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Biomedical subjects

R Karnik

Publications and source records attributed to R Karnik.

50 records · Page 3Linked to original sources
PubMed1987

Cerebral ischemia in children and young adults.

Cerebral ischemia is very rare in children and young adults. There can be a multitude of causes; in many cases etiology remains undetermined. We report here on 7 cases, 11 to 25 years of age. Pathogenetic factors (lupus erythematodes, endocarditis, fibromuscular dysplasia) and risk factors (cigarette smoking, oral contraceptives) were found in 5 patients whereas in 2 cases the etiology was not determinable. Three patients were treated with low weight dextrans, two patients received prostaglandin E1, and in 2 cases regional thrombolysis was performed. Three female patients died, two with occlusions of the rostral part of the basilar artery and one with an occlusion of the carotid artery and lupus erythematodes as the primary disease. Long-term observations of the surviving patients showed good recovery from neurological deficits. Prognosis quoad sanationem seems better in this age group than in elderly patients.

Adolescent↗
PubMed1987

Postprandial increase of cardiac output in patients with acute myocardial infarction.

The influence on the hemodynamics of oral and intravenous nourishment containing the same amount of calories in comparison to isotonic solution of sodium chloride was studied in 14 patients with acute myocardial infarction. Forty minutes after administration of nourishment, a 34% increase in cardiac index, rising from 2.61 +/- 0.43 to 3.49 +/- 0.68 l/min/m2 was measured in the oral group, P less than 0.001. The increase was 22% (from 2.75 +/- 0.54 to 3.36 +/- 0.83 l/min/m2) in the intravenous group, P less than 0.025. Stroke index rose by 26% (from 33.4 +/- 7.8 to 42.1 +/- 10.6 ml/m2) in the oral group, P less than 0.025; and by 13% (from 32.7 +/- 8.3 to 37.0 +/- 9.7 ml/m2) in the intravenous group, P less than 0.05. No increases were seen in heart rate, mean blood pressure and pulmonary arterial diastolic pressure. The systemic vascular resistance decreased significantly in both groups. Thus, changes that mimic those seen during treatment with positive inotropic or vasodilating drugs were found. These effects have to be taken into account when assessing hemodynamic changes following cardiovascular medication.

Adult↗
PubMed1987

Different effects of beta-1-adrenergic blocking agents with ISA or without ISA on peripheral blood flow.

Until recently beta-adrenergic blocking agents were considered contraindicated in peripheral arterial occlusive disease (PAOD). However, in recent years several studies have failed to show negative effects on peripheral blood flow. It was the aim of this study to compare the effects of celiprolol, a beta-1-adrenergic blocking agent with intrinsic sympathomimetic activity (ISA), and of metoprolol, a beta-1-adrenergic blocking agent without ISA, on peripheral blood flow of patients with and without PAOD. In an acute trial 24 patients (group I: 12 patients with PAOD stage I and II; group II: 12 patients without PAOD received a single dose of 200 mg celiprolol or 200 mg metoprolol in a double-blind crossover design. Celiprolol induced no significant changes in calf and skin blood flow at rest or during reactive hyperemia. Basal vascular resistance (BVR) and minimal vascular resistance (MVR) were not affected. Metoprolol, however, significantly reduced muscle blood flow and increased BVR in both groups. Subsequently the patients were treated in a randomized double-blind design with a daily dose of 200 mg celiprolol or metoprolol for three weeks. In long-term treatment skin and muscle blood flow at rest and during reactive hyperemia, BVR, and MVR were not affected by celiprolol. Metoprolol significantly lowered calf blood flow at rest in patients with PAOD; other parameters remained unchanged. In patients without PAOD, metoprolol caused a significant decrease of calf blood flow at rest and an increase of BVR. Calf blood flow during reactive hyperemia, as well as skin blood flow at rest and during reactive hyperemia, showed no significant changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1987

Validity of continuous-wave Doppler sonography of the vertebrobasilar system.

To assess the value of continuous-wave Doppler sonography for detection and exclusion of lesions in the vertebrobasilar system, the ultrasonic and angiographic findings were compared in a prospective study. Altogether, 200 vertebral arteries in 176 patients were evaluated by both methods. Insonation of the vertebral arteries was performed at the mastoid slope and at the origin of the vessel. Of 62 angiographically proven lesions, 45 were detected by ultrasound. Of 138 normal vertebral arteries, 129 were correctly diagnosed. Sensitivity for all lesions was 72.5%, and for hemodynamically relevant lesions it was 91%. Overall specificity was 93.5%. A positive predictive value of 83.3% and a negative predictive value of 88.4% for all lesions shown by angiography demonstrate the high reliability and accuracy of doppler ultrasound of the vertebrobasilar system.

Arterial Occlusive Diseases↗
PubMed1987

Intracoronary streptokinase versus intravenous anisoylated plasminogen streptokinase activator complex in the treatment of acute myocardial infarction.

As part of a randomised multicentre study, 16 patients with acute myocardial infarction were treated with either anisoylated plasminogen streptokinase activator complex (APSAC) administered as an intravenous bolus of 30U or 250,000U of streptokinase by the intracoronary route. The reperfusion was documented angiographically during a 90-minute period and possible reocclusion was assessed at 90 minutes and 24 hours after the start of therapy. The percentage of reperfusion obtained in the APSAC group was 83% versus 63% in the streptokinase group. One reocclusion was seen after 24 hours in the APSAC group. Fibrinolytic activity was more pronounced in the APSAC group but there were no major bleeding problems in either group. The administration of 30U of APSAC by an intravenous bolus injection produced results at least as good as those obtained with intracoronary streptokinase and in addition offered the advantage of a simpler and quicker administration.

Adult↗
PubMed1986

[Diagnosis and therapy of supravalvular aortic dissection (type A)--an interdisciplinary challenge].

Acute dissection of the ascending aorta is a life-threatening disease. Successful management requires close teamwork of internal medical specialist, radiologist and cardiovascular surgeon. The diagnostic and therapeutic approach is reviewed on the basis of 18 of our own cases - 15 men and 3 women aged from 42 to 88 years. Peculiarities of history, pain and ECG give valuable clues to the differentiation of aortic dissection from myocardial infarction and massive pulmonary embolism. As a non-invasive rapidly available diagnostic method echocardiography may yield decisive information about the aortic root and the presence of pericardial effusion. Definite confirmation of diagnosis is accomplished by aortography and/or computed tomography. Blood pressure and aortic flow must be decreased to the lowest level tolerated by the patient to prevent pericardial tamponade or rupture into the mediastinum. The urgency of surgical repair is underlined by a median survival time of 12 hours from onset of symptoms to death with conservative treatment. 7 of our patients were operated on. In 6 cases surgery was performed by means of extracorporeal circulation and the ascending aorta was replaced by a graft. 3 patients survived the operation (2 for over 2 years and three died in the postoperative period due to cerebral and pulmonary complications). In one case with inoperable dissection an axillo-femoral bypass was performed for relief of complete ischaemia of the left lower limb. Postoperatively, maintainance of the patient's blood pressure at the low normal level ist mandatory.

Adult↗
PubMed1986

[Acute occlusion in the vertebrobasilar circulatory system in children and young adults].

Within four years ten patients (six women and four men) under 50 years of age (13-49 years) were observed who presented occlusions of the vertebrobasilar artery. Eight patients were admitted from other hospitals, on an average 41 hours after the acute occlusion; only in one case had a correct first diagnosis been made. In all cases diagnosis was confirmed by means of selective angiography. Conservative treatment comprised in two patients low-molecular dextranes and heparin, in another two prostaglandin E1. In the remaining six patients local fibrinolysis was performed. In the group receiving conservative treatment a 33-year-old female patient survived and her neurological deficits subsided except for an organic psychosyndrome of minor degree. Local fibrinolysis yielded complete recanalization in three cases and partial recanalization in two. Three patients survived, in two patients near-complete recovery was achieved.

Acute Disease↗
PubMed1986

Coumarin induced acral skin necrosis associated with hereditary protein C deficiency.

Hemorrhagic skin necrosis of the toes was observed in a patient with heterozygous protein C deficiency (protein C:Ag 32% and protein C activity 30%) on the 4th day of coumarin treatment overlapping with effective intravenous anticoagulation with heparin. Family studies revealed protein C deficiency in two sisters of the proposita without a history of thromboembolic disease. Immunologic studies in the proposita at the time of coumarin necrosis revealed slight depression of complement factor C4 and the presence of immune complexes. The present case and review of the literature show that the pathogenetic mechanism leading to coumarin necrosis in patients with protein C deficiency seems not yet to be fully understood.

Adult↗
PubMed1985

Selective intracoronary thrombolysis in the coronary care unit without cineangiography.

Selective coronary artery visualization was performed in the CCU by means of a movable fluoroscopy device in 96 patients with suspected myocardial infarction within 6 hours after onset of symptoms. Intracoronary streptokinase (SK) was administered in a total dosage of 200 000 to 400 000 U within 30-60 min to 69 patients with complete (N = 57) or subtotal obstruction (N = 12) of the infarct-related vessel. Recanalization was achieved in 39 of the 57 patients (68%) with initially complete occlusion. Three of the 39 successfully treated patients died (7.7%) versus 8 of 33 subjects (24%) with persistent complete obstruction (chi-square 3.21, not significant). Selective cineangiography subsequently performed in 8 patients and postmortem examination of 12 subjects who had died, showed that all haemodynamically significant lesions had been recognized by the examination in the CCU with one exception. It is concluded that intracoronary thrombolysis performed in the CCU, by means of a standard mobile fluoroscopy equipment is effective, safe, inexpensive and may be started virtually without delay after admission.

Cineangiography↗
PubMed1984

[Regional lysis of acute basilar artery occlusion--case report].

Thrombosis of the basilar artery is not a rare disease, and the mortality is reported to be 60 to 80%. Present standard therapy with heparin infusions yields poor results. The high risk of intracerebral haemorrhage prohibits systemic fibrinolytic therapy. Due to these facts and good experience in our department with the use of local intracoronary lysis in acute myocardial infarction, the method of local thrombolysis was applied in a case of acute basilar artery thrombosis. Fibrinolytic therapy was started via an angiography catheter placed in the vertebral artery in a 28 year-old woman with hemiplegia and severe brain stem symptoms. The patient received 200,000 IU streptokinase within 2 hours and subsequently 300,000 IU urokinase within 10 hours. The vessel re-opened completely. The neurological symptoms decreased during the following weeks. Based on this experience and according to rare reports in the literature we believe local low-dose thrombolysis to be a causal therapy promising success for acute thrombosis of the basilar artery. This therapy can be carried out in every medical centre able to perform selective angiography and experienced in the administration of fibrinolytic drugs.

Adult↗
PubMed1984

Local thrombolysis in arterial occlusive disease.

In a series of 38 subjects intra-arterial catheters were used to infuse streptokinase (SK) or urokinase (UK) just proximal to an acute thromboembolic occlusion in 20 limbs or to perfuse SK directly into the obstructing material in 23 extremities with subacute or chronic occlusions by stepwise advancing the catheter until the distal open segment of the artery was reached. Dosage of SK varied between 50.000 U and 400.000 U and was administered during 1 to 4 hours. Patency could be achieved in 16 out of 20 acute occlusions and in 16 out of 23 chronically obstructed vessels within some hours. A systemic hyperlytic state of 12 to 24 hours duration was observed when total dosage of SK exceeded 80.000 U. In 9 patients thrombolysis was immediately followed by angioplasty. Advantage of the described technique is its rapid effectiveness, low cost, high success rate even in chronic femoro-popliteal occlusions and its applicability to patients in whom systemic thrombolysis would be considered contraindicated on account of old age or other causes.

Acute Disease↗