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Biomedical subjects

J M Sullivan

Publications and source records attributed to J M Sullivan.

At least 109 records · Page 6Linked to original sources
PubMed1988

CHA task force prepares report on care of elderly.

The CHA Task Force on Long Term Care Policy is examining social, spiritual, and economic factors related to America's growing elderly population and to the ways in which society will respond to their special needs. The task force is working to: Articulate the Church's theological and ethical basis for interest in the needs of the elderly, and describe related justice implications Identify the concerns of the elderly, with emphasis on healthcare Identify the Church community's existing approaches to meeting the needs Identify existing resources in the larger community Identify ways in which the Church community can coordinate resources in service of the elderly Identify and recommend for advocacy private and public sector mechanisms for financing long-term healthcare for the frail elderly The task force expects to present a final draft of recommendations to the CHA board in April. The book will be presented to the public at the 73rd Annual Catholic Health Assembly in Nashville, TN, June 19 to 22.

Activities of Daily Living↗
PubMed1987

Association between the severity of diabetes mellitus and coronary arterial atherosclerosis.

The relation between the severity of diabetes mellitus (DM) and the risk of significant coronary artery lesions were studied in 7,655 patients undergoing coronary arteriography for suspected coronary artery disease (CAD) between 1972 and 1982. The principal treatment regimen for DM was used to estimate the severity of DM. DM treated with insulin was defined as the most severe (n = 244), followed by DM treated with oral agents (n = 344) and with diet only (n = 380); 6,687 patients did not have DM. Severity of DM in patients with CAD (70% or greater diameter stenosis) was compared with that in control subjects without CAD (0% stenosis) for each of 9 anatomic locations (proximal, middle and distal portions of right, anterior descending and circumflex coronary arteries) using a retrospective case-control approach. The risk of CAD was highest in patients with DM treated with insulin (odds ratio estimate of the relative risk [OR = 3.0]), followed by patients with DM treated with oral agents (OR = 1.8) and lastly in those treated with diet alone (OR = 1.4). Severity of DM was a significant (p less than 0.05) independent predictor of CAD in a multivariate logistic regression model, whereas age at onset and duration of DM were not. The relative risk of CAD was the same (p greater than 0.05) for each of the 9 coronary segments. The data suggest that the risk of CAD increases with the severity of DM, which was a stronger predictor of CAD than duration of DM.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Fractal analysis of a voltage-dependent potassium channel from cultured mouse hippocampal neurons.

The kinetics of ion channels have been widely modeled as a Markov process. In these models it is assumed that the channel protein has a small number of discrete conformational states and the kinetic rate constants connecting these states are constant. In the alternative fractal model the spontaneous fluctuations of the channel protein at many different time scales are represented by a kinetic rate constant k = At1-D, where A is the kinetic setpoint and D the fractal dimension. Single-channel currents were recorded at 146 mM external K+ from an inwardly rectifying, 120 pS, K+ selective, voltage-sensitive channel in cultured mouse hippocampal neurons. The kinetics of these channels were found to be statistically self-similar at different time scales as predicted by the fractal model. The fractal dimensions were approximately 2 for the closed times and approximately 1 for the open times and did not depend on voltage. For both the open and closed times the logarithm of the kinetic setpoint was found to be proportional to the applied voltage, which indicates that the gating of this channel involves the net inward movement of approximately one negative charge when this channel opens. Thus, the open and closed times and the voltage dependence of the gating of this channel are well described by the fractal model.

Animals↗
PubMed1987

Prognostic value of the pressure-volume ratio in patients with coronary artery disease.

To determine if the peak-systolic pressure/end-systolic volume ratio [PSP/ESV], a load-insensitive index of left ventricular function, predicted perioperative mortality and long-term survival after coronary artery bypass surgery or medical treatment, 4,829 patients with coronary artery disease were studied retrospectively. Cardiac volumes, ejection fraction, and PSP/ESV ratio were computed using standard methods, and follow-up was performed using annual questionnaires. PSP/ESV ratio values were not significantly different (p = .09) between those who died during hospitalization (n = 101) after coronary surgery and those who were discharged. Long-term follow-up in surgically treated patients demonstrated a 97% 3-year and 93% 5-year survival for those with PSP/ESV over 2.292. These were significantly greater (p = .0026) in value in patients with PSP/ESV less than 1.237 (3-year and 5-year survival of 92 and 79.2%, respectively). In the medical group, survival rate for those with PSP/ESV over 2.292 at 5 years was 89.3%, while for those with PSP/ESV less than 1.237 it was 52.5% (p less than .001). Multivariate analysis, however, showed ejection fraction to be a more significant predictor of survival in both the groups compared with PSP/ESV ratio. Thus, PSP/ESV ratio does predict long-term survival in coronary disease patients treated either surgically or medically. Ejection fraction was nevertheless a more powerful predictor of outcome.

Adult↗
PubMed1987

Hemodynamic characteristics of sodium-sensitive human subjects.

Fifty-eight normal subjects and 51 subjects with borderline hypertension underwent microvascular and hemodynamic studies while on an ad libitum diet and during periods of sodium depletion (10 mEq/day) and repletion (200 mEq/day). Hemodynamic measurements included arterial blood pressure, cardiac index, total peripheral resistance, forearm blood flow, vascular resistance, venous compliance, and capillary filtration fraction. Studies of the microcirculation consisted of macrophotography of the bulbar conjunctiva with measurement of anteriolar, venular, and capillary density and diameter. During sodium repletion, cardiac index increased significantly in the normal subjects (2.35 +/- 0.7 vs 2.44 +/- 0.7 L/min/m2; p less than 0.01) and in the borderline hypertensive subjects (2.50 +/- 0.7 vs 2.70 +/- 0.8 L/min/m2; p less than 0.01). However, mean blood pressure rose by more than 5% in only 33 subjects, 13 with normal and 20 with borderline hypertension. When these sodium-sensitive subjects were compared with those whose blood pressure did not rise, the former were found to have significantly higher forearm vascular resistance (32.2 +/- 21 vs 17.9 +/- 12 mm Hg/ml/min/100 g; p less than 0.01), lower forearm blood flow (4.42 +/- 2.7 vs 7.47 +/- 5.0 ml/min/100 g) and lower conjunctival capillary density (3.72 +/- 1.7 vs 5.18 +/- 2.1 [SD] mm/mm2; p less than 0.05). These results indicate that sodium sensitivity in humans is accompanied by elevation of forearm vascular resistance and attenuation of the microcirculation.

Adult↗
PubMed1986

Correlations between EEG state and spontaneous and evoked axial muscle EMG.

The occurrence of changes in the spontaneous EMG activity of the axial muscle lateral longissimus (LL) is highly correlated (P less than 0.001) with the occurrence of changes in EEG state in urethane-anesthetized rats. There is also a highly significant correlation (P less than 0.001) between the desynchronized EEG state and pudendal nerve evoked multi-unit EMG activity in LL. It is suggested that reticular activation upon pudendal nerve stimulation could facilitate subsequent lumbar axial motoneuron responses to this stimulation.

Animals↗
PubMed1986

Borderline hypertension and sodium sensitivity.

The relationship between sodium sensitivity and borderline hypertension was explored in 63 subjects. Thirty percent of those with borderline hypertension and 15% of normal subjects increased mean arterial pressure by more than 5% when daily sodium intake was increased from 10 to 200 mEq. While most displayed an increase in cardiac dimension, stroke volume, and cardiac index, the sodium-sensitive individuals either failed to reduce vascular resistance to the same degree as normal subjects or actually vasoconstricted.

Aldosterone↗
PubMed1986

Catholic hospitals: strategy for survival.

The "ethic" of competition that pervades health care today has altered hospitals' traditional role, fostered alternative care systems, and created cost-containment pressures. If Catholic hospitals are to survive in this environment, they must act collaboratively. First, they must collect and share data relating to community, diocese, and market needs. Second, Catholic hospitals must create a structure for joint planning that enables them to network with each other as well as with community-based health organizations. Third, they must coordinate their efforts statewide so that they can reinforce each other's actions in the public policy arena. Finally, Catholic hospitals must continue to explore the potential of multihospital entities. The bishops' 1980 pastoral letter on health care--an invitation for dialogue calling for structural change in the health care system--was intended to renew the healing mission. Whether Catholic hospitals have the determination, the imagination, and the leadership to renew their mission, however, will depend on board members, chief executives, sponsoring communities, physicians, and staffs, who must address today's concerns in the contexts of faith and of Catholic health care's noble history.

Catholicism↗
PubMed1985

Natural history of left anterior descending coronary artery obstruction: significance of location of stenoses in medically treated patients.

We examined the prognostic significance of an obstructive lesion in the proximal left anterior descending (LAD) coronary artery. Five-year or longer follow-up data were examined from 311 patients with greater than 70% obstruction of the LAD treated without surgery. Mortality was compared in subsets with lesions proximal to and distal to the first septal perforating artery. Survival curves were worse in patients with proximal than with distal LAD disease (p less than 0.05); lesion location remained a significant determinant of survival when ejection fraction, age, and sex were controlled using a Cox regression model. However, when patient subsets were examined, survival with proximal LAD disease was worse than with distal obstruction only in the presence of an associated right coronary artery lesion and an ejection fraction of less than 40% (p less than 0.01). Patients with proximal LAD plus right coronary lesions had a 5-year mortality rate (34.08 +/- 8.9%) that was not significantly (p greater than 0.05) different from that of a group of 66 patients with greater than 50% narrowing of the left main coronary artery (24.02 +/- 4.3%). Thus, proximal LAD disease is more significant than is a distal lesion only in the presence of right coronary obstruction. This two-vessel combination results in a mortality rate as high as that associated with left main coronary artery obstruction.

Cardiac Catheterization↗
PubMed1984

Natural history of chronic mitral insufficiency: relation of peak systolic pressure/end-systolic volume ratio to morbidity and mortality.

The ratio of peak systolic pressure to end-systolic volume (PSP/ESV) is a measure of contractility that is relatively independent of loading conditions. To define the relation of this index to the natural history of chronic mitral insufficiency, follow-up studies were performed in 76 patients. All had isolated mitral insufficiency and were followed up for an average of 48 months. None underwent surgery. Cardiac volumes, ejection fraction and PSP/ESV ratio were calculated and Cox multiple regression analyses were performed to determine the relation of functional status, ejection fraction and PSP/ESV ratio to morbidity and mortality. Twenty-three patients died during follow-up; in 70% of those who died, the PSP/ESV ratio was reduced below the 20th percentile. However, as an independent predictor of mortality, this ratio was less sensitive (p greater than 0.05) than ejection fraction (p less than 0.01). Similarly, functional status change was predicted more accurately by ejection fraction (p less than 0.01) than by the PSP/ESV ratio (p greater than 0.05). Thus, although a decreased PSP/ESV ratio was associated with a higher mortality rate, other clinical and laboratory variables were superior to this index for determining morbidity and mortality in patients with isolated mitral insufficiency.

Adult↗
PubMed1984

Evidence for altered vascular reactivity in sodium-sensitive young subjects with borderline hypertension.

To assess mechanisms associated with the pressor effects of a high sodium diet in susceptible individuals, the hemodynamic and hormonal effects of sodium depletion and repletion were studied in 33 normal subjects and 30 subjects with borderline hypertension. The hypertensive group had significantly higher mean arterial pressure, weight, hematocrit, and upright plasma renin activity. Forearm hemodynamics were measured during periods of ad lib diet, 10 mEq, and 200 mEq sodium diet. The fall in forearm resistance during reactive hyperemia was inversely related to mean arterial pressure at rest (R = .400, p less than .005) and rose significantly in hypertensive subjects during salt depletion, 39 +/- 3.6 to 61 +/- 6.1 mmHg/ml/min/100 g (p less than .05). Sodium sensitivity in either normotensive or borderline hypertensive subjects was defined as an increase in mean blood pressure of more than 5% when sodium repleted. The individuals who were sodium sensitive had a higher forearm vascular resistance during sodium depletion than those who were sodium resistant, 67 +/- 10.5 versus 45 +/- 4.1 mm/ml/min/100 g (p less than .03). We conclude that young individuals with borderline hypertension already have alterations in vascular reactivity. This trait is shared by normotensive individuals whose blood pressure rises in response to sodium.

Adult↗
PubMed1984

Relationship of peak systolic pressure/end systolic volume ratio to standard ejection phase indices and ventricular function curves in coronary disease.

In order to determine the relationship of the peak systolic pressure/end-systolic volume (PSP/ESV) ratio to standard ejection phase indices [ejection fraction (EF), mean normalized systolic ejection rate (MNSER), mean velocity of circumferential fiber shortening (Vcf)], and ventricular function curves (VFC), hemodynamic and angiographic studies were carried out in 38 subjects: 11 normal controls (Group I) and 27 with coronary artery disease (CAD). The CAD patients were subdivided into those without (Group II) and those with (Group III) regional asynergy. EF, MNSER and Vcf were calculated from the ventriculogram using standard formulae. The slope of the left ventricular function curve was constructed by determining left ventricular stroke work index and left ventricular end-diastolic pressure before and after ventriculography, and dividing the change in the left ventricular stroke work index by the change in the left ventricular end-diastolic pressure. Peak systolic left ventricular pressure was determined before left ventriculography; minimal systolic volume was measured from the left ventriculogram. PSP/ESV ratio in the control group (Group I) was 6.4 +/- 2.8. This differed significantly from the ratio in patients (Group II) with CAD but without asynergy (4.7 +/- 2.2 p less than 0.025) and from that in patients (Group III) with CAD and asynergy (2.4 +/- 1.4, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Low-dose D-penicillamine therapy in rheumatoid arthritis. A controlled, double-blind clinical trial.

Two hundred twenty-five patients with active severe rheumatoid arthritis were admitted to a multiclinic, controlled, double-blind trial comparing the use of 500 mg D-penicillamine per day, 125 mg D-penicillamine per day, and placebo. One hundred seventy-one patients completed at least 30 weeks of therapy. The 500 mg D-penicillamine group demonstrated statistically significant improvement over the placebo group in grip strength, average circumference of swollen proximal interphalangeal joints, and patient assessment. While the trend was for greater improvement with the larger dose of D-penicillamine, there was no statistically significant difference among the 3 groups in duration of morning stiffness, walking time, physician's assessment, number of swollen joints, or scores for tender and swollen joints. The slight increase in efficacy of higher dose D-penicillamine was associated with increased toxicity.

Adolescent↗
PubMed1983

Drug suppression of the angiotensin system in congestive heart failure.

Congestive heart failure is frequently associated with elevated systemic vascular resistance. Lowering resistance can improve cardiac performance and alleviate symptoms. The angiotensin-converting enzyme inhibitors offer a new way to lower resistance and have certain advantages, including the inhibition of compensatory mechanisms. However, skillful use of these compounds demands a thorough understanding of their pharmacologic properties and of the pathophysiology of congestive heart failure.

Angiotensin II↗