Posteromedial papillary muscle rupture as a result of right coronary artery occlusion after blunt chest injury.
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Biomedical subjects
Publications and source records attributed to J Neiman.
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The N1-P2 wave of the auditory evoked potential was studied in 19 alcoholics, six of whom had withdrawal seizures on previous admissions. The recordings were made at 1 and 5 days after cessation of drinking. Eight nonalcoholic volunteers were used as controls. The latencies of N1 and P2 were slightly prolonged in alcoholics, but during the detoxification period they frequently shortened (p less than 0.05), occasionally attaining the values of the controls. One day after withdrawal, the amplitude of N1-P2 was consistently reduced in the alcoholics compared to the controls (p less than 0.05 and p less than 0.01), but higher in alcoholics with a seizure history compared to alcoholics without seizures (p less than 0.05 and p less than 0.001). Five days after cessation of drinking, the amplitude in the alcoholic groups always increased from the admission values (p less than 0.05 and p less than 0.01). By that time, the alcoholics with a history of withdrawal seizures had significantly (p less than 0.05 and p less than 0.01) higher amplitudes than those of the controls or the alcoholics without seizures. Large N1-P2 amplitude during alcohol withdrawal may reflect increased cerebral excitability and contribute to the identification of alcoholics with high risk for withdrawal seizures.
Platelet responses stimulated by a range of concentrations of ADP or collagen were studied in platelet-rich plasma (PRP) from alcoholics 24-36 h and 6 days after cessation of drinking, and in PRP from age- and sex-matched controls. The studies were done using plasma from blood anticoagulated with the specific thrombin inhibitor D-phenylalanyl-L-prolyl-L-arginyl chloromethyl ketone (FPRCH2Cl, PPACK); the use of this compound permits the study of platelet responses in plasma at physiological concentrations of ionized calcium. Responses of platelets to ADP (primary aggregation) and collagen (aggregation, secretion of [14C]serotonin from prelabelled platelets, and thromboxane formation) were lower in alcoholics 24-36 h after withdrawal of alcohol compared with controls. This inhibition of platelet function was not due to the presence of alcohol in the blood of the alcoholics. Aggregation in response to ADP did not change during the withdrawal period studied, while collagen-induced aggregation and secretion increased significantly and collagen-induced thromboxane formation tended to increase towards control values. The reduced platelet responses observed in alcoholics and the different rates of "recovery" of different pathways of aggregation towards control values must be due to alterations either in the platelets themselves and/or in the plasma brought about by the chronic presence of ethanol, and its withdrawal.
An auditory event-related potential paradigm was designed to objectively quantify the effects of drugs on the central nervous system (CNS). A series of tones was presented at three random interstimulus intervals (ISI). The amplitude of N1-P2 and the recovery of this complex across ISI appear to be rapid, reliable and sensitive measures of changes in brain function associated with drug intake. To illustrate, an acute dose of diazepam was administered orally to a small group of normal subjects. The amplitude of N1-P2 was reduced and the slope of recovery flattened, indicating a decrease in CNS excitability concomitantly with the established pharmacokinetics of the drug.
A wide variety of movement disorders are associated with alcohol abuse. Some idiopathic movement disorders are markedly improved by small amounts of alcohol and this response occasionally may lead to alcoholism. Alcohol abuse alone or combined with hepatic encephalopathy can cause various types of tremor, asterixis, and cerebellar dysfunction. Alcohol withdrawal is occasionally complicated by transient basal ganglia dysfunction manifested by parkinsonism or chorea. These syndromes are distinct from the movement disorders complicating acquired hepatolenticular degeneration occurring in some chronic alcoholics. This review discusses the clinical and pathophysiologic aspects of the movement disorder syndromes that complicate alcohol abuse.
Although business and industry have been involved with the planning process for some time, hospitals have only recently realized the powerful tool that the process represents.
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