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Biomedical subjects

K B Desser

Publications and source records attributed to K B Desser.

At least 109 records · Page 6Linked to original sources

Correlation of electrocardiogram and vectorcardiogram with coronary occlusion and myocardial contraction abnormality.

Electrocardiograms and Frank vectorcardiograms were recorded in 156 consecutive patients with total occlusion of at least one coronary artery (on arteriography) and associated left ventricular contraction abnormality (on ventriculography). The angiograms and cardiograms were independently reviewed. In the presence of single vessel occlusion, appropriate vectorcardiographic diagnosis of myocardial infarction was determined in 118 of 156 cases (76 percent) compared with a lower electrocardiographic detection rate in 77 of 156 cases (49 percent). Findings diagnostic of two coexisting infarctions were observed in 71 percent of vectorcardiograms and 37 percent of electrocardiograms in 51 patients with double vessel occlusion and two areas of left ventricular dyskinesia. The vectorcardiographic detection rate was similarly superior to the electrocardiographic rate in the presence of subtotal coronary occlusion and myocardial asynergy in single (73 percent versus 53 percent) and double (53 percent versus 28 percent) vessel disease. The incidence rate of false positive diagnoses was 3 percent for electrocardiography and 4 percent for vectorcardiography. It is concluded that the vectorcardiogram is superior to the electrocardiogram in the diagnosis of obstructive coronary artery disease and left ventricular contraction abnormality.

Adult↗

[Pneumomediastinum and mediastinitis, rare complications of a lung abscess. 1 case].

A case is reported with pneumomediastinum and mediastinitis complicating lung abscess in the lingula of a 77-year-old man. Causative factors were the association of virulent organisms having necrotizing properties in a host with diminished resistance and location of the cavity adjacent to the mediastinal pleura. A review of 1119 documented patients with lung abscess revealed that this complication has been reported only twice previously. Early surgical drainage combined with systemic administration of antimicrobial agents are the most effective therapeutic measures for mediastinal infection. Therefore, close observation is required of patients with lung abscess adjacent to mediastinal structures.

Aged↗

Variant angina pectoris. Pain and arrhythmias controlled after postoperative myocardial infarction.

A 30-year-old man with variant angina pectoris and ventricular arrhythmias had an angiographically demonstrable 60% obstructive lesion of the proximal left anterior descending coronary artery that was observed to progress to 100% during spasm. Control of pain and arrhythmia by pharmacologic means was unsuccessful. Aortocoronary saphenous vein-internal mammary coronary bypass was associated with an anteroseptal wall myocardial infarction and relief from both angina pectoris and arrhythmias. It is suggested that infarction of the ischemic myocardium played a role in the successful management of this case.

Adult↗

Relief of angina pectoris in patients with occluded coronary bypass grafts.

Thirty-two patients from a larger series of subjects undergoing routine postoperative evaluation of the aortocoronary saphenous bypass graft procedure were found to have one (20 patients) or all (12 patients) of the implanted grafts totally occluded. Such occlusion occurred in association with persistent postoperative subjective improvement manifested by a significant diminution or complete disappearance of angina pectoris. Postoperative myocardial infarction was documented in only seven cases, and the possibility of successful partial revascularization could be logically applied to only 20 of these 32 patients. Other suggested mechanisms for relief of angina pectoris in this setting are mentioned, although none is scientifically proved. It is concluded that (1) the marked subjective improvement documented in this population does not universally correlate with anatomic success and that (2) a diminution in the degree of angina pectoris cannot be clinically applied as a reliable indicator of postoperative graft patency.

Angiocardiography↗

Influence of pacemaker-induced tachycardia with A-V block on left ventricular blood velocity in man.

Phasic instantaneous left ventricular blood velocity was measured by radiotelemetry in 28 subjects with a Doppler ultrasonic flowmeter catheter during atrial pacing and induced A-V block Type I Wenckebach A-V block with conduction ratios of 9:8 or lower generally produced a stepwise reduction of peak left ventricular blood velocity in relation to shortened R-R intervals. Longer Wenckebach periods resulted in little or no blood velocity alteration during 1:1 A-V conduction. Those beats following a blocked atrial depolarization were associated with augmented blood velocities. In three subjects, bigeminal periods of 3:2 A-V block resulted in larger left ventricular blood velocities when compared with 2:1 A-V block, despite identical R-R intervals following the blocked P wave. This latter phenomenon was attributed to diastolic augmentation of left ventricular contraction following the second and hemodynamically ineffective beat during 3:2 A-V block. Three patients manifested true blood velocity alternation during second-degree A-V block and changing R-R intervals. The variations in peak left ventricular blood velocity observed during atrial pacing and A-V block are related to changing inotropic state and cycle length dependent alterations of left ventricular diastolic filling.

Adult↗

Comparison of the electrocardiogram and vectorcardiogram for the diagnosis of left atrial enlargement.

Standard 12 lead electrocardiograms (ECG) and Frank vectorcardiograms (VCG) were recorded in 21 consecutive patients with mitral valvular disease and angiographically documented left atrial enlargement. Comparative sensitivities for the detection of left atrial enlargement were: diagnostic, ECG = 6/21 (29%), VCG = 14/21 (67%); suggestive, ECG = 3/21 (14%), VCG = 2/21 (9%); non-diagnostic, ECG = 12/21 (57%), VCG = 5/21 (24%). It is concluded that the Frank atrial vectorcardiogram is superior to the standard electrocardiogram for the diagnosis of left atrial enlargement.

Adult↗

Reversible thrombocytosis and anemia due to miconazole therapy.

Miconazole was administered intravenously in six consecutive patients with, active coccidioidal infection. Such treatment was associated with progressive anemia and thrombocytosis. The hematological abnormalities appeared to be dose related and potentially reversible. Bone marrow studies demonstrated erythroid hypoplasia and increased or active platelet production in three subjects. No hemorrhagic or thrombotic episodes were identified. It is suggested that careful hematological monitoring be performed in subjects undergoing systemic miconazole therapy.

Adolescent↗

Bacteroides pericardial effusion and cardiac tamponade in a patient with chronic renal failure.

A 31-year-old woman with chronic renal insufficiency and recurrent pericarditis developed an enlarging cardiac silhouette and physical signs of cardiac tamponade. Cardiac catheterization demonstrated pericardial effusion with hemodynamic evidence of cardiac compression. At pericardial exploration, 1.5 L. of foul-smelling purulent material was removed from a distended pericardial sac. Cultures of both the exudate and pericardium revealed pure growth of Bacteroides fragiles. The patient was subsequently treated with intravenous chloramphenicol and has had an uncomplicated clinical course since that time. This represents the first reported case of cardiac tamponade secondary to culturally proved Bacteroides pericarditis in the setting of chronic renal insufficiency.

Adult↗