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Biomedical subjects

P Weiss

Publications and source records attributed to P Weiss.

At least 145 records · Page 8Linked to original sources
PubMed1990

[Short-term dobutamine therapy in severe cardiac insufficiency].

The feasibility of heart transplantation has stimulated new interest in the therapy of severe refractory congestive heart failure even as an interim solution. We studied the hemodynamics, clinical efficacy and practical implications of a 72-hour dobutamine infusion in 11 patients with NYHA IV refractory congestive heart failure (age 40-73, average 55 years). The dose was 250-1000 micrograms/min, with the goal of increasing cardiac output by 30-50%. Changes in the pharmacokinetics of lidocaine were studied by single dose kinetics in 7 patients. Cardiac output increased from 2.94 +/- 0.68 to 4.77 +/- 1.1 l/min and stroke volume from 35 +/- 10 to 56 +/- 12 ml (p less than 0.001). Pulmonary capillary wedge pressure decreased from 28.5 +/- 5 to 21 +/- 6 and central venous pressure from 14 +/- 6 to 7 +/- 3 mm Hg (p less than 0.007). There was marked worsening of hemodynamics 24-48 h after starting dobutamine. However, after withdrawal of dobutamine a significantly higher cardiac output and stroke volume (3.73 +/- 0.43 l/min, 42 +/- 7 mm Hg. p less than 0.05) persisted. Both clearance and distribution volume of lidocaine increased, while half life decreased significantly (6.61 +/- 1.43 to 5.33 +/- 0.77 h. p less than 0.05). 9 of 11 patients developed Lown IVb ventricular arrhythmia, while in 4 massive diuresis occurred necessitating volume substitution. 6 patients left hospital clinically improved, 2 were transplanted and 3 patients died 1 day to 3 weeks after ending dobutamine. Dobutamine had salutary hemodynamic and clinical effects outlasting the duration of dobutamine therapy. Due to its arrhythmogenic effects it should be administered under ECG monitoring. In patients treated with lidocaine, upward dose adjustments may be necessary with improving hemodynamics.

Adult↗
PubMed1990

Progressive functional deterioration of bioprostheses assessed by Doppler ultrasonography.

Doppler echocardiography was used to study the function of bioprosthetic heart valves by noninvasive means in 32 patients aged 29 to 72 years at various postoperative intervals. There were 24 Ionescu-Shiley, four Hancock, and four Carpentier-Edwards prostheses, 19 in the aortic and 13 in the mitral position. Initial studies were performed at a mean of 2.3 years after implantation and were repeated one, two, and three years thereafter. Flow velocities in the mitral orifice, left ventricular outflow tract, and ascending aorta, as well as mitral pressure half-time, were measured from pulsed-wave or continuous-wave Doppler recordings. Mitral and aortic valve areas and aortic pressure gradients were calculated. In aortic prostheses the valve area decreased and pressure gradient increased progressively in relation to the time from implantation. The mean value (+/- SD) of the aortic valve area was 67 +/- 17 percent of the manufacturer's nominal value at the first examination and 57 +/- 20 percent one year later, 51 +/- 14 percent two years later, and 46 +/- 11 percent three years later (overall differences, p less than 0.01). In mitral prostheses, reduction of the valve area was not related to the time from implantation. The mean mitral valve area was 45 +/- 12 percent of the nominal value at rest and increased to 68 +/- 18 percent during exercise at a mean of 45 months after implantation. There was no change in these values at the one-year repeat study. It is concluded that in a population with predominantly pericardial bioprostheses, (1) aortic tissue prostheses showed a progressive functional deterioration demonstrable by Doppler echocardiography, most probably due to degenerative changes; and (2) in mitral tissue prostheses, there was no significant reduction of orifice area in relation to time from implantation. Reduction of mitral valve areas may, to some extent, reflect a less than full opening at rest.

Aortic Valve↗
PubMed1990

The integration of computers into the occupational therapy department.

Despite the growing interest in and use of microcomputers as an occupational therapy assessment and treatment modality, many factors still limit their widespread adoption in the clinical milieu. Such factors include inadequate background preparation; insufficient financial resources; the overwhelming number of choices of computer hardware, software, and adaptive devices; lack of product support; rapidity of change; and skepticism of administrators and clinicians. The purpose of this paper is to outline procedures that will facilitate the integration of microcomputers into the clinical milieu by (a) identifying the reasons why and how these devices are used improperly; (b) proposing ways to correct these problems; (c) providing recommendations concerning the acquisition of major microcomputer hardware, software, and adaptations; and (d) providing an annotated list of resources for further information.

Attitude to Computers↗
PubMed1990

[Sexual and nonsexual crimes of patients institutionalized for treatment of sex offenses].

The authors compare the sexual and non-sexual criminality of five of the most frequent diagnostic groups of patients having sexuological in-patient treatment: homosexual delinquents, sexual aggressors, delinquents with polymorphous deviate activities, heterosexual peadophils and exhibitionists. The large number of individuals prosecuted for non-sexual crimes in the group (42%) is surprising, although in all diagnostic groups non-sexual delinquency of patients is lower than sexual delinquency. In the sexual sphere the criminal relapse rate is higher in patients with deviant activity (exhibitionists, sexual aggressors and polymorphous deviant subjects), in the non-sexual sphere in patients with deviations as regards the object (in particular in homosexuals). The results provide evidence of the necessity of more widely conceived provisions within the framework of the therapeutic and preventive approach to this type of patients.

Adult↗
PubMed1990

[Anti-angina effect of amiodarone versus delayed-action propranolol. A double-blind randomized study].

Long-acting Propranolol (160 mg/day) and Amiodarone (200 mg/day after impregnation) were compared in chronic stable angina pectoris. Forty-three patients with stable angina of effort were included in a randomised double blind trial (19 in the amiodarone and 24 in the propranolol group). The duration of the study was 8 weeks; the placebo phase (2 weeks) was followed by 6 weeks of active treatment. An exercise stress test was performed before and after the treatment period. The number of episodes of angina and the consumption of glyceryl trinitrate decreased significantly (p less than 0.001) in the same proportion with both drugs with respect to the placebo period. The time to the appearance of criteria of positivity of the exercise stress test increased from 6.82 +/- 0.50 mn to 8.35 +/- 0.50 mn with amiodarone, and from 7.15 +/- 0.47 mn to 9.50 +/- 0.52 with the propranolol preparation. This improvement was very significant compared with the placebo phase (p less than 0.001) but the difference between the two drugs was not statistically significant (p = 0.39). The other parameters which were studied (time to onset of angina, total duration of exercise, maximum heart rate, double product, maximum ST depression) changed in a parallel fashion significantly versus placebo. There were no differences between the two treatment groups with the exception of the resting heart rate which decreased more in patients on propranolol (80.94 +/- 3.92 to 62.47 +/- 1.97) than in patients on amiodarone (84.87 +/- 2.63 to 73.41 +/- 2.01; p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[The effect of marital relations of the parents on the level of general adaptation in sexual offenders].

The authors seek in a group of 297 treated sexual delinquents differences between the group of patients perceiving the relationship of their parents during childhood as harmonious and the group of those who consider it disharmonious. The assembled results are unequivocally to the disadvantage of patients of the second group. The authors found the most marked differences in the sphere of basic psychiatric characteristics (higher number of patients with psychiatric heredity, suicides in the family, alcoholism), characteristics of the initial family (higher incidence of fathers and mothers who were alcoholics, convicted fathers patients with abnormal relations with parents and siblings, spending part of the childhood without the family) and in the sphere of social adaptation (more frequently incomplete basic education, no skilled training, more frequent absenteeism and fluctuations at work). In the sphere of adaptation to partnership and as regards forensic sexological characteristics, there was a less significant, nevertheless convincing, trend shifting the patients from disharmonious families in a direction unfavourable for them. According to the authors' view it may be assumed that these findings are consistent with similar results in other groups of subjects with social problems and that they may be rather associated with a generally criminogenic influence of dysfunctional nuclear families in the delinquent population.

Adult↗
PubMed1989

Identification of the metabolic defect in sialuria.

Sialuria is a rare inborn error of metabolism, the hallmarks of which are moderate developmental retardation, coarse facial features, and an enormous amount of free N-acetylneuraminic acid (sialic acid) in the urine. Until now, the basic biochemical defect in this disorder has remained uncertain. In this report, the activity of the rate-limiting enzyme in the biosynthesis of sialic acid has been measured directly in whole cell lysates by a highly sensitive assay. With this technique, the basic defect in sialuria has been identified unequivocally as the loss of feedback control of uridine diphosphate N-acetylglucosamine 2-epimerase by cytidine monophosphate N-acetylneuraminic acid with resultant overproduction of sialic acid.

Carbohydrate Epimerases↗
PubMed1989

Ligand-induced modulation of the hepatic receptor for asialoglycoproteins. Evidence for the role of cell surface hyposialylation.

In a previous paper, we reported a ligand-induced modulation of the asialoglycoprotein receptors on HepG2 cells whereby these receptors were rendered functionally inert while remaining immunologically intact on the plasma membrane. At that time, it was speculated that the loss in receptor-binding ability was a direct result of a concomitant decrease in cell surface sialic acid residues. Experiments designed to test that hypothesis are presented. The results revealed: 1) an identical response in binding activity and sialic acid content in cells subjected to minimal exposure to neuraminidase; 2) a parallel and synchronous recovery of both parameters following modulation; 3) an invariant binding of high affinity ligands, and 4) the ability of galactose oxidase to restore, at least partially, the cell's ability to bind asialoglycoprotein. These results indicate that ligand-induced surface hyposialylation directly diminishes expression of the asialoglycoprotein receptor.

Asialoglycoprotein Receptor↗
PubMed1989

[Transthoracic color Doppler echocardiography in the diagnosis of insufficiency of heart valve prostheses. A comparison with conventional Doppler sonography].

Color-coded and conventional pulsed wave/continuous wave Doppler detection of valvular or paravalvular regurgitation in 59 patients with 67 cardiac valve prostheses were compared; 21 patients had known regurgitation determined by auscultation. Analysis of the color-coded Doppler findings was made from videotape and blinded as to patient identity and clinical findings. Conventional Doppler Sonography detected 36 instances of aortic and 3 of mitral prosthetic regurgitation. Color-coded Doppler investigation detected 27 instances of aortic and 1 of mitral prosthetic regurgitation resulting in a sensitivity of 72% and specificity of 100% as compared to conventional Doppler sonography. All 21 patients with a regurgitant murmur had pathological conventional Doppler findings, but 3 of them did not show regurgitant flow in the color-coded Doppler examination. The apical four chamber view contributed most to the colour-coded Doppler detection of regurgitant flow, followed by the parasternal long axis view.

Adult↗
PubMed1989

Population pharmacokinetics of tobramycin.

1. Population pharmacokinetic parameters of tobramycin were determined in a heterogenous group of 97 patients using serum samples drawn for the routine monitoring of tobramycin concentrations, following multiple dosing regimens. 2. To describe the accumulation kinetics of tobramycin a two-compartment pharmacokinetic model was required. The best fit to the data was obtained when drug clearance (1 h-1) was related linearly to creatinine clearance (proportionality constant: 0.059 +/- 0.002 x CLcr (ml min-1)) and initial volume of distribution (1) was related linearly to body weight (proportionality constant: 0.327 +/- 0.014 x body weight (kg)). The intersubject variability in these two parameters was 32% and 3%, respectively, whilst the residual or intrasubject variability amounted to 21% of the tobramycin concentration. The terminal half-life of tobramycin, 26.6 +/- 9.4 h, was appreciably shorter than previously reported. 3. The population pharmacokinetic model was validated against data obtained from 34 independent patients and the predicted and observed concentrations were found to be in good agreement. The population pharmacokinetic model was used to design a priori dosing recommendations for tobramycin.

Adolescent↗
PubMed1989

[Forensic and sexual characteristics in patients undergoing institutional sex therapy].

Based on the examination of 238 patients having institutional sexuological treatment, the author assessed the basic differences between homosexual sexual delinquents, sexual aggressors, polymorphic sexual delinquents, paedophiliacs and exhibitionists as regards the number of sentences on account of sexual delicts in the case-history, the presence of alcohol during the sexual delict, antialcoholic treatment in the past, the number of sexuological treatments received, age when the first sexual abnormal manifestations occurred, the age when first prosecuted on account of sexual delinquency and the diagnosis of the deviation.

Adult↗
PubMed1989

[Sexologic forensic expert evaluation of sex offenders].

The authors differentiate between deviant and nondeviant sexual delinquents and focus attention in particular on the forensic evaluation of deviantly conditioned delinquents. They describe some differences in the psychosexual development of deviant delinquents and some anamnestic facts which signalize a deviant structure of the sexual motivation system. They emphasize the necessity of a comprehensive examination of the delinquent, incl. thorough sex diagnosis, psychological diagnosis of the personality, a detailed analysis of controlling and recognizing ability of the time of the crime and they submit suggestions for health measures.

Humans↗