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Biomedical subjects

W Tomkowski

Publications and source records attributed to W Tomkowski.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Prophylactic use of the LGM filter in a patient with a recurrent clinically acute massive pulmonary embolism complicated by pericarditis--case report].

Case of recurrent, clinically acute massive pulmonary embolism treated with rtPA (administered 0.6 mg/kg, during 10 minutes simultaneously with heparin) is presented. Minimal clinical improvement was observed after mentioned procedure. Good clinical response was achieved after LGM filter insertion into vena cava inferior. Clinical course was complicated by Dressler-like syndrome successfully treated with steroids. Problems of massive pulmonary embolism, vena cava filter prophylaxis and pericardial complication of pulmonary embolism are discussed.

Adult↗
PubMed1995

[Ultrasonographic examination of the heart as a basis for determining the cause of inflammatory infiltration changes in the lungs].

Diagnostic difficulties found in a 41 year old female presenting with fever, chills, fainting spells, tachycardia, hypotension, interstitial consolidation in both lungs and enlargement of the cardiac silhouette on a chest radiogram are discussed. Unsuccessful antibacterial and antituberculous therapy led to a supposition of a collagen disease. The diagnosis of a bacterial endocarditis with bacterial pulmonary emboli was made basing on determination of bacterial vegetation on cusps of the tricuspid valve.

Adult↗
PubMed1994

Intrapericardial cisplatin for the management of patients with large malignant pericardial effusion.

Nine patients (seven men and two women), median age 57 years (range 40-68 years), with large malignant pericardial effusion confirmed by cytological examination, were treated with direct intrapericardial administration of cisplatin. After insertion of a polyurethane catheter, fluid was drained and cisplatin (10 mg in 20 ml normal saline) was instilled over 5 min during 5 consecutive days (total cisplatin dose: 50 mg). If fluid reaccumulation occurred the courses were repeated every 3 weeks. All of the patients achieved a complete therapeutic response (no more fluid reaccumulation). The median time of response was 2.8 months (range 1-24 months). Mild nausea occurred in two patients, supraventricular arrhythmia in one patient and infectious complications in one patient. Eight patients died because of disease progression without evidence of cardiac tamponade or stricture. Autopsy, performed in 7 cases, revealed neoplastic involvement of the pericardium in all of the patients, but pericardial effusion was seen in one patient only.

Adult↗
PubMed1994

[Outcome of patients with clinically acute massive pulmonary embolism].

Acute massive pulmonary embolism (AMPE) is an event that places the recipient at an unusually high risk of sudden death. Among 183 patients with thromboembolic disease, AMPE has been diagnosed clinically in 58 cases (32%). Diagnostic criteria: cardiac arrest (24 cases--41%), shock (12--21%) acute cor pulmonale (ACP 15--26%) and ACP with shock (7 cases--12%). There were 33 women and 25 men aged 22-88 years in this group. In 25 patients heparin (H), in 7 streptokinase (S), in 1 tPA, in 7 S after H have been used, 26 patients (45%) survived, 32 (55%) died: there were 20 sudden deaths. Advanced underlying cardiopulmonary diseases or/and recurrent pulmonary embolism seem to be the most important predictors of fatal outcome of AMPE.

Acute Disease↗
PubMed1994

[Pulmonary embolism as a serious complication of chronic obstructive pulmonary disease from material from Ward "R"].

Pulmonary embolism (PE) is a serious complication of the chronic obstructive pulmonary disease (COPD). Retrospective studies on patients with COPD treated intensive care unit (ICU) were performed to determine: 1. frequency of PE, 2. clinical course of PE in ICU-COPD-cases, 3. frequency of PE as a cause of death in the studied group. There was 10.9% of PE in COPD patients. In the analyzed group clinical presentation of PE was characterized by acute, severe, life threatening complications leading to death in 86.7%. PE was the most frequent cause of death (40.6%) in ICU-COPD patients. The results of treatment of PE in COPD are poor and the mortality in that group of patients is very high. We believe, that the improvement of management can be achieved by antithromboembolic prophylaxis, which should be instituted as soon as possible in all ICU-COPD-patients.

Adult↗
PubMed1994

[Effect of large doses of nifedipine on pulmonary hypertension in patients with recurrent pulmonary thromboembolism].

Thromboembolic pulmonary hypertension is an uncommon condition with poor prognosis. Vasodilators may be effective in some patients with that disease. The effect of nifedipine on hemodynamics was investigated in two patients with thromboembolic pulmonary hypertension treated with acenocoumarol. Nifedipine was administered in 20 mg doses hourly during right cardiac catheterization and was repeated after 1 hour until a decrease in systemic pressure occurred. Patients received 80 mg and 120 mg of nifedipine. Pulmonary artery pressures decreased in both cases. An increase of cardiac output and decrease of pulmonary vascular resistance were observed after 60-80 mg of nifedipine and continued to the end of the investigation. No effect on heart rate was observed. We suggest that high doses of nifedipine may be--in some patients--effective in reducing thromboembolic pulmonary hypertension.

Adult↗
PubMed1994

[Evaluation of agreement between clinical and pathomorphologic diagnosis of pulmonary embolism].

The rate of both: false-positive and false-negative diagnoses of pulmonary embolism (PE) is high. To determine the accuracy of the ante-mortem diagnosis of PE we reviewed 78 autopsies and compared the clinical and pathological diagnoses in that group. In 64 cases PE was diagnosed clinically: in 43 it was confirmed by autopsy (67%). In 21 cases (33%) the clinical diagnoses were false-positive. There were 57 pathological diagnoses altogether: in 14 cases (25%) the clinical diagnoses were false-negative. Among falsely diagnosed patients, the diagnoses of myocardial infarction, pneumonia and malignancy were most frequent. We tried to find some distinctive features separating the cases in the subgroups. Among them venous diseases were more frequent in PE than in falsely diagnosed patients.

Adult↗
PubMed1994

[Pericarditis during the course of pulmonary embolism].

Among 121 patients with pulmonary embolism (PE) five (4%) developed pericardial syndrome, connected with PE. Other known causes of pericarditis were ruled out. In 3 cases corticosteroids were administered with anticoagulants and/or fibrinolytic agents without complications. We believe that the clinician considering in similar situations the risk-benefit ratio of anticoagulant or/and fibrinolytic therapy should certainly use corticosteroids and not abstain from the use of anticoagulants and/or fibrinolytic agents in presence of pericardial syndrome after PE. In cases with huge pericardial effusion catheter should be inserted into pericardial space, because of high probability of cardiac tamponade.

Adult↗
PubMed1994

[Pulmonary hypertension during the course of chronic pulmonary thromboembolism--case report].

Chronic thromboembolic pulmonary hypertension is a rare condition. There are two forms of that disease: major vessel thromboembolic pulmonary hypertension (CTEPH) and a "silent form": recurrent microembolism leading to extensive obstruction of the peripheral pulmonary vasculature and resulting also in severe pulmonary hypertension. On the base of case report the new approaches to the management of patients with two mentioned subgroups of thromboembolic pulmonary hypertension are discussed.

Chronic Disease↗
PubMed1992

[Lactate acidosis in the course of status asthmaticus--case report].

A case report of lactate acidosis in the course of status asthmaticus in a 34 year old female is presented. The lactate acidosis was due to increased anaerobic glycolysis in respiratory muscles caused by decreased oxygen recruitment and increased oxygen consumption by respiratory muscles. The authors discuss the clinical significance of lactate acidosis and proper treatment of status asthmaticus.

Acidosis, Lactic↗
PubMed1991

[Treatment of primary pulmonary hypertension with high doses of nifedipine controlled by Doppler echocardiography].

In a 22 year old female with primary pulmonary hypertension Doppler echocardiography revealed a systolic gradient between the right atrium and ventricle of 11.3 kPa (85 mmHg). A trial of high dose nifedipine therapy was started. It's efficacy was assessed by monitoring the tricuspid gradient. During therapy variations of the gradient were seen but without a favorable, steady, decrease trend. Although nifedipine did not produce any improvement during the "acute trial"--nifedipine therapy was continued--initially 60 mg, followed by 80 mg and finally 100 mg per day. Efficacy of this therapy was also controlled by Doppler echocardiography. Nifedipine was discontinued after 8 months due to lack of improvement in the patient's state. The patient died 30 months from the initial symptoms. Pathomorphological examination confirmed the clinical diagnosis. The use of Doppler echocardiography in assessing the vasodilators in primary pulmonary hypertension is discussed.

Administration, Oral↗