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Biomedical subjects

J Kovác

Publications and source records attributed to J Kovác.

At least 19 recordsLinked to original sources
PubMed2004

[Effect of beta radiation brachytherapy in the treatment of restenosis of coronary stents].

Brachytherapy currently represents the only treatment method for in-stent restenosis (ISR) confirmed in randomised clinical studies. In a group of 46 patients, selected for brachytheraphy on the bases of clinical signs of restenosis accompanied with development or deterioration of angina pectoris and with angiography results showing significant in-stent restenosis, we used a beta radiation system BetaCath NOVOSTE. This therapy was safe. Results of acute angiography were positive in 91% of patients. Clinical restenoses within 6 month of clinical monitoring occurred in 8.6% of patients. Due to impairment of more arteries in the majority of patients from the sample, following revascularisation of nontarget vessels was necessary in 19.6% of patients. We haven't observed late thrombosis. It was probably eliminated by prolonged administration of a combination of aspirin and clopidogrel. Dosimetry results during brachytherapy showed that doses of radiation both for a surgeon and a patient corresponded to a fraction of doses received from an x-ray apparatus during fluoroscopy and acquisition. Both an edge restenosis and a diffuse restenosis were identified in stenoses of patients with in-stent restenosis. Brachytherapy with beta radiation seems to be an efficient method for treatment of coronary in-stent restenosis.

Angioplasty, Balloon, Coronary↗
PubMed2003

[Elective coronary angioplasty in the unprotected branch of the left coronary artery].

BACKGROUND: PTCA of the left main stem is an alternative therapy to coronary artery bypass grafting for left main stenosis. METHODS AND RESULTS: For the retrospective analysis, 32 consecutive patients referred for left main PTCA were selected. Patients were subdivided into 2 groups. Group I consisted of 17 patients with no concomitant disease and with good left ventricular function, where CABG was an alternative strategy. 15 patients of the group II were patients to whom bypass was contraindicated for cardiac or extracardiac reasons (malignancy, poor LV function, non graftable) and they were recommended for the palliative treatment of their angina symptoms. We observed 100% procedural success rate of the PTCA in both groups. There was no mortality at 6-month follow up among patients of the group I and 13% clinical restenosis rate at 6 months. In patients of the group II there was total 6-month mortality 26.6%, all due to causes unrelated to procedure or coronary ischaemia (progression of malignancy, intractable heart failure). CONCLUSIONS: PTCA to left main stem represents an alternative treatment to aortocoronary bypass in cases of favourable anatomy with high procedural success and no 6-month mortality in patients with good LV function. In patients in whom CABG is contraindicated, PTCA can be used as a balliative strategy in abating ischaemic symptoms. In this group, short-term prognosis relates to concomitant cardiac or extracardiac disease.

Aged↗
PubMed2000

[Long-term monitoring of patients with a syncope of obscure etiology with an implantable monitoring device].

INTRODUCTION: Generally available methods for the diagnosis of syncopal conditions such as Holter monitoring, the tilt test and invasive electrophysiological examinations, lead to the assessment of the cause of sporadic syncopes only in some patients. The implantable monitoring device REVEAL protracts significantly the monitoring period. METHODS, RESULTS: The authors implanted the implantable monitoring device REVEAL in the course of 14 months to 19 patients with syncopes of obscure origin. During this period it was possible to prove the cause of the syncope in a total of 10 patients (53%), in 8 patients the cause was arrhythmia, in another two an arrhythmic cause was ruled out. During monitoring the authors did not record any serious undesirable events. CONCLUSION: Implantable monitoring devices are an asset in the diagnosis of sporadic syncopes where currently available invasive and non-invasive methods fail. Its use in patients without obvious structural cardiovascular disorders is safe.

Adult↗
PubMed1999

[Sexual activity and the cardiovascular system in health and disease. Use of sildenafil in heart patients].

Sexual intercourse involves mild to medium severe physical exertion of the cardiovascular system. The risk of sudden death associated with sexual activity is very low, and so is the risk of developing infarction. In patients with pre-existing ischaemic heart disease sexual activity is safe in case of controlled angina with tolerance of a medium-grade load on examination on a treadmill. After acute myocardial infarction with a non-complicated course sexual activity can be resumed in a familiar environment with a familiar partner after about 10 days. In stabilized anginous patients sildenafil administration is safe assuming that the patient does not take long-acting nitrates and does not need frequent administration of short-term acting nitrates. It is important to avoid nitrates also in the treatment of acute ischaemic conditions in these patients. At present we do not possess adequate information on the clinical importance of influencing sildenafil elimination by competition with other substances excreted by the same route.

Erectile Dysfunction↗
PubMed1999

[Non-invasive detection of failure of thrombolysis in acute myocardial infarct].

Despite advances in thrombolytic treatment of acute infarction in a major proportion of patients occasionally despite its administration reperfusion of the heart muscle does not occur which implies a negative impact on the long-term prognosis of these patients. With regard to the fact that invasive diagnostic methods are not available in the field, the basis of non-invasive diagnosis and stratification of patients for further reperfusion treatment is assessment of the symptomatology (chest pain) and frequent controls of 12-lead ECG, although controlled trials evaluating their validity for decisions in acute situations are not quite unequivocal. With the development of quantitative bedside enzyme diagnosis it may be anticipated that it will play a more important part in the differentiation of reperfusion failures. The basis of diagnosis in thrombolysis failure is in contemporary clinical practice simultaneous evaluation of all available non-invasive indicators.

Electrocardiography↗
PubMed1998

[Cardiology in the United Kingdom].

The authors describe the contemporary postgraduate system of cardiology in Great Britain with regard to the unification of criteria for specialization in the European Union and discuss opportunities of doctors from the Czech Republic to join this postgraduate system.

Cardiology↗
PubMed1997

[Use of PTCA in a gastroepiploic aortocoronary graft].

The use of the gastroepiploic inferior artery as an aortocoronary graft is at present a method of third choice after the mammary artery and venous grafts in revascularizations of the heart muscle. The results are comparable with those obtained with the mammary artery. With regard to the increasing number of operations are more plentiful on the development of atherosclerosis of the above mentioned graft. This dumps the initial enthusiasm that in this artery atherosclerosis does not develop. Reports on PTCA, when this artery is affected, are so far rate. The authors performed a successful PTCA of this graft in a patient with complete affection of the coronary circulation where alternative possibilities of revascularization of the heart muscle were practically exhausted. To improve the technique a suitable type of catheter must be developed which will make it possible to overcome technical problems associated with cannulation of artery and its dilatation.

Angioplasty, Balloon, Coronary↗
PubMed1995

Catheter aided repositioning of a displaced permanent pacemaker lead.

A 91-year-old woman, who had a pacemaker implanted in 1977, underwent replacement of a pulse generator and lead in 1995 because of recurrent syncope. The new lead dislodged the next day and migrated to the pulmonary artery. Because of her dependence on continued pacing, repeated resuscitation was required. Considering her advanced age and the impact of cardiopulmonary resuscitation on her general condition, we attempted catheter aided repositioning of the pacemaker lead. The procedure was technically successful; lead position was stable and optimal pacing parameters were attained. She was discharged in good condition.

Aged↗
PubMed1995

[Modern diagnosis and therapy of ischemic heart disease and its acute forms in a region without a cardiac care center in 1992].

The authors assembled and analyzed in the submitted study data on the extension of treatment of acute myocardial infarction by thrombolysis as well as data on the extension of invasive diagnostic methods and non-pharmacological treatment of ischaemic heart disease in a Central Moravian region without a cardiocentre. The conclusions were compared with a similar investigation made in 1989. As compared with the previous investigation, a marked increase in the number of patients with acute myocardial infarction treated by thrombolysis from the total number of patients admitted with this diagnosis was recorded. Thrombolytic treatment is now used by 100% of departments on this territory. The number of patients admitted with the diagnosis of acute myocardial infarction within six hours is more than 50% in the great majority of hospitals. The problem of other invasive diagnostic methods and non-pharmacological therapy of IHD is different: the number of examined patients accounts in relation to the number of patients with acute forms only for a mere 5-10%. While thrombolytic treatment is a routine therapy, the number of patients with IHD treated by invasive methods is rather sporadic. The authors assume that the limitation is the non-existence of a natural cardiocentre catchment area with could meet these demands. The authors consider these as a supporting argument in favour of a system of geographically evenly distributed cardiocentres.

Cardiac Care Facilities↗
PubMed1993

[The Williams syndrome in adulthood].

A case report of a 45-year-old woman with Williams syndrome who was indicated, because of increasing problems, for surgery of a supravalvular stenosis of the ascending aorta. In addition to lesions on the aorta, examination revealed multiple stenoses of branches of the pulmonary artery. The patient showed no facial changes or signs of mental retardation. The operation was performed in extracorporeal circulation by suturing a Dacron flap into the stenotic segment of the aorta, and reimplantation and reconstruction of the stenosed aortic arch branches. The procedure was uneventful and, four months after surgery, the patient is completely free of problems.

Aortic Valve Stenosis↗
PubMed1993

[Intracoronary "stents" in the treatment of ischemic heart disease. Brief review].

The author present a brief review of the contemporary development of stents. Stents are used in the therapy of ischaemic heart disease, they are "tubes" inserted by methods of intervention cardioangiology into the coronary lumen to ensure their patency. At present they are indicated in particular in the treatment of acute arterial obliteration after PTCA. Stents used at present do not meet the demands required by long-term follow up. Stents used at present in clinical work are made from different metals. The authors describe also experimental experience with stents made from bioabsorbable materials which potentially appear to have much more suitable properties as regards maintenance of long-term patency of the affected artery. The properties of an "ideal stent" are described.

Angioplasty, Balloon, Coronary↗
PubMed1992

Detachable balloon embolization of an iatrogenic aortocoronary arteriovenous fistula combined with aortocoronary bypass PTCA: a case report.

Coronary artery bypass surgery was performed in a 54-year-old male, and one of the grafts was inadvertently sutured to the vena cordis magna instead of to the left anterior descending coronary artery (LAD). Four years later the patient observed a progression of symptoms including episodes of angina pectoris at rest. Coronary angiography showed stenosis of one of the bypass grafts and notable dilatation of an iatrogenic arteriovenous (A-V) fistula. The stenosed bypass graft was dilated and the A-V fistula occluded by use of a detachable balloon. Embolization was performed rather than surgery, as the LAD was found to be a poor surgical target. The patient's symptoms improved after the procedure; he was followed for 18 months during which time his condition remained stable.

Angina Pectoris↗
PubMed1992

Bacterially expressed core and envelope proteins of human immunodeficiency virus type-1 (HIV-1): comparative evaluation in detection of type-specific antibodies.

Recombinant proteins derived from immunodominant conserved domains of HIV-1 env and gag genes were synthesized in E. coli. An immunoblot system using total cell lysates was employed for the analysis of recombinant bacterial clones. Together 427 serum samples obtained from asymptomatic anti-HIV seropositive individuals, AIDS patients, healthy donors and persons suffering from various conditions were comparatively evaluated for the presence of HIV-1 antibodies using recombinant peptides and commercially available western blot (WB) and ELISA assays. The recombinant antigen product of plasmid pEX41 was found to be superior, with respect to sensitivity and specificity, to the viral gp41 which represents a diagnostically important constituent of the WB.

AIDS Serodiagnosis↗
PubMed1992

Left main coronary artery stenosis.

Between 1 January, 1989, and 28 April, 1990, a total of 888 selective coronary arteriographies were performed at the Institute for Clinical and Experimental Medicine in Prague. Of that number, 58 findings were assessed as at least 50% stenosis of the left main coronary artery (LCA). Having applied exclusion criteria, 50 patients (i.e., 5.63% of all those examined) were entered into a retrospective study. They were 45 men (90.0%) and 5 women (10.0%) with significant cumulation of risk factors for IHD; more than half on them had a history of coronary event. The patients had marked symptomatology--NYHA Class III and higher angina pectoris was present in 96%, a low tolerance of exercise was found in 26 patients undergoing ergometry (average workload of 13 kJ and heart rate of 111/min); exercise testing was invariably evaluated as positive. Coronary angiography regularly revealed multiple coronary artery lesions; the right coronary artery was also involved in 90%; a collateral circulation was present in as little as 34%. The localization of coronary stenoses and the mostly preserved left ventricular mechanical function allowed operative management of IHD in 84% of cases. In the group of patients undergoing surgery, hospital mortality was 4.8%. On long-term follow-up (mean 6.2 months) of the group of patients operated on, 59.9% were free of problem, 31% had NYHA Class II angina pectoris, and there was no improvement at all in one patient only (2.4%). In the group provided conservative therapy (not operated on primarily for severe left ventricular dysfunction), one patient died of recurrent myocardial infarction and cardiogenic shock, 2 have NYHA Class IV angina pectoris, and the remaining subjects continue experiencing NYHA Class III problems.

Adult↗
PubMed1991

Recombinant proteins derived from immunodominant regions of the gag and env genes of HIV-1 and their potential for use in serologic diagnosis.

Based on the published sequences of human immunodeficiency virus (HIV-1) isolates highly conserved regions of the gag and env genes containing immunodominant epitopes were selected and expressed in E. coli. The expression vectors pKK24 and pEX41 produced viral proteins recognized by sera obtained from HIV-1 seropositive individuals. A testing system was designed to determine the practical value of bacterially synthesized proteins of HIV-1 gag and env genes for serodiagnosis of HIV-1 infection.

AIDS Serodiagnosis↗
PubMed1991

[Precordial S-T stress mapping in the evaluation of the effects of percutaneous transluminal coronary angioplasty].

The morphological impact of percutaneous transluminal angioplasty (PTCA) on the treated artery is closely checked by coronary arteriography. Indirect non-invasive evaluations are made possible by electrocardiography, isotope methods and echocardiography which are the commonest visualization methods. The authors used a precordial S-T load map. After complete revascularization following PTCA there was a significant drop of the sum of S-T depressions and in some members of the group it reached normal values. The S-T load map is a suitable non-invasive procedure for monitoring the effect of PTCA.

Adult↗