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Biomedical subjects

A Selzer

Publications and source records attributed to A Selzer.

At least 19 recordsLinked to original sources
PubMed1988

Clinical findings in adult aortic stenosis--then and now.

A retrospective review of 397 patients with valvular aortic stenosis emphasized the changing pattern of this lesion. Compared with the classical criteria for diagnosis of aortic stenosis established a few decades ago, patients were considerably older, mostly showing the degenerative form of this lesion. Among abnormal findings, the most important difference is the lower intensity of the systolic murmur and wider pulse pressure than in the original 'model'.

Adult↗
PubMed1987

Role of digitalis in chronic congestive heart failure and sinus rhythm.

Whereas the use of digitalis in atrial fibrillation is universally accepted, its administration in patients in sinus rhythm for its inotropic properties has recently been questioned. The risk of digitalis administration is high and may be unavoidable because of the occurrence of changes in sensitivity to digitalis. Benefits of digitalis are poorly defined. Hemodynamically digitalis is a weak inotropic agent. Clinical improvement is difficult to detect; furthermore, the role of long-term maintenance digitalis therapy appears questionable, inasmuch as several studies failed to show deterioration after digitalis therapy has been discontinued.

Chronic Disease↗
PubMed1987

Valvular aortic stenosis. A clinical and hemodynamic profile of patients.

We retrospectively reviewed the clinical and hemodynamic findings in 397 patients with valvular aortic stenosis at their first hemodynamic evaluation. This series is considered representative of aortic stenosis because it is heavily weighted toward older patients (average age, 61.1 years) and severe aortic stenosis (87.3% of patients had aortic valve area less than 1 cm2). We identified two categories of symptoms: angina and syncope, which develop during a fully compensated stage of aortic stenosis ("prefailure symptoms"); and dyspnea or congestive failure, which signifies various degrees of left ventricular malfunction. The preponderance of soft or medium intensity systolic murmur and normal or widened pulse pressure emphasizes the changing clinical picture of aortic stenosis in an aging population. Coexisting coronary artery disease was found in 60% of patients, but those with and without coronary disease did not differ significantly, even in the presence of angina.

Adult↗
PubMed1985

Clinical, electrocardiographic, and ventriculographic consequences of isolated occlusion of the right coronary artery.

The effects of total occlusion of the right coronary artery, a sole lesion, were evaluated in an unselected series of 45 patients. Findings ranged from no detectable consequences to massive post-infarction left ventricular scars. Patients were divided into three groups: Group I, those without clinical or ventriculographic evidence of myocardial infarction (10 patients); Group II, those with clinical or angiographic evidence of nontransmural myocardial infarction (eight patients); Group III, those with electrocardiographic evidence of transmural myocardial infarction (27 patients). The critical compensatory importance of collateral vessels was demonstrated (1) by the difference between the presence of adequate collaterals in Groups I and II (89 percent), versus 44.5 percent in Group III (p less than 0.005), and (2) by the fact that the three patients without demonstrable collaterals showed the most extensive wall motion abnormalities. Four patients in Group I had no clinical evidence of ischemic disease, occlusion being an incidental finding. It is concluded that the natural history of total occlusion of the right coronary artery depends largely upon the function of collateral vessels.

Adult↗
PubMed1985

Role of serum digoxin assay in patient management.

Serum digoxin assay is a useful clinical tool in monitoring the administration of digoxin. Its value, however, is generally overrated; judicious use of it applies only to specific clinical problems. Its primary use involves assay values at the two ends of the scale: low ranges may help detect noncompliant patients or those with serious absorption difficulties. Higher ranges are helpful in the clinical recognition of digitalis toxicity.

Atrial Fibrillation↗
PubMed1984

Determinants of prognosis of patients with aortic regurgitation who undergo aortic valve replacement.

Insidious and potentially irreversible left ventricular dysfunction may develop in patients with aortic regurgitation. To determine whether preoperative variables can predict postoperative outcome, 113 consecutive patients with aortic regurgitation who underwent surgical correction between 1962 and 1977 were studied and survivors were followed up for 4.6 +/- 3.3 years. Clinical and hemodynamic examinations were made in all patients before the operation. Echocardiograms were performed in 44 patients preoperatively and in 36 patients postoperatively. Perioperative or postoperative death due to congestive heart failure occurred in only eight patients (19%). No statistically significant predictors of total mortality or death due to cardiac failure were found based on preoperative clinical, hemodynamic or echocardiographic findings. Survivors of the operation showed significant functional improvement: preoperatively, 77% of all patients were in functional class III or IV; postoperatively, 84% of patients were in class I or II (p less than 0.0001). A weak statistical correlation of functional improvement was found with a preoperative presence of increased cardiac diameter on the chest radiograph (p less than 0.05) and the severity of left ventricular hypertrophy (p less than 0.05). Improvement of left ventricular function was also consistently found in survivors and correlated best with the degree of preoperative preservation of left ventricular function. Patients with an echocardiographic preoperative fractional shortening of the minor diameter greater than 26%, end-systolic dimension less than 55 mm and end-diastolic dimension less than 80 mm were most likely to have normal function after the operation. It is concluded that operative mortality and survival after surgical correction of aortic regurgitation cannot be accurately predicted from preoperative findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Present status of prosthetic cardiac valves.

Cardiac prosthetic valves have not yet reached the point of reliability and durability to be used for other than remedial purposes. In mitral valve disease, the prime targets are patients in whom medical treatment could not successfully reverse progressive clinical disability, or in whom less drastic mitral valve operations have failed. In aortic stenosis, the prime targets are patients with substantial cardiac symptoms. In aortic regurgitation, earliest indications of disability provide the timing for valve replacement. In this lesion, prophylactic operations in the absence of symptoms are often proposed. Such operations should be given the most cautious considerations.

Aortic Valve Insufficiency↗
PubMed1982

On the limitation of therapeutic intervention trials in ischemic heart disease: a clinician's viewpoint.

Therapeutic intervention trials using randomization of cases, considered the most reliable available means of evaluating effectiveness of therapy, have serious limitations. They are subject to errors in both directions: suggesting a relation when none exist, or being unable to demonstrate existing relations. When death is used as an outcome of the study, errors are most likely to occur when populations under study contain patients with widely varying prognoses, as is the case in ischemic heart disease. Furthermore, some trials pay insufficient attention to clinical facts and clinical relevance, both in designing and interpreting results of the study. The results of the Anturane reinfarction trial may have been misinterpreted on that basis. Trials dealing with comparison of medical and surgical treatment of coronary artery disease have been disappointing in their negative or inconclusive results. Another approach is needed to reinvestigate this problem, one randomizing patients with high risk subsets of coronary disease.

Angina Pectoris↗