Biomedical subjects
Publications and source records attributed to E Goldberg.
We present a case in which the radiographic appearance of a bipolar pacing lead mimics a wire fracture. Recognition of this normal finding--due to lead construction--will help avoid erroneous diagnosis of wire fracture on chest x-ray films.
This paper briefly reviews the biological properties and occurrence of selected testis-specific isozymes. These include phosphoglycerate kinase B, cytochrome ct, enolase S, and lactate dehydrogenase C4 (LDH-C4). The most extensively studies of these, LDH-C4, is described in detail with particular reference to its potential in an immunocontraceptive technology.
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A prospective study of advanced cardiopulmonary resuscitation (CPR) was carried out on 226 patients in order to examine factors predicting successful resuscitation and 6 month survival. The mean age of all patients was 70 years and median age was 74. Cardiopulmonary resuscitation was successful in 40.5% (137) of all arrests and in 48.7% (110) of the first arrests. Thirty of 207 patients with one or more cardiac arrests were discharged alive (14%). Twenty-one of our patients were alive at 6 months (10.3%). Patients in ventricular fibrillation and/or ventricular tachycardia at the time of arrest were more likely to have successful outcomes. When the patient required Isuprel or bicarbonate, cardiopulmonary resuscitation was significantly less successful. We found no correlation of immediate outcome with the following variables: location of arrest; time of day; pre-existence of shock; coma; stroke; malignancy. Uremia and/or chronic obstructive pulmonary disease was not significantly associated with failed resuscitation. Most notable in our results of specific treatments was the evidence for the need to improve the initial pH, particularly when it was less than 7.2. Failure to do so by the time the second blood gas was drawn was associated with failure of cardiopulmonary resuscitation. Our results also suggest that the adequate treatment of metabolic acidosis, and improved ventilatory management with improved PO2 and optimization of PCO2, play a role in the better outcome of cardiopulmonary resuscitation.
Twenty-four patients with suspected aortic stenosis (Group I) were evaluated noninvasively by continuous wave Doppler ultrasound before undergoing cardiac catheterization. Twenty normal subjects served as the control group (Group II). Maximal velocity measurements in the ascending aorta ranged from 3.0 to 5.8 m/s (mean 4.34 +/- 0.65) in Group I versus 1.0 to 1.6 m/s (mean 1.28 +/- 0.16) in Group II (p less than 0.001). Using the Bernoulli equation, the peak pressure gradient across the aortic valve was calculated from the maximal velocity in the Group I patients. The results correlated well with the peak aortic valve gradient obtained at cardiac catheterization (r = 0.79). In 20 of these 24 patients, the peak Doppler gradient was within 25% of the gradient found at cardiac catheterization. In three patients, the Doppler study under-estimated the gradient by slightly more than 25% but still detected the presence of significant aortic stenosis. The Doppler technique failed to detect critical aortic stenosis in only one patient. Significant overestimation of the gradient by Doppler measurement did not occur in any patient. The technique was particularly helpful in older patients in whom other noninvasive tests often yield inconclusive results. An important but infrequent limitation of the technique is underestimation of the gradient that occurs when the angle of incidence between the ultrasound beam and aortic blood flow is too large. The findings indicate that continuous wave Doppler ultrasound provides a reliable estimate of the valvular gradient in most patients with aortic stenosis.
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Previously reported clinical studies have suggested sodium hydroxide as an effective agent in causing pleural symphysis. To explore the sclerosing potential of this agent, we instilled 0.5% sodium hydroxide into the pericardium of four dogs. Normal saline was instilled into the pericardium of one control dog. Echocardiograms, 24 hour EKG monitoring and intracardiac pressures were recorded. One dog was sacrificed at the end of 24 hours, another at the end of seven days and three other dogs were sacrificed at the end of 28 days. ST elevations and prolonged episodes of supra-ventricular and ventricular tachycardia were noted during and within 24 hours after the intrapericardial instillation of sodium hydroxide in all the dogs. No arrhythmias were noted in the control dog. None of the dogs showed pericardial symphysis. These results suggest that sodium hydroxide causes serious cardiac arrhythmias when instilled intrapericardially and is of limited value in causing pericardial symphysis.
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A 33 year old woman developed left ventricular outflow obstruction due to a fibrous subvalvular membrane 2 years after insertion of a Hancock modified orifice, porcine aortic valve prosthesis. M-mode and two-dimensional echocardiographic studies failed to detect the membrane. Continuous wave Doppler study revealed a maximal velocity of 4.8 m/s and a calculated peak pressure gradient of 92 mm Hg between the left ventricle and aorta. This finding was in close agreement with the peak gradient of 100 mm Hg obtained at cardiac catheterization. Because of its ability to accurately measure valvular gradients, continuous wave Doppler ultrasound study appears to be a useful noninvasive technique in the evaluation of patients with suspected prosthetic valve dysfunction.
The isozyme of lactate dehydrogenase (LDH) that is specific to testes, designated LDH-C4, is the predominant LDH isozyme in mammalian spermatozoa. Four high-affinity monoclonal antibodies have been developed to murine LDH-C4. These antibodies were tested for crossreactivity with LDH-C4 from rat, hamster, rabbit, and human by competitive binding radioimmunoassays. Monoclonal antibodies RG-1 and RG-2 are specific for adjacent or partially overlapping epitopes. The other two monoclonal antibodies each recognize separate and distinct determinants. One of these, designated RG-4, recognizes a sequential determinant that is contained in the coenzyme binding loop, residues 101-115 of the C subunit. Furthermore, RG-4 shows reduced binding affinity for rat LDH-C4 which differs in amino acid sequence at residue 108 and 111 in this region of the molecule. RG-4 also has reduced affinity for LDH-C4 of other species, which is consistent with substitutions in the amino acid sequences of the coenzyme binding loop. These differences between C4 of closely related species is in contrast to the high degree of conservation of this sequence in the LDH-A4 and LDH-B4 isozymes. These results provide useful information regarding homologies among species of LDH-C4 as well as the evolution of this isozyme.
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A peptide bearing an antigenic determinant of the sperm-specific lactate dehydrogenase C4 isozyme (LDH-C4) has been isolated from a tryptic digest of the whole protein. This peptide, comprising residues 152-159 (MC152-159), reacts with rabbit anti-mouse LDH-C4. Immunization of rabbits with synthetic MC152-159 conjugated to bovine serum albumin induces an immune response which is specific for the peptide. Anti-MC152-159 IgG binds 125I-labeled mouse LDH-C4 and competition experiments demonstrate the specificity of this antigen antibody reaction.