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Biomedical subjects

R Arora

Publications and source records attributed to R Arora.

At least 181 records · Page 10Linked to original sources
PubMed1990

Oral metoprolol therapy in dilated cardiomyopathy: hemodynamic evidence for improved diastolic function accompanying amelioration of symptoms.

Twenty patients with dilated cardiomyopathy (11 males and 9 females) aged from 14 to 54 (37.3 +/- 10.5) years were treated orally with metoprolol (dose 37.5 mg-100 mg/day, mean 91 +/- 18.6 mg/day) after a baseline hemodynamic study. On follow-up, all patients showed improvement in symptomatic status by at least one NYHA class within 2 to 4 weeks of the initiation of therapy. Repeat right heart study and left ventricular angiography (venous digital subtraction angiography) afer 3 to 6 months of treatment in 10 patients showed a fall in the mean pulmonary arterial wedge pressure from 24.4 +/- 9.6 to 12.8 +/- 7.7 mm Hg (P = 0.025), right ventricular end-diastolic pressure from 8.8 +/- 4.7 mm Hg to 4.5 +/- 1.9 mm Hg (P = 0.025) and mean pulmonary arterial pressure from 34.2 +/- 12.4 mm Hg to 25.9 +/- 10.9 mm Hg (P less than 0.01). There was no significant change in the left ventricular ejection fraction (18.7 +/- 1.6% vs. 22 +/- 0.48%, P = NS) or cardiac index (2.2 +/- 0.48 l/m/m2 to 2.12 +/- 0.68 l/m/m2, P = NS). These hemodynamic results indicate that the improvement in symptoms and congestive cardiac failure produced by treatment with metoprolol in patients having dilated cardiomyopathy is related to improvement in diastolic function of the myocardium.

Adolescent↗
PubMed1990

Mitral atresia with double outlet right ventricle in an asymptomatic adult.

We report a 20-year-old male patient with mitral atresia, double outlet right ventricle, subaortic ventricular septal defect, valvar pulmonary stenosis and an aneurysm of atrial septum who presented with minimal effort tolerance and cyanosis. The morphological features were confirmed by cross-sectional echocardiography and cine-angiocardiography.

Adult↗
PubMed1990

Preliminary observations on effect of Lactobacillus sporogenes on serum lipid levels in hypercholesterolemic patients.

Short term hypolipidemic effects of oral L. sporogenes therapy (360 million spores/day in tablet form) were studied in 17 patients with type II hyperlipidemia in an open label fixed dose trial. Total serum cholesterol (330 +/- 55 mg/dl vs 226 +/- 46 mg/dl, P less than 0.001), LDL-cholesterol (267 +/- 58 mg/dl vs 173 +/- 54 mg/dl, P less than 0.001) and total cholesterol to HDL cholesterol and LDL-cholesterol to HDL-cholesterol ratios (P less than 0.001) were reduced significantly over a period of three months. HDL-cholesterol was marginally increased (43.6 +/- 7 mg/dl vs 46.8 +/- 8.9 mg/dl, P less than 0.05); however there was no change in serum triglyceride levels.

Adult↗
PubMed1990

Temporary conduction block of optic nerve after retrobulbar anesthesia.

Three patients who experienced temporary visual loss after retrobulbar anesthesia with 2% lidocaine (Xylocaine) are described. Visual evoked potentials (VEPs) consistently increased in latency and decreased in amplitude. Abnormal VEPs such as these recorded for humans after retrobulbar anesthesia are, to our knowledge, reported here for the first time.

Adult↗
PubMed1989

Effect of ursodeoxycholic acid on bile acid metabolism in primary biliary cirrhosis.

We have compared the effect of ursodeoxycholic acid with placebo on the clinical state, blood liver chemistries and serum and urinary bile acids in four patients with primary biliary cirrhosis. All parameters were evaluated monthly, and bile acid composition was measured by capillary gas-liquid chromatography. At the time of admission, all patients showed intense pruritus, and their serum alkaline phosphatase, AST and ALT levels were elevated 4.3, 2.7 and 2.3 times over control values. Serum bile acids were elevated almost 38-fold with 2.5 times more cholic acid than chenodeoxycholic acid. Urinary bile acid output was elevated 28 times the control values, and 36% were 1 beta-hydroxycholic acid, 1 beta-hydroxydeoxycholic acid and hyocholic acid (3 alpha,6 alpha, 7 alpha-trihydroxy-5 beta-cholanoic acid). Three months of placebo administration did not significantly affect the clinical or biochemical presentations, and the serum and urinary bile acid composition did not change. In contrast, ursodeoxycholic acid feeding (12 to 15 mg per kg per day) for 6 months abolished pruritus in two and lessened itching in two subjects and reduced serum alkaline phosphatase, AST and ALT levels by 21, 35 and 47%, respectively. The mean values for the total serum bile acid concentrations in these patients declined 26% from the pretreatment value, but the proportion of ursodeoxycholic acid increased from 3 to 40% of the total bile acids; thus, total fasting serum endogenous bile acid levels decreased almost 50%. Similar changes were noted in the urinary bile acids, in which ursodeoxycholic acid became the major bile acid, and approximately 18% were hydroxylated at C-1, C-6 and C-21.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Percutaneous balloon mitral valvuloplasty in children and young adults with rheumatic mitral stenosis.

Twenty-eight patients with mitral stenosis, 17 females and 11 males, underwent percutaneous balloon mitral valvuloplasty (BMV). The age range was 10 to 30 (mean 17.8 +/- 6.7) years and all were symptomatic (New York Heart Association [NYHA] class III, 12 patients; class IV, 16 patients). BMV was done with a single balloon in 10 patients and double balloon in 16 patients. Following BMV, there was a significant reduction in transmitral end-diastolic pressure gradient from 23.1 +/- 5.8 to 7.6 +/- 4.2 mm Hg (p less than 0.001) and a significant increase in mitral valve area from 1.06 +/- 0.29 to 2.64 +/- 1.35 cm2 (p less than 0.001), along with an increase in cardiac index from 3.40 +/- 1.18 to 4.26 +/- 1.46 L/min/m2 (p less than 0.01). Improvement in symptomatic status by at least one NYHA class was seen in all patients. Mild mitral regurgitation developed in four and moderate mitral regurgitation developed in one patient. Angiographic evidence of atrial septal defect was present in one patient. Follow-up at 8 to 12 weeks in 12 patients has shown sustained hemodynamic improvement. These short-term results indicate that BMV is an effective nonsurgical procedure for the management of patients with rheumatic mitral stenosis.

Adolescent↗
PubMed1989

Rudimentary dysplastic valvar tissue guarding the tricuspid orifice with dilatation of the right ventricle and a patent outflow tract.

Tricuspid regurgitation due to rudimentary and dysplastic tricuspid valvar tissue associated with a patent right ventricular outflow tract is described in a 10-year-old child presenting with cyanosis since birth. The diagnosis was confirmed by cross-sectional echocardiography, angiocardiography and subsequently by histopathological data. We discuss the differentiation of these findings from Uhl's anomaly and from the congenitally unguarded tricuspid orifice.

Child↗
PubMed1989

Determinants of abnormal left ventricular filling in early hypertension.

Thirty-seven untreated subjects with borderline or mild hypertension were studied to establish the prevalence and clinical characteristics associated with abnormal left ventricular filling in this disorder. Subjects were referred to this study because of casual office blood pressure measurements of greater than or equal to 140/90 mm Hg; all were less than 50 years old, had no other cardiovascular or systemic disease and had not received antihypertensive medication for at least 1 year. To precisely determine blood pressure, measurements were made over 30 min with the patient in the supine position and during awake hours with ambulatory monitoring. Left ventricular mass was determined echocardiographically, and Doppler echocardiography was used to assess left ventricular filling. No subject had increased left ventricular mass, but 8 (22%) of the 37 had abnormal left ventricular filling. All eight subjects with abnormal left ventricular filling had an ambulatory systolic blood pressure greater than 130 mm Hg and a supine systolic blood pressure greater than 122 mm Hg. Abnormal filling was not related to left ventricular mass or heart rate. In multivariate analysis, the degree of abnormal filling could best be predicted from a combination of age and supine systolic blood pressure (r = 0.69; p less than 0.001). This study suggests that in untreated early essential hypertension, abnormal left ventricular filling is present in greater than 20% of subjects, precedes detectable left ventricular hypertrophy and is related to age and prevailing level of blood pressure.

Adult↗
PubMed1989

Relative sensitivity of photosynthesis and respiration to freeze-thaw stress in herbaceous species : importance of realistic freeze-thaw protocols.

The relative effect of a freeze-thaw cycle on photosynthesis, respiration, and ion leakage of potato leaf tissue was examined in two potato species, Solanum acaule Bitt. and Solanum commersonii Dun. Photosynthesis was found to be much more sensitive to freezing stress than was respiration, and demonstrated more than a 60% inhibition before any impairment of respiratory function was observed. Photosynthesis showed a slight to moderate inhibition when only 5 to 10% of the total electrolytes had leaked from the tissue (reversible injury). This was in contrast to respiration which showed no impairment until temperatures at which about 50% ion leakage (irreversible injury) had occurred. The influence of freeze-thaw protocol was further examined in S. acaule and S. commersonii, in order to explore discrepancies in the literature as to the relative sensitivities of photosynthesis and respiration. As bath cooling rates increased from 1 degrees C/hour to about 3 or 6 degrees C/hour, there was a dramatic increase in the level of damage to all measured cellular functions. The initiation of ice formation in deeply supercooled tissue caused even greater damage. As the cooling rates used in stress treatments increased, the differential sensitivity between photosynthesis and respiration nearly disappeared. Examination of agriculturally relevant, climatological data from an 11 year period confirmed that air cooling rates in the freezing range do not exceed 2 degrees C/hour. It was demonstrated, in the studies presented here, that simply increasing the actual cooling rate from 1.0 to 2.9 degrees C/hour, in frozen tissue from paired leaflet halves, meant the difference between cell survival and cell death.

Journal Article↗
PubMed1989

Characterization of serum and urinary bile acids in patients with primary biliary cirrhosis by gas-liquid chromatography-mass spectrometry: effect of ursodeoxycholic acid treatment.

We have studied the effect of ursodeoxycholic acid on the serum and urinary bile acids in seven patients with moderate to severe primary biliary cirrhosis. Bile acids were characterized by gas-liquid chromatography-mass spectrometry and quantified by capillary gas-liquid chromatography. Serum bile acids were elevated 26-fold over control values, with 2.2 times more cholic acid than chenodeoxycholic acid. Urinary bile acid output was elevated 22-fold over control values with a cholic acid:chenodeoxycholic acid ratio of 1.6. In addition, lithocholic acid, deoxycholic acid, ursodeoxycholic acid, 1 beta-hydroxycholic acid, 1 beta-hydroxydeoxycholic acid, and hyocholic acid were identified in both serum and urine; the proportions of the 1- and 6-hydroxylated bile acids were much higher in urine than in serum of the patients (32.1% versus 4.2%). Three months of placebo administration did not change the serum and urinary bile acid composition. In contrast, ursodeoxycholic acid feeding (12-15 mg/kg body weight per day) for 6 months resulted in a 25% decline in the total serum bile acid concentration from the pretreatment values. The proportion of ursodeoxycholic acid increased from 2.1 to 41.2% of total bile acids, so that total fasting serum endogenous bile acid levels decreased 62.4%. Ursodeoxycholic acid feeding substantially increased urinary bile acid output, with ursodeoxycholic acid comprising 58.1%. The proportion of 1- and 6- hydroxylated endogenous bile acids was reduced by 45.5% from pretreatment levels and approximately 4.5% of the urinary bile acids were omega-muricholic acid, 1 beta-hydroxyursodeoxycholic acid, and 21-hydroxyursodeoxycholic acid. These results demonstrate significant changes in the serum and urinary bile acid pattern in primary biliary cirrhosis during ursodeoxycholic acid treatment. The beneficial effect of ursodeoxycholic acid may be due to reduction of the hydroxylated derivatives of endogenous bile acids together with the appearance of hydroxylated derivatives of ursodeoxycholic acid or it may be due to displacement of the more hydrophobic endogenous bile acids by the hydrophilic ursodeoxycholic acid.

Bile Acids and Salts↗
PubMed1988

The role of ischemia and ventricular asynergy in the genesis of exercise-induced ST elevation.

Sixty-five patients with ST elevation were retrospectively studied in order to evaluate the clinical significance and underlying mechanisms of ST-segment elevation during exercise. Of these, 50 patients had previous myocardial infarction (Group I) and 15 patients did not (Group II). Exercise thallium-201 imaging was performed on 30 patients, resting gated blood pool imaging was performed on 33 patients, and 23 underwent cardiac catheterization for clinical indications. When the two groups were compared, patients in Group I had more frequent multivessel disease (9/13 vs. 3/10, p less than 0.05), anterior infarctions (33/50 vs. 4/10, p less than 0.02), while Group II patients had more frequent single-vessel disease (7/10 vs. 4/13, p less than 0.05). For Group I patients, the most common reason for termination of exercise was fatigue and/or dyspnea (35/50 vs. 0/15, p less than 0.05), with an irreversible defect noted in both stress and delayed views on thallium imaging (20/24 vs. 1/6, p less than 0.05). In Group II, the most common reason for termination was angina (15/15 vs. 2/50, p less than 0.001), with reversible thallium defects noted more frequently (4/6 vs. 3/24, p less than 0.01). Thus, we conclude that in patients with Q waves, left ventricular dysfunction rather than ischemia is the mechanism for ST elevation. In these patients angina is rare, but fatigue, dyspnea, multivessel disease, and fixed thallium defects are common. In patients with non-Q-wave exertional ST elevation, ischemia is the rule, manifested by frequent chest pain and reversible thallium defects.

Adult↗