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Biomedical subjects

E Glassman

Publications and source records attributed to E Glassman.

At least 19 recordsLinked to original sources

Oral iron therapy with ferrous fumarate and polysaccharide iron complex.

Oral iron replacement therapy with Chromagen, containing ferrous fumarate, and Niferex, containing polysaccharide iron complex, can successfully maintain hematologic and iron indices in dialysis clients and demonstrated fewer adverse effects in selected clients. Their multiple ingredient dose forms, which further support erythropoiesis, and their possible decrease in distressing side effects should enhance client compliance, making these two drugs excellent alternatives to traditional iron therapies.

Administration, Oral

Mechanism of relief of angina after coronary bypass surgery: an angiographic study.

Coronary angiography was performed before and after coronary revascularization in 67 patients. The interval between studies ranged from 1 to 38 months (average 9.9). The patients were separated into four clinical groups on the basis of their symptoms at the time of restudy; Group I, 13 asymptomatic patients; Group II, 19 patients with nonanginal chest pain (18 cases) or dyspnea (1 case); Group III, 12 patients whose angina was relieved but not eliminated; and Group IV, 23 patients whose angina was not alleviated. The graft patency rate was 72 percent in Group I, 78 percent in Group II, 61 percent in Group IIII and 34 percent in Group IV. The sum of diseased, but not bypassed and unsuccessfully bypassed arteries per patient was 1.6 in Groups I and II. 2.9 in Group III and 4.0 in Group IV. The incidence of perioperative myocardial infarction, defined using enzymatic and electrocardiographic criteria, was 8 percent for Group I, 26 percent for Group II, 25 percent for Group III and 52 percent for Group IV. Anginal relief after coronary bypass surgery is achieved by successful and complete revascularization rather than by perioperative myocardial infarction.

Angina Pectoris

Left internal mammary--left ventricular fistula after Vineberg operation.

This communication presents an unusual complication in a patient who underwent the Vineberg procedure with the formation of an internal mammary to left-ventricular fistula, which caused a new apical diastolic murmur. This represents a previously unreported etiology for the appearance of an apical blowing diastolic murmur.

Coronary Disease

Prolapse of the mitral valve: clinical spectrum and coronary arterial distribution.

Coronary angiograms were reviewed in 31 patients with idiopathic prolapse of the posterior mitral leaflet. There were 19 males and 12 females, ranging in age from 33 to 69. The coronary artery which supplied the posterior descending branch was designated as dominant. There were 27 dominant right coronary arteries and 4 dominant left coronary arteries. Attention was paid to whether the origin of the vessel which courses in the posterior atrioventricular groove branch was from the right coronary artery or the left circumflex. In the dominant right coronary artery group, the arterioventricular groove branch arose from the right coronary artery alone in 6 and from the left circumflex alone in 1 patient, and in 20 patients, from both. In the dominant left coronary artery group, the atrioventricular groove branch arose from the left coronary artery in all 4 patients. The frequency of dominant right coronary artery and left coronary and the origin of the atrioventricular groove branch did not differ in the patients with prolapse of the mitral valve from a control group of 30 patients similarly analyzed. In all instances, the atrioventricular groove branch arose from either the right coronary artery ro the left circumflex, or both. In no case was the arterioventricular groove branch totally absent. The results of this investigation do not support the thesis, previously advanced by others, that prolapse of the mitral valve is related to absence of the left circumflex coronary artery, but indicate a normal range of variation in coronary arterial distribution.

Adult

Pseudocoarctation and mid-arch aortic coarctation.

A 21-year-old woman was found to have a mid-arch aortic coarctation in combination with pseudocoarctation. The angiographic disgnosis was established by left atrial injection after transseptal puncture.

Adolescent

Effects of intravenous glucose during pacing-induced angina pectoris in patients with coronary artery disease.

The effects of hypertonic glucose infusion on the anginal threshold determined by atrial pacing was studied in 14 patients with significant coronary artery disease. After glucose, angina occurred at a significantly lower heart rate and double product (systolic arterial pressure x heart rate), suggesting a decreased tolerance to ischemic stress. No stoichiometric relationship was noted between glucose uptake and lactate production, and there was no evidence that hypertonic glucose infusion resulted in enhanced anaerobic glycolysis in the ischemic myocardium. Acute elevation of plasma glucose levels may not be beneficial to patients with coronary artery disease.

Anaerobiosis

The clinical and angiographic spectrum of isolated, nondominant, left circumflex coronary disease.

Sixteen of 994 patients with arteriosclerotic heart disease and dominant right coronary arteries had isolated left circumflex obstruction. Of these, 6 patients had significant (75%) narrowing in the main circumflex, 10 in 1 or the marginal branches and 1 in the atrioventricular groove branch. Angina was mild in 5, moderate to severe in 8, and unstable in 1. Four patients had prior myocardial infarction (MI), and 1 had a recent MI complicated by posterior papillary muscle rupture. The EKG was normal in 5, showed an MI in 2, LBBB in 1, RBBB in 2, ST-T wave changes in 3, LVH in 2, and atrial fibrillation in 2. Left ventricular angiography performed in the right anterior oblique projection revealed normal contraction in 9 patients, apical hypokinesis in 4, posterobasal hypokinesis in 1, and diffuse hypokinesis in 2. The left ventribular end diastolic pressure was normal in 11 patients and elevated in 5. The cardiac index was normal in 12 patients and reduced in 2. Isolated, nondominant, left circumflex coronary disease is an uncommon entity in symptomatic patients. However, when present, it may produce significant clinical and hemodynamic impairment.

Adult

Patent ductus arteriosus in adult patients with aortic valvular disease: the importance of routine screening for a left-to-right shunt at cardiac catheterization.

Two patients, catheterized primarily for the preoperative assessment of clinically apparent aortic stenosis and insufficiency, were found to have a patent ductus arteriosus as well at cardiac catheterization. The association of aortic valve disease and patent ductus arteriosus is reviewed, and the importance of making the diagnosis prior to aortic valve replacement is stressed, emphasizing the routine use of the hydrogenplatinum electrode system.

Cardiac Catheterization

Nutritional control of xanthine dehydrogenase. II. Effects on xanthine dehydrogenase and aldehyde oxidase of culturing wild-type and mutant Drosophila on different levels of molybdenum.

Two new mutants, deficient in aldehyde oxidase and xanthine dehydrogenase, have been isolated from a wild-type stock of Drosophila melanogaster and have been provisionally termed lxd-c and lxd-d, respectively, as both mutants appear to be allelic with lxd (low xanthine dehydrogenase). An analysis has been made of the effects of dietary molybdenum on lxd, lxd-c, lxd-d, lao (low aldehyde oxidase), mal (maroon-like eye color), and pac (Pacific) wild-type flies. On the lower dietary levels of 10(-3) M and 10(-2) M molybdenum, increases in specific activity of both enzymes were observed only in lxd. Furthermore, two- to three-fold increases in specific activity of both enzymes occurred in all strains, except mal, when cultured on 5 x 10(-2) M molybdenum. The lxd and lxd-c strains failed to survive on this high concentration of the ion. Similar concentrations of molybdenum had no effect in vitro. An extra electrophoretic band of xanthine dehydrogenase was observed on polyacrylamide gel from extracts of wild-type flies cultured on certain levels of molybdenum, but its appearance was not always correlated with the increases in specific activity.

Aldehyde Oxidoreductases

Arrhythmias following cardiac surgery: relation to serum digoxin levels.

Arrhythmias were analyzed in 50 patients undergoing cardiac surgery: 27 with valve surgery, 15 with coronary artery bypass (CAB), 5 with CAB and valve surgery, and 3 with miscellaneous procedures. The role of electrolyte abnormalities, pericarditis, serum osmolarity, digoxin level, and the type of surgery performed was evaluated. Thirty-seven out of 50 patients (74 per cent) had a postoperative arrhythmia, and a total of 78 different arrhythmias were noted. Twenty-six out of 27 patients with valve surgery had an arrhythmia vs. six out of 15 patients with CAB (p less than 0.001). Atrial fibrillation was the most common arrhythmia in all groups. Although postoperative hypocalcemia, hypomagnesemia, pericarditis, and wide shifts in osmolarity were common, they did not correlate with arrhythmias. Seventeen patients developed postoperative arrhythmias compatible with digitalis toxicity, including junctional rhythm, atrioventricular dissociation, or atrial tachycardia with block. However, the range of serum digoxin levels in these patients was zero to 2.80 ng. per milliliter. This suggests increased sensitivity to digitalis glycosides or the effects of surgical trauma as the etiology of arrhythmia in many patients. The distinction between digitalis-induced arrhythmia and spontaneously occurring arrhythmia cannot be made with certainty in most postoperative patients. Therapy should reflect an awareness of the potential for postoperative digitoxicity.

Aortic Valve