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Biomedical subjects

J L Bass

Publications and source records attributed to J L Bass.

At least 73 records · Page 4Linked to original sources
PubMed1983

Clinical pharmacology of bupropion and imipramine in elderly depressives.

The clinical efficacy and adverse reaction profile of bupropion, an atypical antidepressant, was compared with the tricyclic imipramine in 63 elderly depressives. Patients were randomly assigned to treatment with 150 or 450 mg/day of bupropion, 150 mg/day of imipramine, or placebo for 35 days. Both doses of bupropion were equivalent to imipramine in antidepressant efficacy. The higher dose of bupropion had a more rapid onset of effect than the low dose and significantly greater anxiolytic activity than either imipramine or the lower dose. Both doses of bupropion had adverse reaction profiles strikingly similar to placebo and, in marked contrast to imipramine, did not produce sedation or anticholinergic side effects. Cognition improved equally in all groups. It was concluded that bupropion has therapeutic advantages over the tricyclics in the treatment of elderly depressives.

Age Factors↗
PubMed1982

The pulmonary vascular response to oxygen and its influence on operative results in children with ventricular septal defect.

The ratio of pulmonary vascular resistance to systemic resistance was determined before and after oxygen administration in 25 children with an isolated large ventricular septal defect and elevated pulmonary vascular resistance (pulmonary/systemic resistance ratio, Rp/Rs greater than 0.25). A fall of 30% or more in the Rp/Rs, after 20 minutes of oxygen inhalation (FiO2 greater than 0.90), was considered a positive response to oxygen. In the 6 children with Down's syndrome, the Rp/Rs fell significantly more in oxygen (52%) than it did in the 19 children without Down's syndrome (31%, p less than 0.05). No other clinical or baseline hemodynamic finding was predictive of vascular responsiveness. Seventeen children underwent closure of the ventricular septal defect. Three of 11 children who responded to O2 expired shortly after operation; each of the 6 children who did not respond to O2 survived operation. Two of the deaths (occurring less than 12 hours after closure) were from low cardiac output; a third child died suddenly 5 days postoperatively. Thirteen children, 7 who responded to oxygen and 6 who did not, were restudied by cardiac catheterization an average of 2.0 years following successful closure of the ventricular septal defect. While the Rp/Rs in room air fell following closure of the defect in both groups, the decrease was 22% in responders and 28% in nonresponders. The results of this study, unlike similar studies performed at higher altitudes, suggest that the preoperative responsiveness of the pulmonary vasculature to oxygen does not predict either operative survival or postoperative pulmonary vascular resistance.

Child↗
PubMed1982

Progressive cardiac conduction defect and cardiomyopathy in siblings with syncope.

Three siblings evaluated for syncope were found to have left bundle-branch block. Progression to complete heart block occurred in all. Pacemaker implantation eliminated syncopal epidoses in each case. Echocardiographic manifestations of cardiomyopathy were present in each child despite normal roentgenographic heart size. Careful family study identified no other affected members with conduction defects. These children area believed to represent a form of familial cardiomyopathy in which clinical manifestations of cardiac conduction system disease predominate.

Bundle-Branch Block↗
PubMed1982

Balloon dilatation of excised aortic coarctations.

Seven children 1-6 years of age underwent aortic resection and re-anastomosis for coarctation of the thoracic aorta. The excised segments were 1-2 cm long and were dilated in vitro with a Grüntzig balloon catheter less than two hours after resection. A pressure of 4-8 atmospheres was used, and the inflated diameter of the balloon was twice the luminal diameter of the undilated coarctation. The diameter of each specimen was increased by an average of 85%, largely because of an increase in the external diameter of the coarctation. However, extremely high pressures were required for successful dilatation, producing transmedial tears in the "normal" aorta distal to the coarctation in three specimens. These results indicate that although balloon dilatation appears feasible as palliation for aortic coarctation, further studies of its safety are necessary before instituting clinical trials.

Angioplasty, Balloon↗
PubMed1981

Selective opacification of arteries with balloon-occlusion angiography.

Selective catheterization of vessels for angiography in infants is often difficult. The authors describe the use of a balloon-tipped catheter to direct contrast material to a selected area; consequently, smaller volumes of contrast material are used than is usually required for conventional angiography. The angiograms obtained provide excellent anatomic visualization.

Angiography↗
PubMed1981

Transvenous angioplasty of experimental branch pulmonary artery stenosis in newborn lambs.

A dilatable form of bilateral branch pulmonary artery stenosis was created in 27 newborn lambs. Nine lambs were long-term survivors and were dilated with modified Grüntzig balloon dilation catheters. They were allowed to recover for 6-9 weeks, during which time there was no significant change in the mean systolic gradients across the narrowed sites. Thirteen arteries underwent dilation. Dilation was associated with a decrease in the systolic gradient in all cases (from 34.9 mm Hg to 8.1 mm Hg) and an increase in the diameter of the narrowed site (from 4.6 to 7.6 mm) as estimated by angiography. Flows and flow distribution were measured in four lambs before and after unilateral dilation using 15-mu radiolabeled microspheres; in each case, the fraction of total flow to the dilated lung rose after dilation (19.2 to 45.4%), as did the total flow to the dilated lung (30.0 to 69.2 ml/kg-min). Four lambs were catheterized every 2-4 weeks for an average of 16 weeks after dilation; the average gradient in these lambs remained below 10 mm Hg despite considerable growth (from 9.6 to 25.9 kg). Gross pathologic examination showed an intact vascular adventitia in all cases; there were multiple linear tears in the intima in recently (less than 7 days) dilated cases, but complete intimal healing had occurred by 2 months after dilation. No significant morbidity could be attributed to the dilation procedure. These results indicate that clinical trials are warranted.

Angioplasty, Balloon↗
PubMed1981

Residency training in community pediatrics.

A required PL-3 rotation in community pediatrics, including assignments to preschool and school settings, private pediatric offices, and in-hospital responsibilities, is described. A university-affiliated community hospital provides the organizational base for the program. After 14 PL-3 rotations, analysis of program content, as well as resident and community response, shows the experience to be a practical and workable model for incorporating community pediatrics into residency training.

Boston↗
PubMed1980

Predictive value of the echocardiographic left atrial dimension in isolated ventricular septal defect.

Echocardiographic left atrial dimension has been reported to correlate with left-to-right shunt (Qp/Qs) in children with isolated ventricular septal defect (VSD) or patent ductus arteriosus (PDA). In 17 children with isolated VSD, we prospectively compared Qp/Qs with the ratio of echocardiographic left atrial dimension to aortic root diameter (LAD/Ao) and with the left atrial dimension corrected for body surface area (LAD/M2). The correlation between LAD/Ao and Qp/Qs was not statistically significant (r = 0.49, p > 0.05). The LAD/M2 correlated significantly with Qp/Qs (r = 0.66, p < 0.01); however, prediction intervals were excessively wide. Our findings indicate that it is inappropriate to predict Qp/Qs in these patients from echocardiographic LAD.

Adolescent↗
PubMed1980

The M-mode echocardiogram in Fabry's disease.

Fabry's disease results from deficient activity of the enzyme alpha-galactosidase A. Cardiac abnormalities result from glycosphingolipid deposition in the myocardium, valvular tissue, and vessel walls. A noninvasive method to examine these abnormalities would be useful in the evaluation of patients. We examined the echocardiograms of 32 patients, 25 hemizygous and seven heterozygous, for Fabry's disease. The aortic root diameter was measured in each hemizygote. In nine patients under 26 years it was 33.2 +/- 1.2 mm. and in two it was dilated. In 16 patients over 26 years it was 38.8 +/- 1.2 mm. (p < 0.01), and in 12 it was dilated. The left ventricular posterior wall was measured in the echocardiogram of 21 normotensive hemizygotes. The difference in thickness between nine patients under 26 years (9.6 +/- 1.3 mm.) and 12 patients over 26 years (12.4 +/- .07 mm.) was not statistically significant. Only two of the nine younger patients had left ventricular wall thickness greater than normal compared to eight of the 12 older patients. The mean left ventricular shortening fraction of 22 hemizygous patients was normal. One hemizygote had echocardiographic evidence of mitral valve prolapse. Four of the seven heterozygotes had normal echocardiograms. Among the other three, one had increased left ventricular wall thickness, a second had disproportionate ventricular septal thickness, and a third had both abnormalities. The echocardiographic aortic root size was normal in each heterozygote. Abnormal echocardiographic findings were more common in older hemizygous patients, a distribution similar to that of the age of onset of cardiac dysfunction. Increased left ventricular wall thickness probably reflects glycosphingolipid deposition in the myocardium. Dilatation of the aortic root may result from degenerative changes of the aortic media. Abnormalities of mitral valve echoes were uncommon.

Adolescent↗
PubMed1980

Developmentally-oriented safety surveys. Reported parental and adolescent practices.

A series of developmentally-oriented safety surveys has been utilized in both private practice and clinic settings in an effort to systematize safety counseling in a practical and meaningful manner, and to provide data comparing the educational needs of various socioeconomic and ethnic groups. Extraordinary deficiencies were identified in parental awareness and reported practice of basic accident prevention techniques at all levels and in all social and ethnic groups.

Accident Prevention↗
PubMed1979

Echocardiographic screening to assess the severity of congenital aortic valve stenosis in children.

Recent reports suggest that peak left ventricular systolic pressure can be estimated from the echocardiogram. This study compares the accuracy of echocardiographic measurements with clinical estimates of severity of aortic stenosis derived from information of the Joint Natural History Study. Twenty-seven children with isolated aortic valve stensosis were evaluated clinically and with echocardiography and cardiac catheterization. From the echocardiograms, the ratio of systolic left ventricular wall thickness to internal dimension (Ws/Ds) showed a better correlation (r = 0.82) with peak left ventricular systolic pressure than did the diastolic ratio. However, there was significant variation so that a precise estimate of peak left ventricular systolic pressure could not be made from the echocardiogram. Eight of the 27 patients had a normal Ws/Ds ratio (0.55 or less), and their cardiac catheterization data revealed mild aortic stenosis not requiring operation. In contrast, clinical criteria based on the Natural History Study identified only three of the patients with mild aortic stenosis. Prospective studies are needed to confirm the usefulness of echocardiography in noninvasive evaluation of children with aortic valve stenosis.

Adolescent↗
PubMed1978

Echocardiographic differentiation of partial and complete atrioventricular canal.

Retrospective examination of echocardiograms was performed in 34 patients with persistent atrioventricular (A-V) canal who had undergone cardiac catheterization. Characteristic findings in 16 patients with partial A-V canal were lack of continuity of mitral and tricuspid valves, paradoxical interventricular septal motion, definite E and A waves of the mitral valve anterior leaflet (MVAL) echoes and late systolic anterior motion of the mitral valve. Eighteen patients with persistent A-V canal had an interventricular communication and were classified as having the complete form. They characteristically had continuous mitral and tricuspid valves, normal interventricular septal motion, disorganized MVAL echoes, and normal systolic mitral valve motion. Combining these findings allowed differentiation of 31 of the 34 patients (91%) as having partial or complete A-V canal. Determining the presence of a VSD from loss of interventricular septal echoes was unsatisfactory. The severity of mitral insufficiency could not be estimated from echocardiograms of our patients with partial A-V canal.

Echocardiography↗