Biomedical subjects

L R Elveback

Publications and source records attributed to L R Elveback.

At least 91 records · Page 5Linked to original sources

PubMed1975

Relation of intraoperative or early postoperative transmural myocardial infarction to patency of aortocoronary bypass grafts and to diseased ungrafted coronary arteries.

Serial preoperative and postoperative electrocardiograms and vectorcardiograms were obtained in 500 patients undergoing saphenous vein aortocoronary artery bypass graft surgery. Evidence of transmural myocardial infarction was found early postoperatively in 67 patients (13 percent). Age and sex distributions, number of vessels diseased or vessels grafted, and preoperative and postoperative New York Heart Association functional classification (mean follow-up, 26 months) did not differ in the groups with and without infarction. Increased duration of cardiopulmonary bypass time (more than 120 minutes) was slightly greater in the group with infarction (P smaller than 0.05). Multivariate analysis revealed that 60 percent of patients in the group with infarction were identified by a 1st day serum glutamic oxaloacetic transaminase value greater than 100 U/liter; however, for each such patient identified, there was approximately one false positive result. Use of other values (creatine phosphokinase, cardiopulmonary bypass time and total anoxic rest time) did not improve discrimination. Twenty-five percent of all transmural infarctions occurred within the zone of myocardium supplied by a diseased ungrafted artery. In 32 patients with early evidence of transmural mycardial infarction in a zone of myocardium supplied by a grafted artery, postoperative angiography showed as many with patent as with occluded grafts. Of 154 patients in the group without infarction who had early postoperative graft angiograms, 30 (19 percent) had one graft occluded and yet no evidence of transmural infarction by our criteria. Therefore, early postoperative evidence of transmural myocardial infarction as defined in this study is an unreliable indicator of the status of the graft supplying the zone of infarction.

Adult↗

PubMed1975

Arteriographic patterns early in the onset of the coronary syndromes.

Coronary arteriography in 300 patients within one year of onset of symptoms of coronary arterial disease revealed already severe anatomical coronary disease in three patient groups: those with angina pectoris alone (164 patients), with subendocardial myocardial infarction (63 patients), and with transmural myocardial infarction (73 patients). The number of vessels diseased (larger than or equal to 50% obstruction), distribution of obstruction, and degree of stenosis were similar in the three groups. However, total occlusion of at least one artery was much more common in transmural myocardial infarction and in subendocardial myocardial infarction with elevation of enzyme levels. We suggest that such occlusions occurred at the time of the infarction. Similarities in coronary anatomy between patient subgroups with angina (on exercise or at rest and nocturnal) indicate that factors other than coronary anatomy intervene in precipitating the different types of angina. Vessel disease was not related to smoking, hyperlipidaemia, or hypertension but coronary disease was manifest earlier in life in smokers or those with hyperlipidaemia.

Adolescent↗

PubMed1975

Prevalence of cholelithiasis in idiopathic late-onset immunoglobulin deficiency.

Twelve of 50 consecutive patients with idiopathic late-onset immunoglobulin deficiency had cholelithiasis. This represents a prevalence rate of 24%, which is significantly above the rate in a control group of 500 patients from this medical center matched 10:1 for age and sex (P less than 0.005). This finding adds a new gastrointestinal abnormality to those known to occur in idiopathic late-onset immunoglobulin deficiency.

Cholelithiasis↗

PubMed1975

Serum enzyme data in diagnosis of myocardial infarction during or early after aorta-coronary saphenous vein bypass graft operations.

In 397 cases, serum glutamic oxaloacetic transaminase (GOT) and creatine phosphokinase (CPK) values were determined on the first, second, and third days after aorta-coronary artery saphenous vein bypass graft operations. Electrocardiographic (ECG) or vectorcardiographic (VCG) evidence of postoperative transmural infarction was found in 48 cases. Multivariate analysis indicated that GOT and CPK concentrations on day 1 had substantial discriminatory value regarding infarction. Discrimination by GOT values was not significantly improved by addition of CPK. Of the 61 cases positive by GOT values measured 1 day postoperatively (greater than 100 U. per liter; normal smaller than 24), 32 (52 percent) were negative by ECG or VCG; of the 336 cases negative by GOT, 19 (6 percent) were positive by ECG or VCG. GOT and CPK values increased with the number of vessels grafted and with the use of ventricular rather than atrial vents. Total serum enzyme values lack specificty in diagnosis of transmural infarction after the saphenous vein bypass operation.

Adult↗

PubMed1975

Aorta-coronary artery saphenous vein bypass surgery: clinical and angiographic results.

In a series of 500 consecutive patients undergoing aorta-coronary artery saphenous vein bypass surgery, operative mortality was 2.5% (1% with one-vessel disease, 2% with two-vessel disease, and 3% with three-vessel disease). Transmural myocardial infarction occurred within 30 days after operation in 67 cases (13%) and caused 10 of the 16 deaths in that period. Among 484 patients followed 1 to 58 months (median, 26 months), there have been 20 deaths. Of the 464 survivors, 65% had complete relief of angina, 24% were improved, and 11% were unimproved. In 162 patients who underwent postoperative graft angiography between 1 and 42 months after surgery, a strong positive relationship existed between clinical response and completeness of myocardial revascularization as defined by the presence of a patent graft to all major coronary arteries with greater than 50% stenosis. A similar relationship was found between postoperative multistage treadmill exercise response and completeness of myocardial revascularization. Thus, 82% of patients completely revascularized were asymptomatic at the time of postoperative graft visualization, and 91% had a negative treadmill exercise response.

Adult↗

PubMed1975

Inheritance of very low serum dopamine-beta-hydroxylase activity.

Serum dopamine-beta-hydroxylas (DBH) activity was measured in blood samples obtained from 841 children ages 6-12, 277 adults subjects, and 114 relatives of children with serum DBH activity of less than 50 units. Approximately 4% of the children and 3% of the adult subjects tested had very low sweum DBH activity (50 units or less). Because these subjects appeared to make up a separate subgroup within the population and because of a striking familial aggregation of subjects with very low enzyme activity, serum DBH activity was measured in blood obtained from members of 22 families of probands with very low serum enzyme activity. The results of sibship and pedigree analyses of the data were compatible with autosomal recessive inheritance of very low serum DBH activity. Unaffected parents of probands had serum DBH activity intermediate between that found in affected individuals and in control population. No significant correlation of serum DBH activity with either systolic or diastolic blood pressure was found in this randomly selected population of children.

Adult↗

PubMed1975

Glucagon-blood catecholamine test: use in isolated and familial pheochromocytoma.

In 149 cases, blood pressure response to glucagon test did not exceed 20/10 mm Hg more than the response in the cold pressor test control and was considered negative. Plasma catecholamine level increases may be seen in 95% of patients without pheochromocytomas. Among six patients with pheochromocytomas, urinary metanephrine levels were of diagnostic importance in two with isolated pheochromocytoma and in one with the multiple endocrine neoplasia of type 2 (MEN-type 2). Urinary metanephrine determinations yielded false-negative results in three patients with MEN-type 2, while vanilmandelic acid level was normal in one and nephrotomograms were positive in two of these three. These results suggest that the early diagnosis of pheochromocytoma in patients with MEN-type 2 may be difficult and may require multiple biochemical and roentgenographic investigations.

Adolescent↗

PubMed1975