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Biomedical subjects

Jerzy Lewczuk

Publications and source records attributed to Jerzy Lewczuk.

At least 19 recordsLinked to original sources
PubMed2006

[Normal coronary angiogram in patient with diagnosis of acute coronary syndrome with ST segment elevation. Was it possible to recognise acute pulmonary embolism earlier?].

A case of a 48 year old male scheduled for early invasive treatment of acute coronary syndrome with ST segment elevation is presented. Clinical suspicion of acute pulmonary embolism was undertaken because of normal coronary angiogram and was confirmed by pulmonary angiography. Differential diagnosis based on medical history, electrocardiogram and laboratory findings was discussed.

Acute Disease↗
PubMed2006

[One-year controlled therapy with doxazosin in patients with pulmonary hypertension due to chronic obstructive pulmonary disease].

UNLABELLED: It was shown recently that a thirty day doxazosin therapy, that was undertaken to prove alpha1-adrenergic hypothesis for pulmonary hypertension, resulted in a significant improvement of pulmonary hemodynamics in patients with hypoxic pulmonary hypertension (HPH) due to COPD. AIM OF THE STUDY: The objective of this study was to learn if 12 months long therapy with 2 mg of doxazosin daily (dosage effective in recent research) may result in persistent hemodynamical and clinical benefits. MATERIAL AND METHODS: To this end, baseline and after 1 year results of echocardiography, symptom-limited maximal exercise test, and arterial blood gaseous analysis were evaluated at baseline and after 12-month study in 32 patients with HPH randomized either to doxazosin treated group (16 patients, aged 60.2 +/- 12 years, or to control group (16 patients, aging 60.5 +/- 4 years). At baseline doxazosin treated COPD patients had less advanced disease than COPD control patients (FVC 2.4 +/- 0.7 vs 1.3 +/- 0.31, p<0,001 and FEV1 1.6 +/- 0.6 vs 0.7 +/- 0.31, p<0,001). RESULTS: This study showed that results of tricuspid gradient, acceleration time, right ventricular enddiastolic diameter, left ventricular enddiastolic diameter and left ventricular ejection fraction did not differ significantly in both groups between baseline and 1-year assessment. The number of METs achieved during exercise test and results of PaO2 and PaCO2 did not change significantly in both groups either. CONCLUSION: The study indicates lack of hemodynamical and clinical improvement during a 1-year doxazosin therapy in patients with HPH due to COPD.

Adrenergic alpha-Antagonists↗
PubMed2006

[Incidence, pathogenesis and importance of nocturnal hypoxaemia in patients with chronic obstructive pulmonary disease].

Noctural hypoxaemia (NH) in patients with chronic obstructive pulmonary disease (COPD) was first described over 40 years ago, however, its importance is not fully established. NH is defined most frequently as a drop in oxygen saturation below 90% and it occurs in almost all COPD patients PaO2 < 55 mmHg and in 30-40% of those with PaO2 < 60 mmHg. The main reason for NH is alveolar hypoventilation which is most pronounced during ohase REM. It is known that even short term episodes of NH increase pulmonary artery pressure, yet, the impact of chronic, isolated NH on pulmonary hypertension development was not found. Also, the relationship of induced by NH cardiac arrythmias with sudden death in COPD was not documented and association of NH with prognosis in COPD was not proved. Actually, there is no need to perform NH examination routinely. According to the ATS/ERS latest standards, the determination of NH can be helpful to qualify COPD patients with PaO2 55-65 mmHg to longterm oxygen therapy.

Causality↗
PubMed2006

Results of one-year anticoagulation in patients with newly detected chronic thromboembolic pulmonary hypertension not treated with pulmonary endarterectomy.

INTRODUCTION: Currently pulmonary endarterectomy is considered the method of choice in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is not known if this option should be recommended in all suitable patients as it is highly variable with respect to prognosis. There is also doubt about selection of adequate time to refer patients with CTEPH for surgery. AIM: To establish whether some patients with CTEPH may clinically benefit from isolated anticoagulation with drugs and if the use of anticoagulation may have any impact on the time of patient referral for pulmonary endarterectomy. METHODS: The prospective analysis involved 29 patients (9 male, 20 female) aged 37 to 82 years, with pulmonary arterial systolic pressure ranging from 39 to 133 mmHg and newly diagnosed CTEPH who had not been treated with pulmonary endarterectomy and were not receiving anticoagulation. Survival, functional status according to NYHA classification, duration of thromboembolism, exercise tolerance and echocardiographic parameters of right ventricular overload before and at one year after initiation of therapy with anticoagulants were evaluated. RESULTS: During follow-up, 3 patients with PASP ranging from 120 to 133 mmHg died. In 26 patients with PASP 39-115 mmHg, who survived, improvement in echocardiographic parameters of right ventricular overload, better exercise tolerance as well as functional status according to NYHA classification was observed. In 12 survivors, pulmonary pressure returned to normal. CONCLUSIONS: The results of this study suggest that favourable effects of isolated anticoagulation are likely in patients with newly detected CTEPH, mild and moderate baseline pulmonary hypertension and acceptable exercise tolerance. They also indicate the necessity of anticoagulation in these patients prior to possible referral for pulmonary endarterectomy.

Acenocoumarol↗
PubMed2006

[Cardiac tamponade due to angiosarcoma--was surgical treatment necessary? A case report].

We present a case of a 49-year-old patient with cardiac tamponade due to haemopericardium. The decision to perform surgery, although controversial, allowed to diagnose cardiac angiosarcoma with metastases to pericardium, vena cava superior and pulmonary trunk. Consequently, chemotherapy was instituted and was initially effective, however, the patient died 12 months later due to the progression of the disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

[Impact of 30 day therapy with doxazosin--alpha1 adrenergic blocker on pulmonary hemodynamics in patients with secondary pulmonary hypertension due to chronic obstructive pulmonary disease].

To prove alpha1-adrenergic hypothesis for pulmonary hypertension we studied 6 patients aged 63.3 +/- 8 (range 50-75) years with stable, advanced chronic obstructive pulmonary disease (COPD), FEV=1.51 +/- 0.3 I and with pulmonary hypertension, mean pulmonary artery pressure 28.3 +/- 8 (range 21-40) mm Hg. a1 blocker, doxazosin was administered per os in a daily dose of 2-3 mg. Pulmonary hemodynamics was performed before and after 30 day of treatment. After therapy, compared to baseline results, pulmonary artery systolic pressure decreased from 48.6 +/- 14 to 42.5 +/- 13 mm Hg, p=0.003, pulmonary artery diastolic pressure from 14.5 +/- 6 to 7 +/- 4 mm Hg, p=0.02), mean pulmonary artery pressure from 28.3 +/- 8 to 21.1 +/- 5 mm Hg, p=0.01 and pulmonary vascular resistance from 389.6 +/- 14 to 234.6 +/- 73 dyn x s x cm5. No significant changes in pulmonary artery wedge pressure, cardiac output, arterial oxygen content, percent saturation of hemoglobin with oxygen and oxygen delivery were found. In summary, the results of 30 day doxazosin therapy support alpha1 adrenergic hypothesis for pulmonary hypertension and suggest potential clinical benefits during long term treatment in patients with pulmonary hypertension due to COPD.

Adrenergic alpha-Antagonists↗
PubMed2005

[How to manage the patients with hypoxic pulmonary hypertension?].

Hypoxic pulmonary hypertension (HPH) develops in many patients with advanced chronic obstructive pulmonary disease (COPD) and aggravates their quality of life and prognosis. The most proper but as yet not satisfactory management of HPH involves COPD prophylaxis. In this article pathophysiological background to use systemic vasodilators in treatment of HPH are described, and hemodynamical and clinical results of short and long term trials are discussed. Authors explain lack of clinical benefits with currently used systematic vasodilators in HPH and indicate promising preliminary results with 5-phosphodiesterase inhibitors. The substantial role of chronic oxygen therapy and pulmonary rehabilitation in management of HPH is emphasized.

Adrenergic alpha-Agonists↗
PubMed2005

[Bronchial adenocarcinoma mimicking acute pulmonary embolism -- a case report].

A case of a 31-year-old male with medical history, clinical symptoms and additional diagnostic tests strongly suggesting diagnosis of acute pulmonary embolism is presented. However, pulmonary emboli were not seen during pulmonary angiography. At autopsy bronchial carcinoma was found and this definitive diagnosis was confirmed by the results of histopathological study.

Adenocarcinoma↗
PubMed2004

Electrocardiographic signs of right ventricular overload in patients who underwent pulmonary embolism event(s). Are they useful in diagnosis of chronic thromboembolic pulmonary hypertension?

Diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) remains a major clinical problem. An attempt was made to learn whether electrocardiography has the potential to alleviate that problem. Sensitivity, specificity, negative and positive predictive value as well as a likelihood ratio of electrocardiogram (ECG) signs of right ventricular overload (RVO) were determined in 56 patients with chronic pulmonary embolism and a mean pulmonary artery pressure (mPAP) ranging from 15 to 80 mm Hg. CPE was recognized as the only disease in 44 patients (Group A) whereas the remaining 12 CPE patients suffered from concomitant cardiac and pulmonary diseases (Group B). Thirty three (59%) of the patients were diagnosed with CTEPH (mPAP exceeding 30 mm Hg). Twelve ECG signs of RVO were identified in the entire population of patients. At least a single ECG sign of RVO was found in 72% of the patients and 7 ECG signs were found exclusively in CTEPH patients. Negative T wave in precordial V1-V5 leads, negative T wave in II, III, aVF, pulmonary P wave and right axis deviation >90% occurred with the highest incidence that was determined to be 43%, 32%, 30%, and 30% respectively. These ECG signs of RVO had positive predictive value of those signs ranged from 80 to 100% in Group A and 25 to 75% in Group B, whereas their negative predictive value ranged from 44 to 76% and from 66.5 to 87.5% respectively. It is concluded that ECG signs of RVO appear to have the potential to aid in diagnosing CTEPH in the patients who underwent acute embolic event in the past.

Aged↗
PubMed2004

[Effect of a 2-year pulmonary rehabilitation on the 7-year prognosis in patients with advanced chronic obstructive pulmonary disease].

Pulmonary rehabilitation (PR) improve the quality of life in COPD patients, however, little has been known whether it may improve the survival. We assessed 7-year prognosis in 46 patients with advanced COPD, 27 of which completed successfully 2-year course of PR whereas 19 COPD patients made a control (C) group. At the end of 7-year observation 41.3% of total number of patients survived, among them 12 (42.8%) PR patients and 7 (38%) C patients. COPD progression was the main (80%) reason of mortality in both groups. The survivors had better results of baseline FVC, FEV1 and treadmill exercise test. They did not differ from non-survivors with age, baseline results of the weight, PaO2, PaCO2 and the number of PR patients. The Cox proportional hazard analysis showed that neither of baseline parameters influenced significantly the 7-year prognosis in this group of COPD patients. In conclusion, PR failed to improve 7-year prognosis in the studied group of patients with advanced COPD.

Adult↗
PubMed2002

[Electrocardiographic signs of right ventricular overload useful in improving diagnosis of chronic thromboembolic pulmonary hypertension (CTE-PH) in patients with chronic exertional dyspnea].

The early recognition of chronic thromboembolic pulmonary hypertension (CTE-PH) is troublesome because of "honey moon" period with chronic dyspnea on exertion as the only one symptom. To find if routine electrocardiography may be useful in improving the diagnosis, value of right ventricular overload (RVO) signs in recognition echocardiographically determined chronic pulmonary hypertension (CPH) and angiographically confirmed CTE-PH in 90 consecutive patients hospitalized due to chronic exertional dyspnea was studied. CPE was found in 76.5% and CTE-PH in 33% of those patients, at least one of twelve founded electrocardiographic signs of RVO was present in 50% patients. The most frequently occurred signs: negative T wave in lead V1-V6, right axis deviation and pulmonale P wave as well as 9 other occurred at frequency below 20% signs of RVO had low to medium sensitivity and negative predictive value and 80-90% positive predictive value for diagnosing CPE and 90-100% positive predictive value for diagnosing CTE-PH. It was concluded that in patients with chronic exertional dyspnea electrocardiographic signs of RVO may be useful in initial diagnosing of CPH and CTE-PH in particular.

Aged↗