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Biomedical subjects

N G Kounis

Publications and source records attributed to N G Kounis.

At least 19 recordsLinked to original sources

Pregnancy-induced increase of supraventricular arrhythmias in Wolff-Parkinson-White syndrome.

Six women suffering from Wolff-Parkinson-White syndrome and who were previously asymptomatic or nearly asymptomatic, were followed prospectively during and after their subsequent pregnancies. Three women experienced several attacks of supraventricular tachycardia (SVT) for the first time and the rest experienced an increase in their attacks. It seems that there is an increased tendency for SVT in pregnancy. Increased adrenergic sensitivity by estrogens, increased plasma volume, stress, and anxiety during pregnancy may be some of the causative factors.

Adult

Anticoagulant-induced shoulder hematoma producing brachial plexus neuropathy--case reports.

Hemorrhagic complications from anticoagulants are common and may manifest in any part of the human body. Skin discoloration, pain, tenderness, and soft-tissue swelling may be the main clinical features. The authors present 3 extraordinary cases of brachial plexus neuropathy associated with anticoagulant-induced hemorrhage. The signs, symptoms, important differentials, and clinical treatment are described with regard to the pathologic anatomy.

Aged

Histamine-induced coronary artery spasm: the concept of allergic angina.

Histamine, the main amine released during allergic reactions, can provoke coronary arterial spasm manifested as angina pectoris. This has been shown during clinical and laboratory studies. The effects of histamine on cardiac function are mediated via H1- and H2- receptors situated on the four cardiac chambers and coronary arteries. Coronary arteries of cardiac patients are hyperactive and contain stores of histamine which can initiate coronary artery spasm. Clinical observations indicate that angina pectoris or acute myocardial infarction can be provoked by acute allergic reaction. The coincidental occurrence of chest pain and allergic reaction accompanied by clinical and laboratory findings of classical angina pectoris seems to constitute the syndrome of allergic angina. The clinical symptoms of allergic angina include chest discomfort, dyspnoea, faintness, nausea, pruritus and urticaria. They are accompanied by signs such as hypotension, diaphoresis, pallor and bradycardia. There are also electrocardiographic findings indicating myocardial ischaemia, arrhythmias and conduction defects. Thus, in patients undergoing acute allergic reaction, the development of chest pain could be explained by the mechanism of coronary arterial spasm provoked by the release of histamine, which constitutes the syndrome of allergic angina.

Angina Pectoris

Endocarditis, pyrexia of unknown origin and occult abdominal malignancy.

Two patients who presented with pyrexia of unknown origin were found to have carcinoma of the caecum without gastrointestinal symptoms. Blood cultures were positive for Escherichia coli, and in one patient the diagnosis of endocarditis was confirmed by echocardiography. This rare association may be fortuitous, but a common pathogenetic basis cannot be excluded.

Aged

Systolic and diastolic septal and posterior wall echocardiographic measurements in normal subjects.

M-mode echocardiographic measurement of septal and left ventricular excursions and velocities was attempted in 109 subjects. Seventy subjects had adequate echocardiograms enabling detailed measurement. Two groups of subjects were studied: a group of normal adults aged nineteen to seventy-eight years and a group of normal juveniles aged nine to eighteen years. The posterior wall excursion (PWE), systolic septal excursion (SSE), diastolic septal excursion (DSE), and diastolic septal velocity (DSV) did not differ in these groups. There were significant differences in the posterior wall excursion during isovolumetric contraction (B-Ce, p less than 0.002), mean posterior wall velocity (PWV mean, p less than 0.002), and systolic septal velocity (SSV, p = 0.05) between the two groups. The measurements were obtained by using the recently published method of the specific points for labeling and description of the wall motion.

Adolescent

Effects of nitroglycerin on myocardial excursions and velocities in the early hours of acute myocardial infarction.

The effects of sublingual nitroglycerin on septal and left ventricular wall motion were determined by echocardiography in the early hours of acute myocardial infarction (MI) in 20 patients admitted via a mobile coronary care unit. Left ventricular and septal echoes were obtained in 11 patients with acute anterior MI and in 9 with acute inferior MI before and after administration of 500 micrograms sublingual nitroglycerin. In the group with acute anterior MI, nitroglycerin did not significantly affect the B-C excursion, posterior wall excursion, and mean posterior wall velocity. Nitroglycerin significantly increased (P less than 0.01), however, the systolic septal excursion, systolic septal velocity, diastolic septal excursion, and diastolic septal velocity. In the group with acute inferior MI, nitroglycerin significantly increased the B-C excursion (P less than 0.01); posterior wall excursion (P less than 0.01); mean posterior wall velocity (P less than 0.01); systolic septal excursion (P less than 0.01); diastolic septal excursion (P less than 0.05), and diastolic septal velocity (P = 0.01) but did not affect the systolic septal velocity. All measurements were obtained by use of a method of labeling and describing specific points of the wall motion that has been described recently.

Administration, Sublingual

Left ventricular excursions and velocities during coronary arterial ligation. Effects of nitroglycerin infusion in an experimental model.

To determine the effects of intravenous nitroglycerin on the velocities and excursions of the acutely ischemic myocardium, 20 open-chest dogs were studied by use of ultrasound. In 10 dogs with acute septal ischemia, the posterior wall excursion during contraction (B-C excursion), the mean systolic posterior wall velocity, and the posterior wall excursion remained unaltered. Nitroglycerin, however, increased all these parameters (P less than 0.01). In 10 dogs with acute posterior wall ischemia the B-C excursion (aneurysmal bulging) increased (P less than 0.01), but the mean systolic posterior wall velocity and posterior wall excursion decreased (P less than 0.01). Nitroglycerin increased even more the aneurysmal bulging (P less than 0.01) and the other parameters (P less than 0.01). Increased regional blood flow, reduced afterload, and mechanical pulling of the ischemic myocardium seem to be a possible mechanism. The measurements were obtained using the recently described method of the specific points.

Animals

Unusual electrocardiographic manifestations in conditions with increased intrathoracic pressure.

Clinical, electrocardiographic and haemodynamic findings of 10 patients suffering from intrathoracic conditions were analyzed. Three patients suffering from left spontaneous pneumothorax, three from large left pleural effusion, three from traumatic rupture of the left diaphragm and one from sliding hiatus hernia were found to have electrocardiographic alternation, while their central venous pressure and pulmonary capillary wedge pressure were increased. With the correction of the condition the electrocardiographic alternation disappeared and the pressures returned to normal. The increase in direct or indirect pressure exerted on the global surface of the heart, as it is reflected in pulmonary capillary and venous pressures, seems to be the cause of the electrical alternation observed in these patients.

Arrhythmias, Cardiac

Amiodarone-induced recurrent allergic pneumonitis.

Two patients with history of amiodarone-induced pulmonary reactions were accidentally treated again with amiodarone and the pulmonary complication recurred. The clinical symptoms and radiographic findings disappeared after amiodarone was discontinued and the administration of corticosteroids. Recurrent pulmonary reaction from amiodarone on different occasions is a rarely reported complication and confirms the relationship of pulmonary toxicity to chronic amiodarone administration.

Amiodarone

Unusual electrocardiographic changes in intrathoracic conditions.

Electrocardiographic, roentgenographic and clinical findings from 5 patients with intrathoracic conditions were studied. Three patients suffering from left spontaneous pneumothorax and one from eventration of the left diaphragm were found to have an unusual phasic voltage alternation in their electrocardiograms. These changes were appearing during the course of the disease and disappearing with the correction of the condition. Respiratory variation of intrathoracic anatomy or amplitude and swinging of the heart seems a possible explanation.

Diaphragmatic Eventration

Early echocardiographic detection of acute myocardial infarction.

Early echocardiographic wall motion changes were detected in a patient with subepicardial infarction of the true posterior wall. Left ventricular wall excursion and velocities were found diminished one hour following the onset of symptoms and before any significant electrocardiographic changes. Sublingual nitroglycerin administration reverted the hypokinetic posterior wall to normal but only temporarily. These observations may be of added value in the early detection of the acute myocardial ischaemia.

Acute Disease