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Biomedical subjects

A Oberman

Publications and source records attributed to A Oberman.

At least 127 records · Page 7Linked to original sources
PubMed1979

Recent status of detection, treatment, and control of hypertension in the community.

The Hypertension Detection and Follow-up Program (HDFP), a national collaborative study, screened approximately 159,000 people for high blood pressure in 14 communities between 1973 and 1974. Results show that detection, treatment, and control of high blood pressure has improved considerably since the 1960s. Whereas in the past about half of all hypertensives knew they had high blood pressure, half of those detected were under treatment, and half of those under treatment had their high blood pressure under control, the corresponding percentages in the 14 HDFP communities a decade later indicate that 75% of hypertensives were detected, 72% of those were under treatment, and 70% of those under treatment had a diastolic blood pressure under 95 mm Hg. While the differences in prevalence of hypertension are between races rather than sexes (with black individuals in some age groups being about twice as likely as white individuals to have hypertension), the differences in detection and treatment rate are largely between sexes and not between races. Women are considerable more likely to be aware of their hypertension, to be under treatment for it, and to have their high blood pressure under control. Rates of control vary considerably among age-sex-race subgroups, from only 8% of white male hypertensives aged 30-39 to 67% of white female hypertensives aged 60--69. It appears that although efforts to combat this disease over the past decade have probably made considerable progress in improving the recognition and treatment of high blood pressure, there remain a large number of undetected, untreated, and uncontrolled hypertensives.

Adult↗
PubMed1979

Unstable angina pectoris: a comparison of the costs of medical and surgical treatment.

This study compares the inpatient costs of therapy of patients with unstable angina pectoris randomized to surgical or medical therapy at the University of Alabama in Birmingham as part of the National Cooperative Study Group. For 74 patients followed up for 2 years, the mean inpatient charges were $4,728 for 22 medically treated patients, $9,528 for 34 surgically treated patients and $20,215 for 18 patients who crossed over from medical to surgical therapy. Differences among the three groups were statistically significant (P less than 0.001). Stepwise multiple regression analysis of total inpatient charges with medical and procedural factors as explanatory variables showed that a history of congestive heart failure, the number of infarctions during the period of the study, the duration of the longest anginal attack, the type of unstable angina and the type of treatment were significant predictors of total inpatient cost, with an R2 value of 0.829 (P less than 0.001). These variables explain the cost of treatment. One should not infer that they will also predict the appropriate type of treatment for patients with unstable angina. Although the cost of surgical therapy was double the cost of therapy for patients treated only medically, those medically treated patients whose therapy failed and who subsequently required surgery incurred mean costs twice those of the surgically treated patients and four times of patients who received only medical therapy. Reassessment of previous criticism of the high cost of surgical therapy is indicated.

Aged↗
PubMed1979

Unstable angina pectoris: an examination of modes and costs of therapy.

Debate exists over the most appropriate form of treatment for patients with unstable angina pectoris. This study examined 106 patients randomized at the University of Alabama in Birmingham as part of the National Cooperative Study Group and focuses on the phenomenon of patients who fail medical therapy and thus require late surgery, and the costs of therapy. Discriminant function analysis revealed that the significant predictors (p less than 0.01) of patients who would later require surgery were: total number of vessels diseased, angina severly, presence of congestive heart failure, hypertension, and number of years that the patient had had angina. By means of this analysis, 85% of the late surgery patients were correctly predicted. Late surgery patients averaged 2.4 diseased vessels vs 1.5 for persistent medical patients (p less than 0.01). Mean charges for the first 2 years in the study were $6,226 (SD $2,967) for persistent medical patients, $10,416 (SD $2,146) for surgery patients, and $20,059 (SD $10,748) for late surgery patients (p less than 0.001). These data indicate that surgery is clearly an expensive procedure; but that it is more expensive for late surgery patients, who have total costs that are twice as high as surgical costs and 3.5 times as high as persistent medical costs.

Alabama↗
PubMed1979

Research related to surgical treatment of coronary artery disease.

In the past 20 years, basic and clinical research have provided new information on coronary artery surgery. For example, several studies have shown that coronary artery bypass grafting is more effective than medical treatment in relieving the symptoms of chronic disabling angina pectoris. However, we still do not have definitive answers to many questions. What factors in the patient, in the operation and in the care after operation determine success in surgical treatment? Does the operation prolong useful life? Is the operation affordable? These questions are difficult. Further research is needed to solve complex problems relating to surgical vs medical treatment of coronary artery disease.

Adult↗
PubMed1978

Left ventricular aneurysmectomy in patients with single vs multivessel coronary artery disease.

To identify clinical syndromes benefiting from post-myocardial infarction (MI) left ventricular (LV) aneurysmectomy, 145 consecutively operated patients were followed a mean of 23 +/- 2 months postoperatively. Of the 145 patients, 49% had single-vessel (SV) coronary artery disease (CAD) (> or = 70% stenosis), 49% had multivessel (MV) CAD, and 2% (3 patients) had an unknown extent of CAD. Patients with SV-CAD and MV-CAD had similar distributions of age, sex, aneurysm location, LV end-diastolic pressure, LV ejection fraction, and scar size. In the SV-CAD group, the major operative indication was incapacitating heart failure (CHF), whereas in the MV-CAD group, the major operative indication was angina, often in combination with CHF. Coronary bypass grafting was done in 17/71 (24%) of SV-CAD and 64/71 (90%) of MV-CAD. Acute (30-day) postoperative survival was 89% (129/145) overall, and long-term survival 73%. Throughout the follow-up period, survival was similar in SV-CAD and MV-CAD. At follow-up, 89% of all survivors had CHF symptoms of functional Class II severity or less, and 97% of survivors had angina of Class II severity or less. Improvement in angina was most striking in the multivessel group whose angina had been more severe preoperatively. Thus, in patients undergoing LV aneurysmectomy and concomitant coronary revascularization: 1) SV-CAD is common; 2) SV-CAD has predominantly CHF preoperatively and usually relief of CHF postoperatively; 3) MV-CAD has both angina and CHF preoperatively, with symptomatic relief of both postoperatively; and 4) preoperative CAD extent does not influence survival.

Coronary Artery Bypass↗
PubMed1978

Long-term patency of saphenous veins for coronary bypass grafting.

The patency of 871 aortocoronary saphenous vein grafts in 438 patients was evaluated for a mean (+/- SEM) of 12.1 +/- 0.3 months after operation. Second studies were performed in 62 patients (134 grafts) at a mean of 42 +/- 1.3 months postoperatively (range, 13 to 61 months). The 1-year patency rate was 79.4% and increased from 76% for 546 grafts placed in 1970-1973 (Period I) to 85% for 325 grafts in 1974-1976 (period II) (P = 0.001). Overall patency was highest (82%) for grafts to the anterior descending system and lowest (76%) for the right system. These patency rates also increased between periods I and II from 79 to 88% (P < 0.05) for the anterior descending and 72 to 83% (P < 0.05) for the right system. For 47 right coronary arteries having associated distal manual endarterectomy, the graft patency rate was 62% vs 78% for those not endarterectomized (P < 0.05). Of 116 grafts patent at the initial study, five were occluded at the second study, a late failure rate of 3.7% and a mean annual attrition rate of 1.7% between 12 and 42 months after operation. High-grade (> 50%) stenoses were present in three of the five grafts at initial study. Development of late stenosis was observed in two grafts (1.7%). These data document improved 1-year patency rates for grafts in period II and a low incidence of late failure and development of late stenosis for up to 61 months following operation. Continued use of saphenous vein grafts to all three coronary arterial systems appears justified.

Adult↗
PubMed1978

Longevity in military pilots: 37-year followup of the Navy's "1000 aviators".

The 37-year nonmilitary mortality rate for initially healthy aviators was determined in a followup program on the U.S. Navy's "1000 Aviator" cohort. Of the 800 survivors of World War II and the Korean conflict, 95 were found to have died from nonmilitary causes over this followup period. This is markedly less than the 208 that would be expected from a random sample of white American men over a similar period (p less than 0.005). It is also significantly less than the 143 that would have been expected from a group of men who had passed an initial insurance physical (p less than 0.005). Lower-than-expected death rates occurred in all three major categories of cause of death in this age group: cardiovascular, neoplastic, and accidental. The generally good socioeconomic background, the positive genetic influence of long-lived parents, the above average intelligence, and the health and fitness orientation of the military aviator are all thought to be factors contributing to this increased longevity.

Accidents↗
PubMed1977

Changes in working status of patients following coronary bypass surgery.

Coronary artery bypass surgery has gained a major role in the management of ischemic heart disease. Relief of symptoms is often the primary goal for these surgical procedures while other effects relating to rehabilitation of such patients have been neglected. To determine change in work status as a result of operation, job status and hours worked before and after surgery were analyzed in 350 patients who had coronary artery bypass grafting procedures. Overall, there was no improvement in return to work or hours worked after surgery. Hours worked before surgery, relief of symptoms, severity of disease, number of bypass grafts placed, and level of education all related substantially to a change in work capacity. It appears that if the potential for enhanced productivity is to be realized, rehabilitative measures must be intensified following coronary artery surgery.

Angina Pectoris↗
PubMed1977

Long-term results of the medical treatment of coronary artery disease.

The natural history of patients with ischemic heart disease varies widely depending upon the anatomic lesion and extent of left ventricular dysfunction. Several clinical variables may also be used to help determine the likelihood of long-term survival. Individuals with high-grade isolated disease of the left anterior descending coronary artery, without significant impairment of ventricular function, have little morbidity and mortality for the 2-year period after arteriography. At the other end of the spectrum, medically treated patients with stenosis of the left main coronary artery or three-vessel disease without such involvement have a reduced life expectancy compared with patients treated surgically. Global judgments on long-term results of the medical treatment of coronary artery disease are meaningless. Efforts should be made to delineate optimal treatment for various subgroups of patients under the broad rubric of ischemic heart disease.

Adult↗