
PubMed1979

Pharmacokinetics of l-carnitine in man following intravenous infusion of dl-carnitine.

The pharmacokinetics of l-carnitine were studied in adult male patients following intravenous infusion of dl-carnitine hydrochloride-L-Carnitine appears to distribute into a rapidly perfused and then a more slowly perfused body space following administration. The overall apparent distribution volume Vd (ss) is consistent with extracellular body water. Serum levels of l-carnitine, from two different dose levels were adequately described by a two-compartment model. 80% of the administered dose was recovered in 24 hour post dose urine.

Adult↗
PubMed1979

Carotid sinus syncope induced by malignant tumors in the neck. Emergence of vasodepressor manifestations following pacemaker therapy.

Three patients had carotid sinus syncope secondary to malignant neoplasms in the neck. Pacemaker therapy controlled the cardioinhibitory reflex with bradycardia, but the patients manifested varying episodes of hypotension due to a vasodepressor reflex that most likely resulted from persistent irritation of the carotid sinus by the tumor. These episodes seemed to be self-limiting. Surgical treatment in resistant cases is a possibility.

Carcinoma, Squamous Cell↗
PubMed1977

Adverse effects of right ventricular pacing in a patient with aortic stenosis, Hemodynamic documentation and management.

A patient with moderate aortic stenosis, left ventricular hypertrophy, and a permanent right ventricular pacemaker for a sick sinus node presented with hypotension, dizziness, and angina pectoris with paced beats. The hemodynamics of pacing were documented with non-invasive and invasive studies. The patient was successfully treated with a programmable generator and pacing at a lower rate. The neccessity of evaluating the effects of a temporary pacemaker before insertion of a permanent one and of a reevaluation of the hemodynamic status in the presence of unexplained cardiac failure in a patient with permanent pacemaker are emphasized in this case report.

Angina Pectoris↗