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Biomedical subjects

M J Osborn

Publications and source records attributed to M J Osborn.

At least 55 records · Page 3Linked to original sources
PubMed1986

Symptomatic "isolated" carotid sinus hypersensitivity: natural history and results of treatment with anticholinergic drugs or pacemaker.

Because syncope may occur intermittently in patients with carotid sinus hypersensitivity, a knowledge of its natural history is needed as a basis for interpreting the usefulness of therapy. Fifty-six consecutive patients are described (47 men and 9 women; mean age 61 years) with carotid sinus hypersensitivity and syncope in whom 24 hour ambulatory monitoring and intracardiac electrophysiologic study revealed no other cause for the syncope. The mean duration of symptoms was 44 months (range 1 to 480) and the mean number of episodes was 4.0 (range 1 to 20). During a follow-up period of 6 to 120 months (median 40), syncope recurred in 3 of 13 patients who received no treatment, in 2 of 23 patients who received a pacemaker and in 4 of 20 patients who received anticholinergic drugs (incidences corrected for totals available at follow-up: 27, 9 and 22%, respectively). Two-thirds of the patients receiving no treatment were asymptomatic compared with all nine of the patients with syncope and a pure cardioinhibitory response to carotid sinus massage who received an atrioventricular (AV) sequential pacemaker. Although pacing was effective in abolishing syncope, its use should be reserved for recurrent episodes because of the high rate of spontaneous remission of symptoms.

Adult↗
PubMed1986

Increased vagal tone as an isolated finding in patients undergoing electrophysiological testing for recurrent syncope: response to long term anticholinergic agents.

Features suggestive of an isolated increase in vagal tone during electrophysiological study were found in 12 patients with recurrent near syncope or syncope. Results at neurological and cardiac evaluation were otherwise normal. The increased tone or heightened sensitivity to vagal tone was manifested by abnormal atrioventricular nodal refractoriness and conduction that were reversed with atropine. The patients underwent long term treatment with an anticholinergic agent (propantheline bromide) and 75% improved. Before treatment they had experienced a median of seven episodes (range 3-28) of near syncope or syncope during 10.5 months (range 1-60). During treatment these episodes decreased to a median of one (range 0-15) during 22.5 months (range 3-67); six patients experienced no further symptoms. Three patients continued to have syncope while on treatment, and one of these required permanent cardiac pacing. No additional cause for syncope was identified in any patient. During electrophysiological assessment of patients with syncope, evidence may be obtained pointing to an increase in vagal tone. In many of these patients treatment with anticholinergic drugs seemed to improve or eliminate the symptoms.

Adolescent↗
PubMed1985

Energy dependence of lipopolysaccharide translocation in Salmonella typhimurium.

Energy inhibitors block translocation of pulse-labeled core lipopolysaccharide to outer membrane under conditions which allow maintenance of constant specific radioactivity of intracellular precursor pools throughout the chase period. Under the conditions used, approximately 75% of the total cellular label was membrane-bound at initiation of chase. Translocation of core lipopolysaccharide from inner to outer membrane showed apparent first order kinetics (t1/2 = 1.2 min, 32 degrees C). Translocation was blocked by arsenate (5-10 mM) under conditions where proton motive force was unchanged, while the uncouplers 2,4-dinitrophenol (0.1 mM to 0.8 mM) and carbonyl cyanide-m-chlorophenyl hydrazone (12-30 microM) inhibited translocation with no apparent effect on the ATP pool. Therefore, core lipopolysaccharide translocation appears to require maintenance of both proton motive force and high energy phosphate pools. Electron microscopic experiments show no gross disruption of zones of adhesion, the putative sites of lipopolysaccharide translocation, in the presence of arsenate or 2,4-dinitrophenol suggesting that energy is not required simply for maintenance of these structures.

2,4-Dinitrophenol↗
PubMed1985

Surgical treatment of accessory atrioventricular pathways and symptomatic tachycardia in children and young adults.

Twenty-seven patients aged 21 years or younger (mean 15) with symptomatic tachycardia underwent operation for ablation of an accessory atrioventricular pathway. Six patients had associated Ebstein's malformation of the tricuspid valve. Supraventricular tachycardia had been present for a mean of 5 years. At electrophysiologic study, 4 patients were found to have 2 accessory pathways. Left ventricular free wall pathways were found in 14 patients, right ventricular free wall pathways in 10 and septal pathways in 6. Successful initial ablation of all the pathways was achieved in 26 of the 27 patients. No patient died perioperatively and none had persistent complete heart block. During a mean follow-up of 11 months, no patient had recurrence of an arrhythmia related to the accessory pathway. Thus, the surgical treatment of children and young adults with accessory atrioventricular pathways and symptomatic supraventricular tachycardia is safe and effective. For these patients, unless the tachycardia can be easily controlled with a minimal number of drugs and adverse effects, surgical ablation should be considered early in the clinical course.

Adolescent↗
PubMed1985

Amiodarone pulmonary toxicity: report of two cases associated with rapidly progressive fatal adult respiratory distress syndrome after pulmonary angiography.

Use of amiodarone, an investigational antidysrhythmic agent, has been associated with cases of pulmonary toxicity. The mechanism of amiodarone pulmonary toxicity is unknown, and recommendations for the assessment and treatment of patients with this condition continue to evolve. In two patients with clinically diagnosed amiodarone pulmonary toxicity, a rapidly progressive and fatal adult respiratory distress syndrome developed after pulmonary angiography. Physicians should be aware of the potential for serious complications of pulmonary angiography in patients with presumed or clinically diagnosed amiodarone toxicity.

Aged↗
PubMed1985

Bipolar tined polyurethane ventricular lead: a four-year experience.

With the advent of polyurethane as an insulating material for permanent pacemaker leads, concern has arisen over the integrity and long-term durability of polyurethane-insulated pacing leads. Specific concern has arisen over particular bipolar tined polyurethane ventricular leads. We have assessed our 4-year experience with this lead. This experience involves two groups of patients, those with leads manufactured before a certain date and those with leads manufactured at a later date. In the first group (judged to be at increased risk) the failure rate was 8.8%, and in the second group (judged not to be at increased risk) the rate was 3.9%. Lead failure occurred at an average of 17.5 months in the first group. Adequate follow-up on the second group is not available to determine whether or not the failure rate may eventually be as high as that in the early group. Actuarial analysis suggests that survivorship free of lead failure is probably not significantly different in the two groups. This experience points out the need for determining lead failure rates, identifying optimal lead design and configuration, and establishing a lead registry or mechanism by which the integrity of various pacing leads can be evaluated.

Electrocardiography↗
PubMed1985

Amiodarone pulmonary toxicity. Assessment by bronchoalveolar lavage.

Bronchoalveolar lavage was used to demonstrate morphologic changes in alveolar macrophages characteristic of amiodarone effect in lung tissue obtained by biopsy. This procedure may be useful in the assessment of abnormal chest x-ray findings in patients suspected to have amiodarone toxicity.

Amiodarone↗
PubMed1985

Update on infections involving permanent pacemakers. Characterization and management.

From January, 1974, to December, 1983, 75 patients with infections related to permanent pacemakers were successfully treated. Demographic characterization, mode of presentation, types of infecting organisms, potential predisposing factors, significance of a retained infected pacemaker lead, and various medical and surgical treatment methods were analyzed. Likely infecting organisms depended on the mode of presentation and the time of the infection. Dermatologic diseases accounted for a significant number of secondary infections. Removal of the entire infected pacing system was required for eradication of infection in 74 of 75 patients. In 31 patients, the infected system was removed at the same time that the new system was implanted. In 26 patients, a two-stage procedure was used that included a period of temporary pacing between explantation of the old system and implantation of the new. No difference in complications or incidence of reinfection was found between these two groups. Infections occurring within 2 weeks after operation accounted for 15% of the cases. In these patients, Staphylococcus aureus was the most common organism. In patients with later infections, Staphylococcus epidermidis was the most common.

Adult↗
PubMed1985

Permanent cardiac pacing after the Fontan procedure.

Permanent cardiac pacing after a Fontan procedure is complicated by complex cardiovascular anatomy. Of 332 patients undergoing the Fontan procedure at the Mayo Clinic, we evaluated 15 who postoperatively required permanent pacing (mean age 16.5 years, range 4 to 31 years). Underlying congenital cardiac defects included univentricular heart in nine patients, double-outlet right ventricle in three, and tricuspid atresia in three. The indication for pacing was postoperative heart block in seven patients, congenital heart block in five, postoperative sick sinus syndrome in two, and heart block because of previous operation in one. Pacemakers were implanted immediately postoperatively in 11 patients and 12 to 57 months later in four patients. VVI systems were used in nine patients, DDD in four, AAI in one, and a Medtronic Activitrax VVI in one. All ventricular leads were epicardial. Four atrial leads were transvenous endocardial and one was epicardial. Three patients died 4, 9, and 69 months later of causes unrelated to pacing. Among the 12 survivors, mean follow-up was 34 months (range 1 to 107 months). Two patients had a total of three episodes of loss of ventricular capture because of increased chronic thresholds. Our current approach to pacing after a Fontan procedure includes (1) intraoperative placement of temporary atrial and ventricular electrodes, (2) intraoperative attachment of a permanent ventricular epicardial lead for congenital or surgically induced high-grade atrioventricular block, (3) postoperative insertion of transvenous atrial leads if dual-chamber pacing is indicated, and (4) use of programmable pulse generators with high output capability.

Adolescent↗
PubMed1984

Two decades of cardiac pacing at the Mayo Clinic (1961 through 1981).

Pacemaker procedures performed at the Mayo Clinic for the years 1961, 1971, and 1981 were reviewed to examine the changes that have occurred in a large pacemaker practice during the 2 decades since the advent of pacemaker therapy. Major changes in trends and practice have occurred; in addition to numerical growth, the indications for permanent pacing and the technologic alternatives available have expanded considerably. The increasing choices available today (in all areas of pacemaker practice) provide a challenging stimulus to physicians as they seek the best clinical options in patient care.

Cardiac Pacing, Artificial↗
PubMed1984

Cardiac histologic findings in patients with life-threatening ventricular arrhythmias of unknown origin.

Percutaneous endomyocardial biopsy (right ventricle in 10, left ventricle in 2) was performed in 12 patients, aged 9 to 57 years, with serious ventricular arrhythmias occurring in the setting of normal cardiac anatomy and mechanical function. Light microscopic examination of tissue revealed histologic abnormalities in 11 patients, including myocardial cellular hypertrophy in 7, interstitial fibrosis in 5, endocardial fibrosis in 2, myocardial degenerative changes in 1 and increased interstitial cellularity in 1. One patient had histologic evidence of acute lymphocytic myocarditis. Thus, a majority of patients with serious ventricular arrhythmias and normal cardiac anatomy had histologic abnormalities, bringing into question the concept of primary electrical heart disease or idiopathic ventricular tachycardia.

Adolescent↗
PubMed1984

Changing experience with dual chamber (DDD) pacemakers.

Dual chamber (DDD) or "universal" pacemakers have had a significant impact on the advancement of artificial pacemakers by providing a more physiologic approach to cardiac pacing. However, with the early generation of DDD pacemakers (pacemakers that sense and pace in both the atrium and the ventricle), a significant number of patients experienced pacemaker-mediated tachycardia because intact ventriculoatrial conduction was sensed in the atrium and a reentrant tachycardia was induced. Newer generation DDD pacemakers have provided longer atrial refractory periods, which should correct this problem. In this study the first and second years of a 2 year experience with DDD pacemakers were compared to determine if the newer generation devices have allowed maintenance of pacing in the DDD mode as opposed to reprogramming to some alternate mode because of pacemaker-mediated tachycardia or other pacing problems. The results showed a significant decrease in pacemaker-mediated tachycardia during the second year and continuation of pacing in the DDD mode in a higher percent of patients. This improvement is attributed to improvement in the pulse generator as well as better patient selection.

Adult↗
PubMed1984

Electrophysiologic testing in the upright position: improved evaluation of patients with rhythm disturbances using a tilt table.

Patients are traditionally evaluated in the supine position in the electrophysiology laboratory, although symptoms due to a cardiac rhythm disturbance are often maximal clinically during standing. The assumption of the upright position results in dependent displacement of blood, followed by prompt vasoconstriction to maintain arterial pressure. This normal response may aggravate tachyarrhythmias by increasing catecholamine levels or may precipitate vasodepressor syncope if the vasoconstrictor response is absent. The use of a tilt table during electrophysiologic testing was evaluated over a 12 month period in 104 patients having a mean age of 60 years (range 37 to 81): 59 with supraventricular tachycardia, 6 with vasovagal syncope and 39 with carotid sinus hypersensitivity. Twenty-three patients (22%) had significant abnormalities when upright that were not present when supine: eight patients with supraventricular tachycardia who had their clinical syndromes of palpitation and syncope reproduced when upright, but only minimal symptoms when supine; two patients with supraventricular tachycardia who had sustained atrioventricular reentry when upright, but only two to eight beats of tachycardia when supine; six patients with syncope and a normal cardiac evaluation before electrophysiologic testing who had their typical spells only after being placed upright during a vasovagal event and seven patients with carotid sinus hypersensitivity who had their clinical syndromes reproduced with carotid sinus massage only when upright, developing hypotension despite maintaining their heart rate with sinus rhythm or pacing (vasodepressor response). In 22% of patients, electrophysiologic testing in the upright position provided clinically important information that was not evident during standard testing in the supine position.

Adult↗
PubMed1984

Apparent pacemaker failure due to reversion circuitry within the programming device.

While being evaluated for a recurrent tachyarrhythmia, a patient with a permanent pacemaker underwent reprogramming of the unit from the DVI to the VVI mode for assessment of the underlying rhythm. Subsequent reprogramming of the pacemaker to the DVI or DDD mode was impossible despite multiple attempts and the use of multiple programmers. The problem was considered to be a malfunction of the pacemaker circuitry, and plans were made for the pacemaker to be explanted and a replacement unit implanted. Before the procedure, the pacemaker company was notified of the explantation. We subsequently learned that a special programming sequence had to be carried out because of reversion circuitry present in the pacemaker but not described in the available literature. This report emphasizes the need for familiarity with each of the individual pacemakers being implanted and the need for the manufacturer to be as specific as possible given the complexity of current units.

Equipment Design↗
PubMed1984

Improved liquid-chromatographic determination of mexiletine, an antiarrhythmic drug, in plasma.

In this improved reversed-phase liquid-chromatographic procedure for determination of mexiletine in plasma, mexiletine and an internal standard, chlorodisopyramide, are extracted with methylene chloride from 0.5 mL of serum or plasma; the extract is then concentrated and injected onto a C18 chromatographic column. Mexiletine in the column effluent is detected by monitoring absorbance at 210 nm. It is quantified by use of mexiletine-internal standard peak-height ratios. The relation between this ratio and mexiletine concentration is linear from 0.1 to 5.0 mg/L. The lower limit of detection is about 50 micrograms/L. At a mexiletine concentration of 2.0 mg/L in serum, intrarun precision (CV) is 2.9% and inter-run precision is 5.9%; at 0.5 mg/L, these CVs are 5.7% and 9.6%, respectively. Analytical recovery of added mexiletine in serum is 68-88%. Therapeutic concentrations of some commonly administered drugs in patients' specimens did not interfere. In serum from 38 patients receiving mexiletine for cardiac arrhythmia, concentrations measured by this method correlated with therapeutic efficacy.

Animals↗
PubMed1983

An intermediate step in translocation of lipopolysaccharide to the outer membrane of Salmonella typhimurium.

Evidence for transient localization of newly synthesized lipopolysaccharide at the periplasmic face of the inner membrane has been obtained by immunoelectron microscopic techniques. Salmonella typhimurium galE mutants in which O-antigen synthesis is dependent on addition of exogenous galactose were employed, and the distribution and fate of pulse-synthesized O antigen was examined by indirect ferritin labeling with anti-O-antigen IgG of spheroplasts prepared by treatment with lysozyme/EDTA. O-reactive lipopolysaccharide appeared rapidly at the exposed periplasmic face of the inner membrane after addition of galactose and was rapidly depleted upon termination of the pulse. Control experiments showed that secondary redistribution of lipopolysaccharide from outer membrane did not occur under the conditions employed for spheroplast formation and immunolabeling, and the pulse-chase kinetics were consistent with those expected for an intermediate in translocation of lipopolysaccharide to the outer membrane. In addition, undecaprenol-linked O antigen was detectable at the periplasmic face of the inner membrane within 30 sec after addition of galactose to a galE deep rough double mutant, and it accumulated stably in that location. The mutation in synthesis of the lipopolysaccharide core in the deep rough strain prevents transfer of O-antigen chains from undecaprenol phosphate to lipopolysaccharide. The result suggests that attachment of O antigen to lipopolysaccharide occurs on the extracytoplasmic side of the inner membrane and supports the conclusion that lipopolysaccharide is translocated to the outer membrane from the periplasmic, rather than the cytoplasmic, face of the inner membrane.

Antigens, Bacterial↗
PubMed1983

Catheter ablation of the atrioventricular conduction system in patients with supraventricular tachycardia.

In rare circumstances, patients with disabling supraventricular tachycardia that proves refractory to treatment with medication or antitachycardia pacing devices may require interruption of normal atrioventricular conduction and implantation of a permanent pacemaker for effective control of their arrhythmia. In the past, a cardiac surgical procedure was required to interrupt normal atrioventricular conduction; however, a closed-chest catheter technique to interrupt normal atrioventricular conduction has recently been described. We describe three patients in whom normal atrioventricular conduction was interrupted with this closed-chest technique. The procedure was accomplished without complication in all patients after invasive electrophysiologic studies were used to evaluate the mechanisms of tachycardia, the characteristics of the atrioventricular conduction system, and the potential use of antitachycardia pacing systems. All patients remain alive 5 to 9 months after the procedure, with no signs of recovery of normal atrioventricular conduction and no evidence of pacemaker dysfunction. Catheter ablation of the atrioventricular conduction system offers a promising alternative to a cardiac surgical procedure in carefully selected patients with disabling supraventricular tachycardia.

Adult↗