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Biomedical subjects

J Janousek

Publications and source records attributed to J Janousek.

54 records · Page 3Linked to original sources
PubMed1989

[Cardiac arrhythmia following total correction of tetralogy of Fallot].

41 patients after surgical correction of the tetralogy of Fall of aged 2-24 years (mean 11.2 y.) were followed for 12-65 months (mean 39.5 m.) for known or suspected dysrhythmias. 24-hour ambulatory ECG and exercise testing demonstrated nonsignificant ventricular ectopy (grade 0-1 according to a modified Lown classification) in 28 patients (group I) and significant (grade 2-5) ventricular dysrhythmias in the remaining 13 patients (group II). There were 2 cases of sudden late death in group II, whereas all patients in group I are alive. The victims of sudden death had no, other serious dysrhythmias and received no antiarrhythmic treatment. Ejection fraction of the functional part of the right ventricle estimated by radionuclide angiocardiography was not different in both groups whereas, global right ventricular ejection fraction differed nearly significantly (group I: 39.6 +/- 8.3%, group II: 31.9 +/- 10.4%, p = 0.052). Thus, a diminished global right ventricular ejection fraction caused by an extensive resection and large patch in the right ventricular outflow tract may be connected with the occurrence of higher grades of ventricular ectopy. These may lead to sudden late death.

Adolescent↗
PubMed1989

[Amyloidosis in plasmacytic myeloma with dominant manifestations of joint involvement].

The authors describe a case of plasmocytic myeloma complicated by the development of systemic amyloidosis. The symptoms were dominated by marked macroglossia and arthropathy which by the objective finding and subjective manifestations imitated rheumatoid arthritis. In the discussion the authors emphasize general manifestations of amyloid arthropathy.

Aged↗
PubMed1989

[Various systems of long-term ECG (Holter) monitoring in clinical practice].

Seven various 24-hour ambulatory ECG systems from six producers (Trendsetter 9000A--Del Mar Avionics, Epicardia HC and PC--Medicomp, Epicardia FD--Hellige, Spacelabs 90,101-Spacelabs, Medilog 4000--Oxford, Laser Holter 8000T--Marquette) were used over a 4-year period to gather the experience with a total of 449 24-hour ECG recordings. The quality of the automatic analysis, the mode of access to the ECG data, control and correction possibilities, operator time consumption, report quality, costs and availability of consumeables were individually evaluated. In the country's specific conditions/shortage of some type of consumeables), Laser Holter 8000T was regarded as the most useful device followed by Epicardia FD and Medilog 4000.

Electrocardiography↗
PubMed1989

Diagnostic and therapeutic use of transesophageal atrial pacing in children.

Transesophageal atrial pacing was used in 29 consecutive patients aged 1 day to 16.5 years (mean 8.04 years) to replace the following procedures: intracardiac electrophysiologic study in patients with selected arrhythmias (21 patients), intracardiac overdrive or synchronized direct current cardioversion of supraventricular tachyarrhythmias or drug administration in patients with acute reciprocating supraventricular tachycardia (9 patients). Atrial capture was achieved without discomfort in 27 patients (93.1%). The diagnostic or therapeutic goal of the procedure was achieved in 26 children (89.7%). Transesophageal atrial pacing may replace intracardiac pacing procedures, direct current cardioversion and drug administration in patients with selected cardiac arrhythmias and has proved appropriate as a first diagnostic or therapeutic step.

Adolescent↗
PubMed1989

Detection of Borrelia in the synovial tissue from a patient with Lyme borreliosis by electron microscopy.

We describe a woman who suffered for several years from joint pain with subsequent development of arthritis of her left knee. Because of these symptoms she was subjected to repeated studies including arthroscopy and menisectomy. IgG antibodies to Borrelia determined by ELISA were reported to be present and showed an increase of IgG titer to 1:1024. Histology from the last synovial biopsy disclosed only evidence of a nonspecific synovitis and marked inflammatory infiltration with lymphocytes and plasma cells. Borrelia-like structures were detected electron microscopically on semithin Epon sections from the lumen of the strongly infiltrated blood capillary. In our case the detection of Borrelia indicated the basis for increase of antibodies against Borreliae. It established the correct diagnosis and led to specific therapy of the disease after several years of unsuccessful attempts to control it.

Antibodies, Bacterial↗
PubMed1989

[Tumor of the left atrium and supraventricular tachycardia in the fetus--prenatal diagnosis and treatment].

During the 29th week of gestation the authors diagnosed supraventricular tachycardia of the foetus and pathological echogenity in the region of the mitral valve, most probably of tumourous aetiology. By transplacental digitalization the supraventricular tachycardia was controlled; according to Doppler analysis the tumour did not interfere with the flow to the mitral orifice. Post-natally the diagnosis of a tumour in the left atrium was confirmed. Surgery was so far postponed in view of the normal haemodynamics.

Adult↗
PubMed1988

Reduction of incorrect antibiotic dosing through a structured educational order form.

Antibiotics are often used inappropriately in hospitals. We created a structured antibiotic order form designed to guide physicians toward correct therapeutic decisions without restricting their clinical options. Educational messages and graphic reminders were incorporated into a new form required to order parenteral antibiotics at a teaching hospital. Pharmacokinetic considerations were emphasized. The forms were supplemented with brief literature reviews and appropriate references. Before introduction of the form, pharmacokinetically incorrect orders for clindamycin, cefazolin sodium, and metronidazole hydrochloride accounted for 90%, 60%, and 75% of patient-days of therapy for these drugs, respectively. Immediately after implementation of the form, nonrecommended dosing schedules dropped to under 6% of patient-days for all three antibiotics. Savings from these drugs alone accounted for over $76,000 annually. We conclude that in a period of increasing constraints on hospital budgets and proliferating restrictions on physicians' clinical choices, educational intervention at the time orders are written can provide a cost-effective and noncoercive means of improving some forms of acute-care clinical decision making.

Anti-Bacterial Agents↗
PubMedDate not supplied

New antiarrhythmic drugs in pediatric use: propafenone.

Propafenone hydrochloride, a class 1C antiarrhythmic agent, combines sodium channel-blocking effects with beta-blocking capacities and a weak calcium antagonism. The drug exerts marked electrophysiologic effects on accessory atrioventricular pathways. In patients with atrioventricular nodal reentry tachycardia, propafenone is able to block conduction in the fast conducting pathway. In addition, propafenone is very effective in young patients with supraventricular tachycardia based on enhanced abnormal automaticity. In pediatric patients, left ventricular performance remains unimpaired. Proarrhythmic events have been noted in children only occasionally. In accordance with the electrophysiologic profile, intravenous and oral propafenone is an effective agent for treatment of supraventricular tachycardia based on a reentry mechanism and due to abnormal automaticity (i.e., supraventricular tachycardia based on an accessory atrioventricular pathway, atrioventricular nodal reentry tachycardia, junctional ectopic tachycardia, and atrial ectopic tachycardia). In children with ventricular dysrhythmias, efficacy seems to be related to the underlying cardiac diagnosis. Propafenone is well tolerated in the majority of young patients. Incidence of proarrhythmic events seems to be lower with propafenone than with other class 1C agents. However, the risk of these serious adverse events should be taken into account when therapy with propafenone is considered, particularly in patients with structural heart disease.

Atrioventricular Node↗