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Biomedical subjects

K Kaplan

Publications and source records attributed to K Kaplan.

At least 37 records · Page 2Linked to original sources
PubMed1986

Prophylactic anticoagulation following acute myocardial infarction.

Although several large trials have failed to demonstrate unequivocally that anticoagulation decreases mortality following myocardial infarction (MI), anticoagulation has been advocated to prevent embolic cerebrovascular accidents (CVAs). Since CVAs occur during hospitalization in only 1.5% to 3% of MIs, it is not justifiable to anticoagulate all patients after MI because the risk of anticoagulation exceeds the potential benefit. However, a group of patients who are at high risk of developing left ventricular thrombi (LVT) and CVA following MI can be identified. Thirty percent to 40% of patients with transmural anterior MI develop LVT, and early anticoagulation with heparin sodium prevents LVT formation and CVAs in this group. A two-dimensional echocardiogram before hospital discharge allows the identification of patients at risk for later embolization and helps determine the need for anticoagulation with warfarin sodium following hospitalization.

Cardiovascular Diseases↗
PubMed1985

Frequency of pericardial effusion as determined by M-mode echocardiography in acute myocardial infarction.

A pericardial friction rub occurs in 6 to 16% of patients after acute myocardial infarction (AMI), but the incidence of pericardial effusion (PE) is not known. M-mode echocardiography was done 1, 3 and 5 days after AMI in 43 consecutive patients admitted within 24 hours of AMI, and PE was detected in 16 (37%). The PE was small in 7 patients, moderate in 6 and large in 3. A pericardial friction rub developed in 8 (19%), of whom only 4 had PE. Pleuritic chest pain diminished by sitting up and relieved by antiinflammatory agents developed in 12 (28%), of whom only 5 had PE. The peak creatine kinase level was significantly higher in patients with PE (1,769 +/- 1,003 U) than in those without (1,181 +/- 838 units). More patients with PE were in Killip classification II, III or IV (11 of 16 [69%] vs 9 of 27 [33%]). The presence of PE was not associated with age, site of AMI, development of Q waves, use of heparin or previous AMI. In conclusion, PE as detected by M-mode echocardiography is frequently present after AMI, and its presence is not closely associated with the occurrence of a pericardial friction rub or typical pericardial pain.

Aged↗
PubMed1985

Prophylaxis of supraventricular tachyarrhythmia after coronary bypass surgery with oral verapamil: a randomized, double-blind trial.

This study investigated the efficacy of oral administration of verapamil, started 24 hours after coronary artery bypass grafting (CABG), in reducing the incidence of postoperative supraventricular tachyarrhythmia (SVT). Two hundred patients were randomly assigned in a double-blind fashion to receive a one-week course of either a placebo or 80 mg of verapamil every 6 hours. Overall, SVT developed in 23 control and 14 verapamil-treated patients, a 39% reduction in incidence (p less than 0.10). Of the patients who received at least four doses and continued to receive the study drug, 17 in the control and 7 in the verapamil group experienced SVT, a 53% decrease in incidence (p less than 0.06). Atrial fibrillation constituted 34 of the 37 SVT episodes and was associated with a slower ventricular response in the group given verapamil (115 +/- 8 versus 156 +/- 4 beats per minute; p less than 0.001). No evidence was found linking postoperative SVT with the withdrawal of beta-blocking drugs. Adverse effects required that 20 patients in the verapamil and 6 in the placebo group be removed from the study. Hypotension or pulmonary edema or both developed in 13 of the patients receiving verapamil, but in only 1 of the control patients (p less than 0.001). We conclude that although verapamil has potential merit for the prophylaxis of SVT after CABG, its use in this setting is associated with a high incidence of unacceptable hemodynamic side effects.

Administration, Oral↗
PubMed1985

Myocardial necrosis in a patient with mixed connective tissue disease.

A 23-year-old black woman with mixed connective tissue disease developed acute onset of shortness of breath and evidence of pulmonary edema. Cardiac isoenzymes, electrocardiograms and radionuclide myocardial scintigraphy were consistent with focal myocardial necrosis. The patient has had no further myocardial complication since initiation of therapy with steroids.

Adult↗
PubMed1985

Brain abscess.

The results of CT brain scan in diagnosing and monitoring the course of brain abscesses and the recognition of the major role that anaerobic bacteria play in causing this disease have led to a reduction in disease mortality and have allowed a greater percentage of infected patients to recover without major neurosurgical procedures. Monitoring intracranial pressure, the availability of new antibiotics, and recognition and treatment of some of the more unusual syndromes associated with defective or suppressed immune systems have helped lead to a reduction in disease mortality from about 50 per cent to 10 per cent with excellent functional recovery in the majority of the patients.

Anti-Bacterial Agents↗
PubMed1983

Intravenous nitroglycerin for the treatment of angina at rest unresponsive to standard nitrate therapy.

Thirty-five patients who had angina at rest that was unresponsive to standard therapy comprised of oral or topical nitrates and beta-blocking drugs were treated with a continuous infusion of intravenous nitroglycerin (IVNTG). The infusion was started at 10 micrograms/min and increased by 10 micrograms/min increments every 5 minutes until an infusion rate of 50 micrograms/min was reached. After each episode of rest angina, the infusion was increased by 50 micrograms/min in the same stepwise manner. Data from a 24-hour baseline control period were compared with those from a 24-hour IVNTG endpoint period at which time the highest IVNTG infusion rate was administered. The average IVNTG infusion rate was 140 +/- 15 micrograms/min. With IVNTG therapy, the number of episodes of angina at rest decreased from 3.5 +/- 0.4 to 0.3 +/- 0.1, sublingual nitroglycerin use decreased from 1.9 +/- 0.3 to 0.4 +/- 0.1 mg/day, and morphine sulfate administration decreased from 5.5 +/- 1.3 to 0.4 +/- 0.2 mg/day (all p less than 0.001). When each patient's response on the endpoint day was analyzed, 25 were defined as complete (no rest angina), 8 as partial (greater than 50% decrease in the number of episodes/day from control values), and 2 as nonresponders. No significant drug-induced adverse effects occurred. IVNTG appears to be effective therapy for angina at rest refractory to standard oral and topical medications.

Adult↗
PubMed1983

An intensive drug monitoring study suggesting possible clinical irrelevance of impaired drug disposition in liver disease.

1 Liver disease can alter the disposition and clinical effects of drugs. However, even though altered drug disposition occurs, there is no clinical evidence relating it to an increased susceptibility to adverse drug reactions (ADRs). 2 An intensive prospective drug monitoring study of 2,582 hospitalized patients was conducted. The adverse drug reactions probability scale (APS) was used to assess ADRs. Only non-mild, definite or probable ADRs (APS greater than or equal to 5) were included. Severity of liver dysfunction was assessed by a composite clinical and laboratory index (CCLI). 3 The frequency of ADRs was higher in 402 patients with cirrhosis (27.4%) than in 661 with renal dysfunction (22.8%) and in 249 with other parenchymatous liver diseases (13.7%) or in 1,270 patients with neither liver diseases nor renal dysfunction (10.9%) (chi 2 3 = 85.53, P less than 0.001). The frequency of ADRs in cirrhotics was highly correlated with the severity of the liver dysfunction measured by CCLI (r = 0.82, P less than 0.001). 4 Drugs predominantly eliminated by liver metabolism were not among those most commonly inducing ADRs or those causing severe reactions in cirrhotics. Thus, frusemide caused the most common and the most severe ADRs, whereas reactions induced by sedatives were uncommon. Drug-induced hepatic encephalopathy was more common in cirrhotics receiving diuretics (13.3%) than in those receiving sedatives (1.8%) (chi 2 y.c. = 5.29, P less than 0.025). Patients with alcoholic liver disease had more drug-induced hepatic encephalopathy (7.7%) than those with non-alcoholic liver disease (1.2%) (chi 2 y.c. = 11.86, P less than 0.001). 5 These results indicate that susceptibility to ADRs is increased only in severe cirrhosis and that the most common and severe ADRs seem more likely related to enhanced pharmacodynamic action than to impaired drug disposition.

Brain Diseases↗
PubMed1983

Pulmonary emboli from a platelet-rich thrombus attached to a pacemaker electrode.

A patient with recurrent, fatal pulmonary emboli originating from thrombus attached to a permanently-implanted pacemaker electrode is described. While most thromboemboli are composed predominantly of fibrin and erythrocytes, histologic and immunologic studies showed this thrombus to be rich in platelets. A possible therapeutic approach to this rare situation is discussed.

Atrial Fibrillation↗
PubMed1982

A case analysis method for the model of human occupation.

This paper introduces a method for analyzing clinical cases, which is based on ten primary questions and on criteria for selecting level of treatment. The questions and the criteria are derived from the model of human occupation. Four steps in the method are: gathering data in relevant categories; reviewing and analyzing data using the questions in sequence; selecting levels of treatment; and recording case studies. Three brief case studies taken from an acute care psychiatric setting are described to illustrate the use of this method.

Achievement↗
PubMed1980

Lack of platelet effect with the aspirin analog, salsalate.

Platelet function as determined by platelet aggregation and the release reaction was found to be normal in 8 patients receiving a nonacetylated analog of aspirin, salsalate, while all 5 aspirin controls had abnormal platelet function. Mean bleeding time in patients taking salsalate was less than that in aspirin controls. This study demonstrates that salsalate, which has anti-inflammatory activity and reduces prostaglandin synthesis, does not interfere with normal platelet function.

Arthritis↗
PubMed1980

Rapid drop in serum iron concentration in myocardial infarction.

Two hundred one patients admitted to the Coronary Care Unit had repeated serum iron determinations. There was a rapid (within 24 to 48 hours), pronounced decrease (mean = 64%) of the serum iron concentration in 87% of the 112 patients who had a diagnosis of acute myocardial infarction. Seventy-nine per cent of the 89 patients who did not have an acute myocardial infarction did not have a drop in serum iron concentration. This suggests an association between myocardial infarction and rapid decrease in serum iron concentration.

Creatine Kinase↗
PubMed1977

Undernutrition.

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Developing Countries↗