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Biomedical subjects

I Wiener

Publications and source records attributed to I Wiener.

At least 73 records · Page 4Linked to original sources
PubMed1982

Perforation of the gallbladder due to blunt abdominal trauma.

Gallbladder perforation due to blunt trauma is an uncommon finding. We report our experience with six patients. The factors predisposing to perforation include a distended gallbladder because of either fasting or alcohol ingestion in normal patients, and obstruction of the cystic in patients with cholelithiasis. The diagnosis of gallbladder perforation after blunt injury may be suspected in patients with signs of an acute abdomen and hypotension that is not explained by blood loss. Peritoneal lavage that contains bile suggests the tentative diagnosis of trauma to the biliary tract or gallbladder, as well as to the liver or upper bowel. A cholecystectomy is the preferred treatment when gallbladder perforation occurs in the traumatized patient.

Abdominal Injuries↗
PubMed1982

Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: incidence, clinical features, and long-term evaluation.

Of 1484 pacemakers placed at our institution between 1970 and 1980, there were 18 patients between the ages 20 and 40 years who were not postoperative congenital heart disease cases. Twelve of these patients had primary sick sinus syndrome (SSS) as the indication for pacing. Eleven of 12 patients were markedly symptomatic with syncope, near syncope, or lightheadedness. Ambulatory monitoring revealed evidence of sinus node disease in all patients studied. Electrophysiologic studies were falsely negative in the five patients in whom they were performed. Patients tolerated pacemaker therapy well and became asymptomatic with pacing. We conclude that SSS in young adults is uncommon, but still represents the most common indication for permanent pacemaker therapy in this age group. The decision for pacemaker therapy should depend on symptoms and results of ambulatory monitoring. These patients can expect symptomatic improvement with pacing.

Adult↗
PubMed1982

Epicardial activation of the human ventricle: effects of left ventricular hypertrophy.

To determine the effects of left ventricular hypertrophy on epicardial activation of the human heart, intraoperative epicardial mapping of 40 to 66 points was performed in 10 patients undergoing aortic valve replacement. Mean calculated left ventricular mass was 364 +/- 98 g. All patients had normal left ventricular contraction. Earliest epicardial activation occurred in the anterior right ventricle in all patients. In 9 patients, it was the only epicardial breakthrough point. One patient had a single inferior left ventricular breakthrough point. Epicardial activation spread from the right ventricle towards the left ventricle in both the anterior and inferior direction. Latest epicardial activation occurred at the base of the left ventricle in 9 patients and the base of the right ventricle in 1. When compared with patients with coronary artery disease, normal ventricular contraction, and no left ventricular hypertrophy, patients with hypertrophy had fewer left ventricular breakthrough points (p less than 0.001) and were more likely to have latest activation at the left ventricular base (p less than 0.0010. We conclude that left ventricular hypertrophy is associated with marked changes in the pattern of epicardial activation. These changes may reflect delay in spread from endocardium due to the increased wall thickness.

Adult↗
PubMed1982

Correlation between release of cholecystokinin and contraction of the gallbladder in patients with gallstones.

The role of endogenously released cholecystokinin (CCK) in mediating gallblader (GB) contraction was evaluated in 12 normal volunteers and 24 patients with gallstones (11 additional gallstone patients were excluded because of failure of adequate ultrasonographic visualization). CCK concentrations before and after oral administration of fat (Lipomul((R))) were measured by a specific radioimmunoassay. CCK release was correlated with changes in GB volume determined simultaneously by ultrasonography. On the basis of gallbladder contraction and operative findings, gallstone patients were divided into "contractors" (14), "noncontractors" (6), and "hydrops" (4). Lipomul caused prompt release of CCK in normal volunteers and all groups of gallstone patients. The changes (basal to peak) in plasma CCK (pg/ml) for the different groups were as follows: normal volunteers (108 +/- 9 to 200 +/- 16), contractors (77 +/- 10 to 128 +/- 13), noncontractors (59 +/- 7 to 159 +/- 38), and hydrops (43 +/- 5 to 113 +/- 47). The total integrated output of CCK (0-60 min) was greater in normal volunteers (3975 +/- 762 pg-min/ml) than in contractors (1530 +/- 567 pg-min/ml). Lipomul caused similar GB contraction in normal volunteers and contractors (from basal volumes to maximal contraction); these changes were from 19.5 +/- 2.3 ml to 5.6 +/- 1.0 ml in normal volunteers, and from 19.6 +/- 3.2 to 5.2 +/- 1.0 in contractors. Plasma concentrations of CCK and GB volume were highly correlated in the 12 normal volunteers (r = -0.89, p < 0.01) and in the 14 contractors (r= -0.99, p < 0.01)), but the GB was significantly (p < 0.01) more sensitive to changes in plasma CCK in the gallstone contractors than in the normal volunteers. The authors suggest that there may be two groups of gallstone patients, noncontractors and contractors. Stasis may be important in the pathogenesis of gallstones in the noncontractors, whereas in contractors, the authors speculate that an abnormality in the CCK-gallbladder relationship (characterized by diminished CCK release and increased GB sensitivity to CCK) may be involved in the evolution of the disease.

Adult↗
PubMed1982

Effect of colectomy on cholecystokinin and gastrin release.

Studies were conducted to determine the effect of resection of the colon on the release of cholecystokinin (CCK) and gastrin. A standard food stimulation test was performed in five dogs. Peripheral blood samples were collected for future measurement of CCK and gastrin by specific radioimmunoassay. Each dog underwent subtotal colectomy with side-to-end ileoproctostomy. The food stimulation test was repeated at approximately weekly intervals for eight weeks after colectomy. Basal plasma CCK levels of 139 +/- 21 pg/ml before colectomy did not change after colectomy. Total amount CCK released after food was increased significantly at both four (5.94 +/- 0.78 ng min/ml) and eight (13.00 +/- 2.72 ng min/ml) weeks after colectomy in comparison with that observed prior to colectomy (2.94 +/- 0.54 ng min/ml). Basal serum gastrin levels of 28 +/- 9 pg/ml did not change significantly after colectomy. Total amount of gastrin released after food was increased significantly at both two (8651 +/- 2294 pg min/ml) and three (6940 +/- 1426 pg min/ml) weeks after operation, but at none of the later weeks. The precolectomy output, used for comparison, was 5608 +/- 1346 pg min/ml. It was concluded that resection of the colon leads to an increase in release of CCK and gastrin after food stimulation. This finding provides further evidence that the colon contains a factor that inhibits the release of CCK and gastrin, and that the colon functions as an endocrine organ.

Animals↗
PubMed1982

Rapid AV nodal re-entrant tachycardias presenting with syncope or pre-syncope: use of electrophysiological studies to select therapy.

Five patients with recurrent syncope or pre-syncope due to rapid supraventricular tachycardias underwent electrophysiological study. In each patient, an AV nodal re-entrant tachycardia could be induced. By leaving a coronary sinus catheter in place, the effects of drugs on the ability to induce tachycardia could be tested on sequential days. Drug effects were highly variable, but in each patient it was possible to determine a drug which prevented induction of tachycardia. Patients treated with this drug have had no recurrent symptoms or tachycardias with a followup of 4-21 months. Although AV nodal re-entry is highly dependent on autonomic tone, electrophysiological study appears to be a useful means of selecting therapy in patients with severe, symptomatic tachycardias.

Adult↗
PubMed1982

Determinants of ventricular tachycardia in patients with ventricular aneurysms: results of intraoperative epicardial and endocardial mapping.

We performed epicardial and endocardial mapping in 11 patients with ventricular aneurysms; six had chronic, recurrent ventricular tachycardia and five had no ventricular arrhythmias more severe than isolated ventricular premature complexes. Forty to 66 epicardial and 16-40 endocardial points were recorded during stable sinus rhythm in each patient. Local electrograms were evaluated as to timing and presence of fragmentation (duration greater than 50 msec, amplitude less than 1 mV, absence of discrete intrinsicoid deflection). Activation of the epicardial surface of the aneurysm was abnormal in all patients, and extended beyond completion of the QRS in three patients in the arrhythmia group and two in the nonarrhythmia group (NS). Activation of the epicardial border zone was normal in all patients. Electrograms from the endocardial surface of the aneurysm were abnormally fragmented in all patients and the mean duration of activation was not different between patients with and without arrhythmias (85.5 +/- 14.1 vs 96.2 +/- 13.8 msec, NS). However, in patients with ventricular tachycardia, electrograms from 33-58.3% (mean 45.5 +/- 8.8%) of the endocardial border zone showed fragmentation, compared with 0-16.7% (mean 4.9 +/- 7.4%) of the endocardial border zone in patients without arrhythmias (p less than 0.05). Fragmentation was always along the septal border of the aneurysm. The mean duration of the most prolonged endocardial border zone electrogram was 97.5 +/- 17.0 msec in ventricular tachycardia patients and 67.0 +/- 27.1 msec in patients without arrhythmia (p less than 0.05). Five of six ventricular tachycardia patients had electrical activity in the endocardial border zone extending beyond the end of the QRS, compared with one of five patients without ventricular tachycardia (p less than 0.05). We conclude that fragmented electrical activity is present in all patients with ventricular aneurysms, but the extent and severity of fragmentation in the endocardial border zone is greatest in patients with recurrent ventricular tachycardia.

Adult↗
PubMed1982

Clinical use of oral verapamil in chronic and paroxysmal atrial fibrillation.

We evaluated the effectiveness of oral verapamil therapy for control of ventricular rate in digitalized patients with atrial fibrillation (AF) with three clinical problems: chronic AF with rapid rate at rest (four patients), chronic AF with accelerated rate during modest exercise (five patients), and rapid rates during paroxysmal AF (four patients). Patients in the first two categories were evaluated both by open-label dosage titration and by a randomized, double-blind, cross-over protocol. In chronic AF with rapid rate of rest, there was a significant reduction in resting heart rate (from 125 +/- 7 to 87 +/- 14, P less than 0.01) and in peak exercise heart rate (from 162 +/- 33 to 126 +/- 25, P less than 0.01). In chronic AF with rapid rate during exercise, there was also a significant decrease in resting heart rate (from 90 +/- 7 to 66 +/- 4, P less than 0.01) and in peak exercise heart rate (from 126 +/- 19 to 101 +/- 15, P less than 0.01). These effects continued during longterm follow-up of one to 12 months (mean seven months). In patients with paroxysmal AF, verapamil slowed the ventricular response from 16- +/- 24 to 72 +/- 4 P less than 0.01) with only some amelioration of symptoms. Therapy was well tolerated despite a high prevalence (seven of 13 patients) of radiographic cardiomegaly (cardiothoracic ratio greater than 0.55). We conclude that verapamil is a safe and useful drug for control of ventricular rate in digitalized patients with chronic and paroxysmal AF.

Administration, Oral↗
PubMed1982

Reduction of postprandial release of pancreatic polypeptide after development of pancreatic fibrosis.

We have measured the plasma pancreatic polypeptide response to a meal before and after the development of pancreatic fibrosis in dogs. Peripheral blood samples were collected in five dogs before and after a standard meal for measurement of pancreatic polypeptide by a specific radioimmunoassay. The next day, all of the pancreatic ducts were ligated in each dog, and one month after pancreatic ductal ligation, the food study was repeated. The dogs were sacrificed on the following day, and the pancreas of each dog was studied morphologically. Before pancreatic ductal ligation, plasma pancreatic polypeptide concentrations showed a biphasic response to a meal; a primary, rapid increase lasted 30 to 45 minutes, and a secondary, prolonged increase lasted for more than 180 minutes. One month after pancreatic ductal ligation, plasma concentrations of pancreatic polypeptide, at each time period during the initial 60 minutes after food, were significantly less than the corresponding sample before pancreatic ductal ligation. The total amount of pancreatic polypeptide released after a meal during the initial 60 minutes was diminished significantly by pancreatic ductal ligation. Neither plasma concentrations of pancreatic polypeptide nor the total amount of pancreatic polypeptide release after a meal showed a significant change during the last 180 minutes after food. Results of histologic observations showed destruction and fibrotic replacement of the acini of the pancreas after ligation of the pancreatic ducts. The islets were well preserved. Since the cells of origin of pancreatic polypeptide are distributed in both the acini and islets of the pancreas in dogs, we suggest that the primary, rapid phase of pancreatic polypeptide after a meal may be derived chiefly from cells in the acini, whereas the secondary phase of response may be derived chiefly from cells in the islets.

Animals↗
PubMed1981

Septal myocardial perfusion imaging with thallium-201 in the diagnosis of proximal left anterior descending coronary artery disease.

The use of myocardial perfusion imaging (MPI) to identify obstructive coronary disease of the left anterior descending coronary artery proximal to the first septal perforator (prox LAD) was studied in 60 patients. Perfusion of the septum and anteroapical areas with thallium-201 injected during exercise was compared to results of coronary arteriography. Septal MPI defect was found in 92.3% of patients with obstruction of the proximal LAD, 27.7% of patients with obstruction of LAD distal to first septal perforator, 0% in patients with obstructions involving right or circumflex arteries, and in 10.5% of patients without coronary disease. Anteroapical MPI defects were found with similar frequency in the three groups with obstructive coronary disease. Septal MPI defect had a sensitivity of 92.3% and specificity of 85.4% in the diagnosis of proximal LAD disease. Normal septal perfusion with thallium-201 virtually excluded proximal LAD disease.

Adult↗
PubMed1981

Effects of lidocaine on regional intraventricular conduction in patients with coronary artery disease.

Studies of isolated heart muscle and canine models of myocardial ischemia have demonstrated that lidocaine slows conduction in abnormal but not in normal tissues. To determine lidocaine's effects on intraventricular conduction (IVENT) in patients with coronary artery disease (CAD), we studied this agent in seven patients following left anterior descending coronary artery (LAD) bypass surgery. Epicardial electrodes were placed on the right atrium, left ventricle (LV) in the distribution of the LAD, and on the right ventricle (RV). On postoperative day 7, lidocaine was administered as 100 mg bolus followed by 4 mg/minute infusion for 2 hours. At constant atrially paced rate, bipolar electrograms were recorded from the LV and RV for the 2 hours of infusion and for 2 hours after discontinuation of infusion. Conduction intervals were measured from the earliest onset of QRS in three simultaneously recorded surface ECG leads to the major deflection of the electrogram from each ventricle. At peak effect, with mean lidocaine level of 2.7 +/- 0.5 mg/ml, lidocaine slowed LV conduction by a mean of 6 +/- 1 msec (14 +/- 2%) (p less than 0.001) and in the RV by 1 +/- 0.3 msec (4 +/- 1%) (p less than 0.01), QRS duration changed 1 +/- 1 msec) 1 +/- 1%) (NS). The values returned to baseline within 2 hours after discontinuation of lidocaine infusion. The difference in lidocaine's effect between the diseased LV and the normal RV was significant (p less than 0.001).

Adult↗
PubMed1981

Termination of circus movement tachycardia utilizing an accessory atrioventricular pathway by retrograde concealed penetration of the atrioventricular node through the bundle branch system. A mechanism of tachycardia termination in Wolff-Parkinson-White syndrome.

A 30 year old woman with Wolff-Parkinson-White syndrome underwent electrophysiologic study for investigation of circus movement tachycardia utilizing the accessory pathway for retrograde conduction. The accessory pathway was located on the right side. Episodes of circus movement tachycardia with left and right bundle branch block were induced. Some episodes of circus movement tachycardia with left bundle branch block terminated spontaneously. Two episodes of spontaneous termination at the level of the atrioventricular (A-V) node were preceded by prolongation of the H-V interval causing delay in atrial activation. This delayed atrial cycle was then followed paradoxically by spontaneous termination of the tachycardia in the A-V node. A similar phenomenon could be demonstrated reproducibly with single echo beats induced by coronary sinus extrastimuli. It appears that retrograde concealed penetration of the A-V node through the bundle branch system during anterograde left bundle branch block is the most likely mechanism for this phenomenon.

Adult↗
PubMed1981

Traumatic colonic perforation. Review of 16 years' experience.

The surgical management of colon injuries in civilian practice requires individualization. Primary repair, either by debridement and suture or resection and anastomosis, is a safe method of management in selected cases and results in a shorter hospital stay, less morbidity and a complication rate that is no higher. In this series, over half of the colon injuries were managed in this way. Exteriorization and proximal colostomy are accepted methods of management, but possibly should be reserved for the more severely injured patient. The criteria for individualization are briefly summarized.

Adult↗