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Biomedical subjects

M E Sullivan

Publications and source records attributed to M E Sullivan.

At least 73 records · Page 4Linked to original sources
PubMed1989

Heterocyclic analogues of benzamide antiarrhythmic agents.

A series of heterocyclic N-[(diethylamino)alkyl]arenamides related to acecainide was prepared and examined for antiarrhythmic activity. The compounds were synthesized from the corresponding known heterocyclic carboxylic acids or esters by using standard amide formation methods. The effects of the compounds on the electrophysiological properties of canine Purkinje fibers and ventricular muscle strips were determined. Most of the compounds showed effects consistent with weak class I activity. Two compounds, N-[2-(diethylamino)ethyl]-3,4,5-trimethyl-1H-pyrrole-2-carboxamide and N-[2-(diethylamino)ethyl]-1H-indole-2-carboxamide, displayed prolongation of the action potential duration and functional refractory period indicative of modest class III electrophysiological activity. Representative compounds were examined by using molecular modeling techniques. Compounds of differing activity classes displayed qualitatively different electrostatic potential maps.

Action Potentials↗
PubMed1988

The uninsured: Blue Cross and Blue Shield responds through community-based programs.

A voluntary local program to underwrite medical care costs for uninsured children has been developed by Blue Cross of Western Pennsylvania. It offers at no cost routine physician and hospital out-patient care services for children to age 19. It is funded by voluntary contributions from the community and matched by the Blue Cross Plan. This program has enjoyed much success and is being replicated by other Plans.

Adolescent↗
PubMed1987

The ultrastructure of erythropoiesis in vitro: description and utilization of a new methodology.

A simplified methodology has been developed which makes it possible to examine the ultrastructural details of cells cloned in vitro while retaining the cell/cell relationships within semi-solid cultures. Using mouse erythropoiesis as the model for study, electron microscopy revealed many normal characteristics of red blood cell differentiation and maturation, as well as several distinct dyserythropoietic features. The usefulness of this technology should apply to fine structural studies of clonally-derived material such as hematopoietic cells, tumor cell lines and primary tumor cultures.

Animals↗
PubMed1987

Synthesis and antiarrhythmic activity of novel 3-alkyl-1-[omega-[4-[(alkylsulfonyl)amino]phenyl]-omega- hydroxyalkyl]-1H-imidazolium salts and related compounds.

Novel 3-alkyl-1-[omega-[4-[(alkylsulfonyl)amino]phenyl]-omega-hydroxyalkyl]-1H -imidazolium salts were synthesized and investigated for their class III electrophysiological activity on isolated canine cardiac Purkinje fibers and ventricular muscle tissue. Structure-activity relationships are discussed for a series of 25 compounds. Compound 3, 1-[2-hydroxy-2-[4-[(methylsulfonyl)amino]phenyl]ethyl]-3-methyl-1H- imidazolium chloride, prolonged the functional refractory period in anesthetized dogs when given intraduodenally and was also effective in preventing reentrant ventricular tachycardia induced by programmed electrical stimulation when administered intravenously in anesthetized dogs 24 h after an acute myocardial infarction. Both enantiomers of 3 were synthesized. No enantioselectivity was found in the electrophysiological effects of 3.

Animals↗
PubMed1987

Synthesis and cardiac electrophysiological activity of 2- and 3-[(substituted phenyl)alkyl]quinuclidines. Structure-activity relationships.

The syntheses and cardiac electrophysiological effects of 21 2- and 3-substituted quinuclidines and some quaternary ammonium derivatives are described. The 2-substituted quinuclidines 2-8 were prepared by alkylation of 2-methylene-3-quinuclidinone. The Wittig reaction with 3-quinuclidinone afforded the 3-substituted derivative 9, which was subsequently converted to 10 and 11. The electrophysiological profiles of the compounds were determined in canine cardiac Purkinje fibers and ventricular muscle strips. The 3-[(substituted phenyl)alkyl]quinuclidines selectively increased action potential duration (Vaughan Williams class III activity). In the 2-substituted series some of the compounds both increased action potential duration and decreased conduction velocity (class I activity). For some of the 2-substituted quinuclidines, appropriate substitution of the phenyl ring was shown to be a requirement for significant class III electrophysiological activity. Selected compounds were efficacious in a programmed electrical stimulation model in the anesthetized dog.

Action Potentials↗
PubMed1987

Synthesis and antiarrhythmic activity of novel 3-alkyl-1-[omega-[4-[(alkylsulfonyl)amino]phenyl]-omega- hydroxyalkyl]-1H-imidazolium salts and related compounds. 2.

Novel analogues of the class III antiarrhythmic agent 1-[2-hydroxy-2-[4-[(methylsulfonyl)amino]phenyl]ethyl]-3-methyl-1H- imidazolium chloride, 1 (CK-1649), were prepared and investigated for their class III electrophysiological activity on isolated canine cardiac Purkinje fibers and ventricular muscle tissue. Structure-activity relationships are discussed for a series of 11 compounds. One compound, N-[4-[1-hydroxy-2-(4,5-dihydro-2-methyl-1H-imidazol-1- yl)ethyl]phenyl]methanesulfonamide hydrochloride, 9, was comparable in activity to 1 in vitro and prolonged the functional refractory period in anesthetized dogs when given intraduodenally. Unlike 1, compound 9 was ineffective at preventing ventricular tachycardia induced by programmed electrical stimulation in anesthetized dogs 24 h after an acute myocardial infarction.

Action Potentials↗
PubMed1987

Improved technique for closure of median sternotomy incision. Mersilene tapes versus standard wire closure.

A continuous series of 2,135 cardiac surgical procedures performed with a median sternotomy is reviewed. Standard closure with steel wire was used in 1,650 patients, and a new technique with Mersilene tape was used with 485. The rate of sternal dehiscence was 2.4% among those having wire closure, and there were no instances of dehiscence among the 485 patients with Mersilene tape closure (a statistically significant difference at p less than 0.005). The method was quick and easy to perform and highly effective in establishing firm and permanent approximation of the sternum. Presence of factors associated with increased risk of postoperative sternal dehiscence did not affect the outcome when Mersilene tape was used. We highly recommend this technique in all median sternotomy incisions.

Clinical Trials as Topic↗
PubMed1986

Synthesis and class III antiarrhythmic activity of (phenylbut-2-enyl)ammonium salts. Effect of conformation on activity.

The syntheses of seven 4-(substituted phenyl)but-2-en(or yn)yl quaternary ammonium salts and four related tertiary amines are described. The Meerwein arylation reaction was the preferred synthetic method for the required intermediate 1-aryl-4-halo-2-butenes (15a-c, 18). In the case of 18, the trans stereochemistry of the Meerwein adduct of 2,3-dimethylbutadiene was established unambiguously by 2D NMR and X-ray studies. The title compounds represent conformationally restricted analogues of the class III antiarrhythmic agent clofilium (1) and exhibit comparable potency and efficacy in the in vitro evaluation using isolated canine Purkinje fibers. These results suggest that the alkylene chain in 1 is extended in the active conformation. Computer-aided conformational analysis (MM2) supports this conclusion. Selective catalytic hydrogen conditions were developed for the conversion of the unsaturated analogue 2 to clofilium (1) with minimal hydrogenolysis of the allylic quaternary ammonium moiety, thus completing a novel and efficient synthesis of this substance.

Action Potentials↗
PubMed1986

Antiarrhythmic drug therapy: new drugs and changing concepts.

The effective treatment of life-threatening ventricular arrhythmias (VA) leading to sudden cardiac death remains a major health problem. Cellular electrophysiological techniques that have provided insight into the underlying mechanisms of these arrhythmias have also provided a convenient classification of antiarrhythmic drugs based on their dominant electrophysiological action. Traditional pharmacological approaches to the management of VA have involved primarily class I agents. Newer drugs in this class are potent conduction depressants (class IC agents), which, however, have been limited in their clinical impact on VA because of unwanted cardiac and extracardiac side effects. Other recent approaches include the introduction of class III agents, which are thought to interrupt primarily reentrant impulses by specific prolongation of action potential duration and refractoriness without compromising normal cardiac conduction. Newer approaches may also include drugs with greater specificity of action, agents with combinations of electrophysiological effects (class I/III, I/II), drugs exemplifying novel mechanisms of action such as anion antagonism (class V), and agents controlling sympathetic neural outflow. The growing awareness of the potential proarrhythmic effects of antiarrhythmic drugs has also become important in drug development and assessment, as emphasized by the search for improved methods of drug selection (e.g., programmed electrical stimulation). Finally, the desired characteristics of a new antiarrhythmic agent are presented as a goal for future drug development.

Action Potentials↗
PubMed1985

Foregut cysts of the mediastinum. Results in 20 consecutive surgically treated cases.

Mediastinal cysts of foregut origin represent an important diagnostic group. Classified according to their anomalous embryonic origins, they include bronchogenic, esophageal, enteric, and nonspecific cysts. A series of 20 consecutive surgically treated cases from the thoracic surgical service of a large medical center is reported, all successfully resolved without mortality. Described are 12 bronchogenic, four enterogenous, and four nonspecific cysts, occurring in a variety of thoracic locations. Close attention to symptomatology reveals a wide range of manifestations, from total absence of symptoms to life-threatening respiratory distress. Definitive diagnosis was accomplished in some cases by means of noninvasive radiologic techniques, while angiography, bronchoscopy, and esophagoscopy were also useful in selected instances. Operative therapy consisted of complete excision if possible or partial excision if adhesion to intrathoracic bodies had occurred.

Adult↗
PubMed1983

Effect of a skin moisturizer on the water distribution in human stratum corneum.

The effect of a skin moisturizer on the water content distribution in human stratum corneum was examined from the rate of water loss from the skin surface. An increase of 9% in the water content was calculated from the water loss data. This increase was not evenly distributed across the tissue. Most of the increase occurred near the skin surface. In the first one-tenth of the stratum corneum the increase was estimated to be about 100%.

Body Water↗
PubMed1981

Aortocoronary Gore-Tex graft: 18-month patency.

Despite widespread success with Gore-Tex (polytetrafluoroethylene) vascular grafts in peripheral artery operations, very little use has been made of this material in aortocoronary bypasses. We present the case of a 61-year-old woman with a 6-month history of angina who was found to have no suitable saphenous vein available at operation and who therefore underwent Gore-Tex bypass grafting to the right coronary artery. Coronary angiograms made 6 months and 18 months postoperatively showed patency of the 6 mm Gore-Tex replacement graft as well as the internal mammary artery placed to the left anterior descending coronary artery. Although frequent follow-up and close observation are recommended in patients with aortocoronary Gore-Tex grafting, the unique design of this material has made it the best alternative for synthetic coronary bypass conduit in the absence of the saphenous veins, particularly when these veins are found to be inadequate only at the time of operation.

Blood Vessel Prosthesis↗
PubMed1981

Percutaneous transluminal dilation of aortocoronary saphenous vein bypass grafts.

To evaluate the efficacy of percutaneous transluminal angioplasty as a possible alternative to repeated open heart surgery for symptomatic aortocoronary saphenous vein graft stenoses, the procedure was initiated at Shadyside Hospital in January 1978. Percutaneous transluminal angioplasty has been used in nine aortocoronary graft stenoses and 11 native coronary artery stenoses. Of the nine grafts, eight (88 percent) were successfully dilated, including three that had been totally closed as visualized by angiography. Of the 11 coronary dilations, only four (36 percent) resulted in improved flow. The more favorable results experienced with the graft dilations was thought to be due to the nature of the occlusive processes affecting these grafts. The fibrous intimal proliferative disease that is found in most grafts is easily compressible, while the nature of the disease in the coronary arteries is not so readily predictable. Better instrumentation and careful evaluation before and after angioplasty will improve the results and extend the indications for coronary artery and saphenous vein graft transluminal angioplasty.

Adult↗
PubMed1981

A patient education system for a rural primary care centre.

The paper describes a systems approach for integrating health education into a rural primary health care centre. Mechanisms chosen to accomplish this were: 1. health education protocols: patient-oriented teaching guides which identify the objective to be completed by the patient and specify the content to be taught by the educator as well as the methods and materials to be used for each objective of the patient's educational experience; 2. patient education diagnosis: process designed to make the education responsible to the environmental, economic and psychological factors influencing a person's health behaviour; 3. documentation instruments; simple guides to collect data to be used in evaluating education and health behaviour outcomes.

Alabama↗
PubMed1980

Percutaneous transluminal angioplasty in the management of occlusive disease involving the coronary arteries and saphenous vein bypass grafts: preliminary results.

Since January, 1978, we have evaluated 18 patients in whom segmental occlusive disease of the aorta-coronary saphenous vein graft or the native coronary circulation was present. The significantly occluded vessels were restored to relatively normal circulation by means of percutaneous transluminal dilatation in 10 of these patients, with technical failures in seven patients and the occurrence of a thrombosis during the procedure in one other. Successful dilatation occurred in six of the seven patients with saphenous vein graft stenosis. Percutaneous transluminal angioplasty of the native coronary arteries in 11 patients resulted in five successful dilatations. All dilatation procedures are performed with the use of local anesthesia with an open-heart team standing by. In the event of technical failure or incipient thrombosis with developing infarction, the patient is transferred for immediate bypass. On the basis of these early results, we have developed guidelines of the indications for percutaneous transluminal dilatation of the coronary arteries and their saphenous vein grafts. The need for improved instrumentation to broaden these guidelines is discussed. Case histories of five patients are presented, and a summary table for all 18 patients is also provided. Certain inherent complications are discussed, but our preliminary results are encouraging, particularly with regard to stenoses of saphenous vein bypass grafts.

Adult↗
PubMed1979

Horticultural therapy--the role gardening plays in healing.

Horticultural therapy is an adjunct therapy--to be used in addition to occupational and physical therapies, and combining means used by both. It is meant to increase the motivation of the physically and/or mentally handicapped, while at the same time stimulating the five senses and furnishing a means of self-gratification and self esteem. Now that neurologically orientated psychologists are identifying schizophrenia as being biologically based and capable of being reversed with exercise, it is time to study the many benefits of gardening as a therapy method.

Persons with Disabilities↗