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Biomedical subjects

K L Wanderman

Publications and source records attributed to K L Wanderman.

33 records · Page 2Linked to original sources

Parasympathomimetic action of scorpion venom on the cardiovascular system.

Although the precise mechanism of the cardiovascular effects in man evoked by the venom of the yellow scorpion has yet to be completely elucidated, previous studies indicate that excessive adrenergic activity is present in many of the cases. This report describes two patients in whom yellow scorpion sting was followed by bradyarrhythmia with varying degrees of atrioventricular block which promptly regressed after the administration of atropine; this is consistent with a direct parasympathomimetic effect of the venom or with a central effect producing increased vagal tone. It is suggested that the cardiovascular actions of the venom may represent a wide spectrum of effects on the autonomic nervous system, ranging from the predominantly sympathomimetic to the predominantly parasympathomimetic.

Adult↗

Left ventricular performance in mitral regurgitation assessed with systolic time intervals and echocardiography.

Among 22 patients with isolated mitral regurgitation of various origins, systolic time intervals (preejection period [PEP] index, left ventricular ejection time [LVET] index and PEP/LVET) and echocardiographic measures of left ventricular performance (end-diastolic diameter [Dd], end-systolic diameter [Ds], and the percent change in minor axis diameter [% delta D]) were calculated. The patients were classified into two groups, those with a normal or supernormal % delta D (group I, 15 patients) and those with a decreased % delta D (group II, 7 patients). On group analysis, prolongation of the preejection period, shortening of the left ventricular ejection time and an increase in PEP/LVET was generally characteristic of patients with mitral regurgitation. These changes were accentuated when mitral regurgitation was complicated by echocardiographic evidence of diminished left ventricular contractile performance (% delta D less than 30 percent). An increase in PEP/LVET to greater than 0.05 was consistently associated with abnormal left ventricular performance, whereas a normal PEP/LVET ratio reflected normal or supernormal left ventricular performance. An inverse linear relation was found between PEP/LVET and % delta D. When compared with previous data on the relation of these variables among patients without valve insufficiency, PEP/LVET proved to be increased for any level of % delta D in mitral regurgitation. The state of digitalization did not appear to influence the relation between PEP/LVET and % delta D. The use of echocardiographic measurements augments the determination of systolic time intervals in the analysis of left ventricular performance in patients with mitral regurgitation.

Adolescent↗

Isolated anomalous right ventricular muscle bundle in the asymptomatic adult.

Muscular obstruction to right ventricular outflow is usually at the infundibular level, but, less commonly, it can occur within the body of the ventricle due to an anomalous muscle bundle. This lesion is almost always associated with a ventricular septal defect or other cardiac lesions, and is usually discovered in infancy or childhood. Two asymptomatic adults with severe obstruction due to right ventricular muscular band as an isolated lesion are presented. The lesion can be tentatively diagnosed on clinical grounds and confirmed by angiocardiography. The advisability of surgical correction in the asymptomatic adult with such an isolated lesion is uncertain.

Adult↗

A statistical approach to the recognition of inferior wall myocardial infarction by the Q/R ratios.

To sharpen ECG criteria for diagnosis of inferior wall myocardial infarction (IWMI), the distribution of Q duration and Q/R ratios in leads 3 and aVF in four groups have been analyzed. Two of these groups are teaching samples (200 ECGs of patients with various diagnoses, but in whom no myocardial infarction was found on post-mortem, and 123 ECGs of patients in whom IWMI was found on post-mortem examinations) and two control samples (408 ECGs of healthy men and 60 ECGs of patients with clinically proved IWMI). The chosen combination of conditions Q/R3 greater than 25 percent and Q/RaVF greater than 10 per cent gives minimal number of errors for the teaching samples. The diagnostic rule gave 5-7 percent errors over the control samples. It is shown that use of Q duration greater than 0.04'' gives less satisfactory results in the diagnosis of IWMI.

Diagnosis, Computer-Assisted↗

Electrocardiographic changes following intravenous pyelography.

One hundred consecutive patients who underwent i.v. pyelography had ECG performed before, immediately following and 5 min after the injection. ECG changes appeared in 15 patients and were considered to be major in five of them. The incidence of ECG changes was significantly higher in patients with abnormal ECG prior to pyelography. The average age of the patients who developed changes was higher than that of patients in whom no ECG changes were observed. There was no significant difference in the incidence of ECG changes after standard and infusion pyelography.

Clinical Trials as Topic↗

Pseudoaneurysm of the left ventricle after myocardial infarction: A curable form of myocardial rupture.

Rupture of the myocardium following an acute infarction is occasionally compatible with survival. In such cases, pre-existent pericardial adhesions confine the bleeding to a limited space within the pericardial sac and produce a chamber which communicates with the left ventricular cavity. The chamber gradually enlarges and forms a pseudoaneurysm. Two cases are described in which the diagnosis was made preoperatively and the pseudoaneurysm was surgically resected. Twenty-one previously reported cases are reviewed, as well. The condition's progressive nature leading to death from heart failure or rupture of the pseudoaneurysm, and its amenability to surgical cure make it imperative that the diagnostic features be well known. The diagnosis should be suspected in cases of progressive heart failure developing shortly after the acute phase of myocardial infarction, in which chest roentgenograms show an enlarging heart shadow characterized by a distinct posterior or lateral bulge. The diagnosis can be confirmed by left ventriculography, which should be performed immediately in all suspected cases.

Angiocardiography↗

Quadruple valve commissurotomy.

A 12-year-old girl in congestive heart failure was diagnosed to be suffering from severe polyvalvular disease due to a combination of congenital and rheumatic lesions. Cardiac catheterization demonstrated stenotic lesions of all the heart valves. The child underwent quadruple valve commissurotomy and is symptom free and thriving 2 years later.

Child↗

Spontaneous closure of a traumatic ventricular septal defect after blunt trauma documented by serial echocardiography.

A ventricular septal defect (caused by blunt chest trauma) that closed spontaneously over a period of 5 years was documented by serial echo-Doppler examinations. The shunt was relatively small and the patient was without symptoms from the time the lesion was discovered until its closure. In the absence of cardiac decompensation or pulmonary hypertension, a conservative approach, including serial echo-Doppler examinations, can be justified.

Adolescent↗