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Biomedical subjects

L Fisher

Publications and source records attributed to L Fisher.

At least 199 records · Page 11Linked to original sources
PubMed1983

Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery.

There are few data on the long-term effects of new Q waves on survival and morbidity after coronary bypass graft surgery (CABG). We followed 1340 patients who underwent CABG in 1978 at 10 hospitals participating in the Coronary Artery Surgery Study (CASS). The incidence of perioperative Q-wave infarction was 4.76% (range 0.0-10.3% by hospital). The rate of infarction was higher in patients who had an increased left ventricular end-diastolic pressure or cardiomegaly on the preoperative chest radiograph. Patients who received more grafts or who had longer cardiopulmonary bypass time were also at higher risk of infarction. In a stepwise discriminant analysis of 44 clinical, angiographic and surgical variables, cardiopulmonary bypass time, topical cardiac hypothermia and cardiomegaly entered the stepwise selection of variables. Long-term survival was adversely affected by the appearance of new postoperative Q waves. The hospital mortality was 9.7% in the 62 patients who had new postoperative Q waves and 1.0% in the 1278 patients who did not (p less than 0.001); the 3-year cumulative survival rates were 85% and 95%, respectively (p less than 0.001). In patients who survived to hospital discharge, the presence of new postoperative Q waves did not adversely affect 3-year survival (94% and 96%, respectively). The survival rates were worse in patients who had a history of infarction or who had impaired left ventricular function preoperatively. The number of readmissions to hospital after CABG among the patients who had a transmural perioperative infarction was similar to to that among patients who did not. We conclude that the appearance of new Q waves after CABG adversely affects survival. The major impact on mortality occurs before hospital discharge. Patients who are destined to have a perioperative infarct cannot be predicted from commonly measured preoperative and angiographic variables.

Adult↗
PubMed1982

WISC scatter and behavioral competence in high-risk children.

Examined the relationship between WISC scatter and school competence measures for 101 boys at risk for psychiatric disorder. This sample, shown in previous research to be less competent in school than controls, was predicted to have greater scatter than a standardization sample. Further, within the high-risk sample, an association was predicted between two measures of scatter and lowered school competence, as measured by Fisher's (1980) peer and teacher ratings. The results suggested that the mean scatter variable available for both samples is significantly higher in the high-risk group than in the intelligence test standardization sample. This scatter measure also measures. The second measure did not relate significantly to any of the school measures. These findings suggest that one of the two scatter measures is a valid index of less competent school functioning and may be in combination with other measures, a useful predictor of future psychopathology.

Child↗
PubMed1982

Percutaneous transluminal coronary angioplasty: report from the Registry of the National Heart, Lung, and Blood Institute.

Data have been collected from 34 centers in the United States and Europe performing percutaneous transluminal coronary angioplasty since September 1977. The procedure was carried out in 631 patients, with an average age of 51 years (range 23 to 76), of whom 80 percent had single vessel coronary disease, 17 percent had double or triple vessel disease and 3 percent had stenosis of the left main coronary artery. Coronary angioplasty was successful (greater than 20 percent decrease of coronary stenosis) in 59 percent of the stenosed arteries. The mean degree of stenosis was reduced from 83 to 31 percent. Emergency coronary bypass operation was required in 40 patients (6 percent). Myocardial infarction occurred in 29 patients (4 percent). In-hospital death occurred in six patients (1 percent), three with single vessel and three with multivessel disease. Ninety-one patients have been followed up for at least 1 year after coronary angioplasty. Of the 65 patients with an initially successful angioplasty, 83 percent were in improved condition compared with their status before angioplasty. Thus, the initial satisfactory results obtained in a few centers have now been confirmed in many centers using transluminal coronary angioplasty.

Adult↗
PubMed1982

Repetitive skill deterioration with fast and exercise-lowered blood glucose.

Using a computerized system for measurement of the variability of force exerted at 26 points in each pedal revolution during the repetitive habituated task of cycling, healthy adult males 6 times performed for 20 minutes, either (a) 3 hours after a meal (fasting) or when so fasted and then fed glucose (b) immediately before, or (c) 30 minutes before performance. Both light and moderate workloads were used. As expected, blood glucose concentrations fell modestly below basal with exercise under (a) or (c) but not under (b). ANOVA of force mean and variability statistics significantly contrasted the 3 treatments, and 2 linear functions from multivariate analysis showed (a) and (c) to be significantly different from (b). These two treatments depressing blood glucose were more variable in force applied, with altered pattern of average forces, especially for points in the task where changes occurred in the force/time relationship. These points may use more immediate feedback correction. Such deterioration of movement control has significant applied implications and invites study of its neural aetiology.

Adult↗
PubMed1982

Estimation of myocardial infarct size by digital computer analysis of the VCG.

This study described the linear relationship of the myocardial infarct size, measured postmortem, to the integral of the sequential vector spatial magnitudes analyzed at 400 samples per second during the initial period of abnormal depolarization (IAD) in 25 patients with myocardial infarction (MI) and ten controls. The equation for the fitted regression line was: %MI = -0.35 + 3.33 IAD; r = .90; p less than .001. The duration of abnormal depolarization was determined by two computer algorithms: first, using the classical method of pathological Q wave duration, whenever possible; and a new method of measurement of an abnormally slow rate of rise of vector spatial magnitude with time (dm/dt), when there were no Q waves in the Frank orthogonal lead input signals. There was not a significant difference in the mean values of IAD of the MI group or the control group calculated by the two algorithms.

Aged↗
PubMed1982

Parental communication deviance as a predictor of competence in children at risk for adult psychiatric disorder.

Measures of communication deviance derived from three different Rorschach situations were obtained from parents of 62 children vulnerable to future psychiatric disturbance. The families were maritally intact, with one parent having a history of previous psychiatric hospitalization and a male index child, 7 or 10 years of age. Amount of parental communication deviance in one situation was not significantly related to amount of communication deviance observed in another setting. However, mothers who exhibited high levels of communication deviance in both the Individual and Family Consensus situations tended to have offspring who were judged as low functioning in multiple settings, based on teacher ratings, peer ratings, and parental report. Conversely, children judged as high functioning in multiple settings had mothers who were free of high levels of communication deviance in both Rorschach situations.

Child↗
PubMed1982

Determinants of coronary surgery in a consecutive patient series from geographically dispersed medical centers. The coronary artery surgery study.

The Coronary Artery Surgery Study registry enrolled 24,959 patients from 1974 through 1979. Of these patients, 12,556 had anginal chest pain symptoms and significant angiographic coronary disease (greater than or equal to 70% lesion in a major vessel or greater than or equal to 50% in the left main coronary artery) and were considered coronary bypass surgery candidates. Stepwise linear discriminant-function analysis of clinical and angiographic determinants of therapeutic assignment revealed that myocardial jeopardy (a composite score of the relationship of proximal lesions to retained wall motion in anterior and inferior segments) was the most important determinant. Site-to-site variability, another important predictor of therapeutic assignment, was assessed after adjusting for differing patient populations and was found to be significant (p less than 0.001). Other significant predictors were angina severity, the number of operable vessels, change in activity level, unstable angina and the presence of a left main lesion. Temporal changes (between 1974 and 1979) in the use of beta-blocking drugs and in therapeutic assignment of patients with left main lesions and one-vessel disease suggested altered decision-making in response to the reporting of major coronary surgery trials. We conclude that the dominant factors in therapeutic assignment for patients with completed arteriographic evaluations reflect considerations of jeopardized myocardium and continuing diversity of opinion about the importance of therapeutic and prophylactic indications for coronary surgery.

Actuarial Analysis↗