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Biomedical subjects

D E Forman

Publications and source records attributed to D E Forman.

26 records · Page 2Linked to original sources
PubMed1992

Management of acute myocardial infarction in the very elderly.

Coronary artery disease is highly prevalent among the elderly, and the incidence of myocardial infarction (MI) is high. Still, the notion of optimal treatment for the elderly patient with MI remains unclear. This review will first discuss some of the characteristics of the aging myocardium that impact on the care of elderly cardiac patients. Next, the therapeutic options and their appropriateness for the aged patient are presented. Thrombolytic and beta-blocker therapies are reviewed extensively since they remain among the controversial issues in geriatric cardiology. Other well-known as well as experimental therapies are also discussed.

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PubMed1992

Enhanced left ventricular diastolic filling associated with long-term endurance training.

Normal aging is associated with an impairment in early left ventricular diastolic filling. To test the hypothesis that long-term endurance exercise training is associated with enhanced ventricular diastolic filling indices, we compared transmitral pulsed Doppler inflow spectra in healthy young adults; healthy elderly, sedentary subjects (sedentary old); and healthy elderly, endurance athletes (master athletes). Our data demonstrate that, despite an increase in left ventricular mass, early diastolic filling was enhanced in master athletes compared to the sedentary old. Blood pressure of both master athletes and the sedentary olds was greater than the young adults, but the higher blood pressure did not correlate to changes in filling parameters. Resting systolic function and heart rate were not significantly different in all three different groups. Early left ventricular filling indices in master athletes more closely resemble transmitral inflow patterns of healthy young adults. Long-term endurance exercise is associated with physiologic hypertrophy and ventricular filling dynamics more characteristic of the young than the old.

Adult↗
PubMed1992

PTCA in the elderly: the "young-old" versus the "old-old".

OBJECTIVE: To evaluate the use of percutaneous transluminal coronary angioplasty (PTCA) in elderly coronary artery disease (CAD) patients. DESIGN: A prospective study of patients 60 years and older undergoing de novo PTCA. We analyze patient risk factors, underlying disease, and clinical outcomes, with at least 3-year follow-up. Comparisons between different age strata among these patients are made to clarify differences between the young old (60 to 69 years), the middle old (70 to 79 years), and the very old (80 years and older). SETTING: Beth Israel Hospital, Boston, both a primary care and tertiary care teaching hospital. PATIENTS: 907 consecutive elderly cardiac patients referred for PTCA are studied. INTERVENTIONS: PTCA's were completed using the newest catheter technologies as they became available. All patients were premedicated with aspirin and dipyridamole, and all were anticoagulated with heparin. RESULTS: Subdivision by age demonstrates that the majority (67%) of patients aged 60 to 69 were males, but females were preponderant (61%) in those aged 80 and older. Octogenarians also had lower incidence of hypercholesterolemia, tobacco use, and family history of CAD, and a higher frequency of CHF, angina, and previous MI. Although total procedure-complications increased with age, critical complications (MI, reocclusion, CABG, death) did not. Primary procedural success was similar in all age strata, but older patients had a higher prevalence of multi-vessel disease and longer hospital stay. Follow-up shows that most patients did well after PTCA; there was no increase in repeat PTCA, CABG, and MI with age. CONCLUSIONS: While advanced age is associated with changes in risk and clinical parameters for CAD patients, age alone is not a reasonable criterion to limit the use of PTCA.

Age Factors↗
PubMed1991

Clinical issues related to discontinuing digoxin therapy in elderly nursing home patients.

Digoxin is commonly used to treat congestive heart failure. Digoxin augments ventricular systolic performance, but does not benefit patients whose congestive heart failure is caused by poor diastolic function. We studied 47 elderly nursing home patients who were receiving long-term digoxin therapy. The left ventricular ejection fractions were measured using both a standard and a highly portable echocardiography machine. Thirty-five of 47 patients had normal ejection fractions (50% or greater). In this subgroup, 23 patients were in normal sinus rhythm. Digoxin was discontinued in 14 patients with good systolic function and normal sinus rhythm, but in nine cases physicians refused to stop the digoxin. Follow-up evaluations showed no deterioration off digoxin. Excellent correlations existed between estimated left ventricular ejection fractions from the two echocardiography machines. Many nursing home patients taking digoxin do not need it. Physician reluctance to discontinue digoxin may change with the availability of highly portable echocardiography.

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PubMed1981

Postnatal development and differentiation of the secretory elements of the rabbit parotid and submandibular glands.

The development of the secretory elements of the parotid and submandibular glands has been examined in postnatal rabbits. In the submandibular gland, there are 2 principal types of secretory cells, serous and mucous. At birth, these occur in approximately equal proportions, and, by 28 days postnatal, the mucous elements greatly outnumber the serous ones. Initially, development of the parotid gland lags significantly behind that of the submandibular gland. Lobules, which are widely separated at birth, appear compact by 28 days postnatal, at which time also serous acinar cells contain an adult content of secretory granules. In both glands, secretory granules develop within component cells of intercalated ducts by 14 days postnatal. Although the glands appear virtually mature by 28 days postnatal, which corresponds approximately to the onset of weaning, minor structural changes occur over the following 3 postnatal weeks.

Animals↗
PubMed1981

Postnatal development and differentiation of contractile cells within the rabbit testis.

This study has been determined the postnatal development and differentiation of smooth muscle cells within the rabbit testicular capsule and within the peritubular tissue surrounding seminiferous tubules. Smooth muscle cells within the tunica albuginea are not identifiable at birth by light microscopy but by electron microscopy myocytes in early stages of development may be shown to be present. It is not until 42 to 49 days postnatum that smooth muscle cells can be identified by light microscopy. Differentiation of smooth muscle cells within the capsule is completed by 128 days postnatum. At this time, the muscle is arranged in two organized layers, a superficial layer of longitudinally oriented cells and a deeper layer of circularly arranged cells. At birth, the peritubular tissue consists of two to four layers of undifferentiated cells and, during the first postnatal week, the tissue becomes more condensed and generally is arranged in two cellular layers. Cells of the inner layer contain small bundles of microfibrils whereas cells of the outer layer are fibroblast in nature. Differentiation of the peritubular tissue is completed by 112 days postnatum. At this stage, it consists of four layers, two acellular and two cellular. The inner cellular layer, composed of attentuated myoid cells, possesses a basal lamina on both surfaces and is surrounded by two delicate connective tissue lamellae. The myoid cells of the peritubular tissue thus achieve structural maturity at approximately the same time postnatally as do those within the testicular capsule, which corresponds to the time when spermatogenesis becomes established. The relative contributions of the myoid cells in the peritubular tissue and within the testicular capsule to the movement of non-motile spermatozoa out of the testis and the possible significance of the peritubular tissue as a component of the permeability barrier are discussed in relation to the present findings.

Animals↗
PubMedDate not supplied

Neuropsychological functioning among cardiac rehabilitation patients.

PURPOSE: The underlying pathophysiology contributing to coronary heart disease also predisposes patients to cerebrovascular disease and associated cognitive disorders. Although prior studies have focused on the neuropsychological sequelae of specific cardiac problems, few have examined the associated cognitive capacities and limitations of typical cardiac patients. The current study was designed to examine neuropsychological functioning among a sample of cardiac rehabilitation (CR) patients. METHODS: Using neuropsychological instruments, patients were compared in a CR program to age-matched outpatient control subjects who had no known history of cardiac or neurologic disease. Cardiac rehabilitation patients were then divided into dichotomous subgroups based on whether they had undergone coronary artery bypass grafting, had experienced a myocardial infarction, had hypertension, or had impaired ejection fraction. Neuropsychological functioning was examined relative to each of these factors. RESULTS: Cardiac rehabilitation patients had poorer neuropsychological test performance than did control subjects, with subtle relative deficits on measures of response generation, memory, and verbal abstraction, and particularly verbal fluency. Low ejection fraction, hypertension, and prior coronary artery bypass graft were associated with greater relative neuropsychological impairments. CONCLUSIONS: Although CR patients were not grossly neuropsychologically impaired as a group, it appears highly likely that many within a given program exhibit some degree of neuropsychological dysfunction. Including neuropsychological screening as part of pre-CR testing would help to identify such patients. This information may help staff to impart health care information in a manner that is most effective for the individual patient and may also be useful in the formation of realistic goals.

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