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Biomedical subjects

R Gorlin

Publications and source records attributed to R Gorlin.

At least 37 records · Page 2Linked to original sources
PubMed1992

Fish oils in the prevention of atherosclerosis.

The hypothesis that oils derived from the flesh of fish and marine mammals inhibit the atherosclerotic process is critically reviewed. Populations consuming a diet rich in fish have low rates of coronary heart disease. Dietary fish oil is associated with changes in serum lipids, prostaglandin and leukotriene metabolism, enhanced endothelial function and effects on growth factors released from platelets, leukocytes and endothelial cells. Dietary fish oil supplementation has been associated with inhibition of atherosclerosis experimentally induced by dietary hyperlipidemia and balloon injury. Results of studies of the use of fish oil to inhibit postangioplasty restenosis in human subjects have been inconclusive.

Animals↗
PubMed1992

Russek Lecture. Must cardiology lose its heart?

Regulations and restrictions imposed by external agencies are forcing cardiologists into an unnatural self-protective and defensive posture against their patients. The key to breaking the pattern of mutual skepticism and mistrust lies in returning the focus to its rightful place: the patients' needs. Thus, payment systems must be devised that reward cognitive skills, time spent with patients and continuity of care as they reward technologic interventions and procedures. In advocating necessary changes in the system, only physicians themselves can provide a convincing voice in the political arena. They must look beyond their own self-interest to recapture the moral and ethical high ground where the best care of their patients and their own professional satisfaction stand side by side.

Cardiology↗
PubMed1992

Polycystic ovary syndrome: lack of hypertension despite profound insulin resistance.

It has been hypothesized that insulin resistance and hyperinsulinemia contribute to the development of arterial hypertension. To further investigate this relationship, we compared arterial blood pressure in controls and women with polycystic ovary syndrome (PCO), an insulin-resistant state. Fourteen PCO women and 18 normal control women of similar age, body mass index, and race were studied. Plasma glucose and insulin levels were determined in an oral glucose tolerance test. The insulin sensitivity (SI) index was determined by the minimal model method. Systolic and diastolic blood pressure were measured by 24-h ambulatory monitoring. Left ventricular mass was assessed by echocardiography. The two groups had comparable fasting glucose levels, but the 2-h postload glucose was higher in PCO (8.0 +/- 0.5 vs. 5.6 +/- 0.3 mmol/L; P less than 0.001). Compared to controls, PCO women were significantly more insulin resistant by fasting insulin, 2-h insulin concentrations, and SI (28.3 +/- 6.7 vs. 68.3 +/- 10.0 min-1/nmol.mL; P less than 0.01). Average ambulatory systolic (121 +/- 2 vs. 118 +/- 2 mm Hg) and diastolic (76 +/- 2 vs. 73 +/- 2 mm Hg) blood pressures were similar for PCO and control women. No difference was found in left ventricular mass. Therefore, despite profound insulin resistance and hyperinsulinemia, women with PCO do not have increased arterial pressure or left ventricular mass.

Adult↗
PubMed1991

Thrombosis-related markers in unstable angina pectoris.

While thrombus formation has been implicated in the pathogenesis of unstable angina, the value of thrombus-related markers for distinguishing unstable from stable angina is not well defined. Fibrin D-dimer and plasminogen activator inhibitor were prospectively analyzed in the peripheral blood of 46 patients (26 with unstable angina and 20 with stable angina or normal coronary arteries). Baseline blood samples were drawn within 24 h after rest pain in patients with unstable angina and in 19 of these 26 patients in less than 6 h. In patients with unstable angina, mean +/- SD (median) values for fibrin D-dimer and plasminogen activator inhibitor values measured 0.09 +/- 0.06 (0.07) microgram/ml and 9.1 +/- 9.6 (5.9) IU, respectively, compared to 0.11 +/- 0.10 (0.05) microgram/ml and 5.5 +/- 1.9 (5.0) IU/ml, in patients in the control group (p = NS for all comparisons between the two groups). Recurrent in-hospital pain, coronary anatomy and need for intervention showed no relation to the levels of these markers. In 19 additional patients (9 with unstable angina and 10 control patients) samples from the coronary sinus and the peripheral blood were also analyzed. Again, in patients with unstable angina all samples were drawn less than 24 h after rest pain; in six of nine patients samples were drawn in less than 6 h. A coronary sinus to peripheral blood gradient for either of these markers could not be demonstrated. The differences between peripheral and coronary sinus D-dimer and plasminogen activator inhibitor concentrations were also similar in patients with unstable angina and control patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Hypertension and vascular disease in the 1990s.

Many pharmacologic agents are effective in normalizing blood pressure in the hypertensive patient. The major issues in antihypertensive therapy today transcend control of blood pressure and focus, instead, on safety considerations, patient acceptance, and additional benefits to target organs. With the drugs currently available, 10-15% of patients withdraw from therapy because of undesirable clinical side effects. Nonclinical side effects such as hyperlipidemia, hypokalemia, and hyperglycemia can limit the clinician's choice of drugs, especially for elderly patients. Antihypertensive agents should also limit target organ damage. The prevalence of stroke can be reduced solely by controlling blood pressure, but inhibition of cardiac ischemic events requires use of specific classes of agents. Beta blockers reduce mortality and reinfarction postmyocardial infarction, whereas angiotensin-converting enzyme (ACE) inhibitors affect several factors leading to heart failure, including cardiac and vascular hypertrophy, remodeling and dilatation postmyocardial infarction, and arrhythmias. Specific actions on intrarenal and other vascular dynamics may make these drugs appropriate for use in patients with diabetes and perhaps hypertensive kidney disease and systemic arterial disease. The range of options available in antihypertensive therapy in the 1990s affords the physician the opportunity to meet additional goals of therapy, specific for each patient.

Antihypertensive Agents↗
PubMed1991

Digitalis and beta-blocking agents: effects on depression following myocardial infarction.

Depression is frequently seen in patients following myocardial infarction (MI), many of whom are receiving digitalis glycosides, beta-blockers, or other agents that may exert central nervous system (CNS) effects. In a prospective study of the clinical significance of post-MI depression, 335 patients were assessed using a standardized diagnostic interview for depression at 8 to 10 days, and 190 were reinterviewed at 3 to 4 months. Patients prescribed digitalis, beta-blockers, or other cardioactive medications at hospital discharge were identified. Logistic regression analyses were performed to determine the contribution of these agents to depression at 3 to 4 months, controlling for medical and sociodemographic factors as well as for baseline depression. Treatment with digitalis predicted depression at 3 to 4 months (p less than 0.05); no other medications, including beta-blockers, predicted depression (p greater than 0.10). Digitalis may have CNS effects that contribute to depression post-MI and this finding should be considered in the differential diagnosis of depression in cardiac patients.

Adrenergic beta-Antagonists↗
PubMed1991

Do we need another antihypertensive agent?

The factors to be considered in selecting antihypertensive agents have traditionally centered around balancing efficacy against adverse side effects. The former can be achieved by a variety of agents alone or in combination. The latter not only involves safety but is also concerned with whether an otherwise safe agent is tolerated by the patient so compliance with the treatment regimen can be achieved. A relatively new consideration is how antihypertensive agents affect other disease states that may or may not be associated with hypertension. For example, how a drug may affect diabetes, gout, myocardial hypertrophy, atherosclerosis, and coronary events must be evaluated. These concerns taken together answer the question of why yet another antihypertensive agent may be needed in the pharmacologic armamentarium.

Adrenergic beta-Antagonists↗
PubMed1990

Angiographic patterns of balloon inflation during percutaneous transluminal coronary angioplasty: role of pressure-diameter curves in studying distensibility and elasticity of the stenotic lesion and the mechanism of dilation.

There are few in vivo data concerning the mechanisms of balloon inflation during coronary angioplasty. To characterize how lesions dilate, videodensitometry was used to measure the diameter of the inflated balloon across 29 coronary lesions in 27 patients. Pressure-diameter curves for each lesion were derived with use of a standardized incremental inflation protocol in which pressures between 2 and 6 atm in 3 mm low profile balloons approximated normal vessel diameter. The diameter of coronary stenosis before and after angioplasty was also measured. Pressure-diameter curves showed that the most improvement in luminal caliber occurred at low inflation pressure. A distensibility factor was defined as the ratio of the amount of balloon inflation at 2 atm compared with the balloon diameter at 6 atm. Eccentric irregular lesions (n = 11) had a greater distensibility factor (0.49 +/- 0.17) than did lesions (n = 18) without this configuration (0.33 +/- 0.14) (p less than 0.02). The former were soft, presumably because of thrombus in these lesions. In addition, there were no differences in patterns of balloon inflation for lesions requiring additional inflation or for dilations resulting in an intimal crack or dissection after angioplasty. There was often a loss of luminal caliber when balloon diameter at 6 atm was compared with the diameter after angioplasty. This was defined as elasticity or recoil. There was a significant direct correlation between the amount of elasticity and the extent of balloon inflation at 6 atm (that is, lesions more fully dilated at 6 atm showed more elasticity).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1989

Balloon valvuloplasty in adult aortic stenosis: determinants of clinical outcome.

STUDY OBJECTIVE: To determine the clinical variables affecting outcome after balloon aortic valvuloplasty. DESIGN: Longitudinal follow-up of consecutive case series. PATIENTS: Consecutive sample of 36 patients with severe calcific aortic stenosis, and without active infection or left ventricular mural thrombus. INTERVENTIONS: Percutaneous transluminal dilatation of the aortic valve until the peak gradient was reduced by 50% or a maximal balloon size was used. Hemodynamic measurements taken before and after dilatation. MEASUREMENTS AND MAIN RESULTS: Thirty-three patients had a successful dilatation. Eighty-nine percent (95% confidence interval [CI]. 74% to 97%) improved symptomatically at 2 weeks, but by 26 weeks only 56% (CI, 35% to 76%) remained improved (P = 0.0078). Mortality rates were high at 8 (9%) and 26 (28%) weeks. Predictors of adverse events included left ventricular ejection fraction (P = 0.04, r = 0.46), pulmonary artery systolic pressure (P = 0.048, r = 0.65), pulmonary vascular resistance (P = 0.008, r = 0.69), and right ventricular end-diastolic pressure (P = 0.009, r = 0.43) at 8 weeks and all these factors except left ventricular ejection fraction at 26 weeks. These clinical outcomes were unrelated to other cardiac or pulmonary diseases. CONCLUSIONS: Symptomatic improvement is only temporary in many patients undergoing balloon aortic valvuloplasty, and the mortality rate in the mid-term follow-up period is high. Valve surgery remains the treatment of choice for aortic stenosis in the adult.

Aged↗
PubMed1989

Determinants of collateral filling observed during sudden controlled coronary artery occlusion in human subjects.

Higher grades of collateral circulation limit the extent of myocardial ischemia observed during balloon inflation in patients with single vessel coronary disease undergoing coronary angioplasty. However, the grade of collateral filling during sudden coronary occlusion varies from patient to patient. To assess which characteristics may predict a high grade of collateral filling, baseline clinical and angiographic variables were correlated with the grade of filling during coronary occlusion in 67 patients (whose angina ranged from 1 week to 36 months in duration) undergoing left anterior descending or right coronary artery angioplasty. A second contralateral arterial catheter was used to assess the collateral filling that reached the vessel dilated before and during transient total occlusion by the angioplasty balloon. Thirty-six patients had a proximal stenotic lesion ranging in severity from 65 to 99%. On a 0 to 3 scale, mean collateral filling grade before inflation was 0.4 versus 1.8 during inflation (p = 0.001). All 19 patients with 95 to 99% stenosis had at least grade 2 collateral filling during inflation. In contrast, 18 of 21 patients with less than or equal to 80% stenosis had only grade 0 or 1 collateral filling during inflation. There were significant positive correlations between collateral grade during inflation and 1) baseline lesion severity (r = 0.76), 2) baseline collateral filling grade (r = 0.50), and 3) vessel dilated. There was no relation between collateral filling during inflation and age, gender, risk factors, duration of angina or proximal versus distal location of the lesion. Lesion severity was the only independent variable associated with collateral filling grade.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The nature and course of depression following myocardial infarction.

Two hundred eighty-three patients admitted to cardiac care units for myocardial infarction at two urban teaching hospitals were interviewed 8 to 10 days after infarction and 171 were reinterviewed 3 to 4 months later. Initially, 45% met diagnostic criteria for minor or major depression, including 18% with major depressive syndromes. Depression was not associated with the severity of cardiac illness but was associated with the presence of noncardiac medical illnesses. Three to 4 months after infarction, 33% of patients met criteria for minor or major depression. The large majority of patients who initially met criteria for major but not minor depression showed evidence of depression at 3 months and most patients with major depression had not returned to work by 3 months. Treatment of major depressive syndromes after myocardial infarction may reduce chronicity and disability, while minor depressive syndromes may be similar to normal grief and tend to be self-limited.

Aged↗
PubMed1989

Cardiopulmonary resuscitation: qualifications and performance of housestaff and trained internists.

Eighty-six physicians in the Internal Medicine Department of the Mount Sinai Medical Center were evaluated on attitudes and knowledge of basic and advanced cardiac life support. Information was gathered over a one-week period using a self-administered questionnaire. Eighteen (21%) of the respondents did not know of the availability of basic and advanced cardiac life support courses at this institution. Of the physicians who had never taken either course, 8 (25%) stated it was because it was not offered at a convenient time or place. All housestaff officers were noted to have completed both courses, a percentage much higher than that of the trained internists (p less than .0001). Previous formal training in cardiac life support was found to be associated with a higher level of confidence in the ability to administer cardiac lifesaving techniques (p less than .0001) and a higher overall knowledge score (p = .003). We determined that the housestaff officers in internal medicine were the physicians most qualified to perform resuscitation efforts because of their completion of life support courses, their confidence in administering these techniques, and their greater overall knowledge. Wider publicity on the availability of cardiac life support courses, more convenient scheduling of such courses, and mandatory certification in basic life support for all physicians, with additional certification in advanced cardiac life support for physicians with extensive ward responsibility, are needed.

Attitude of Health Personnel↗