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W Tomkowski

Publications and source records attributed to W Tomkowski.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Pulmonary embolism in malignancy of the lung: a retrospective clinical evaluation and pathomorphologic personal material].

The incidence and clinical significance of pulmonary embolism (PE) in pulmonary malignancy were analysed among 111 autopsy cases including: 65 primary and 24 metastatic lung cancer, 8 hematological malignancies and 14-malignant pleural mesothelioma. In 34 (31%) cases PE was found, in 4 (12%) patients cancer tissue emboli was documented. In nonsmall cell lung cancer the frequency of PE was 40%, compared to 24% in small cell, 25% in metastatic lung cancer and 14% in mesothelioma. Deep venous thrombosis of lower extremities was the source of thrombotic material in 35% cases. In remaining cases the sources of thrombotic material were different (caval vein inferior, superior, and their main branches, right heart cavities, pulmonary artery). In 8 patients with PE the acute form of DIC was observed. In 15 (44%) patients the clinical ante mortem diagnosis of PE was done. In 26% of all analysed cases PE was the direct cause of death. We concluded that PE is a frequent and dangerous complication of lung neoplasms. Clinical diagnosis can be extremely difficult.

Adenocarcinoma↗
PubMed1996

[Lung function and exercise tolerance in patients with chronic major vessel thromboembolic pulmonary hypertension].

We studied 14 consecutive patients with severe pulmonary hypertension due to chronic major vessel thromboembolic pulmonary hypertension (CPTEH), clinical entity that may be successfully surgically treated by pulmonary thrombendarterectomy. Resting pulmonary mechanics and gas exchange were investigated. Exercise tolerance was studied by 3 different exercise tests. Pulmonary volumes and flows were normal. Some patients presented with decreased lung compliance and reduced diffusion capacity for carbon monoxide. Majority of patients had hypoxaemia and respiratory alkalosis. Exercise tolerance was very limited. In 6 minute walking test patients covered 346 +/- 95 meters. During Bruce test patients completed from 1 to 4 stages. During incremental maximal symptom limited test on cycloergometer patients achieved 56 +/- 18 watts. We concluded that patients with CPTEH present with resting hypoxaemia deteriorating further on exercise and severely limited exercise tolerance.

Adult↗
PubMed1996

[LGM inferior vena cava filters--follow up 50 patients].

In the Department of Medicine at the Institute of Tuberculosis and Lung Diseases 50 LGM inferior vena cava filters have been inserted since 1993. Indications for filters placement were as follows: recurrent pulmonary embolism (PE) despite anticoagulation-16 patients (pts), severe bleeding complications of thrombolytic or anticoagulant therapy-9 pts, contraindications for thrombolytic and/or anticoagulant treatment-3 pts, massive PE-6 pts, chronic thromboembolic-major vessel pulmonary hypertension (CTEPH)-18 pts, extensive deep vein thrombosis of lower limbs or vena cava inferior in patients with urgent indications for surgery-10 pts. In every patient diagnostic procedures were performed after 1, 3, 6, 12, 24 and 36 months of follow-up period. Only one non-fatal episode of recurrent PE was documented. Other complications were rare and insignificant. The LGM inferior vena cava filters are effective and safe in such selectively chosen group of patients.

Female↗
PubMed1996

[Implantation of LGM inferior vena cava filters in patients with chronic pulmonary hypertension during a course of major vessel thromboembolism--observation of 18 patients].

CTEPH have not been widely recognised until recently. Introduction of the new, sophisticated, non-invasive diagnostic tools accounts for rapid progress in that field. Patients with high pulmonary hypertension have a very poor prognosis. Medical treatment (vasodilators, anticoagulants) does not change outcome. Pulmonary thromboendarterectomy is the only therapeutic option for the patients. It is essential to prevent further episodes of pulmonary embolism both over the long term and during the high risk perioperative period by means of inferior vena cava filters. In the Department of Medicine, Institute of Tuberculosis and Lung Diseases 18 LGM ivc filters have been inserted in patients with CTEPH since 1994. In 7 patients PTE was performed-in 5 cases good result was achieved, 2 patients died after surgery. In the latter group 5 patients died mainly because of severe heart failure. Only one non-fatal episode of pulmonary embolism was observed. It should be concluded that the LGM ivc filters are safe and effective in preventing episodes of pulmonary embolism in patients with CTEPH.

Chronic Disease↗
PubMed1996

[Low doses of rtPA administered as a bolus in treatment of clinically acute massive pulmonary embolism].

12 patients (7 male and 5 female) with confirmed pulmonary embolism (PE) with: angiography-5 cases, conventional contrast-enhanced CT-2 cases, echocardiography-2 cases, autopsy-3 cases were diagnosed as clinically acute PE. Criteria of clinically acute PE were: cardiac arrest-1 case-2 cases, shock-1 case, acute cor pulmonale-9 cases and acute cor pulmonale with shock. All patients were treated with heparin, administered with therapeutic prolongation of aPTT. Clinically acute PE (if possible confirmed with angiography, TC and/or echocardiography) was treated with rtPA administered in 10 minutes lasting bolus in doses 0.6-0.8 mg per kg of body weight (50 mg of rtPA during 10 minutes administered into peripheral veins). In 9 patients with pulmonary hypertension, significant decrease of tricuspidal gradient (measured echocardiographically during several hours after administration of rtPA) was documented. Improvement in PaO2, SaO2 and decrease of heart rate and respiratory rate were also achieved. No serious bleeding complications were observed after mentioned treatment. Control investigations (conventional contrast-enhanced CT and spiral CT) performed several days after rtPA administration revealed thrombus in pulmonary artery. We conclude: I rtPA administered in bolus simultaneously with heparin significantly decreased pulmonaryhypertension; rtPA administered simultaneously with heparin is safe method of treatment of PE; hemodynamic improvement after administration of rtPA is not univocal with full fibrynolitic effect.

Adult↗
PubMed1996

[Clinically silent pulmonary embolism in patients with proximal deep venous thrombosis].

In 18 patients with proximal deep venous thrombosis (PDVT) confirmed by phlebography, no symptoms and signs of pulmonary embolism (PE) were observed. All patients were treated with nadroparin. During first 6 days of treatment in all patients perfusion lung scans were performed. 8 patients (44.4%) of all group developed lung scans positive for PE (silent PE). Period of successful treatment of PDVT was 10 days. No evidence of recurrent PE were observed during the period of treatment. We conclude that: 1. Frequency of silent PE in patients with PDVT is very high-lack of symptoms and signs of PE does not exclude the presence of PE in this group of patients. 2. In all patients with PDVT perfusion lung scan should be performed even in cases with no symptoms and signs of PE. 3. Low molecular weight heparins administered subcutaneously are effective in treatment either silent PE or PDVT.

Adult↗
PubMed1996

[Pericardial syndrome in the course of pulmonary embolism in personal material].

UNLABELLED: Dressler-like syndrome has been described in about 3-4% of patients after pulmonary embolism (PE). Out of 207 patients admitted to our hospital in whom the clinical diagnosis of PE was confirmed by scintigraphy, spiral computer tomography and angiography, in 19 patients (9.2%) pericardial fluid was detected and pericardial syndrome (PS) after PE was diagnosed. Other causes of pericarditis were excluded. Mean value of pericardial fluid in echocardiographic examination-behind left ventricular posterior wall was 3.84 mm (range 2-10 mm). No clinical or echocardiographic symptoms of cardiac tamponade were observed. In 6 patients PS complicated clinically massive PE, in 3 patients-non-massive PE, in 10 patients recurrent PE. In 6 patients fibrinolytic and in 13 patients heparin therapy was instituted. In 3 cases corticosteroids were given. No increase of pericardial fluid during fibrinolytic or heparin therapy was observed. CONCLUSIONS: 1. PS after PE is more frequent, than it was estimated previously 2. During therapy of PE the echocardiographic monitoring of the amount of pericardial fluid is mandatory 3. The clinician considering in similar situations the risk-benefit ratio of fibrinolytics and anticoagulants should not abstain from the use of these drugs in the presence of PS after PE, in cases with high probability of cardiac tamponade-pericardial catheter should be used.

Adult↗
PubMed1996

[The value of measuring adenosine deaminase activity in pericardial effusion fluid for diagnosing the etiology of pericardial effusion].

The diagnosis of tuberculous pericarditis is difficult. The cultures of the pericardial fluid for M.tuberculosis are often negative. The determination of ADA activity in pleural fluid in TB patients /PTS/ is very useful. It seemed reasonable to measure ADA activity in pericardial effusion. ADA activity in pericardial fluid of 40PTS/19 women and 21 men/with large pericardial effusion of different etiologies who were treated in our institute in years 1988-1995 was investigated. The median age was 44 years. In each case the pericardiocentesis was performed. PTS were grouped as follows: group I-4 PTS with strongly suspected TB pericarditis, group II-32 PTS with malignancy and group III-4 PTS with miscellaneous diseases. In group I the mean ADA activity was 24U/I(3-60), in group II 18U/I (3-60) and in group III 18U/I (0-37) (with a cutoff value for ADA activity of 40U/I). It was definitive bacteriologic diagnosis of TB pericarditis in PTS of group I. Our observation does not confirm the earlier data about the high ADA activity in clinically suspected TB pericarditis without bacteriologic diagnosis. The value of ADA determination in pericardial fluid is its high specificity (97%) in excluding of TB etiology of pericardial effusion.

Adenosine Deaminase↗
PubMed1996

[Evaluation of intrapericardial cisplatin administration in cases of recurrent malignant pericardial effusion and cardiac tamponade].

30 consecutive patients with large malignant pericardial effusion (MPE) entered this prospective study. After pericardiocentesis and insertion of a polyurethane catheter, pericardial fluid was drained. Malignant etiology of pericardial fluid was confirmed by cytological examination. After confirmation of MPE cisplatin (10 mg in 20 ml normal saline) was instilled over 5 minutes during 5 consecutive days directly into pericardial space. If fluid reaccumulation occurred the courses were repeated every 3 weeks. Treatment was considered successful if the patient with malignant effusion survived 30 days without recurrence of symptoms of large pericardial effusion and other interventions directed to the pericardium were required. Positive effect of intrapericardial treatment with cisplatin was achieved in 18 cases (60%). Mean period of response was 3, 7 months (+/-6). Cisplatin administered directly into pericardial space is effective and safe method of treatment of recurrent MPE. Sclerosis of the pericardial space is rare complication connected with CP. Positive effect of CP can depend on improvement of lymphatic drainage from heart. CP seems to be method of choice in intal intrapericardial treatment in patients with malignant cardiac tamponade and recurrent MPE in course of lung cancer.

Adult↗
PubMed1996

[Echocardiographic analysis of cardiac size and function in patients with severe obstructive sleep apnea].

The purpose of this study was to determine usefulness of non invasive echocardiographic measurements in patients with severe obstructive sleep apnea (OSA). Diagnosis of OSA was established by polysomnography. We investigated 18 patients (16M, 2F), mean age 45 +/- 10 years, mean weight 114 +/- 16 kg and mean apnea/hypopnea index 69 +/- 23. Two-dimensional (2D) and Doppler echocardiography (DOP) was used to assess: 1. Systolic function of left ventricle by determination of cardiac output (CO), ejection fraction (EF), 2. Diastolic function of left ventricle by calculation of mitral early diastolic velocity to arterial velocity ratio (Ev/Av) and atrial flow to total mitral flow ratio (AF/Tf), 3. Right ventricle thickness in systole (RVWS) and diastole (RVWD), and its diastolic diameter (RVD), 4. Pulmonary arterial pressure (PAP) by evaluation of acceleration time in the pulmonary artery (ACT) and tricuspid regurgitation jet velocity (TR). Results (mean +/- SD): Co 6.67 +/- 2.0 L/min, EF 44 +/- 5.6%, RVWS 10.9 +/- 1.3 mm, RVWD 6.7 +/- 1.1 mm, RVD 30.3 +/- 2.8 mm, Ev/Av 1.22 +/- 0.39, Af/Tf 0.38 +/- 0.11, AcT 121.4 +/- 20.3 ms. These data confirm that intermittent hypoxia and increased ventricular afterload cause both systolic and diastolic left ventricular dysfunction. Right ventricular hypertrophy found despite normal resting, wake, PAP could be probably attributed to transient pulmonary hypertension during repeatable nocturnal hypoxic episodes.

Adult↗
PubMed1996

[Massive pulmonary artery embolism complicated by acute pulmonary heart disease].

43-year old woman, with considerable overweight had been admitted to Intensive Medical Care Unit with suspicion of pulmonary embolism (PE). The patient had the limb immobilized in gypsum for last several weeks. This episode was tangled with recurrent thrombosis of deep veins in the left limb, treated with heparin and oral anticoagulants irregularly without sufficient control. Taking into consideration the data of anamnesis, clinical picture and the results of ECG, chest X-ray, gasometric and echocardiographic examination we got much closer to the recognition of PE. Our suspicion of PE was confirmed by the result of pulmonary angiography. Indications for thrombolytic treatment (r-tPA) had been established. During the following hours considerable improvement of general state was observed. The therapy was continued with constant drip infusion of heparin. No prolongation of therapeutic PTT was observed. The deficit of AT III was diagnosed. In this situation the patient was given AT III to obtain normalization of its level and therapeutic extension of PTT. Therefore there were settled indications for the operation of uterus with myoma changes. As the rich thrombolytic material in the leg's vein was found the patient was implanted LGM Filter, with excellent prophylactic effect (no PE in perioperative period). The clinical course of our case enabled to present most of diagnostic, therapeutic and preventive methods applied in venous thromboembolism.

Administration, Oral↗
PubMed1995

[Indications for prophylactic vena cava filters introduced subcutaneously in patients with thromboembolic disease--preliminary report].

In 10 patients with thromboembolic disease 1 Gunther filter and 9 LGM filters were inserted. Indications for filter placement were: pulmonary hypertension caused by recurrent pulmonary embolism in 3 cases; planned surgery in 2 patients with pulmonary embolism and deep venous thrombosis; recurrent pulmonary embolism despite of anticoagulant treatment in 2 cases, previously performed thrombo-endarterectomy in 1 case; contraindications for anticoagulant treatment in 1 case and complications of anticoagulant therapy also in 1 case. No serious complications after filter placement were observed.

Adult↗
PubMed1995

[Weaning from mechanical ventilation in patients with exacerbations of chronic respiratory insufficiency--personal experience].

Nineteen patients with exacerbation of chronic respiratory insufficiency treated with mechanical ventilation were included in the study. The mean weaning time from the respirator was 15.9 days (+/- 12.1), ranging from 2 to 49 days. Success was met in 9 patients using inspiratory pressure support (IPS), in 2 synchronized intermittent mandatory ventilation (SIMV), in 8 the simplest model (stepwise prolongation of spontaneous ventilation during continuous mechanical ventilation--CMV/SV). All options were used in the same patients throughout the weaning procedure. The use of IPS led to a successful weaning in those patients in whom other options (CMV/SV, SIMV) were not fortunate. The application of IPS was begun at 40 cm H2O, gradually decreasing the support pressure. The duration of spontaneous breathing in all weaning options was not only depended on gasometric values, continuous SaO2 monitoring, but mainly on the patients' subjective sense of fatigue. The impression of exhaustion preceded the changes of gasometric parameters and fall of SaO2. The basis of effective weaning is proper selection of respirator parameters, providing almost identical gasometric values if individual patient's to those prior exacerbation of chronic respiratory insufficiency. The duration of weaning negatively correlated (0.25) with FEV1 values.

Adult↗
PubMed1995

[Implantation of a LGM suprarenal vena cava filter--case report].

In the case of 53 years old woman LGM filter was inserted over renal veins. Indications for those procedures were: vena cava thrombosis in distal part of vena cava what not allowed to place filter below renal veins, malignancy, planned surgery, proximal deep vein thrombosis and past history of pulmonary embolism. Indications for suprarenal placement of vena cava filters and results of such as procedure were discussed.

Colonic Neoplasms↗