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Biomedical subjects

P Romaniuk

Publications and source records attributed to P Romaniuk.

At least 19 recordsLinked to original sources
PubMed1992

[Experiences with surgical therapy of Budd-Chiari syndrome].

The obstruction of the hepatic venous outflow tract with or without involvement of the inferior vena cava results in the Budd-Chiari syndrome (BCS). With its very heterogenous etiology and variable epidemiology the rare disease either takes a chronic or an acute foudroyant clinical course. In general the prognosis is poor. Together with the clinical signs the diagnosis is based on radiological measures and the histology of the hepatic parenchyma. The exact etiological investigation of the BCS is of great significance. Typical findings are discussed and a diagnostic scheme is developed. Between 1979 and 1991, altogether 16 operations were carried out in 13 patients with a BCS. Predominantly there were undertaken a porto-systemic shunt procedure or an orthotopic liver transplantation, respectively, in 6 cases each. The need for an always individually tailored therapeutic strategy of the BCS is underlined by a case history. An overview analyzes the different therapeutic modalities of the BCS and their differential indications.

Adolescent↗
PubMed1991

[Coronary ventricular fistulas in patients with heart transplants].

In detailed angiographic follow-up examinations in patients after heart transplantation, coronary artery-ventricular fistulas were observed in two of ten patients. In one patient, in the first postoperative year, 19 right ventricular biopsy procedures were performed obtaining a total of 71 tissue specimens and one year after transplantation, additionally, three specimens were obtained from the left ventricle. Coronary angiography demonstrated a fistula from the first anterior ventricular branch of the right coronary artery into the right ventricle (Figure 1) as well as a second smaller fistula between from a septal perforator of the left anterior descending artery into the left ventricle. At follow-up angiography two months later, the fistulas were unchanged in site and extent (Figure 2). Angiographically there was diffuse hypokinesis of the right ventricle and moderate tricuspid regurgitation. In the second patient, in the first year after transplantation, 20 right ventricular biopsy procedures were performed obtaining a total of 80 tissue specimens. One year after transplantation coronary angiography showed a fistula between a septal perforator of the left anterior descending artery into the right ventricle (Figure 3) which, two months later, was unchanged in morphology and, as in the first case, the size of the shunt was small. Angiographically, there was moderate tricuspid regurgitation and apical hypokinesis of the left ventricle. If a relationship between the fistulas and biopsies is postulated, from a total 196 biopsy procedures obtaining 748 tissue specimens, the rate of this complication would be calculated at 1.5%. It cannot be ruled out, however, that the fistulas had been congenitally present in the donor hearts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Method-related complications of balloon catheter valvuloplasty of heart valve stenosis in children and adults].

Within a short term of 7 years percutaneous valvuloplasty of congenital and acquired stenosis, the cardiac valves and the great central vessels has significantly improved. If strict criteria for the selection of patients are used the method is an important addition to cardiac therapy, since it requires no thoracotomy, no heart lung machine surgery, no complicated interventional follow up treatment and gives remarkable short and long term results. Starting from a thorough study of 300 publications (4836 patients) a survey of possible complications, their frequency and in percutaneous valvuloplasty is given for various methods. The compiled data and commentaries give a negative survey and shall lead to a new evaluation of indications. Some types of interventions (primarily the percutaneous rupture of degenerative calcified stenosis of the aortic valve in higher age) will lead only by significant improvements of technique (stabilization of myocardiac circulation, prevention of extreme hypotonic phases, use of cutting and sawing instruments: valvuloplasty under cardioscopy?) to acceptable long term therapy results.

Adult↗
PubMed1990

[Percutaneous transvascular pulmonary valvuloplasty. Early and late results].

Since the introduction into practice in may 1986 at the Institute of Cardiovascular Diagnostics we performed 45 valvuloplasties until March 1990 in 34 children (6.2 +/- 4.9 years old) and 11 adults (29.5 +/- 9.6 years) with valvular pulmonary stenosis. The invasively obtained pressure gradient at the valve diminished from 83.4 +/- 30.7 mm Hg to 35.7 +/- 19.0 mm Hg. Intraoperative complications in three patients (short term asystole, severe bradycardia, increase of right ventricular pressure to 300 mm Hg after valvuloplasty) were controlled, but demanded the end of the intervention. No significant insufficiency of pulmonary valves after valvuloplasty was seen. 18 patients were clinically investigated 14.6 +/- 9.4 months after intervention. The late results for these patients proved the method as a long term curing treatment. According to our present results pulmonary valvuloplasty is the alternative method for valve surgery especially in critical pulmonary valve stenosis in newborns.

Adult↗
PubMed1990

[The possible significance of coronary vascular resistance in chronic ischemic heart disease].

From a pool of patients, treated because of cardiac diseases on ward for 4 years, 8 subjects, the mean age of which amounted to 46 (SD 12) years, showing stable angina pectoris in usual physical activity, were chosen. In these patients widespread examinations including invasive procedures had not been evident for one of the well defined heart diseases. In two patients dysrhythmias appeared during standardized exercise test while in four other subjects acute cardiac findings consisted of chest pain, significant depression of ST segments or inversion of T waves were observed. One patient had a normal result of the exercise test. A myocardial thallium-201 imaging was performed in four subjects. In three patients imaging showed questionable or mild signs of ischemia. The result suggest the existence of unknown shapes in coronary heart disease, the origin of which is possibly connected with a disorder of microvascular smooth muscle reactivity.

Adult↗
PubMed1990

[Percutaneous coronary angioplasty in chronic coronary disease with single and multiple obstructed vessels (analysis of 315 interventions 1978-1988)].

315 percutaneous transluminal coronary angioplasties performed during 1978-1988 in 261 patients with ischemic heart disease were analyzed for three different variants according to primary effectiveness, failure rate the most frequent complications and costs of materials as well as duration of intervention and fluoroscopy. Only variant 3 of the proceeding (soft-tip-applicators, flat profile balloon catheter, Kaltenbach long-wire technique, streptokinase rinsing of instruments, permanent infusion of instruments during the procedure) is an applicable routine method. It has a primary effectiveness of 86%. For multiple vessel PTCA this variant however resulted in significantly prolonged investigation and fluoroscopy intervals, so it is advisable only for selected groups of patients.

Adult↗
PubMed1990

[Transfemoral balloon occlusion of the coronary sinus in patients with angina pectoris].

The aim of the study was to demonstrate the possibility of transfemoral balloon occlusion of the coronary sinus and to detect changes of the left ventricular function during this occlusion in patients with angina pectoris. In 9 of 18 patients a stable occlusion over 15 seconds was performed. There were found only short term negative effects on the left ventricular contraction and relaxation. The coronary sinus pressure increased to 53 +/- 11 mm Hg. Numerous venous anastomoses made it difficult to occlude completely the sinus. The retrograde perfusion of the myocardium reached 20-30% of the antegrade one.

Adult↗
PubMed1990

[Concentration of thiobarbituric acid-reactive substances (TBARS) in the plasma of patients with atherosclerosis with different localizations and different degrees of severity].

The concentration of thiobarbituric acid reactive substances (TBARS) formed as a result of lipid peroxidation and prostanoid metabolism was measured in the plasma of patients with coronary or peripheric atherosclerosis. From the results conclusions were deduced to the function of reactive O2-species in the atherogenesis. We found in plasma of patients with coronary as well as with peripheric atherosclerosis increased TBARS concentrations dependent on the dimension of atherosclerosis as an index of activation of reactive O2-species formation. The TBARS concentration correlated with the cholesterol and LDL-cholesterol concentration in plasma.

Adult↗
PubMed1989

[Therapeutic principles in myocarditis].

The incomplete aetiopathogenetic knowledge, the non-uniform clinical and diagnostic criteria as well as the course of the myocarditis which is prognostically not to be foreseen cause controversial therapeutic consequences. In the first place of the treatment is the causal treatment of the factors evoking or maintaining the inflammation. By means of immunosuppression an improvement of the findings is obtained in approximately 50% of the patients with myocarditis. Thus the immunosuppressive therapy cannot be recommended in general. It is sought for new active agents. The disturbed haemodynamics is, apart from medicamentous measures, positively influenced above all by convalescent treatment. Individually reconciled measures of the complex rehabilitation are accompanyingly necessary and render possible an improvement of the quality of life at long sight. In individual cases only the heart transplantation may have a favourable influence on the prognosis of the in most cases young patients.

Adult↗
PubMed1989

[Ultrasound sonographic diagnosis of myocarditis using quantitative texture analysis of 2-dimensional echocardiography images].

In a prospective study we tested the possibility to differentiate myocardial tissue by means of the quantitative texture analysis of two-dimensional echocardiographic images. 12 patients with a bioptically ascertained myocarditis and 12 healthy patients of a control group were echocardiographically examined. The results demonstrated that the echocardiographic image texture in myocarditis is characterized by an increase of the texture parameters entropy, second difference moment and long-run emphasis as well as by a decrease of the parameters angular second moment, inverse difference moment and run-length nonuniformity as well as by different values of the ring and sector sums of the power spectre. The digital image processing of echocardiography images seems thus to open a new way to the noninvasive diagnostic of myocarditis.

Biopsy↗
PubMed1989

[Differential therapy of myocardial ischemia in females].

Peripheral perfusion abnormalities are considered a possible reason for myocardial ischemia in the absence of visible coronary artery stenoses. In 85 women (age: 41-58 years, mean age: 46 +/- 8) with pathological exercise ECG (precordial mapping: 50 leads), hemodynamic studies were performed without medication, after sublingual nitroglycerin (NTG, 0.8 mg), sublingual Nifedipin (N, 30 mg), and intravenous Dipyridamol (D, 0.5 mg/kg). Eighteen women showed normal coronary arteries and a normal myocardial perfusion (group I), 21 an impaired perfusion due to coronary stenoses (Group II), and 46 women a reduced perfusion without visible changes (Group III). Reference methods were measurement of pulmonary artery pressure, 201-TI-scintigraphy, and coronary angiography. In group II, enddiastolic and endsystolic left ventricular volume (EDV, ESV) as well as enddiastolic pulmonary artery pressure (pAd) were increased, the ejection fraction (EF) was reduced, and cardiac output (CO) was normal. In group III, ESV, EDV, EF, and CO were significantly reduced, while pAd increased. In group II, N led to a normalization of ESV, EDV, EF, and pAd. In group III, NTG led to a reduction of pAd and EDV, and concomitantly to a further reduction of the already low CO. In both groups the reduction of ST-segment depressions after NTG was significant. N led to a moderate reduction of pAd and ST-segment depression, but to an increase of CO in both groups. D exhibited a comparable effect in group III. In group II an increase of ST-segment changes and of pAd with unchanged CO was observed. With regard to longterm treatment of women in group III, N and D seemed to be more efficacious than nitrates due to a beneficial effect on cardiac output.

Administration, Sublingual↗
PubMed1989

[Embolization therapy using detachable balloons].

Report on the application of a new (valve equipped) detachable balloon for percutaneous transvasal embolization therapy in 372 patients with (noncerebral) curative preoperative and palliative indications.

Embolization, Therapeutic↗
PubMed1989

[The effect of ionic and nonionic x-ray contrast media on myocardial perfusion and myocardial function].

The influence of injections of Amidotrizoate and Iopromide into the left coronary artery on global myocardial perfusion and function (pressures in the left ventricle, heart rate) as well as excitation formation and transmission was studied in 16 patients with ischaemic heart disease. No statistically significant differences in myocardial perfusion measured were found with xenon-133 in this small group between rest and dipyridamole load for ionic and non-ionic contrast media.

Adult↗
PubMed1989

[The effect of ionic and nonionic contrast media (amidotrizoate, iopromide) on cardiac function (contractility, relaxation, perfusion)].

In 30 patients the influence of ionic (Amidotrizoate) and non-ionic (Iopromide) contrast agents on the heart parameters contractility, relaxation, perfusion and the rate of extrasystoles was investigated. They were significantly less influenced by Iopromide than by Amidotrizoate. A negative inotropic action was detectable only for Amidotrizoate. It is concluded that non-ionic contrast media should be used especially for critical patients.

Coronary Circulation↗