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Biomedical subjects

H Gilutz

Publications and source records attributed to H Gilutz.

27 records · Page 2Linked to original sources
PubMed1993

A modified isometric test to evaluate blood pressure control with once-daily slow-release verapamil.

Blood pressure at rest is not predictive of round-the-clock values. Blood pressure should therefore be measured during effort to evaluate hypertension and its response to treatment. The effect of sustained-release verapamil (240 mg taken once a day) on blood pressure at rest and during isometric effort was therefore investigated. Overall, verapamil reduced blood pressure significantly in 41 of 45 hypertensive patients: the mean systolic blood pressure at rest (+/- SD) fell from 151 +/- 35 mmHg to 137 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 97 +/- 21 mmHg to 83 +/- 7 mmHg (P < 0.001), while the systolic blood pressure during isometric effort fell from 186 +/- 23 mmHg to 156 +/- 13 mmHg (P < 0.001) and the diastolic blood pressure from 118 +/- 14 mmHg to 95 +/- 8 mmHg (P < 0.001). The simple, inexpensive handgrip method described is cost-effective and strongly recommended as an integral part of the evaluation of hypertensive patients. The combination of a drug to which compliance is good and a simple method of blood pressure evaluation should result in improved effectiveness of treatment in the long term.

Adult↗
PubMed1993

The prognostic importance of two easily obtainable noninvasive markers after intravenous thrombolytic therapy in acute myocardial infarction.

The predictability of left ventricular function, short- and long-term prognosis, assessed by means of two easily obtainable noninvasive markers, was prospectively studied in 110 consecutive patients undergoing thrombolytic therapy for acute myocardial infarction. Positive noninvasive markers were defined as follows: a) > 50% reduction in ST segment elevation within 120 min of initiating therapy, and b) early peak of creatine kinase (CK) activity < 12h after the start of thrombolysis. Seventy-five (68%) of the patients had two positive markers and are classified as the responder group. The nonresponder group consisted of 35 patients (32%) who had 0-1 positive markers. Left ventricular function was assessed 6-12 weeks after therapy by equilibrium radionuclide ventriculography. Left ventricular ejection fraction (LVEF) and survival rates at 1 month and 36 months were significantly higher in the responder group compared to the nonresponder group (54 +/- 12% vs. 43 +/- 11%, P < 0.05; 99% vs. 89%, P < 0.06; and 95% vs. 80%, P < 0.05 respectively). Thus, the combined analysis of two easily obtainable noninvasive markers can predict post-treatment preservation of left ventricular function and survival up to 36 months in patients with acute myocardial infarction undergoing thrombolytic therapy.

Adult↗
PubMed1992

Short- and long-term comparative study of anistreplase versus streptokinase in acute myocardial infarction.

Streptokinase is well established as an effective thrombolytic. Anistreplase, a new thrombolytic drug, is a complex of streptokinase and acylated human plasminogen that can be administered by intravenous bolus and activates plasminogen at the clot site. Although both streptokinase and anistreplase are effected in treating myocardial infarction (MI), they have different pharmacologic properties. This study was designed to identify short- and long-term differences in their clinical effectiveness, safety in use, and survival rates in patients with acute MI. One hundred ten successive patients under seventy years of age admitted within three hours after onset of sustained chest pain suggestive of acute MI were randomized to receive either 30 units of anistreplase intravenously over five minutes or intravenous injection of 750,000 units of streptokinase over thirty to sixty minutes. Reperfusion was achieved in 34 of the 52 (65%) patients treated with anistreplase and in 41 of the 58 (71%) patients treated with streptokinase (p = NS). The two drugs were equally effective in preserving left ventricular ejection fraction, which was found to be significantly better in patients with anterior wall MI who had achieved reperfusion than it was in those who did not (p less than 0.02). One-month, twelve-month, and thirty-six-month survival rates were high (96% to 88%) with no significant difference between the two treatment groups. The authors conclude that the two drugs are equally effective thrombolytic agents but that anistreplase has the advantage that it can be administered as a bolus injection.

Aged↗
PubMed1991

[Evaluation of verapamil for hypertension by an isometric exercise test].

Since the resting blood pressure (BP) does not predict round-the-clock values, in order to evaluate the disease and its response to treatment BP should be measured during exertion. Verapamil, either 120 mg or 160 mg, twice daily, was given to 60 hypertensives at rest and during isometric effort, according to our previously reported protocol. There was a significant response (p less than 0.005) to the treatments. Sustained release verapamil, 240 mg once a day, reduced systolic and diastolic BP significantly in 38 of 45 hypertensives at rest and during isometric effort. A simple, inexpensive, cost-effective, hand-grip method is strongly recommended as an integral part of treatment evaluation. The combination of highly effective drugs together with a simple method of BP evaluation may result in improved long-term treatment.

Blood Pressure↗
PubMed1991

Mid left anterior descending coronary artery originating from the right coronary artery.

Dual connection of the left anterior descending coronary artery to the left and right coronary arteries is a very rare congenital anomaly. In this report we describe two cases in which the mid-position of the left anterior descending coronary artery is connected to the right coronary artery, one directly and the second by way of the infundibular artery. To the best of our knowledge, connection of the mid-position of the left anterior descending to the infundibular artery has not been previously described.

Adult↗
PubMed1991

The relationship between causal attribution and rehabilitation in patients after their first myocardial infarction. A cross cultural study.

Full rehabilitation of a patient following myocardial infarction (MI) involves resumption of work and the restoration of quality of life. Two groups of patients (87 Israeli and 98 Swedish) were admitted to the CCU and followed up after their first MI. To evaluate the patients' own perception of events ('causal attribution theory'), sequential interviews were scheduled. Physical risk factors correlated poorly with rehabilitation outcome at 6 months. However, two patient clusters were pinpointed according to the patients' subjective explanation of the factors contributing to their MI. These 'causal attribution scores' had a predictive value, independent of culture, age, education, disease severity and depression. It is therefore concluded that evaluation of patient perception may assist in planning intervention for high risk psychologically debilitated patients, and thus favourably enhance their rehabilitation outcome.

Adaptation, Psychological↗
PubMed1983

Alpha 1-antitrypsin in acute myocardial infarction.

Alpha 1-antitrypsin serum levels were measured in 48 patients with acute myocardial infarction and in 19 control patients either with coronary heart disease without necrosis, or with neither coronary disease nor inflammation. Alpha 1-antitrypsin was significantly raised in the group of patients with acute myocardial infarction. As some patients individually showed no change in alpha 1-antitrypsin levels, however, they were divided into two groups according to the maximum serum levels attained. Patients with non-increasing levels of alpha 1-antitrypsin showed increased mortality and a higher incidence of cardiogenic shock, whereas reinfarction occurred more frequently in the group with high alpha 1-antitrypsin levels. Our findings may suggest that the course of a myocardial infarction is determined not only by the severity of the ischaemic event, but also by the response of the "acute" phase reaction" mechanism. We conclude that a failure of alpha 1-antitrypsin levels to increase after myocardial infarction may be associated with a worse clinical course.

Coronary Disease↗