A survey of management of arrhythmias following myocardial infarction.
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Adrenergic beta-Antagonists↗
Biomedical subjects
D Hunt
Publications and source records attributed to D Hunt.
Emergency external cardiac pacing in life-threatening bradyarrhythmias.
We report seven cases of life-threatening bradyarrhythmias in which successful external cardiac pacing was established with a minimal delay, enabling more definitive transvenous pacing to be effected later.
Aged↗
Pituitary hormone response to cigarette smoking.
Nausea was induced by having subjects smoke two high nicotine cigarettes in quick succession. Plasma levels of prolactin, adrenocorticotropic hormone, beta-endorphin/beta-lipotropin, growth hormone, arginine vasopressin, and neurophysin I increased without changes in thyroid stimulating hormone, luteinizing hormone, or follicle stimulating hormone. Nausea and pituitary hormone release correlated with high nicotine intake (smoking 2.87 mg nicotine cigarettes) but did not occur during lower nicotine intake (smoking 0.48 mg nicotine cigarettes). Individual differences in nausea and related hormonal responses may provide an objective method for predicting receptivity to smoking.
Adult↗
The epidemiology of childhood scalds in Brisbane.
Scald injuries in Brisbane have shown a stable pattern over the past 5 years which is similar to that of other Australian cities. The great majority of scald accidents occur to children between 1 and 2 years of age, between the hours of 1600 and 1900, in the home of the average Australian family while both parents are in attendance. The kitchen and bathroom are the sites of most scalds, with the hot cup of tea the greatest offender.
Accidents, Home↗
The survival of treated hypertensive patients and their causes of death: a report from the DHSS hypertensive care computing project (DHCCP).
A prospective study has been carried out to determine the causes of death and risk factors for survival in 4994 patients referred with a diagnosis of hypertension to hospital specialist clinics and 457 patients treated by their general practitioners for this condition. At the time of entering the prospective study, 69% of the patients were already being treated for hypertension. Four hundred and eleven patients have died, and their causes of death and death rates have been compared with the rates for the population of England and Wales. Ischaemic heart disease accounted for over one-third of the deaths and stroke for one-fifth. The death rates for these conditions were two to five times those expected for men and women aged 50-59 years and up to twice the rate expected for the age group 60-69 years. Survival in these selected patients was impaired by the following independent risk indicators: cigarette smoking, previous history of myocardial infarction or stroke, diagnosis of angina, impaired renal function and raised blood sugar. The following factors were not independent positive risk factors: smoking a pipe or cigars, obesity, a low plasma potassium and an elevated serum uric acid.
Adolescent↗
The costly bonus: cocaine related crime among methadone treatment clients.
This paper examines the relationship between the use of cocaine and criminal activity among 368 current methadone maintenance clients and 142 narcotics users not in treatment. Findings include an increase of cocaine use among methadone clients in the last ten years and the indication that cocaine plays an increasingly important role in the criminal activity of both methadone clients and users not in treatment. We find a direct relationship between escalating use of cocaine and increasing involvement in crime. The relationship is related to properties of the drug itself, its costs and the lifestyle associated with cocaine use.
Adult↗
Distribution of gentamicin among subcellular fractions from rat renal cortex.
A substantial amount of data is available to suggest that lysosomal sequestration of aminoglycoside antibiotics plays a role in the pathogenesis of aminoglycoside-induced renal tubule cell injury; however, relatively little information is available on the subcellular distribution of aminoglycosides in the kidney during treatment protocols of the type that ultimately go on to produce extensive lethal renal tubule cell injury and acute renal failure in experimental animals. This study assessed the distribution of gentamicin and subcellular membranes on a discontinuous sucrose density gradient after in vivo exposure of rats to four daily 100 mg/kg doses of gentamicin as compared to in vitro exposure of normal rat renal cortex to gentamicin during tissue homogenization at drug levels comparable to those seen after in vivo treatment. After both in vivo and in vitro exposure, major localization of gentamicin, the lysosomal marker enzyme N-acetyl-beta-D-glucosaminidase (NAG), and the endoplasmic reticulum marker enzyme NADPH-cytochrome c reductase, occurred in a very light membrane fraction. Within this membrane fraction, gentamicin was more closely associated with the NAG than with the NADPH-cytochrome c reductase. The results could not be explained by complete lysosomal disruption during subcellular fractionation after in vivo gentamicin. These data provide additional insights into both the possibilities for subcellular interactions of aminoglycosides in the kidney, and into the methodology required to optimally assess such interactions.
Acetylglucosaminidase↗
Acute changes in iron metabolism following myocardial infarction.
Fifty six patients admitted consecutively to the coronary care unit with ischemic chest pain participated in a controlled prospective study of acute changes in iron metabolism. Following myocardial infarction there were significant reductions of plasma iron by 8.1 mumol/L (P = 0.002), total iron binding capacity by 12.9 mumol/L (P = 0.003), and plasma transferrin by 0.70 g/L (P = 0.007). In contrast, there was a significant elevation of serum ferritin by 218 micrograms/L (P = 0.0005). The magnitude and duration of these acute changes in iron metabolism was greater in patients with higher peak serum creating kinase levels, suggesting that these changes are influenced by the extent of tissue necrosis. Comparison with the control group showed that alteration in dietary iron intake was not a significant factor. The possible mechanisms of these acute changes and their similarity to those observed in the anemia of chronic disease are discussed.
Adult↗
Abdominal wound closure comparing the proximate stapler with sutures.
Proximate staple closure of transverse and vertical abdominal wounds is compared with suture closure in a prospective, blind, randomized trial. Fifty-seven wounds were randomly allocated to 3/0 Prolene or Proximate staple closure. Each wound was photographed after removal of staples or sutures and again in the sixth postoperative week. The photographic slides were independently assessed by eight observers, who graded the cosmetic result of each wound on a scale from 1 to 10. The cosmetic score in transverse wounds closed with sub-cuticular sutures was better than with staples. Cosmetic scores in vertical wounds were almost equal for staples and sutures. Staple closure was faster than suture closure. Proximate staple closure is considered a suitable and faster method for vertical abdominal wounds.
Abdomen↗
Arrhythmogenic right ventricular dysplasia. Clinical, electrophysiological, and pathological features.
Arrhythmogenic right ventricular dysplasia (ARVD) describes the syndrome of recurrent ventricular tachycardia of right ventricular origin and cardiomyopathic changes of the right ventricle. We report the clinical, electrophysiologic, and angiographic characteristics of four patients who presented with ventricular tachycardia of left bundle branch block configuration, and in whom the right ventricular origin of tachycardia was confirmed by endocardial mapping, and a diagnosis of ARVD was substantiated by histological examination. ARVD should be suspected in all patients with ventricular tachycardia of left bundle branch block configuration, especially in young adults with an otherwise normal heart. Once suspected, diagnosis can often be established by non-invasive investigation. Surgical treatment may be difficult because of the diffuse nature of right ventricular involvement.
Adolescent↗
Psychiatric aspects of coronary artery surgery. A prospective study.
A psychiatric assessment was carried out before operation, and at three months and 12 months after operation, in 77 men undergoing coronary artery bypass graft surgery. Neither psychiatric assessment before the operation nor perioperative surgical assessment could predict the physical outcome of surgery. The physical results of surgery were good, but there was a 20% decrease in the number of patients who were in employment after the operation. Abnormally high scores on measures of anxiety and depression were present in about 50% of patients before the operation, and in about one-third of patients after the operation. Impairment in various aspects of personality-functioning since surgery was reported by 7%-29% of patients. These complaints were not correlated with the surgical result. Attention is drawn to this area of persisting postoperative morbidity.
Adult↗
The effects of smoking on ACTH and cortisol secretion.
The relationship among changes in plasma nicotine, ACTH, and cortisol secretion after smoking were investigated. Ten male subjects smoked cigarettes containing 2.87 mg nicotine and 0.48 mg nicotine. No rises in cortisol or ACTH were detected after smoking 0.48 mg nicotine cigarettes. Cortisol rises were significant in 11 of 15 instances after smoking 2.87 mg nicotine cigarettes, but ACTH rose significantly in only 5 of the 11 instances where cortisol increased. Each ACTH rise occurred in a subject who reported nausea and was observed to be pale, sweaty, and tachycardic. Peak plasma nicotine concentrations were not significantly different in sessions when cortisol rose with or without ACTH increases, but cortisol increases were significantly greater in nauseated than in non-nauseated smokers. Our data suggest that smoking-induced nausea stimulates cortisol release by stimulating ACTH secretion and that cortisol secretion in non-nauseated smokers may occur through a non-ACTH mechanism. It is not clear whether nicotine or some other stimulus inherent in smoking is responsible for cortisol secretion without ACTH secretion.
Adrenocorticotropic Hormone↗
The prevalence of hepatitis B viral markers in anesthesia personnel.
The prevalence of hepatitis B viral markers is increased in some groups of medical workers who are exposed to blood from patients carrying the virus, but this has not been studied critically in physicians and others who administer anesthesia. Physician anesthesiologists (M.D.) and nurse anesthetists and anesthesia assistants (non-M.D.) at four university-affiliated hospitals were evaluated for hepatitis B markers as determined by seropositivity for hepatitis B surface antigen, antibody to the hepatitis B surface antigen, or antibody to the hepatitis B core antigen. In the 86 subjects (38 M.D., 48 non-M.D.) who represented 80.4% of possible participants, the overall prevalence of serologic markers of hepatitis B was 23.3%. The frequency did not differ between M.D. (23.7%) and non-M.D. (22.9%) groups or between men (20.3%) and women (26.9%). Of 81 subjects who had no clinical history of hepatitis, 16 (19.8%) had positive serologic markers. The frequency of seropositivity increased with time since graduation from medical school (M.D.) or nursing school or college (non-M.D.). The prevalence of serologic markers of hepatitis B virus in this study of anesthesia personnel is five to eight times that of the general population but is similar to that of other medical workers who frequently are exposed to blood.
Adult↗
Prophylaxis of primary ventricular fibrillation in acute myocardial infarction. The case against lignocaine.
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Anti-Arrhythmia Agents↗
Exacerbation of bronchial asthma following treatment with amiodarone. Demonstration of an antiadrenergic effect in vitro.
We describe a patient with bronchial asthma whose respiratory symptoms worsened during treatment and rechallenge with amiodarone. Laboratory studies on cultured pulmonary cells demonstrated an anti-beta-adrenergic effect of amiodarone not due to inhibition of beta-adrenergic receptor binding. Amiodarone should be used with caution in patients with obstructive pulmonary disease.
Amiodarone↗
Electrophysiologic studies in survivors of late cardiac arrest after myocardial infarction.
Nine patients resuscitated from life-threatening ventricular arrhythmias (VA) within 3 months of an acute myocardial infarction (AMI) underwent electrophysiologic studies (EPS) with clinical follow-up for at least 12 months. Neither reinfarction, drug therapy, nor electrolyte imbalance was a precipitating factor. VA was induced by ventricular pacing in six of nine patients. Five patients were prescribed empiric drug therapy, while the four other patients had repeated EPS to select optimal drug therapy. One patient remained unstable and died of VA in the hospital. No patient was discharged and successfully maintained on a drug known to prevent induction of VA, yet only two patients (25%) had a further recurrence of VA, one fatal. Our findings suggested that either drug therapy that is determined empirically or found not to suppress the induction of VA during EPS can be associated with a successful outcome in some of these patients, or the natural history of VA after myocardial infarction is that they are self-limiting in the absence of a new ischemic event.
Arrhythmias, Cardiac↗
Prevalence of diabetes and impaired glucose tolerance in the biracial (Melanesian and Indian) population of Fiji: a rural-urban comparison.
Rural-urban and ethnic comparisons of impaired glucose tolerance and diabetes mellitus were made in the biracial population of Fiji in 1980. No statistically significant differences existed in age-standardized impaired glucose tolerance prevalence between rural and urban groups or between Melanesians and Indians. The age-standardized prevalence of diabetes in the rural Melanesian male population was one-third that of the urban male population (1.1 vs. 3.5%). In females, there was a sixfold rural-urban difference (1.2 vs. 7.1%). By contrast, rural and urban Indians had similar rates (12.1 vs. 12.9% for males; 11.3 vs. 11.0% for females). Standardization of two-hour plasma glucose for age and obesity did not eliminate the rural-urban difference in plasma glucose concentration for Melanesian males and females. The results in Melanesians confirm previously reported rural-urban diabetes prevalence differences, and suggest that factors other than obesity, such as differences in physical activity, diet, stress, or other, as yet undetermined, factors contribute to this difference. The absence of a rural-urban difference in diabetes prevalence in Indians may suggest that genetic factors are more important for producing diabetes in this ethnic group, or that causative environmental factors such as diet operate similarly upon both the rural and the urban populations.
Adult↗
The stability of glyceryl trinitrate tablets during patient use.
The stability of glyceryl trinitrate (GTN) tablets stored in ways commonly used by patients was investigated to enable pharmacists and physicians to give better advice about tablet storage. Analysis of 43 samples of tablets collected from hospital patients showed that the GTN content of these samples differed significantly from that of fresh tablets. Tablets kept in the manufacturer's bottle contained significantly more GTN than those transferred to other airtight vials (p less than 0.05) or pill boxes (p less than 0.005). The content of GTN was also significantly lower in tablets stored in pill boxes compared with other vials (p less than 0.01). Similar trends were found when tablets were stored in glass or plastic vials, pill boxes or were left exposed to air in the laboratory. These results emphasize that the best way to store GTN tablets is in the manufacturer's container. However, since many patients find that this bottle is awkward and inconvenient, a suitable alternative would be to carry a few tablets in a small airtight container (preferably glass). The unused tablets should be discarded every two weeks and nothing else should be added to the container. The use of pill boxes should be strongly discouraged.
Drug Packaging↗