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Biomedical subjects

P Block

Publications and source records attributed to P Block.

At least 37 records · Page 2Linked to original sources
PubMed1994

Abnormal free fatty acid uptake in subacute myocardial infarction after coronary thrombolysis: correlation with wall motion and inotropic reserve.

UNLABELLED: Iodine-123-free fatty acid analogs, such as beta-methyliodophenylpentadecanoic acid (BMIPP), allow for myocardial metabolic studies with SPECT. The goal of this investigation was to determine whether BMIPP uptake can be used to differentiate viable myocardium from scar tissue soon after coronary thrombolysis for acute myocardial infarction. METHODS: BMIPP and 99mTc-sestamibi (MIBI) myocardial distribution after injection at rest were analyzed in 22 patients 4 to 10 days after coronary thrombolysis. The relative uptake of the two tracers was compared on a segmental basis to the regional wall motion and to the inotropic reserve assessed by two-dimensional echocardiography and low-dose dobutamine stimulation. RESULTS: Three segmental patterns were identified in the infarct-related coronary artery territory. Segments with normal BMIPP and MIBI uptake showed normal wall motion. Segments with more reduced BMIPP uptake than MIBI uptake (mismatching) showed either normal wall motion or demonstrated inotropic reserve during dobutamine stimulation. Segments with matched defects always showed abnormal wall motion and did not demonstrate inotropic reserve, regardless of the MIBI uptake. CONCLUSION: In patients with subacute myocardial infarction, combined imaging of BMIPP and MIBI at rest might be more sensitive than MIBI or wall motion at rest alone to demonstrate myocardial areas that have been acutely ischemic. Mismatching is due to more severely depressed fatty acid metabolism than expected on the basis of the flow and is indicative of jeopardized, but viable myocardium. In dysfunctional segments, mismatching may correspond either to stunned or to hibernating myocardium. Matched defects are associated with scar tissue.

Coronary Angiography↗
PubMed1993

Regional distribution of 123I-(ortho-iodophenyl)-pentadecanoic acid and 99Tcm-MIBI in relation to wall motion after thrombolysis for acute myocardial infarction.

To characterize the myocardium after thrombolytic therapy for infarction single photon emission computed tomographic (SPECT) studies with 123I-(ortho-iodophenyl)-pentadecanoic acid (oPPA) and 99Tcm-methoxyisobutyl isonitrile (MIBI) were obtained at rest in nine patients within a fortnight after the acute event. A decreased oPPA activity compared to MIBI was observed in 15/45 segments (7/9 patients). The segments with discordant oPPA/MIBI activities showed less severe wall motion abnormalities than the segments with concordant decreased oPPA and MIBI activities (P = 0.004). A significant association was found between discordant oPPA/MIBI activities and the early evolution of wall motion following thrombolysis: discordant oPPA/MIBI activities were present in nine of the 11 segments (82%) with improved wall motion, while the wall motion of the seven segments with similar decreased oPPA and MIBI activities was unchanged or had deteriorated (P = 0.018). It is concluded that metabolic abnormalities often persist longer than perfusion and wall motion abnormalities soon after thrombolysis, and that 123I-oPPA in combination with 99Tcm-MIBI is useful to demonstrate myocardial areas which have been salvaged by thrombolysis.

Aged↗
PubMed1993

Survival at 15 to 18 years after coronary bypass surgery for angina in women.

BACKGROUND: Coronary bypass surgery in women is associated with lower survival than in men. We need to know whether this is because of patient-related factors and whether the lower survival is present in all subgroups of patients and for all time periods during which the surgery was performed. METHODS AND RESULTS: Using actuarial techniques, we determined the outcome of coronary bypass surgery performed for chronic stable and unstable angina in 1979 women and 6927 men. The operative mortality was 2.7% for women and 1.9% for men (P = .02). The higher operative mortality in women was seen in those with three-vessel disease or greater and abnormal left ventricular function (5.4% versus 2.8%, P = .009) and those with stable angina (2.6% versus 1.5%, P = .006). The 5-, 10-, 15-, and 18-year survival for women was 86 +/- 0.9%, 70 +/- 1.5%, 50 +/- 2.5%, and 37 +/- 6.4%, respectively, and for men, 88 +/- 0.4%, 73 +/- 0.7%, 54 +/- 1.2%, and 42 +/- 1.9%, respectively (P = .03). The lower survival in women compared with men was seen in those with three-vessel disease or greater and abnormal left ventricular function (at 10 years, 69 +/- 1.8% versus 73 +/- 0.8%, P = .005). At 15 years, the incidence of reoperation was 26 +/- 2.4% versus 28 +/- 1.2% and of myocardial infarction, 30 +/- 2.8% versus 32 +/- 1.3%, P = NS for either. The incidence of no angina or mild angina was 70% in women and 78% in men, P < .0001. The operative mortality and late survival of those operated on in different time periods for either women or men was not significantly different. Women were older (64 +/- 9.4 versus 61 +/- 9.9 years, P < .0001) and smaller (body surface area, 2.0 +/- 0.2 versus 1.7 +/- 0.2 m2, P < .0001), had a higher incidence of diabetes, systemic hypertension, and unstable angina, and had a smaller lumen of the left anterior descending coronary artery (1.7 +/- 0.4 versus 1.9 +/- 0.4 mm, P < .0001), right coronary artery, and diagonal arteries. More men were smokers, and men had a higher incidence of prior myocardial infarction, previous coronary bypass surgery, and extent of coronary disease and of abnormal left ventricular function. The Cox regression model of survival showed that independent risk factors for lower survival were older age, previous coronary bypass surgery, previous myocardial infarction, and diabetes. Sex was not an independent risk factor for poorer survival. CONCLUSIONS: Women have a higher operative mortality and lower long-term survival than men after coronary bypass surgery for angina. However, the differences are small, even if statistically significant. Importantly, patient-related factors and not sex are independent predictors of poorer survival. Therefore, coronary bypass surgery should not be delayed or denied to women who have the usual indications for surgery.

Actuarial Analysis↗
PubMed1992

Sociotropy and autonomy: relationship to antidepressant drug treatment response and endogenous-nonendogenous dichotomy.

This study evaluated the relationship of sociotropic and autonomous personality traits with response to pharmacotherapy for 217 depressed outpatients using the Sociotropy-Autonomy Scale. Sociotropy was related to nonendogenous depression, whereas autonomy was related to endogenous depression. Subjects who had high autonomous-low sociotropic traits showed greater response to antidepressants (and greater drug-placebo differences) than those who had high sociotropic-low autonomous traits (who showed no drug-placebo differences). Hierarchical multiple regression analysis showed that the sociotropy-autonomy, but not the endogenous-nonendogenous, distinction was a predictor of drug treatment response. The combination of endogeneity and autonomy predicted response to placebo. If replicated, these findings may enable better matching of patient traits to various treatment modalities for depression.

Adult↗
PubMed1991

Measurement and interrelations of psychiatric symptomatology in inpatients.

For 152 psychiatric inpatients scores on the Beck Depression Scale, State form of the State-Trait Anxiety Inventory, the Self-report Inventory, Hopelessness Scale and 3 MMPI scales, Hypochondriasis, Schizophrenia, and Hypomania, were factor analyzed. The two factors appeared to confirm Gotlib's 1984 suggestion that such questionnaires measure general distress, as responding endorses negative affect.

Adult↗
PubMed1991

Late potentials and ejection fraction at hospital discharge: prognostic value in thrombolyzed and non-thrombolyzed patients. A preliminary report. The Belgian Working Group for Signal Averaging.

The prognostic value of the use of thrombolytic therapy (TL), the ejection fraction (EF) and the presence of late potentials (LP) in the signal-averaged ECG (filter less than 40 Hz) at the time of hospital discharge was assessed in a multicenter prospective study. This report presents the follow-up at 4 months of the first 263 patients. Thrombolytic therapy was given to 41%. The mean ejection fraction was 45%. The average duration of the high frequency QRS complex (HFQRS) was 104 ms. The mean duration of the terminal signal under 40 microV (D40) was 31 ms. The combination of both HFQRS greater than 110 ms and a D40 greater than 40 ms was considered as presence of LP. The cardiac mortality at 4 months was 5.7% (15 patients). Late ventricular tachycardia or fibrillation occurred in 2.3% (6 patients). The relative risk (RR) for cardiac death or late events was 5.14 with a 95% confidence interval (CI) of 1.2 to 22.0 when no thrombolytic therapy was used. The RR was 3.39 (CI: 1.4 to 8.4) for patients with an EF lower than 30%. The single most important electrocardiographic parameter was a D40 greater than 40 ms (RR: 3.14, CI: 1.3 to 7.8). The presence of LP had a RR of 4.28 (CI: 1.7 to 10.5). With stepwise regression analysis it was evident that cardiac function and information obtained by signal averaging offered independent prognostic information. The presence of LP at hospital discharge after acute infarction offers additional prognostic information to EF for the risk of later cardiac death, especially in patients without thrombolysis.

Aged↗
PubMed1990

Detection of late potentials on the averaged QRS signal recorded at rest and during a standardized stress test after acute myocardial infarction.

The high-amplification signal-averaged ECG (SAECG) allows the detection and analysis of late potentials (LP), which are related to a higher risk of severe ventricular arrhythmias in patients with myocardial disease and coronary artery disease. Because of excessive noise, this technique is usually performed at rest and occasionally immediately after interruption of exercise. Until now, however, it has not been used during exercise. The authors relate in this paper the method and results of the SAECG recorded at rest and during a standard stress test on 30 patients with a recent first myocardial infarction (day 10-14), in good condition, without ECG evidence of significant residual ischemia or bundle branch block. The SAECG was recorded during the steady state of a standardized stress test when a heart rate (HR) corresponding to 80% of the maximal HR was reached during a first test. Three patients had three criteria for LP, three others had two criteria, and two had only one. It has been impossible to analyze the SAECG during exercise because of excessive noise. One patient out of 30 in our study, 21 subjects had normal SAECG at rest and during exercise. None of the 6 patients with more than 1 abnormal criterion at rest became normal during the stress test despite a decrease of the duration criteria in all and an increase of the amplitude (root mean square) the terminal 40 ms (RMS40), as opposed to the 2 patients with just one positive criterion at rest (RMS 40 less than 25 muV) who became normal during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1990

The use of videoendoscopy in the study of fluorescence.

Diagnosis of malignancies by means of fluorescence detection is effected, at present, using fiberoptic endoscopes. Difficulties in the detection of fluorescence arise from the low fluorescent efficiency of the most widely used drug (hematoporphyrin derivative), and from the loss of intensity of the signal within the fiberoptic bundles and the ocular lens of the fiberendoscope. The electronic video-endoscope, carrying a microchip camera at its tip, permits a more sensitive detection of fluorescence, since the signal is drawn directly from the cavities. Furthermore the electronic image, stored in a computer, can be manipulated to produce a more enhanced contrast between the fluorescence of normal and malignant tissues. An example of electronic manipulation would be the subtraction of the image obtained under green light excitation from that obtained under violet light excitation.

Endoscopy↗
PubMed1990

Endogenous and non-endogenous depressions: relations to life events, dysfunctional attitudes and event perceptions.

A comparison was made between endogenous and non-endogenous depressed patients on several characteristics on which they traditionally have been asserted to differ, and which play important roles in cognitive approaches to depression. The non-endogenous patients reported more dysfunctional attitudes and a greater number of recent life events than did endogenous patients. These results support the distinction between endogenous and non-endogenous depressions, and suggest that cognitive theories of aetiology may be more relevant for the latter group. However, both groups perceived their recent upsetting events in relatively maladaptive ways, consistent with the idea that biased perceptions are more related to the depressive state, whereas dysfunctional attitudes may represent a trait vulnerability.

Adaptation, Psychological↗
PubMed1990

Dysfunctional attitudes in depressed patients before and after clinical treatment and in normal control subjects.

To evaluate the role of maladaptive thinking patterns in depression, the authors administered the Dysfunctional Attitude Scale to 112 depressed patients before and after 3-6 weeks of treatment with antidepressants or placebo. Twenty-two normal subjects were also assessed twice. Depressed patients had a significantly higher initial mean score than control subjects, but during treatment their score significantly decreased, and the posttreatment score of those with complete recoveries was nearly as low as the control subjects' final score. The higher the initial dysfunctional attitude score the poorer the response to treatment. Patients with endogenous depression had significantly lower scores than nonendogenously depressed patients.

Adolescent↗
PubMed1990

[Mean high-amplification electrocardiogram during a submaximal exercise test following acute myocardial infarction].

The mean high-amplification ECG (MECG) used to detect delayed potentials (DPs) has so far been used only at rest and after exertion. In this article, the results are reported of recording the MECG at rest and during exercise (ER) obtained in 19 patients, the ER having been carried out at the subacute stage of myocardial infarction. Despite a significant increase in the background noise during exercise from 0.9 microV to 2.2 microV, it was possible to analyse the MECG recorded during exercise to detect DPs in all cases. In this small group of patients, no significant changes occurred with regard to the appearance or delayed potentials during exercise, although there was a reduction in the duration of HFQRS and an increase in the amplitude of RMS40 during exercise which was, however, much less marked in patients presenting DP.

Aged↗
PubMed1989

Relations of sociotropic and autonomous personality characteristics to specific symptoms in depressed patients.

A number of writers have suggested that two sets of personality characteristics are associated both with vulnerabilities to depression in response to different classes of events and with different clinical presentations of depression. The present study examined the relations between levels of sociotropic and autonomous personality characteristics and specific, theoretically derived clusters of symptoms in 80 unipolar depressed patients. As was predicted, sociotropy was related to the cluster of symptoms associated with the concept of anxious-reactive depression and was unrelated to the autonomous symptoms cluster. In contrast, the predicted relations of autonomous personality characteristics and symptoms were not found. These results support the idea that the symptom picture in depression may be related to personality characteristics, but they also suggest that the measurement of autonomy may require revision.

Adolescent↗
PubMed1989

Radionuclide assessment of right ventricular regional wall motion abnormalities in anterior left ventricular infarction.

Because of its potential use in the detection of right ventricular myocardial infarction, we performed radionuclide ventriculography in 80 consecutive cases of electrocardiographically anterior acute MI. Regional wall motion of both ventricles was studied on amplitude-phase images. Forty-five patients (56%) showed normal right ventricular function and 35 (44%) regional right ventricular dyskinesia: 19 in the septal, 14 in the apical and 2 in the free wall region. Right ventricular septal, respectively apical asynergy were virtually always associated with asynergy in the homologous parts of the left ventricle. This could be a consequence of the proximity of these regions, or alternatively be due to a common vascular supply. Thus it remains uncertain if asynergy in these regions signifies necrosis of part of the right ventricular wall. Free wall asynergy was considered as evidence of right ventricular wall necrosis. Thus, in our study group the prevalence of right ventricular myocardial infarction in anterior left ventricular myocardial infarction was at least 2.5%.

Adult↗
PubMed1989

Gastric emptying of liquids after highly selective vagotomy for duodenal ulcer.

In a group of clinical patients with duodenal ulcer submitted to highly selective vagotomy, gastric emptying studies were performed pre-operatively and 2 weeks and 6 months after surgery. A standard liquid meal labeled with radioactive technetium was used for scanning. In this group of duodenal ulcer patients, no abnormal emptying was noted prior to surgery as compared with controls. After highly selective vagotomy, the gastric emptying time for liquids was statistically shorter as compared with preoperative values. It is concluded that highly selective vagotomy may be the operative treatment of choice for duodenal ulcer patients with respect to acid secretion, but that it alters gastric motility and emptying significantly.

Duodenal Ulcer↗
PubMed1989

Management of gallstone pancreatitis during pregnancy and the postpartum period.

In a 22 year study, 21 women had acute pancreatitis develop during pregnancy (11 women) or within six weeks post partum (ten women). Gallstones were the cause of the pancreatitis in all. Operation during the acute attack of pancreatitis was required in only two. Acute pancreatitis subsided in the remaining 19 patients; they were operated upon during the second trimester or the early postpartum period. During pregnancy, surgical treatment for gallstone pancreatitis should consist of cholecystectomy and exploration of the common bile duct without operative cholangiography. During the postpartum period, operative cholangiography is used to determine whether or not exploration of the common bile duct is necessary. Acute pancreatitis associated with pregnancy is "gallstone" pancreatitis; there is no evidence that pregnancy is a specific etiologic factor in pancreatitis. As opposed to nonoperative treatment of symptomatic gallstone pancreatitis in pregnancy, which is accompanied by maternal morbidity or fetal mortality, surgical treatment during the optimal time of the second trimester or early postpartum period was associated with no maternal morbidity or fetal mortality and no recurrent pancreatitis.

Acute Disease↗
PubMed1989

Echocardiography and magnetic resonance imaging in cardiac amyloidosis.

Cardiac amyloidosis is an uncommon cause of heart failure. Based on an observation of immunocytic cardiac amyloidosis with a fatal course, the diagnostic modalities are reviewed with special emphasis on echocardiographic findings. The possible role of magnetic resonance imaging is discussed.

Amyloidosis↗
PubMed1988

Personal vulnerability, life events, and depressive symptoms: a test of a specific interactional model.

We tested Beck's (1983) hypothesis that depressive symptoms occur when an individual experiences a negative life event that specifically matches the individual's personal motivational vulnerability. Ninety-eight undergraduates completed measures of depression level, recent life events, and sociotropic and autonomous achievement motivations. Consistent with the theory, sociotropy was associated with depression level and also served as a moderator of the relations between depression and frequency of recent negative social events. However, sociotropy also demonstrated nonpredicted interactive effects with negative events categorized a priori as autonomy related. Autonomy was unrelated to depression and showed no evidence of being a vulnerability to any type of life event. The findings generally support the value of examining the role in depression of interactions between personality characteristics and life events, although they do not support the specific matching predictions.

Achievement↗