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Biomedical subjects

A Oberman

Publications and source records attributed to A Oberman.

At least 109 records · Page 6Linked to original sources
PubMed1984

Effect of dietary change on the return of hypertension after withdrawal of prolonged antihypertensive therapy (DISH). Dietary Intervention Study of Hypertension.

The possibility exists that dietary modification may increase the number of patients who remain normotensive after drug withdrawal. In an effort to resolve this question, former Hypertension Detection and Follow-up Program Stepped Care participants (n = 496) were randomized into four major groups at the end of the programme (greater than 5 years antihypertensive therapy): controls (continue medication); discontinue medication, no dietary intervention; discontinue medication and weight loss; discontinue medication and reduce sodium. Groups 1, 2 and 4 were further divided into obese (greater than or equal to 120% ideal weight, and non-obese groups). The weight reduction group (greater than or equal to 120% ideal weight) lost 10.1 +/- 11 lbs without changing dietary sodium (n = 87). The sodium restriction group reduced urine sodium excretion from 145 to 97 mEq per day (n = 169). Sixty per cent of the weight loss group were normotensive at 56 weeks compared to 35% withdrawn from medication without dietary intervention. The highest 56 weeks success rates were in the mild non-overweight hypertensives on sodium restriction (78%), and the mild overweight hypertensives on weight reduction (72%). Randomization to either weight loss group or sodium restriction group increased the likelihood of remaining off drugs (adjusted odds ratio of 3.43 for the weight group and 2.17 for the sodium group (P less than 0.05). Age, severe hypertension greater than 5 years previous to entry into Dietary Intervention Study of Hypertension (DISH) or need for several drugs increased the chance of failure.

Adult↗
PubMed1983

Trimazosin for the treatment of hypertensive patients failing to respond to thiazides.

In a double-blind study of two populations-one in Birmingham, Alabama, the other in Encinitas, California-a total of 32 hypertensive patients whose blood pressure was not controlled by thiazides alone were evaluated for their response to trimazosin. Patients showing a persistent diastolic blood pressure above 90 mm Hg while receiving 2 mg polythiazide once a day (at Birmingham) or 50 mg hydrochlorothiazide twice a day (at Encinitas) during a baseline 4-week period were randomly assigned to trimazosin and placebo groups. At both clinics, patients had a greater blood pressure response to trimazosin than to placebo in both supine and standing positions. When the data were pooled, the change in supine blood pressure (systolic/diastolic) between the average baseline values and the double-blind period was more than twofold greater for the trimazosin group, a decrease of 12.3/10.9 mm Hg (p less than 0.001). A lesser decrease of 5.4/5.4 mm Hg occurred in the placebo group, significant only for the diastolic pressure (p less than 0.01). Comparative differences between the trimazosin and the placebo groups were more marked for the standing blood pressures, -11.7/-10.0 mm Hg (p less than 0.0001) vs no significant change, +2.3/-2.8 mm Hg, respectively. Little change occurred in the patients' heart rates in either position in either treatment group. Adverse reactions were not clinically important and occurred in about half of the patients in the trimazosin and placebo groups. Therapy was not discontinued in either group because of adverse reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1982

Validation of a risk function to predict mortality in a VA population with coronary artery disease.

A multivariate risk function based on the Cox model was developed in the VA Study of Coronary Artery Bypass Surgery to predict the survival of patients with stable angina pectoris. The methods used in developing and evaluating the performance of the risk function (validation) are described. Performance was evaluated internally by the methods of resubstitution, half-sample replication, and jackknifing, and externally by use of an independent patient population.

Actuarial Analysis↗
PubMed1982

Employment status after coronary artery bypass surgery.

With a few exceptions, prevailing data on return to work after coronary artery bypass surgery indicate no net gain in employment status for at least several years after the operation. Despite the improved surgical experience and advances in the medical management of postoperative patients, only limited employment benefits occur after surgery, and no gains in work rehabilitation over the past decade have been noted. Several characteristics--preoperative work status, nonwork income, occupation, relief of symptoms, age, perception of health, education and severity of disease--appear to be important for estimating the likelihood of employment after surgery. Other influences, such as attitudes of the family, employers and physicians, undoubtedly alter the probability of return to the work force, but are less well documented. Unless constructive approaches toward work rehabilitation are made, the possibility of return to gainful employment should not be considered an indication for or a necessary consequence of coronary artery bypass surgery.

Age Factors↗
PubMed1982

Epidemiologic study of candidates for coronary artery bypass surgery.

Simplified estimates of the potential patients eligible for coronary artery bypass surgery are presented. Various means of identification are discussed, as well as effects of two levels of stenosis. Although ultimate operability is not directly considered, the results demonstrate a substantial and growing pool of eligible patients. Data from the National Center for Health Statistics characterizes the trend toward more arteriograms and bypass procedures and more procedures being performed in smaller hospitals. Unexplained patterns exist with regard to racial and geographic differences. Factors that contribute to the increase of bypass procedures include more catheterizations being performed, declining mortality, the aging of the U.S. population, less reluctance to perform surgery, repeat operations, and increased availability of surgical teams and facilities. Factors discouraging an increase in the number of procedures include cost, equivocal results relative to increased survival in certain stages of disease, and improved alternative therapies.

Angina Pectoris↗
PubMed1982

Costs and benefits associated with treatment for coronary artery disease.

Direct and indirect costs of medical and of surgical treatment are presented for patients entered into the Birmingham portion of the Coronary Artery Surgery Study. For comparison, similar results are shown for the Birmingham portion of the national Cooperative Unstable Angina Study. In the Unstable Angina Study, mean inpatient costs at the end of 1 year in the study were $6867 for medical therapy, $10,574 for surgical therapy and $23,045 for those who failed medical therapy and required late surgery. A stepwise multiple regression analysis shows that the single best predictor of cost was the number of myocardial infarctions that the patient had while in the study. A discriminant-function analysis identified 85% of the medical patients who required late surgery. A significantly lower proportion of surgical than medical patients returned to work. Total inpatient costs for patients in the Coronary Artery Surgery Study (i.e, patients with stable angina) were $3432, $11,100 and $13,554 for medical, surgical and late surgical patients, respectively, for the first year in the study. There was no significant difference in the percentage of medical and surgical patients who were working at the end of 1 year. According to their own perceptions, the surgical group was in the best and the late surgical group in the worst health.

Aged↗
PubMed1981

Coronary revascularization surgery: feasibility after myocardial infarction.

Since coronary revascularization improves prognosis in some patients with multivessel disease, can the potential benefits be extended to "prophylaxis" in selected postinfarction patients as well? These investigators sought the answer on the basis of patient characteristics, types of surgery, survival data, and mode of death in the postinfarction population of 129 patients who had early angiography.

Angiography↗
PubMed1981

Effect of bypass surgery on survival in patients in low- and high-risk subgroups delineated by the use of simple clinical variables.

A multivariate risk function was developed on data from all 508 medical patients in the Veterans Administration (VA) randomized study of coronary bypass surgery. The variables, in order of importance, were ST-segment depression on resting ECG, history of myocardial infarction, history of hypertension and New York Heart Association functional classification III or IV. These noninvasive variables have been reported to be risk factors in natural-history studies of coronary heart disease (CHD). Applying the risk function to medical and surgical patients of the 1972-1974 cohort yielded a 5-year probability of dying for each patient. Investigation of treatment effects in approximate terciles obtained by collapsing the probability distribution into low-, middle- and high-risk groups showed that surgery was beneficial for patients in the high-risk tercile even after removal of patients with left main coronary artery disease (17% surgical vs 34% medical mortality at 5 years; p less than 0.01). This finding was accentuated when patients in the 10 hospitals with the lowest operative mortality (3.3%) were compared. Mortality results in the low-risk tercile favored medical treatment (medical vs surgical mortality 7% vs 17%; p less than 0.05). The risk function predicted mortality well not only for te VA medical group, but also for an independent symptomatic CHD population from the University of Alabama arteriography registry. This report further delineates the advantages and limitations of coronary bypass surgery in CHD patients with chronic stable angina.

Coronary Artery Bypass↗
PubMed1981

Long-term follow-up of lung volume measurements in initially healthy young aviators.

Lung volume measurements on a large number of initially healthy young military aviators (the U.S. Navy's "1000 Aviator" cohort) were recorded periodically in follow-up from 1940-69. Vital capacities were measured spirometrically and total lung capacities were measured planimetrically from chest roentgenograms. Residual volumes were calculated by subtracting the vital capacity from the total lung capacity in each subject. Additional variables available for analysis were cigarette smoking histories, family histories, aviation career patterns, pulmonary symptoms, cardiac disease diagnoses, and anthropometric measurements. Multiple linear regression techniques were used on these variables to construct prediction equations for each lung volume in 1969. From these longitudinal analyses, cigarette smoking and pulmonary symptoms were found to be associated with an "obstructive lung volume pattern in 1969, while coronary artery disease and weight gain were found to be associated with a "restrictive" lung volume pattern in 1969. A career in military aviation had no significant association with lung volumes.

Adult↗
PubMed1981

Eight-year follow-up of exercise electrocardiograms in healthy, middle-aged aviators.

To study to prognostic capabilities of the exercise electrocardiogram (ECG) in a fit, healthy, middle-aged population, 548 members of the U.S. Navy's "1000 Aviator" cohort were exercised to 85% predicted maximum heart rate in 1969 and then followed-up in 1977 for the development of clinically evident coronary artery disease (CAD). Of these subjects, 23 (4.2%) had significant ST depression during their exercise test in 1969. At the end of the 8-year follow-up period, 38 of the 548 subjects (6.9%) had developed clinically evident CAD. The sensitivity (percent of disease predicted by an abnormal test) and predictive value (percent of abnormal tests predictive of disease) of an abnormal exercise test were 15.7% and 26%, respectively. We conclude that even in a carefully screened aviator population with a low risk for CAD, a single normal exercise ECG does not exclude the presence of latent CAD. Furthermore, in this population, a single abnormal exercise ECG should not be a disqualifying defect without further work-up.

Adult↗