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Biomedical subjects

J M Gore

Publications and source records attributed to J M Gore.

At least 145 records · Page 8Linked to original sources
PubMed1987

Serum estradiol and coronary artery disease.

Serum estradiol levels were measured in 300 men undergoing coronary angiography. Among these men, there were no significant differences in the serum estradiol levels between patients with (mean, 26.4 pg/ml) and those without (mean, 30.9 pg/ml) angiographically confirmed coronary artery disease. There were no significant differences in any of the established coronary risk factors when patients were subdivided according to the presence or absence of coronary artery disease or according to the extent of disease. In addition, no significant correlation was noted between mean serum estradiol levels and the extent of coronary artery disease as classified by the number of obstructed coronary vessels. A matched-pairs analysis was carried out in which patients who had normal coronary arteries were matched with those who had coronary artery disease on the basis of age, cigarette smoking, prior history of myocardial infarction, and body mass index. The mean serum estradiol level in the patients with coronary artery disease was 28.7 pg/ml, and the mean estradiol level was 31.4 pg/ml for the matched patients with normal coronary arteries. In addition, when serial (three) estradiol determinations were carried out in 100 patients, no association was observed between degree of estradiol variability and the occurrence and/or extent of coronary artery disease. The results of this observational study fail to support an association between serum estradiol levels and the presence or degree of coronary artery disease in men as documented by coronary angiography.

Adult↗
PubMed1987

Current practice patterns in the management of acute myocardial infarction. Survey of the American College of Chest Physicians.

Over the past decade, the management of patients with acute myocardial infarction has undergone remarkable change due in part to the availability of new diagnostic and therapeutic modalities. Many of these techniques have gained widespread acceptance and use without the benefit of studies demonstrating efficacy. A survey of 391 members of the Section on Clinical Cardiology of the American College of Chest Physicians was conducted to assess current practice patterns in the management of acute myocardial infarction. Significant differences in the routine (greater than or equal to 50 percent of the time) use of various management approaches were found, with exercise tolerance testing, echocardiography, Holter monitoring, and cardiac rehabilitation frequently employed, whereas electrophysiologic studies, pyrophosphate scans, pulmonary artery catheterization, and cardiac pacing were infrequently used. Significant differences in the use of these procedures were noted with regard to the age of the physician and his or her geographic location of practice. These differences in practice patterns indicate that physicians have not reached consensus with regard to the value of these new diagnostic procedures and therapeutic approaches in the treatment of patients with acute myocardial infarction. Given the incremental costs of these procedures, clinical trials to assess their efficacy are clearly indicated.

Cardiac Pacing, Artificial↗
PubMed1987

A community-wide assessment of the use of pulmonary artery catheters in patients with acute myocardial infarction.

As part of an on-going population-based study of patients hospitalized with acute myocardial infarction (MI) in all 16 hospitals in the Worcester, Massachusetts Standard Metropolitan Statistical Area, temporal trends in the use of the pulmonary artery (PA) catheter were examined. Three thousand two hundred and sixty-three patients with validated acute MI during the calendar years 1975, 1978, 1981 and 1984 comprised the study population. There has been a consistent and significant increase in PA catheter use in patients with acute MI over time, from 7.2 percent in 1975, 13.8 percent in 1978, 14.8 percent in 1981 to 19.9 percent in 1984 (p less than .001). Ninety-six percent of patients undergoing PA catheter investigation had either congestive heart failure (CHF), hypotension or cardiogenic shock. For the combined time periods, the in-hospital case fatality rate (CFR) for patients in CHF with a PA catheter was 44.8 percent compared to 25.3 percent for patients without a PA catheter (p less than .001). For patients with hypotension and a PA catheter, in-hospital CFR was 48.3 percent compared to 32.2 percent for hypotensive patients not receiving a PA catheter (p less than .001). In contrast, for patients in cardiogenic shock the in-hospital CFR was 74.4 percent for those receiving a PA catheter as compared to 79.1 percent for patients in shock not receiving a catheter. The use of a PA catheter was associated with an increased length of hospital stay irrespective of the development of acute clinical complications. Long-term prognosis for discharged hospital survivors who had a complicated MI, for up to a five-year follow-up period was similar whether the patient did or did not receive a PA catheter during the acute period of hospitalization. In conclusion, we could not demonstrate a beneficial effect associated with the use of the PA catheter on selected patient outcomes, including in-hospital and long-term prognosis and average hospital stay, in this community-wide study of patients hospitalized with acute MI.

Catheterization, Swan-Ganz↗
PubMed1987

The increased use of diagnostic procedures in patients with acute myocardial infarction. A community-wide perspective.

As part of a community-wide study examining time trends in the incidence and case-fatality rates of 3263 patients hospitalized with validated acute myocardial infarction (MI) during the years 1975, 1978, 1981, and 1984, we examined changes over time in the use of various noninvasive and invasive diagnostic tests during hospitalization for acute MI. In terms of the noninvasive procedures, exercise testing before hospital discharge increased from only 0.1% of patients in 1975 to 40.3% in 1984, while use of echocardiography (2.5%, 1975; 15.3%, 1984), Holter monitoring (1.0%, 1975; 34.0%, 1984), and radionuclide ventriculography (2.6%, 1975; 52.7%, 1984) also increased dramatically. Concerning the invasive procedures, use of coronary arteriography in patients with acute MI increased from 3.1% in 1975 to 9.8% in 1984. A more striking increase was noted in the use of pulmonary artery catheterization (7.2%, 1975; 19.9%, 1984). Examination of patient characteristics associated with the use of these tests demonstrated that the increased use of these diagnostic procedures was not due to changes in the clinical characteristics of patients hospitalized with acute MI; rather, it was the result of changes in physician practice patterns. If the practice patterns seen in this community-based study are similar to those seen throughout the United States, the charges for these diagnostic tests in 1984 are estimated to approach 600 million dollars. Given current interest in cost-containment and evaluation of clinical practices, these results suggest the need for further observational studies and clinical trials to assess the cost-effectiveness of these diagnostic tests. To assess the cost-effectiveness, it will be necessary to determine if the use of these tests improves the short-term or long-term prognosis of patients hospitalized with acute MI.

Cost-Benefit Analysis↗
PubMed1987

A new wrinkle to the earlobe crease.

Several studies had indicated that the earlobe crease may be a marker of coronary artery disease (CAD). This prospective study of 261 consecutive men undergoing coronary arteriography was carried out to evaluate the association of the earlobe crease with the presence and extent of CAD. A positive earlobe crease was detected in 67% of this population. When examining the presence of CAD in men with (n = 175) and without (n = 86) an earlobe crease, 85% of those with and 85% of those without an earlobe crease showed some degree of CAD. Since the prevalence of an earlobe crease increased with advancing age, we examined the age-specific prevalence rates of CAD in men with and without an earlobe crease and found no significant differences in those rates. A similar lack of association between earlobe crease and CAD was seen when we simultaneously controlled for other potentially confounding factors. We conclude that the reported association between earlobe crease and CAD is due to the fact that the prevalence of earlobe crease and CAD each increase with age.

Aged↗
PubMed1987

Occult malignant neoplasm in patients with deep venous thrombosis.

An association between venous thrombosis and cancer was first suggested by Armand Trousseau and subsequently confirmed by multiple postmortem studies. In a previous study, patients with pulmonary embolism, as assessed by pulmonary angiography, were at significantly increased risk of occult cancer with a comparison group of patients without pulmonary embolism. This nonconcurrent prospective epidemiologic study extends these findings by demonstrating a significantly increased risk of occult cancer in patients with deep venous thrombosis (DVT) confirmed by impedance plethysmography as compared with those with suspected DVT in whom the diagnosis was ruled out. Differences in the incidence of malignant neoplasms were greatest within the first two years after the diagnosis of DVT, and patients younger than 50 years with venous thrombosis were at particularly increased risk of occult cancer (relative risk, 19.0). These findings indicate that all patients with DVT or pulmonary embolism should have an appropriate diagnostic workup and careful follow-up, particularly with regard to the risk of occult cancer.

Aged↗
PubMed1987

Accurate patient diagnosis of acute porcine valve failure.

Spontaneous porcine bioprosthetic valve failure is usually of gradual onset. We report a case of acute porcine mitral valve rupture resulting in rapid hemodynamic decompensation. The patient perceived the moment of valvular failure as the abrupt onset of a vibrating sensation in his chest. As the number of patients with porcine bioprostheses continues to increase, acute valvular failure may become a more common clinical entity.

Acute Disease↗
PubMed1986

Preliminary experience with synchronized coronary sinus retroperfusion in humans.

Synchronized coronary sinus retroperfusion (SCSR) with arterial blood has been extensively tested in animals. This intervention offers temporary support to areas of ischemic myocardium while a method of definitive revascularization is being sought. The feasibility and safety of this procedure for patients with unstable angina was therefore tested. A No. 7F autoinflatable retroperfusion balloon catheter (USCI) was inserted percutaneously into the coronary sinus of the study patients. Arterial blood was obtained through a No. 8F catheter placed in the femoral artery. Arterial blood was infused in a retrograde fashion into the coronary venous system during cardiac diastole by means of a piston-driven pump that was electrocardiographically synchronized with the drainage of the venous system during systole. This procedure was performed in five patients with unstable angina refractory to maximum medical therapy. SCSR significantly decreased the frequency of anginal episodes and the requirement for antianginal medications. SCSR also provided time for patient stabilization before diagnostic cardiac catheterization or therapeutic intervention. This preliminary experience suggests that synchronized coronary sinus retroperfusion is a feasible and safe procedure. It can be performed at the bedside with no apparent adverse effects to the patient. Retroperfusion also appears to be effective in relieving ischemic symptoms as assessed by clinical parameters. Based on our preliminary experience, further delineation of its clinical applications is warranted.

Adult↗
PubMed1985

Effect of bepridil in patients with chronic stable angina: results of a multicenter trial.

The effects of bepridil, a calcium antagonist with a half-life of approximately 42 hr, were assessed in a double-blind, randomized, placebo-controlled crossover trial. Forty-four patients (39 men, five women) with exercise-induced angina pectoris and ST segment depression with exercise testing (modified Bruce protocol) were studied. Compared with placebo bepridil (400 mg daily) increased total exercise time, time to onset of angina, time to 1 mm of ST segment depression, time to 2 mm of ST segment depression, and total work achieved (all p less than or equal to .001). Both frequency of angina and nitroglycerin consumption decreased during the bepridil compared with the placebo period (p = .02 and .03, respectively). Minor side effects were noted during both the bepridil and placebo phases. Four patients experienced side effects that limited therapy (dizziness in three and abnormal results of liver function tests in one) and one patient died during the bepridil phase. This study suggests that bepridil, 400 mg daily, is effective for the treatment of exercise-induced myocardial ischemia and angina pectoris.

Angina Pectoris↗
PubMed1985

Physicians' attitudes and practices toward CPR training in family members of patients with coronary heart disease.

A survey of 482 physicians practicing in central and western Massachusetts was carried out to examine attitudes and reported practices toward cardiopulmonary resuscitation (CPR) training for family members of patients with coronary heart disease (CHD). Seventy-nine per cent of physicians felt that CPR training was important for the family members of patients with CHD yet only 6 per cent actually provided information about CPR to families. Further studies are indicated to determine why physician behavior is at odds with their stated beliefs and to guide appropriate remedial action.

Adult↗
PubMed1984

Validity of serum total cholesterol level obtained within 24 hours of acute myocardial infarction.

The relation of a serum cholesterol level obtained during acute myocardial infarction (AMI) to the patient's usual baseline level is unclear. Many physicians tend to ignore cholesterol levels measured during AMI and will wait several months before obtaining a repeat cholesterol measurement; in many instances this delays interventional programs. Using the Framingham study cohort of patients, the records of all persons sustaining AMI were reviewed. Eighty-three patients were identified who had total cholesterol (TC) levels recorded within 2 years of AMI, within 24 hours of hospitalization for AMI and within 2 years after hospital discharge. In these persons, there was no statistically significant difference in the TC values measured at these 3 times. Thus, TC levels drawn within the first 24 hours of AMI accurately reflect a baseline level and can be used in instituting intervention programs.

Cholesterol↗
PubMed1984

Bepridil for chronic stable angina pectoris: results of a prospective multicenter, placebo-controlled, dose-ranging study in 77 patients.

Bepridil, a new calcium-channel blocking agent with an extended plasma elimination half-life of greater than 50 hours, was compared to placebo in 77 patients with confirmed coronary artery disease and chronic stable angina pectoris. The effects of bepridil were compared with those of placebo on angina frequency, nitroglycerin tablet use, the resting ECG and hemodynamics at rest and maximal exercise using a study design comprising 5 sequential 2-week single-blind treatment phases. After 2 weeks of placebo (phase 1), bepridil was given for 3 phases (2, 3 and 4) at total daily dosages of 200, 300 and 400 mg, respectively; the study was completed after a final reintroduction of placebo (phase 5). Within each phase once- and twice-daily regimens of bepridil were randomly compared. Bepridil (300 mg/day) reduced anginal frequency 68%, from 8.5 +/- 1.1 (standard error of the mean) to 2.7 +/- 0.7 attacks/week and nitroglycerin tablet use 76% (p less than 0.001). Bepridil improved exercise duration 26%, from 6.9 +/- 0.4 to 8.7 +/- 0.5 minutes (p less than 0.001) and exercise work 52%, from 2.7 +/- 0.3 to 4.1 +/- 0.4 kpm X 10(-3) (p less than 0.001) on a standardized treadmill protocol. Resting and peak exercise heart rate and blood pressure were unaffected by bepridil. The antianginal effects were similar with either once- or twice-daily treatment schedules. Minor side effects of nausea, epigastric discomfort and tremor were infrequent and there were no major side effects. The results of this large but preliminary, single-blind and short-term study suggest that bepridil is an effective and well tolerated antianginal agent when administered once daily.

Angina Pectoris↗
PubMed1984

Superior vena cava syndrome. Its association with indwelling balloon-tipped pulmonary artery catheters.

The placement of flow-directed pulmonary artery catheters has become a routine procedure in hospitals throughout the country. There have been scattered reports of complications associated with their placement, but in general, if it is done under proper conditions, it is associated with low morbidity and mortality. Recently, there have been questions raised regarding the thrombogenicity of these catheters. We report three cases of superior vena cava syndrome associated with the use of indwelling pulmonary artery catheters that we have encountered and a review of experience of others.

Aged↗