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Biomedical subjects

M Pavlovic

Publications and source records attributed to M Pavlovic.

At least 19 recordsLinked to original sources
PubMed2000

[The prehospital phase in patients with acute myocardial infarct in Slovakia. A challenge].

Better management of patients with acute myocardial infarction during the prehospital phase is at present a challenge not only for health workers but for society as a whole. The authors pay attention to knowledge of the complex problem of the prehospital phase in patients with acute myocardial infarction which is a prerequisite for finding possible solutions for a favourable effect on their management. The authors analyzed 3,040 patients who were admitted to hospital alive within 96 hours after the development of complaints with suspicion of a first or repeated acute myocardial infarction. They focused attention in particular on prehospital time delay. They found that within a satisfactory time interval (within 2 hours) 29.8% patients were delivered and within a yet acceptable interval of 4 hours 51.6% patients (with respect to effectiveness of thrombolytic treatment). Similarly undesirable are also data on the patient time delay. Within the optimal first hour after development of complaints following the decision of the patient (subjects present) to ask for or seek medical assistance was the decision of 34% patients, during the first two hours 47.5% and within 4 hours 61.2% patients with acute myocardial infarction. The ratio of time delay of the patient in the total prehospital delay is 45.5% even in patients who were admitted during the first hour after development of acute myocardial infarction. In patients who were admitted 4 hours after development of complaints it is 79.5%. The patient is admitted to hospital most quickly if he calls the medical emergency service and latest when he decides to see a doctor. Physicians and other health workers contributed only in 16.4-20.9% patients with acute myocardial infarction to their early decision to seek medical assistance. Patients with an early decision (within one hour) call most frequently the medical emergency service and are taken to hospital by this service. The time delay due to transport is shortest in these patients. The late hospital admission of patients with acute myocardial infarction in Slovakia calls for reduction of the time interval from the development of complaints to hospital admission (total prehospital delay), in particular the time taken by the patient to make up his mind (patient time delay). Early calling of the emergency medical service and transport of the maximum possible number of patients with acute myocardial infarction to hospital by the emergency medical service will greatly improve the management of patients with acute myocardial infarction. Comprehensive implementation of the survival chain (24), the most comprehensive implementation of recommendations of the European Society of Cardiology and the European Resuscitation Council for in the management of patients with acute heart attacks during the prehospital phase (21) and early effective treatment which begins already in the prehospital phase has a favourable impact on the condition of patients with acute myocardial infarction and on their prognosis. Along with early and effective treatment of patients with acute myocardial infarction in hospital and their stratification these are the most important approaches to the development and control of sudden cardiac death. Knowledge of the complex problem of the prehospital phase in patients with acute myocardial infarction is the prerequisite for the elaboration of high standard prehospital management of patients with acute myocardial infarction.

Adult↗
PubMed1999

Oblique gantry--an alternative for heavy-ion cancer therapy.

PROBLEM: To design a gantry-type beam delivery system for heavy-ion therapy beams. In order to allow for installation of the gantry in hospital environment, small overall gantry size and low weight are required. The isocentric configuration is to be preferred. SOLUTION: A new gantry concept with oblique output beam is introduced. Transformations between the treatment angle, angles of gantry and patient table rotations are derived. RESULTS AND CONCLUSIONS: The isocentric gantry with the overall radius of 2.8 m is feasible using the 60 degrees output beam. The oblique output beam imposes some restrictions on gantry capabilities, which has to be carefully evaluated by radiation oncology community.

Equipment Design↗
PubMed1999

Angiotensin I converting enzyme and angiotensinogen gene polymorphisms related to 24-h blood pressure in paediatric type I diabetes mellitus.

UNLABELLED: The aim of this study was to evaluate two putative predictive genetic markers for hypertension in children and adolescents with diabetes mellitus. Ambulatory blood pressure measurements were performed in 199 patients with type I diabetes mellitus (mean age 16.5 years, mean duration of diabetes 7.7 years) and compared to those of 1141 healthy children. The local allele frequencies were established based on a control population consisting of 181 healthy subjects. The allele frequencies of the angiotensinogen gene M235T polymorphism was nearly identical in insulin-dependent diabetes mellitus patients (MM 33%, MT 51%, TT 16%) and controls (MM 35%, MT 49%, TT 16%). In contrast, the genotype distribution of the angiotensin I converting enzyme gene insertion/deletion (I/D) polymorphism was different between patients with type I diabetes mellitus (DD 26%, ID 49%, II 25%) and the control group (DD 37%, ID 44%, II 19%) (P=0.04). Relative nocturnal systolic and diastolic pressures in patients with diabetes were higher than in healthy age- and height-matched controls; no association was found with the angiotensinogen gene M235T polymorphism. Relative nocturnal diastolic blood pressure was higher in patients homozygous for the I allele of the angiotensin I converting enzyme gene. CONCLUSION: Nocturnal systolic and diastolic blood pressure is higher in patients with type I diabetes than in healthy children. The formerly described, but controversial, association of the M235T polymorphism with arterial hypertension could not be confirmed in this study.

Adolescent↗
PubMed1999

Circadian blood pressure during the early course of type 1 diabetes. Analysis of 1,011 ambulatory blood pressure recordings in 354 adolescents and young adults.

OBJECTIVE: Little information is available on the early course of hypertension in type 1 diabetes. The aim of our study, therefore, was to document circadian blood pressure profiles in patients with a diabetes duration of up to 20 years and relate daytime and nighttime blood pressure to duration of diabetes, BMI, insulin therapy, and HbA1c. RESEARCH DESIGN AND METHODS: Ambulatory profiles of 24-h blood pressure were recorded in 354 pediatric patients with type 1 diabetes (age 14.6 +/- 4.2 years, duration of diabetes 5.6 +/- 5.0 years, follow-up for up to 9 years). A total of 1,011 profiles were available for analysis from patients not receiving antihypertensive medication. RESULTS: Although daytime mean systolic pressure was significantly elevated in diabetic subjects (+3.1 mmHg; P < 0.0001), daytime diastolic pressure was not different from from the height- and sex-adjusted normal range (+0.1 mmHg, NS). In contrast, both systolic and diastolic nighttime values were clearly elevated (+7.2 and +4.2 mmHg; P < 0.0001), and nocturnal dipping was reduced (P < 0.0001). Systolic blood pressure was related to overweight in all patients, while diastolic blood pressure was related to metabolic control in young adults. Blood pressure variability was significantly lower in girls compared with boys (P < 0.01). During follow-up, no increase of blood pressure was noted; however, diastolic nocturnal dipping decreased significantly (P < 0.03). Mean daytime blood pressure was significantly related to office blood pressure (r = +0.54 for systolic and r = +0.40 for diastolic pressure); however, hypertension was confirmed by ambulatory blood pressure measurement in only 32% of patients with elevated office blood pressure. CONCLUSIONS: During the early course of type 1 diabetes, daytime blood pressure is higher compared with that of healthy control subjects. The elevation of nocturnal values is even more pronounced and nocturnal dipping is reduced. The frequency of white-coat hypertension is high among adolescents with diabetes, and ambulatory blood pressure monitoring avoids unnecessary antihypertensive treatment.

Adolescent↗
PubMed1999

[Early diagnosis of acute myocardial infarct].

Inappropriately long patient time delay (PTD) is the main cause for undesirable pre-hospitalization delay, so called global pre-hospital time delay (GTD). The fact that patients treated for cardiovascular diseases have long GTD is alarming. General awareness of basic symptomatology and of the importance of time factor for further course of the disease may substantially influence the duration of AIM pre-hospitalization phase. Pre-hospitalization care of patient is a very demanding task for the first-contact physician (most often general practitioner) mainly because of the symptomatology variability. If there is a suspicion for AIM it is recommended to treat the patient as life-threatened and to assure the transport to hospital as rapid and "comfortable" as possible. The organisational structure of emergency units in hospitals must accept the main presumption for future treatment success-vital importance of immediate management of possible AIM patient. In this connection most important task for the doctor is rapid diagnostics, because of the requirement for hospitalization at coronary unit or intensive care unit and the need for urgent treatment. Exceptional attention must be paid to AIM high risk patients. Unrecognition of AIM, mainly in the early period, when the diagnostic process may be difficult, can have catastrophic consequences: 1. sudden cardiac death due to ventricular fibrilation and 2. impossibility to administer fibrinolytic therapy in the period of its maximum treatment. At the present state of knowledge because of the consequences of undiagnosed AIM it is safer to presume cardiac origin of the symptoms, above all of pain until proving other reason. Therefore the idea of so called Chest Pain Evaluation Units seems to be very interesting.

Hospitalization↗
PubMed1999

[Epidemiology and prevention of cardiovascular diseases after 1989].

During the past 30 years the geographical distribution of cardiovascular diseases in Europe has substantially changed. The highest rates that were reported in the mid sixties in Finland occurred in 1990/91 occurred in central and eastern Europe. The reasons for such different development of cardiovascular mortality have not been explained yet. The epidemy of cardiovascular diseases in post-socialist countries may be only partially associated with high prevalence of the three classical risk factors (hypercholesterolemia, smoking, hypertension). Presumably other, yet unrecognized risk factors have potentiated the classical ones (psychosocial stress, specific nutritional deficiencies). A decrease in mortality from cardiovascular diseases can be attributed to improvements in care of patients with cardiovascular diseases, mainly with coronary heart disease including AMI, with favourable effects on survival and to a decline in risk factors prevalence or to a combination of both. Similar detailed information for Slovakia is lacking. Therefore it is difficult to predict the future incidence of cardiovascular diseases and AMI in Slovakia. The authors in the review article focused on some epidemiological and preventive aspects of cardiovascular diseases and their implementation at present. In order to achieve a reversal of the unfavourable trend of cardiovascular mortality it is insufficient only to answer the basic questions, as e.g., what was the reason for such differing trends in disease rates and mortality from cardiovascular diseases in our country (and in post-socialist countries of central and eastern Europe) and e.g. in Finland or in the U.S.A., where cardiovascular mortality decreased almost by half. For the appropriate formulation of prevention measures with a focus on cardiovascular diseases, detailed analysis of the current specific situation in our country is also necessary.

Cardiovascular Diseases↗
PubMed1998

Treatment of early AIDS-related Kaposi's sarcoma with oral all-trans-retinoic acid: results of a sequential non-randomized phase II trial. Kaposi's Sarcoma ANRS Study Group. Agence Nationale de Recherches sur le SIDA.

OBJECTIVE: To assess the efficacy and safety of all-trans-retinoic acid (ATRA), a retinoid with antitumour activity that inhibits in vitro the growth of Kaposi's sarcoma cells, in patients with low-risk AIDS-associated Kaposi's sarcoma. DESIGN: Non-randomized phase II study, using a group sequential procedure to determine whether the response rate to ATRA was above 10%. SETTING: Nine referral French centres. PATIENTS: Twenty HIV-seropositive men with CD4 cells > or = 200 x 10(6)/l, low-risk Kaposi's sarcoma [T0I0S0 according to the classification of AIDS Clinical Trials Group (ACTG)] not previously treated with systemic anti-Kaposi's sarcoma agents, and with at least four measurable lesions were included. INTERVENTIONS: ATRA was given orally 45 mg/m2 daily for 12 weeks. MAIN OUTCOME MEASURE: Tumour response evaluated according to ACTG criteria. RESULTS: Nineteen patients were evaluated for response: partial response, stabilization and progression were found in eight (42%), seven (37%), and four (21%) patients, respectively. Gradual flattening and lightening of lesions was observed in responders after at least 2 months of ATRA. All patients with partial response at week 12 pursued ATRA for another 15+/-7 weeks. Further improvement was observed in six patients. Median duration of response was 332 days. Cheilitis, transient headaches and skin dryness were the main toxicities noted. No significant changes in HIV viral burden or serum interleukin-6 pathways were observed. CONCLUSIONS: ATRA is well tolerated and effective enough in Kaposi's sarcoma patients to warrant further evaluation.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Seizure disorders in preschool children in a Serbian district.

All children born in 1989 and 1990 in the district of Krusevac in Central Serbia (population 140,000) were followed to the end of 1995. The total number of children was 3,102. The cumulative incidence of febrile seizures was 25.1/1,000, that of single febrile seizures 3.9/1,000 and that of epilepsy (i.e. recurrent afebrile seizures) 6.5/1,000. The peak age-specific rate of the first febrile and the first afebrile seizure was in the second year of life (11.6/1,000 and 2.9/1,000, respectively). Among 20 cases of epileptic children, the most common type of seizure was the generalized type--14 cases (70%), while 6 children (30%) suffered from partial seizures. Of these epileptic children, there were 7 children (35%) with associated neurological abnormalities and/or mental retardation, including one with tuberous sclerosis. Thirteen of the total number of epilepsy cases were considered as having active epilepsy (i.e. still having had seizures and/or being on antiepileptic therapy). The calculated point prevalence rate was 4.2/1,000 on December 31, 1995.

Child, Preschool↗
PubMed1997

Melanoma cells constitutively release an anchor-positive soluble form of protectin (sCD59) that retains functional activities in homologous complement-mediated cytotoxicity.

Protectin (CD59), a glycosylphosphatidylinositol-anchored cell membrane glycoprotein, is differentially expressed on melanocytic cells and represents the main restriction factor of C-mediated lysis of melanoma cells. In this study, we report that CD59-positive melanoma cells constitutively release a soluble form of CD59 (sCD59), and that its levels directly correlate (r = 0.926; P < 0.05) with the amount of membrane-bound CD59. SDS-PAGE analysis showed that the molecular components of sCD59 are similar to those of cellular CD59 expressed by melanoma cells. Melanoma-released sCD59 is anchor positive since it inserts into cell membranes of homologous cells that transiently increase their expression of CD59. Moreover, sCD59 is functional: it blocks the binding of the anti-CD59 mAb YTH53.1 to melanoma cells and reverses its effects on C-mediated lysis. In fact, preincubation of mAb YTH53.1 with scalar doses of conditioned media of CD59-positive but not of CD59-negative melanoma cells reduced significantly (P < 0.05), and in a dose-dependent fashion, the enhancement of C-mediated lysis of anti-GD3-sensitized melanoma cells induced by the masking of cellular CD59 by mAb YTH53.1. Altogether, these data demonstrate that CD59-positive human melanoma cells release a soluble form of CD59 that is structurally similar to cellular CD59, retains its anchoring ability, is functional, and may impair the effectiveness of clinical approaches to humoral immunotherapy for human melanoma.

Animals↗
PubMed1997

Surgical aspects of fusiform and saccular extracranial carotid artery aneurysms.

The purpose of this paper is to analyse surgical aspects of aneurysms of the distal extracranial internal carotid artery. Nine cases of extracranial carotid artery aneurysm are reported. Five were fusiform, located at the carotid bifurcation, and four were saccular, confined to the internal carotid artery. An end-to-end plication technique and Dacron patch angioplasty were employed for all fusiform aneurysms. In three saccular lesions, resection and 4-mm polytetrafluoroethylene (PTFE) graft interposition were carried out. In one case with a high lesion, ligation of the carotid artery was performed. Ligation resulted in severe postoperative stroke and fatal outcome. One patient with a saccular lesion developed a transient ischaemic attack after the operation. In other patients no central neurological deficit was produced by the surgery itself. Transient cranial nerve damage occurred in four patients (two hypoglossal nerve: two superior laryngeal nerve). As demonstrated by these cases, synthetic material may be used in restoration of the carotid artery. It is concluded that, according to type, location of the aneurysm and adequacy of contralateral cerebral blood flow, selective management is necessary.

Aged↗
PubMed1997

Angiotensin I-converting enzyme-gene-polymorphism: relationship to albumin excretion and blood pressure in pediatric patients with type-I-diabetes mellitus.

The purpose of this study was the evaluation of a predictive genetic marker for nephropathy and hypertension in patients with type-I-diabetes mellitus (IDDM). The study was performed on 247 pediatric patients with IDDM. The mean age was 15.5 years (range 3.1-29.3), the mean duration of diabetes was 7.6 years (range 0.1-25.7). Age-related blood pressure and nocturnal albumin excretion rate were compared with the insertion/deletion-(I/D) polymorphism of the angiotensin-I converting enzyme gene. The genotype distribution did not differ significantly between IDDM patients (ID 48%, D 28%, I 24%) and the control group (ID 44%, D 37%, I 19%). Neither in the entire group, nor in patients with IDDM for more than 5 years, was a correlation found bet-ween allele distribution and albumin excretion rate. No correlation was found between genotype and blood pressure. When patients with a chronological age above 12 years were analysed separately, the genotype distribution between the groups with normal and elevated blood pressure showed no significant difference. The previously reported association of the I/D-polymorphism with nephropathy could not be confirmed in this study. The development of microalbuminuria, nephropathy and hypertension will be followed in our pediatric patients.

Adolescent↗
PubMed1996

[Chronic renal insufficiency. Present views on pathogenesis, clinical aspects and treatment].

The authors present contemporary views on the pathogenesis, clinical picture and treatment of chronic renal failure. A comprehensive approach to the pathogenesis of renal failure revealed new therapeutic methods such as treatment with erythropoietin, vitamin D etc. The authors emphasize substantial changes in the quality and range of the clinical picture which developed due to the prolonged survival of patients with dialyzation treatment. New problems developed such as e.g. dialyzation amyloidosis, aluminium intoxication, endocrine changes, increased occurrence of malignities etc. These must be foreseen, diagnosed and treated. While during the first half of this century uraemia was a fatal disease, at the end of the nineties patients survive due to the dialyzation and transplantation programme.

Humans↗
PubMed1996

[Diagnosis of renal tumors with percutaneous biopsy].

The authors describe four, out of 506 cases of renal biopsies in which this diagnostic procedure enabled to reveal a tumour. Two cases of tumours which were intentionally subdued to renal biopsy justified an angiomyolipoma and a focus (metastasis) of tubulopapillomatous carcinoma) in the kidney. In one case the renal biopsy revealed renal infiltration thus enabling to state the diagnosis of chronic lymphatic leukaemia subsequently, and in the last case where the diagnosis of chronic lymphatic leukaemia had been stated in advance, the renal biopsy was performed due to suspective glomerulonephritis. In these cases the unexpected results of renal biopsy were of great diagnostic value. Such intentional use of biopsy is rare. (Fig. 3, Ref. 6.)

Adult↗
PubMed1996

The importance of choice of anaesthetics in studying radiation effects in the 9L rat glioma.

In the present study we demonstrate that the glycolysis of the tumour 9L glioma, in vivo, may be manipulated with ketamine/xylazine combinations of anaesthetics. Xylazine alone or in combination with ketamine causes hyperglycaemia which is enhanced by glucose injections. Intracellular tumour pH is acidified when glucose is administered with ketamine/xylazine. However, the combination of inorganic phosphate and insulin with ketamine/xylazine and glucose caused an alkaline shift in the tumour pH as measured by 31P NMR. The anaesthetic combination of ketamine/acepromazine did not produce alterations in blood glucose or in tumour pH status as detected by 31P NMR spectroscopy. These results demonstrate dramatic effects of ketamine/xylazine on the acidification or alkalinisation of the cells of 9L glioma. These altered metabolic states are of potential therapeutic importance. The choice of xylazine alone would be useful for chemotherapy and hyperthermia modalities, both known to be dependent upon glucose metabolism and resultant acidification.

Anesthetics↗
PubMed1996

Changes of glycoprotein patterns in sera of humans under stress.

Stress exhibits adverse effects on many vital processes in which glycoproteins play a significant role(e.g. cell-cell/matrix interactions, immune response, neoplastic growth, implantation, prenatal development), yet only scarce attention has been directed towards studying stress induced changes in glycoprotein patterns. Using SDS-electrophoresis, blotting and digoxigenin-labelled lectins (Sambucus nigra agglutinin, Galanthus nivalis agglutinin, Datura stramonium agglutinin, Maackia amurensis agglutinin and peanut (Arachis hypogaea) agglutinin),sera were analysed from 30 individuals chosen randomly from a severely stressed population of 309 male volunteers with no specific medical symptoms. Significant changes were found in glycoprotein pattern and content, compared with healthy controls of matching age and sex. Occasionally minor non-specific deviations from the reference values for several analytes (haemoglobin, glucose, bilirubin and alanine aminotransferase) were detected in the tested group, but glycoprotein GP4S (Mr = 45 000), detected by Datura stramonium agglutinin and Sambucus nigra agglutinin, appeared in 96.7% of samples of the stressed population. The same population also revealed an approximately 500-fold increase of GP37 in comparison with the control sera. These results suggest that stress, as a non-specific syndrome, induces specific biochemical changes, which could be of diagnostic relevance as risk makers before any more serious symptoms of stress-related consequences have developed.

Adult↗
PubMed1996

[Chronic renal insufficiency].

The authors submit a review on the etiopathogenesis, clinical picture and treatment of chronic renal insufficiency. They emphasize the fact that based on pathogenetic ideas it proved possible to influence the majority of pathological processes: retention and deficiency of substances as well as impaired regulation. After introduction of treatment, using erythropoietin, calcitriol as well as due to advances in the technique and quality of dialysis treatment, the patients' quality of life improved substantially. The authors draw attention also to the danger of accumulation of some drugs in renal insufficiency and its development.

Humans↗
PubMed1996

[Classification of patients with acute myocardial infarct].

Stratification of patients after myocardial infarction by a scale of non-invasive examinations--Holter monitoring, early ergometry, examination of late ventricular potentials, heart rate variability, echocardiography, monitoring of haemodynamic parameters by means of electric bioimpedance, clinical state monitoring, evaluation of MI localisation, and the age of the patients enable a sufficiently accurate assessment of residual myocardial ischaemia, and to reveal electrical instability and dysfunction of myocardium. The signs detected in this way enable, after mathematical analysis of the results, to assess the degree of risk in individual patients, and to evaluate accurately the defined groups (men, women) regarding the prognosis. These relatively simple examinations help to identify the patients whose states require coronarographic examination or revascularization intervention, or on the contrary, to select those patients who may return to their occupation without major risk of re-infarction and sudden death. (Tab. 3, Fig. 7, Ref. 52.)

Adult↗