The URL for this document is http://emperor.vwh.net/petition/appealof.htm
DENIAL OF MEDICAL TREATMENT THREATENS MILOSEVIC'S LIFE
by Jared Israel and George Szamuely [11 May 2001]
We are members of the International Committee (ICDSM) that is circulating the petition to Free President Milosevic from jail. In our view, Slobodan Milosevic's arrest is a clear escalation of Washington's attempt to destroy Yugoslav sovereignty. Washington is demanding that Milosevic be transferred to The Hague where a show trial would be staged. This trial would blame the Serbian people for NATO's crimes of aggression. Meanwhile, Mr. Milosevic is being denied critical medical treatment.
A group of doctors who are deputies in the Serbian and Yugoslav Parliaments have examined Slobodan Milosevic's medical file. The doctors belong to different parties. Some are members of the governing coalition. The doctors have written a Medical Appeal. It expresses in the sharpest possible medical language their concerns about Milosevic's health. Below is our summary of the doctors' statement, written in layman's language, followed by the doctors' Appeal itself.
SUMMARY OF PHYSICIANS' APPEAL
While in jail, President Milosevic has been suffering from crisis hypertension. He has also suffered a cardiac infarction. He was taken to a hospital and underwent a brief treatment. Following this, he should have been kept in intensive care under the supervision of specialists. Instead he was almost immediately returned to his jail cell, where the only follow-up treatment consists of receiving two medications. The doctors state it bluntly: Never in medical history have these medications cured a condition such as that of Mr. Milosevic. By keeping him in jail, rather than in intensive care under specialist supervision, the government is subjecting President Milosevic to suffering heart failure or stroke, unavoidable under his present conditions.
We urge all readers of this summary, and the medical statement below, to sign the petition "FREE MILOSEVIC NOW". President Milosevic's medical condition is itself sufficient reason for freeing him. In addition, though Belgrade officials have kept the former President in jail for six weeks, supposedly so that they could present evidence of alleged crimes, they have yet to bring forth a single witness against him. What further evidence is needed that his arrest was simply an attempt to satisfy a US Administration that is determined to punish the leader of a small country who had the temerity to assert his nation's sovereignty? One must also ask: Given this clear denial of necessary medical treatment, is this part of an effort, orchestrated by Washington, to ensure that President Milosevic dies in prison before his scheduled show trial collapses through its own absurdity?
Please circulate this statement on his medical condition. Please sign and circulate the petition to FREE MILOSEVIC NOW! Below we have posted the doctors' full statement. Please post our summary and the medical information and the FREE MILOSEVIC! petition on any Websites, email lists, and get this information into the news media.
- Jared Israel and George Szamuely are members of the International Committee to Defend Slobodan Milosevic
To Support the Doctors' Appeal, Please Sign the Petition, Posted Following the Doctor's Appeal. Send Signers' Names to freeslobo@aol.com
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APPEAL OF YUGOSLAV DOCTORS
The following as an Appeal from Physicians who are Deputies of the Federal and Republican Parliaments, to the authorities of the Republic of Serbia and the Federal Republic of Yugoslavia, and to the medical and general public, urging adequate therapy for treating Slobodan Miloševic and the provision of proper conditions in which treatment can take place.
PREVENT THE FATAL OUTCOME OF MILOŠEVIC`S HEART DISEASE
DO NOT PARTICIPATE IN HIS TACIT MURDER
The severely ill Slobodan Miloševic can be effectively treated only by highly competent, highly specialized staff in conditions in which exacerbation such as sudden cardiac death, stroke or other complications, unavoidable in current conditions, can be avoided.
We, medical doctors, members of the National Assembly of the Republic of Serbia and the Parliament of the Federal Republic of Yugoslavia, had access to the medical records of Slobodan Miloševic and having obtained the opinion of a competent team of experts, herein address the medical and general public by this appeal devoid of political bias, based exclusively on the principles of the medical profession and of science.
We describe his health conditions as follows:
1. Psychological aspects of heart disease
2. Symmetrical hypertrophic cardiomyopathy
3. Hypertensive crisis (malignant hypertension)
1. Psychological aspects of heart disease:
Stress is defined as an experience in which the circumstances exceed the capacity of the person to cope, resulting in excessive excitement of the person.
or more than fifty years now it has been widely known that conditions such as hypertension and asthma may reflect unconscious conflicts manifested in somatic symptoms.
Emotions are experienced both psychologically and physiologically. Although the forms of these cognitive manifestations of emotions may vary a great deal (anger, fear, anxiety, joy), the somatic repertoire of autonomous responses is limited. Emotional excitement, via the centrally induced sympathetic discharge, is manifested in the cerebrovascular system similarly to physical stress or strain: by tachycardia, elevated blood pressure, increased oxygen consumption, accelerated muscular flow and fall of splenic and renal flows. Cardiovascular consequences of emotion, as opposed to physical strain, may be more harmful because of absence of accompanying muscular activity and metabolic vasodilatation. Thus, the emotional stress accelerates the heart rate increasing the heart load. Accumulation of small stresses resulting from long-term conflicts promotes development of essential hypertension and coronary atherosclerosis.
Increased neurohumoral activity (adrenocortical, sympathetic, rennin-angiotensin) resulting from stress contributes to dysfunction of endothelial cells. Increased activity of the sympathic system influences the lipid metabolism, as well. The cholesterol level correlates with depression and emotional instability in a positive manner, while it is negatively correlated with motivation and joy. Therefore, both atherosclerotic plaques and clots and vasospasm are related to stress reaction.
Stress may result in elevated blood pressure, but there is no evidence that it may maintain hypertension. In absence of other promoters, stress may act as a trigger. It is frequently accompanied with numerous arrhythmias that may result in sudden cardiac death. Norepinephrine and isoproterenol (endogenous catecholamines) may lead to development of "contraction bands", myocardial lesions similar to skeletal lesions that burst upon excessive contraction. Such lesions are associated with 80% victims of sudden death, including those in whom atherosclerosis has not been previously diagnosed. These changes were recorded in pilots who lost control over their planes, patients with pheochromocytoma, cocaine-induced death. The changes in the cell wall permeability permitting excessive Ca2+ influx may be the underlying mechanism of this phenomenon.
2. Symmetrical hypertrophic cardiomyopathy
From the hemodynamic point of view, these patients have hyperdynamic systolic function with high ejection fraction (estimated at 70% on coronarography and shown in the form of a banana-shaped cavity in the systole). This "supernormal" systolic function leads to increased O2 consumption that, together with abnormal blood flow through the myocardium may result in symptoms of ischemia. The basic difference between this and hypertensive heart disease is absence of history of hypertension in the former.
3. Hypertensive crisis (malignant hypertension)
This is an emergency conditions necessitating prompt therapy. It is characterized with one or more of the following signs:
The absolute level of blood pressure is of lesser importance than the rate of elevation and absolute difference between the usual values and those measured in crisis.
Emergency therapy is necessitated since hypertensive encephalopathy, acute dissection of aorta, pulmonary edema, pheochromocytoma-related crisis, intracranial hemorrhage may develop.
Therapy: In the acute phases the patient should be strictly immobilized with headrest at 30o. These are acutely ill people, usually extremely anxious. It is of utmost importance to provide peaceful, supportive environment. Admission to intensive care unit is crucial, 12-lead EEG, intravenous therapy (with measurements of central venous pressure, if possible), arterial line of nitropruside is administered, all laboratory analysis, (accompanied with fundus oculi examination as well as neurological and nephrological consultation) are required.
Interestingly:
STRESS – risk for sudden heart death.
On April 11th, at the initial examination, the prison physicians suspected the development of acute coronary syndrome and asked for cardiological consultation.
A multidisciplinary team (headed by Dr. Neškovic) suspected acute cardiac ischemia because of typical echographic findings (akinesia, i.e. completely static cardiac apex, together with apical part of the anterior, lateral wall and the septum) and ECG findings (2 mm ST segment depression, negative T waves) and asked for emergency coronarography!
If any other patient had had such findings and if the multidisciplinary team had met in Bujanovac where no conditions for invasive diagnostic procedures were available, the patient would have been placed in a coronary unit, where strict rest would have been prescribed with nitroglycerin and heparin infusion, as in the case of Miloševic!
His family would have been advised that he had had an infarct and all protective measures would have been introduced. Even if no typical ECG evolution of acute infarction (Q tooth formation) developed, it would have been defined as a case of non-Q infarction (subendocardial) where reperfusion of the surrounding tissues ensued.
Had this happened to Miloševic in Niš or any other major town, he would have received streptokinase in the first six hours after the occurrence of pain (because of the accompanying echographic and ECG findings)!
Dr. Neškovic and late Dr. Popovic wrote to Miloševic, while he was in office, describing him the nature of coronary disease, elevated blood pressure … substantiating longer history of these symptoms.
After coronarography, the patient has recovered, although his discharge summary says that 24 after the procedure no ECG or echographic abnormalities are present (the same as on admission). They even contemplated discharging him a few hours after coronarography.
He will be the first patient cured by this procedure!
Incompatibility of his echographic findings and ventriculography is another problem. Ventriculography shows typical image of HMC, while the echography is suggestive of simple hypertensive hypertrophy.
Also, the presence of the muscular bridge before the branching of the anterior descending artery and denuded microcirculation provide the basis for the diagnosis of microvascular angina.
The blood pressure variations occurring abruptly and acutely, substantially aberrant from the normally recorded ones, make us ask: Is there any other place in the world where hypertensive crisis is managed with a tablet of presolol and prilazide?
Complete investigation was ordered as early as April 23rd, but what has been done so far?
How can such a serious condition be diagnosed in prison conditions that require a multidisciplinary approach?
The warning and our appeal suggest the only possible conclusion: the severely ill Slobodan Miloševic can be effectively treated only by highly competent, highly specialized staff in conditions in which exacerbation such as sudden cardiac death, stroke or other complications unavoidable in current conditions can be avoided.
We also warn the public that even well regulated blood pressure, according to the referential data, may cause stroke in 38% of cases so that in this particular case we wonder what one can expect knowing the conditions in which Miloševic is treated.
In Belgrade, May 9th 2001.
|
Dr
Cvetkovic Aleksandar |
To view list of signers,
go to http://emperor.vwh.net/petition/petition.htm
To add name(s) of signer(s) write to freeslobo@aol.com
FREE PRESIDENT MILOSEVIC NOW! HANDS OFF YUGOSLAVIA!
We the undersigned demand that the Serbian authorities immediately release Slobodan Milosevic and all other Serbian patriots from jail.
The arrest of Mr. Milosevic is an attempt by NATO leaders to blame the Serbian people for crimes against Yugoslavia committed by NATO.
We demand that Mr. Milosevic immediately be given proper medical treatment, in the hospital of his choice, with doctors of his choice, for a heart condition that appeared only after he was jailed.
We demand that neither Slobodan Milosevic, nor any other Yugoslav, be sent to the Hague Tribunal.
We demand an end to the arbitrary kidnapping, arrest, harassment and persecution of Yugoslav leaders and soldiers and ordinary people whose crime was to set an example to the world by resisting NATO aggression.
Free Slobodan Milosevic at once!
End persecution of Mr. Milosevic and all Yugoslav patriots and soldiers at once!
Jail the real war criminals: the NATO leaders who committed crimes against humanity and against Yugoslav sovereignty and who continue to commit those crimes today.
Names of singers can be read at http://emperor.vwh.net/petition/petition.htm
For Statements by signers see http://emperor.vwh.net/petition/states.htm
This petition is being circulated by the International Committee to Defend Slobodan Milosevic (ICDSM) at icdsm@aol.com . Signing indicates agreement with the content of the petition. One need not be an ICDSM member to sign, nor does signing make one a member of the Committee. We urge any and every person and group to sign the petition, circulate it, print it, place it on Websites, etc. Please send names of new signers to freeslobo@aol.com. You may write your own support literature, or use available material, which will be posted and updated at www.tenc.net
or more information see http://emperor.vwh.net/petition/sign.htm