Biomedical subjects

J Kasalický

Publications and source records attributed to J Kasalický.

At least 19 recordsLinked to original sources

PubMed2001

Pretest clinical diagnosis of coronary artery disease and stress myocardial perfusion scintigram.

BACKGROUND: To assess the probability of perfusion defects at exercise stress myocardial perfusion SPECT scintigraphy from pretest clinical diagnosis (medical personal history, previous ergometric investigation). To determine the value of clinical factors for probability of scintigraphic defects with respect to avoiding unnecessary investigation in subjects with low probability of abnormal scintigrams. MATERIAL AND METHODS: 2143 subjects (1235 men, 908 women) were investigated by SPECT perfusion scintigraphy at stepwise increasing exercise stress. They were divided into three groups with regard to their medical history and exercise test at scintigraphy: subjects without any signs of coronary artery disease (CAD), patients with high likelihood of CAD (i.e., typical anginal pain, in particular at stress, positive stress ECG changes, angiographically documented important CAD) and patients after myocardial infarction (MI). Important risk factors (hypertension, diabetes, age and sex), as well as the role of revascularisation procedures, were taken into account for multiple logistic regression in order to express their importance for the odds of scintigraphic defect visualisation. RESULTS: Perfusion scintigraphic defects (PSD) were found in 5.2% of subjects without signs of CAD, in contrast to patients with manifest CAD (68.8% with PSD) and in those after MI (90.2% with PSD). There were other important factors corroborating the likelihood of PSD (in decreasing order of importance): diabetes, male, ECG changes at stress, increasing age. Successful revascularisation improved scintigraphic images. CONCLUSION: The examination of CAD symptom-free subjects, in particular with atypical chest discomfort, is useless. SMPS in patients after documented MI is to be carried out for other intended purposes, not for CAD diagnosis only. SMPS is highly recommended in patients with CAD symptoms and high CAD probability in order to decide further treatment and prognosis.

Journal Article↗

PubMed2001

18F-fluorodeoxyglucose accumulation in the heart, brain and skeletal muscle of rats; the influence of time after injection, depressed lipid metabolism and glucose-insulin.

BACKGROUND: To study the effect of lipid depressing drugs on (18)FDG myocardial concentration. The changes of (18)FDG uptake in myocardium, brain and skeletal muscle of rats were compared as influenced by acipimox, tyloxapol and glucose with insulin. MATERIAL AND METHODS: 5.55 MBq of (18)FDG were administered to Wistar rats. Control rats were killed 15, 30, 45 and 60 minutes following intravenous injection and the radioactivity concentration (cpm/g of tissue) in relation to injected cpm was determined in a well crystal adjusted to 511 KeV in order to check the time of maximal (18)FDG tissue uptake. The radioactivity in myocardium, skeletal muscle and brain in intact animals was compared with that of rats treated with tyloxapol (tritton WR 1339, 125 mg intravenously immediately before (18)FDG injection), acipimox (nicotinic acid derivative, 25 mg by stomach cannula 15 minutes before (18)FDG), or glucose with insulin (intravenous injection of 0.04 g and 0.04 UI immediately before (18)FDG). The animals were killed 45 minutes following (18)FDG injection. RESULTS: Tyloxapol and acipimox significantly elevated myocardial (18)FDG concentration (tyloxapol +37% and acipimox +48%), but the increase in (18)FDG concentration after glucose and insulin was slight and insignificant. The changes in skeletal muscle after lipid depressing agents were quite contrasting; the decrease in (18)FDG concentration was -74% after tyloxapol and -44% following acipimox administration. The accumulation of (18)FDG in brain was not influenced markedly by the drugs used or by glucose with insulin. CONCLUSION: The highest (18)FDG uptake in myocardium could be achieved by depressing the lipid metabolism and not by administration of glucose with insulin only. A marked increase in glucose accumulation in myocardium is not possible without previous shift from the utilisation of fatty acids. This finding is fully in agreement with present knowledge about energetic metabolism of myocardium.

Journal Article↗

PubMed2000

[Transmyocardial laser revascularization of the myocardium and coronary reconstruction without extracorporeal circulation].

The authors report their experience with myocardial revacularization using transmyocardial laser revascularization combined with aortocoronary reconstruction without the use of extracorporeal circulation. The discussion section addresses indications for the procedure, operative tactics, the benefits and limitations of the above technique.

Adult↗

PubMed1998

The effect of repeated strontium-89 chloride therapy on bone pain palliation in patients with skeletal cancer metastases.

One hundred and eighteen patients with painful skeletal metastases of malignant diseases (predominantly prostate, breast and lung cancer) were treated with 150 MBq of strontium-89 chloride (Metastron, Amersham, UK) intravenously. The results were evaluated according to a score considering pain relief, mobility, analgesic intake and general feeling. In only five patients (4.2%) was no improvement observed; mild improvement was noted in 48 (40.7%), and substantial or complete improvement in 56 (47.5%) and 9 (7.6%), respectively. The mean painless period after a single 89SrCl dose was 3.3 +/- 2.28 months (in patients with prostate, lung, breast and other types of cancer it was 3.65 +/- 2.11, 3.29 +/- 1.27, 3.08 +/- 0.48 and 3.44 +/- 1.36 months, respectively). During a 3-year study, 89SrCl treatment was successively repeated up to 5 times in some patients (total number of Metastron applications was 256) who benefited from the first Metastron administration and did not show signs of myelosuppression. Even after repeated treatment, relief was consistent and the duration of the period without pain increased (in particular in patients with breast cancer, in whom the period of relief was prolonged from 3.08 +/- 0.48 months after the first dose to 5.33 +/- 2.36 months after the fifth 89SrCl administration). The increased painless period was not observed after repeated treatment in the patient group comprising miscellaneous types of cancer, and the degree of improvement was less apparent. During the course of successive 89SrCl treatments, transient signs of myelosuppression indicated by a decrease in white cell and thrombocyte counts of at least 25% were observed 10 times after Metastron administration (twice in two patients), i.e. in 3.9% of all 89SrCl administrations; these transient haematological changes of moderate grade were closely connected with Metastron administration. Palliative treatment of metastatic skeletal pain with 89SrCl improves the quality of life in most patients suffering from prostate, lung and breast cancer and may be safely repeated with the same benefit and without significant myelosuppression. The beneficial effect of 89SrCl treatment seems to be less pronounced in other types of cancer with painful skeletal metastases.

Adult↗

PubMed1993

Analysis of ventricular activation in patients with chronic non-Q wave myocardial infarction: comparison with left ventricular asynergy and myocardial perfusion defects.

In this report, we dealt with ventricular activation abnormalities in 30 patients with previous non-Q myocardial infarction (MI) by means of the CARDIAG 128.1 device, which enables analysis of ECGs, VCGs and body surface potential maps. The diagnosis was verified by left ventriculography, echocardiography and perfusion scintigraphy. Twenty-nine healthy subjects served as the control group. Morphological findings confirmed the presence of a significant subgroup with serious left ventricular asynergy. Seven electrocardiological variables, which significantly differed from control values, disclosed that non-Q MI is responsible for localized activation time prolongation, and that inferoposterior scars tend to delay the entire activation of ventricles, and to cause disturbances of the terminal depolarization phase together with a decrease in voltage production during QRS. Lesions of the anterior wall and the apicomesial part of the inferoposterior wall affect the distribution of the Q wave more often than the posterior basal ones. The probability of such abnormalities increases with the degree of asynergy. Some VCG criteria increase the sensitivity of electrocardiological analysis. These parameters will be used for evaluating the diagnostic value of electrocardiological analysis in the chronic non-Q MI. Non-Q myocardial infarctions represent a heterogeneous group of infarctions from both electrophysiological and morphological aspects.

Adult↗

PubMed1991

Myocardial scintigraphy using 99m-Tc-methoxyisobutylisonitrile (Tc-MIBI): Is it equivalent to 201-Tl?.

The results of selective coronary angiography, myocardial 201-Tl scintigraphy (stress and redistribution) and after 99m-Tc-methoxyisobutylisonitrile stress and rest injections (Tc-MIBI, Cardiolite, DuPont de Nemours, USA) were compared in 19 patients with manifest ischemic heart disease in identical three projections and after same ergometric load. All three investigations were carried out within three consecutive days. 16 patients had significant stenoses of 1-3 main coronary arteries inclusive of left coronary artery main stem, insignificant stenoses (less than 50%) were present in remaining 3 patients. Scintigraphic localizations of accumulation defects in both Tc-MIBI and 201-Tl stress scintigraphy were in accordance in 70.6% of evaluated left ventricular wall segments. A positive 201-Tl redistribution and rest-stress Tc-MIBI scintigraphic difference agreed in 52.6% images of all three projections with verified accumulation defects. The sensitivity of the detection of ischemic area in reference to the coronary angiography was nearly identical in 201-Tl (75%) and Tc-MIBI scintigraphy (81.2%). False positive accumulation defects in the apical area were revealed in three patients with insignificant coronaro-angographic findings equally after both radiopharmaceuticals. Better physical properties of 99m-Tc from the point of view of a gamma camera detection, a possibility to get markedly higher counting rate and sufficient accumulation of the radiopharmaceutical in the perfused myocardium enable to reach scintigraphic pictures with a high contrast after labelled Tc-MIBI injection, even in case of sequential impulse summation during heart cycle (gating). Thus MIBI labelled by 99m-Tc is equivalent to 201-Tl as used for myocardial scintigraphy in patients with ischemic heart disease.

Adult↗

PubMed1991

Diagnosis of myocardial ischaemia by means of precordial ST mapping and exercise 201-thallium scintigraphy.

The authors compared the results of examination by means of exercise precordial ST mapping and exercise 201-thallium scintigraphy in 43 patients with ischaemic heart disease and in 10 controls. The methods have been found to be equally helpful in establishing the diagnosis of myocardial ischaemia. 201-thallium scintigraphy is preferred when trying to quantify the lesion and to localize it. The currently available techniques of exercise EGG mapping do not always make determination of ischaemia distribution possible. The benefits inherent in either method are their non-invasiveness and good reproducibility, features making them ideal tools for assessing the effect of treatment.

Adult↗

PubMed1990

[The importance of 201Tl scintigraphy in stress tests for the diagnosis of silent myocardial ischemia].

Using thallium scintigraphy after a load (LTS), the authors tested suspected silent myocardial ischaemia (SIM) in subjects without angina pectoris. They examined 21 active pilots suspected of SIM after a previous ECG loading test (LET) and 33 patients with diabetes type I and II. In six pilots (28.6%) they found on LTS accumulation defects suggesting ischaemic disorders of the large coronary arteries. All except one had during submaximal load during LTS obvious depression of the ST segment on the ECG. Except one, in another five pilots small depressions of the ST segment were associated with normal LTS. Twelve diabetic patients (36.4%) had obvious minor accumulation defects on LTS. Only two had on the ECG a ST depression under 2 mm during LTS. Based on data in the literature suggesting a higher sensitivity and specificity of LTS, as compared with LET and the possibility of a false positive diagnosis of SIM from LET alone, the authors recommend when SIM is suspected to use also LTS. A more detailed diagnosis of SIM is essential not only with regard to the assessment of work capacity but also for the long-term follow-up of patients with SIM for assessment of its incidence, impact and prognosis in our population.

Adult↗

PubMed1989

Determination of left ventricular wall motility injury by factor analysis in patients with advanced ischemic heart disease.

Left ventricular phase and amplitude images (Fourier analysis, PAI) and factor analysis images (FAI) from gated radionuclide ventriculography were obtained in 235 patients after myocardial infarction (MI) and in 44 patients with well documented ischemic heart disease (IHD) in order to assess areas of regional left ventricular motility injury (LVMI). The sensitivity of FAI for LVMI detection was higher than with PAI (36.3% vs 22.7% in patients without MI; 76.6% vs 68% in those after anterior MI; and 53.2% vs 31.9% after posterior MI, respectively). In 2.9% of all patients PAI were unclear due to small time activity amplitudes and heart rate irregularity, whereas FAI could be easily assessed. Significantly decreased left ventricular ejection fraction was observed predominantly after anterior MI in connection with distinct signs of LVMI in a large area of anterior wall or in the anteroseptal and/or apical region. Areas of LVMI could be sharply delineated in FAI; however, in contrast to PAI, FAI is unable to distinguish between dyskinetic and akinetic regions. The use of both PAI and FAI is recommended for more detailed detection of regional LVMI in patients with IHD.

Coronary Disease↗

PubMed1989

[Topography of foci of perfusion defects after myocardial infarct on standard ECG and thallium stress scintigraphy].

65 patients after previous myocardial infarction well documented by electrocardiography were investigated by 201-Tl scintigraphy after submaximal ergometry. Topographic results of the scintigraphy in three planes were compared with the location of previous infarction demonstrated by standard electrocardiography. 30% of disagreements and partial agreements in more than half the patients were caused predominantly by inability of electrocardiography to qualify a true ischaemic necrosis in the interventricular septum, by limited ability to localize exactly the site of myocardial infarction and by underestimating its size, in particular in the posterior left ventricular wall, where the lesion often extends to the lateral wall. Some principal disagreements of both methods in different findings on the anterior and posterior left ventricular walls stress the low value of standard electrocardiography for exact topographic diagnosis of the infarct site. The authors express their opinion that the size of myocardial infarction and its influence on left ventricular function measured by non-invasive methods in the acute state would be more important for the prognosis of the patient.

Adult↗

PubMed1989

[Diagnosis of myocardial ischemia using functional ST mapping and 201Tl stress scintigraphy].

The authors compared the value of two non-invasive methods in the diagnosis of myocardial ischaemia, i.e. precordial working maps of the ST segment and working scintigraphy of the myocardium with 201T1 after a load. On comparison with the finding on the coronary arteries, the authors found a high sensitivity of mapping, 89.3%, and of 201T1 scan, 92.9%, while the specificity of both methods was lower, 57.1%. Both methods are equally valuable for diagnosis of myocardial ischaemia; for assessment of the site of affection thallium scintigraphy of the myocardium is preferable.

Adult↗

PubMed1989

A comparison of radionuclide and contrast left ventriculography and coronary angiography in patients after myocardial infarction.

61 patients after myocardial infarction were investigated by selective coronarography, contrast (LVG) and gated radionuclide ventriculography (RNV, rest and mild exercise). Left ventricular ejection fraction (LVGEF and RNVEF, resp.) and regional contractility disturbances were determined (in RNV by Fourier transform and factor analysis). A high correlation of rest LVGEF and RNVEF was found, with lower RNVEF values. A significantly lower rest RNVEF with no change during exercise was observed in comparison to 29 control persons. The ability of RNV to detect regional wall contractility impairment was nearly the same as that of LVG. RNVEF was negatively influenced by LAD obstruction and furthermore in combination with other main coronary artery jeopardy. Gated RNV is a valuable noninvasive method that could replace contrast LVG in the assessment of left ventricular function.

Adult↗

PubMed1988