Biomedical subjects

N Sadick

Publications and source records attributed to N Sadick.

At least 19 recordsLinked to original sources

PubMed2005

Randomized double-blind trial of sotalol versus lignocaine in out-of-hospital refractory cardiac arrest due to ventricular tachyarrhythmia.

AIM: We aimed to compare the efficacy of sotalol versus lignocaine for the treatment of patients with out-of-hospital ventricular fibrillation refractory to > or = 4 defibrillatory shocks. BACKGROUND: The outcome of patients in ventricular fibrillation refractory to > or = 4 defibrillatory shocks is poor. In a previous randomized trial, sotalol was superior to lignocaine for acute termination of ventricular tachycardia not causing loss of consciousness. METHODS: Patients of the Ambulance Service of New South Wales treated by paramedics with continued ventricular fibrillation despite standard resuscitation and > or = 4 defibrillatory monophasic shocks were eligible. Drug doses were sotalol 100 mg or lignocaine 100 mg, given as i.v. boluses. A further 2 min of cardiopulmonary resuscitation was given and then defibrillation was repeated twice. If this failed, half the initial dose of the trial drug was repeated and a further > or = 2 shocks were given. RESULTS: Sixty patients were randomized to sotalol and 69 randomized to lignocaine. There was no significant difference between the two groups in the clinical characteristics of the patients or in the number of shocks received. Outcomes in the sotalol and lignocaine groups were survival to hospital admission in 7 (12%) and 16 (23%), respectively (P = 0.09), and survival to hospital discharge in 2 (3%) and 5 (7%), respectively (P = 0.33). CONCLUSIONS: Sotalol is not superior to lignocaine for treatment of ventricular fibrillation refractory to multiple shocks. The overall outcome of this group of patients is poor regardless of the pharmacological intervention (lignocaine or sotalol).

Aged↗

PubMed2001

Small-vessel sclerotherapy.

Small vessel telangiectasias are commonly seen in clinical dermatology. This article focuses on the evaluation of these patients and treatment. The types of sclerosing agents and the techniques of sclerotherapy are discussed in detail.

Humans↗

PubMed2001

Elliptografting: the right fit.

BACKGROUND: A number of new recipient grafting techniques have evolved employing micrografting, minigrafting, and follicular unit technologies as larger hair transplantation sessions incorporating smaller grafts have evolved. OBJECTIVE: To introduce a new recipient graft device-the elliptograft-and compare it to standard circular minigrafts and laser-generated slot grafts. METHODS: A blinded study was performed of 30 patients (mean age 44 years) with grades II-V male pattern Norwood or medium Ludwig female pattern androgenetic alopecia. Ten patients were transplanted with the second-generation elliptograft punch, 10 were treated with 2 mm circular minigrafts, and 10 were transplanted with the recipient sites created by the hybrid Er:YAG/CO2 laser in a slot configuration. The front three rows in each patient were transplanted utilizing No-Kor needle-generated micrografts in all three patient study subgroups. RESULTS: Comparable hair growth density was achieved utilizing conventional circular minigraft, freehand laser slit, and elliptograft technologies. Healing time was slightly prolonged in the laser transplant subgroup; however, the time for initial hair growth was comparable in all three patient populations. Aesthetic improvement was judged superior in the elliptograft population by blinded physician observers, which correlated with good patient satisfaction. CONCLUSION: Combined micro-mini elliptografting utilizing the newly described elliptograft punch produces excellent hair density correlated with high patient satisfaction.

Adult↗

PubMed2000

Interaction between transient metabolically mediated dilatation and pressure induced constriction in the canine coronary artery.

This study explored the interaction between metabolically mediated vasodilatation (ventricular extra-activation) and pressure induced vasoconstriction (transient augmentation of aortic diastolic pressure). Eight dogs having formalin-induced heart block were chronically instrumented with aortic and left ventricular catheters and an electromagnetic flow probe on the left circumflex coronary artery. At a heart rate of 60 beats/min a single ventricular extra-activation introduced at 200 ms after the normal paced beat resulted in a 13 +/- 1% decrease in diastolic coronary vascular resistance index (DCVRI) in the first response beat (D1) and a persistent vasodilatation lasting for five beats (D1-D5). An increase in aortic diastolic pressure (32 +/- 3% for 520 +/- 15 ms) resulted in 13 +/- 2% increase in DCVRI in the D1 which was not evident in subsequent beats. Following a combined intervention, DCVRI in D1 was not significantly different from control but DCVRI did decrease to a greater degree in the subsequent response beats (D2-D7). These data indicate that the responses of two opposing vasoactive stimuli, i.e., pressure induced vasoconstriction and metabolic vasodilatation, were negated in the first response beat. The metabolically mediated vasodilatation was unaltered in the subsequent response beats.

Animals↗

PubMed1997

The development of a Marjolin's cancer in a human immunodeficiency virus-positive hemophilic man and review of the literature.

BACKGROUND: The malignant potential of chronic ulcers and scars secondary to a variety of injuries is well characterized in the medical literature. Furthermore, it has been reported that human immunodeficiency virus (HIV)-positive patients have a higher incidence of basal cell carcinoma (BCC) than the general population. OBJECTIVE: To describe a case of an unusually aggressive morpheaform BCC that developed in a 28-year-old HIV-positive patient. The tumor developed in a scar 25 years after the initial trauma (Marjolin's ulcer). METHODS: Description of a case and review of the literature of Marjolins ulcer. RESULTS: The tumor was removed in a seven-stage, 21-section, micrographically controlled excision. Intraoperatively, perineural invasion of the infraorbital nerve was observed. The postoperative defect was repaired using a full-thickness skin graft. CONCLUSION: Although most malignancies arising within chronic scars are SCCs, BCCs and a number of other tumors have been described. Mohs micrographic surgery was effective in treating this aggressive morpheaform BCC. A high degree of suspicion in any changing healed scar is recommended.

Adult↗

PubMed1994

Can the electrophysiologic study predict treatment outcome in patients with sustained ventricular tachyarrhythmias unrelated to coronary artery disease?

UNLABELLED: Sustained ventricular tachyarrhythmias unrelated to coronary artery disease are uncommon. Currently there are no clear guidelines to aid selection of the most appropriate treatment strategy. Therefore, factors potentially predictive of arrhythmia recurrence and death and the ability of the electrophysiologic study to predict treatment outcome in patients with spontaneous sustained ventricular tachyarrhythmias unrelated to coronary artery disease were examined in 41 medically treated patients followed for a median of 25 (range 1-76) months. Examined factors were: syncope associated with the spontaneous arrhythmia, the morphology and cycle length of the presenting arrhythmia, underlying ventricular function, cardiac pathology, and the results of drug assessment at electrophysiologic study. Random variability in the ease of arrhythmia induction at electrophysiologic study was measured for the group as a whole and was allowed for in prediction of an effective drug response. The 95% confidence intervals for variability in the ease of repeat arrhythmia induction at the same study were < or = 1 extrastimulus and for variability in the ease of repeat arrhythmia inductions at different studies were < or = 2 extrastimuli. Poisson regression models were used for data analysis. Arrhythmia recurrence was most likely in: (1) patients on treatment not predicted to be anti-arrhythmic at electrophysiologic study; (2) patients whose treatment was not assessable at electrophysiologic study because the arrhythmia was not reliably inducible; (3) patients with impaired ventricular function; and (4) re-entered patients whose arrhythmia had recurred on previously allocated therapy. The risk of arrhythmia recurrence decreased with time from hospital assessment. All five deaths occurred in patients with impaired ventricular function. CONCLUSIONS: drug efficacy should be tested at electrophysiologic study in patients with reproducibly inducible clinical arrhythmias. Treatment not proven to be anti-arrhythmic at electrophysiologic study is usually ineffective. Patients with ventricular dysfunction are at highest risk of death from arrhythmia recurrence and should be considered for an implantable defibrillator, arrhythmia surgery, or heart transplantation if drug treatment is not predicted to be effective or is not assessable at electrophysiologic study.

Adolescent↗

PubMed1992

Clinical response of alopecia, trichorrhexis nodosa, and dry, scaly skin to zinc supplementation.

Two unrelated patients had dry brittle hair, alopecia, trichorrhexis nodosa, dry scaly skin, pigment dyschromia, short stature, and neurosecretory growth hormone deficiency. By means of the zinc tolerance test, patient 1 was shown to have zinc deficiency, whereas no clear zinc deficiency could be demonstrated in patient 2. In both patients, hair and the skin abnormalities responded to oral zinc therapy.

Alopecia↗

PubMed1989

Hyperemic response to coronary occlusion during a single diastole in conscious dog.

This study determined whether the reactive hyperemic response to a 400-ms diastolic coronary occlusion is dependent on ventricular systole. Studies were obtained on 11 conscious dogs with complete heart block paced at 60 beats/min. A pressure catheter was chronically implanted in the aorta. An electromagnetic flow probe and pneumatic occluder were implanted on the circumflex coronary artery. Three interventions were employed: 1) interruption of pacing for a single beat generating a long diastolic period of 2,000 ms in duration (LDC); 2) introduction of a 400-ms diastolic coronary occlusion early in a long diastole (LD4); and 3) a 400-ms diastolic occlusion during uninterrupted pacing (400R). The rise in diastolic coronary vascular resistance index noted during LDC was inhibited significantly in the last 600 ms of diastole during LD4. Thus an intervening systole is not required for a reactive hyperemic response to a diastolic coronary occlusion. During 400R, the resistance index was lower than that found during LD4. The reactive hyperemic response may be caused by either a myogenic or metabolic mechanism or by both. The greater vasodilatation observed after the postocclusion systole in 400R probably reflects metabolic influences.

Animals↗

PubMed1988

Continuous varicella-zoster infection associated with acyclovir resistance in a child with AIDS.

Acyclovir has become the treatment of choice for varicella-zoster virus (VZV) infections in immunocompromised individuals. This article describes a 4-year-old girl congenitally infected with human immunodeficiency virus who developed a continuous cutaneous infection with VZV that persisted over a 14-month period until her death. Initial episodes of varicella and zoster were responsive to acyclovir treatment; however, subsequent recurrences necessitated administration of multiple courses of acyclovir. Lesions became markedly hyperkeratotic, slow healing, and persistent despite acyclovir therapy. Numerous attempts to isolate virus from the lesions yielded only one isolate late in the course of therapy. This virus clearly demonstrated acyclovir resistance in vitro. Bizarre manifestations of VZV infection could present both diagnostic and therapeutic dilemmas. Prolonged acyclovir treatment of highly immunocompromised patients with acquired immunodeficiency syndrome and severe VZV may lead to the appearance of resistant virus.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Usefulness of ejection fraction response to exercise one month after acute myocardial infarction in predicting coronary anatomy and prognosis.

The prognostic value of left ventricular (LV) ejection fraction (EF) measured during maximal exercise testing early after acute myocardial infarction (AMI) was assessed in 75 patients, aged 65 years or younger, a mean of 36 days after AMI. At follow-up for a mean 12 months (range 6 to 26), medical complications developed in 15 patients: cardiac death in 5, ventricular fibrillation in 1, reinfarction in 2, unstable angina in 5, and severe cardiac failure in 2. Seven other patients underwent coronary artery bypass grafting for severe angina. When LVEF less than 50% at rest was compared with LVEF of 50% or more, the 2-year life-table survival free of complications was 54 +/- 21% compared with 84 +/- 19% (p less than 0.05). When exercise LVEF less than 50% was compared with LVEF of 50% or more, the 2-year survival rate free of medical complication was 42 +/- 32% compared with 83 +/- 20% (p less than 0.05). LVEF change from rest to exercise was not related to prognosis. Patients with combined medical and surgical events tended to have lower rest and exercise LVEFs, but changes in LVEF during exercise were again unrelated to prognosis. Sixty-five patients underwent coronary arteriography. After inferior AMI the mean LVEF was lower in those with multivessel than in those with 1-vessel coronary artery disease at rest (47 +/- 13% vs 59 +/- 7%, p less than 0.005) and during exercise (47 +/- 13% vs 59 +/- 9%, p less than 0.005); however, the change in LVEF during exercise was not related to coronary anatomy anatomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

PubMed1987

Dermatologic findings and manifestations of acquired immunodeficiency syndrome (AIDS).

We present a review of the spectrum of human T-lymphotropic virus type III (HTLV-III) infection with particular emphasis on cutaneous manifestations in 217 patients. Correlations are made with immunodeficiency as measured by absolute T-helper cell number. A classification is presented of these dermatologic findings.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Metabolic mediation of single brief diastolic occlusion reactive hyperemic responses.

We tested the hypothesis that coronary reactive hyperemia following a single brief diastolic occlusion and subsequent systole is coupled to myocardial metabolic activity and myocardial O2 consumption (MVO2). Sixteen conscious dogs with Formalin-induced heart block were studied. A 400-ms diastolic occlusion was introduced during normal ventricular pacing, resulting in a reactive hyperemic repayment of 216 +/- 22%. A 400-ms diastolic occlusion was also introduced during a higher level of myocardial metabolic activity induced by ventricular paired pacing. MVO2 and mean coronary blood flow were significantly increased relative to these parameters during normal pacing, but reactive hyperemic repayment (189 +/- 18%) was not significantly changed. A third set of conditions was designed to measure the response to a 400-ms occlusion during normal pacing while eliminating the difference in magnitudes of myogenic influences that may exist between paired pacing and normal pacing. Adenosine and phenylephrine were infused intravenously during normal pacing to maintain mean aortic pressure and mean coronary flow at paired pacing levels. MVO2 was similar to O2 consumption during normal pacing in the absence of drug infusion, but the reactive hyperemic repayment was significantly reduced (94 +/- 22%) relative to paired pacing. Thus the magnitude of reactive hyperemic response after a brief diastolic occlusion is related primarily to myocardial metabolic activity.

Adenosine↗

PubMed1986

Unusual features of scabies complicating human T-lymphotropic virus type III infection.

Four cases of "exaggerated scabies" are described in patients who were immunodeficient secondary to human T-lymphotropic virus type III (HTLV-III) infection. As in classical scabies, these patients had a pruritic dermatitis but lacked the usual distribution of the eruption. The rash was initially misdiagnosed in all four patients. Scabies should be considered in pruritic dermatitis in patients at risk for HTLV-III infection.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Vacuolar myelinopathy of the brain and lamellar ichthyosis.

A 13-month-old child with lamellar ichthyosis and numerous cutaneous and systemic infections died following an abrupt episode of severe hypotension. Postmortem examination revealed white matter vacuolation in the brain stem tegmentum and cerebellar hemispheres similar to that seen in toxicity from hexachlorophene, to which our patient was not exposed. The patient had been treated with many commonly used medications, including 13-cis-retinoic acid, a relatively new drug with apparent therapeutic benefit in hyperkeratotic dermatoses. This had been given systemically during the patient's last week of life. Possible relationships between the white matter lesions and extrinsic toxic agents are discussed.

Anti-Bacterial Agents↗

PubMed1984

Granulocytic sarcoma. A new finding in the setting of preleukemia.

Preleukemia is a well-defined syndrome of hematopoietic dysfunction that may antedate the development of acute myelogenous leukemia. Granulocytic sarcoma refers to neoplastic infiltration in the skin, composed of immature cells of the granulocyte series. We report two cases of granulocytic sarcoma in the setting of preleukemia. The clinical importance of these cases, as well as the cutaneous manifestations of leukemia and the clinical spectrum of granulocytic sarcoma, are presented.

Aged↗

PubMed1984

Effect of aminophylline on coronary reactive and functional hyperaemic response in conscious dogs.

This study was undertaken to determine whether adenosine release from myocardial cells plays a role in coronary reactive and functional vasomotion. Reactive hyperaemic blood flow responses to 10 s complete occlusions and 400 ms diastolic occlusions of the left circumflex coronary artery and to the vasomotor responses to the increased cardiac demand following ventricular extra-activation were examined in a chronic, heart-blocked dog preparation during a control period and following intravenous bolus administration of aminophylline (5 mg X kg-1). Aminophylline administration resulted in a 19% decrease in the blood flow debt repayment ratio of 10 s reactive hyperaemic responses compared with the control period. However, administration of aminophylline had no effect on the coronary vascular response to 400 ms diastolic occlusions or to ventricular extra-activations. These observations indicate that adenosine may play a role in the coronary vascular response to prolonged interventions but that other factors, as yet unidentified, may be implicated in the beat-to-beat regulation of coronary vascular resistance.

Aminophylline↗

PubMed1984

Effects of intravenous verapamil on the haemodynamic response to exercise in patients with angina pectoris.

The effects of intravenous Verapamil (V) on exercise haemodynamics and ventricular function were compared in 13 patients with stable effort angina. Intravascular pressures, thermodilution cardiac output and radionuclide ejection fraction were measured simultaneously at rest and during exercise. At rest Verapamil produced systemic vasodilation. During exercise at identical workloads compared to control, Verapamil increased cardiac index (CI) and decreased AVO2 difference. Pulmonary artery wedge pressure was lower. Ejection fraction was higher (control-55 +/- 11% vs V-64 +/- 11%) as the disproportionate increase in end systolic volume relative to the end diastolic volume was prevented. Verapamil is effective in exercise induced angina and alters haemodynamics primarily through its vasodilating properties associated with an increased CI.

Adult↗

PubMed1982

Verapamil in stable effort angina: effects on left ventricular function evaluated with exercise radionuclide ventriculography.

A double blind placebo-controlled study was performed in 12 patients with stable angina pectoris to evaluate the effects of oral verapamil (320 mg/day) on left ventricular function, as measured at rest and during exercise with gated equilibrium radionuclide ventriculography. On verapamil, patients had a lower heart rate-blood pressure product at each work load than with placebo. Anginal threshold increased by 28 +/- 19 watts (p less than 0.005), and maximal exercise capacity increased by 20 +/- 14 watts (p less than 0.001) with verapamil, but the rate-pressure product at the onset of angina and at maximal exercise was unchanged. Left ventricular ejection fraction at rest during verapamil therapy was the same as with placebo therapy. On exercise during placebo therapy, the ejection fraction decreased from 40 +/- 9 to 35 +/- 11 percent (p less than 0.025) because end-systolic volume increased disproportionately compared with end-diastolic volume. On exercise during verapamil therapy, the ejection fraction did not decrease (44 +/- 8 versus 45 +/- 12 percent) and was significantly higher at identical work loads than on placebo because of a smaller increase in end-systolic volume. Oral verapamil is effective treatment for effort angina and may prevent the decrease in left ventricular ejection fraction due to exercise-induced ischemia.

Aged↗