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Biomedical subjects

R J Luchi

Publications and source records attributed to R J Luchi.

At least 37 records · Page 2Linked to original sources
PubMed1988

Veterans Administration Cooperative Study for treatment of patients with unstable angina. Results in patients with abnormal left ventricular function.

In a prospective randomized trial, 468 patients with unstable angina pectoris who were stratified according to clinical presentation (Type I or Type II angina) and left ventricular function (normal or abnormal) were assigned to medical or surgical treatment groups. Left ventricular function was defined as abnormal if the ejection fraction was less than 0.50, or if the end-diastolic pressure was 16 mm Hg or greater. Left ventricular function was abnormal in 134 patients, 66 of whom were assigned to surgical and 68 to medical treatment groups. The cumulative 3-year mortality for surgical patients was 6.1% and for medical patients, 17.6% (p = 0.039). This 3-year figure represents a 65% reduction in mortality with surgery. Survival was significantly better for surgical patients whose ejection fractions ranged from 0.30 to 0.49 (p = 0.05). Survival of patients whose ejection fractions were greater than 0.69 was better with medical treatment (p = 0.049). Thus, surgery appears to be the treatment of choice for patients with unstable angina pectoris and abnormal left ventricular function.

Aged↗
PubMed1987

Comparison of medical and surgical treatment for unstable angina pectoris. Results of a Veterans Administration Cooperative Study.

We conducted a multicenter, randomized, prospective study comparing medical therapy alone with coronary-artery bypass surgery plus medical therapy in 468 men with unstable angina pectoris. Patients were entered in the study from June 1, 1976, to June 30, 1982. Among those assigned to surgery who received bypass grafts, operative mortality was 4.1 percent. Arteriography performed after one year of follow-up revealed that 74.8 percent of the grafts studied were patent. The cumulative rate of crossover from medical to surgical therapy after two years was 34 percent; the operative mortality among patients crossed over was 10.3 percent. Nonfatal myocardial infarction occurred in 11.7 percent of the patients treated surgically and 12.2 percent of those treated medically (no significant difference). Most of the nonfatal myocardial infarctions in the surgical group occurred in the perioperative period. Overall, the two-year survival rate computed by life-table analysis did not differ between the two groups. However, the curves reflecting mortality as a function of left ventricular ejection fraction were significantly different (P = 0.03); surgery was associated with a significantly reduced mortality among patients with lower ejection fractions. We conclude that patients with unstable angina pectoris have a similar outcome after two years whether they receive medical therapy alone or coronary bypass surgery plus medical therapy. However, patients with reduced left ventricular ejection fractions may have a better two-year survival rate after coronary bypass surgery.

Adrenergic beta-Antagonists↗
PubMed1987

Cardiac tamponade and constrictive pericarditis complicating endoscopic sclerotherapy.

We report a case of suspected esophageal perforation with injection of a sclerosing agent into the pericardium during endoscopic sclerotherapy of esophageal varices. Immediately after the procedure, the patient developed fever and a pericardial friction rub. Eight months later, he presented with cardiac tamponade and constrictive pericarditis. This complication should be considered whenever a patient presents with inadequate cardiac output, venous congestion, and a pulsus paradoxus following sclerotherapy.

Adult↗
PubMed1985

Penile laceration from a Foley catheter.

Traction-induced penile laceration has not been reported previously as a complication of long-term indwelling Foley catheterization. Four occurrences of this injury in three elderly, demented patients were observed in an acute-care Geriatric Evaluation Unit. The most severe case, a nearly complete transverse laceration of the glans, reepithelialized but did not reapproximate. In the other cases, a laceration along the median raphe reapproximated. In all cases, local treatment was successful in effecting healing, and none of the patients exhibited signs or symptoms of systemic illness. These injuries were caused by prolonged traction on the unsecured Foley between the inflated balloon and the weighted collection system producing a local ischemic necrosis. This complication can be prevented by securing the Foley to the patient with tape, ensuring that the drainage system is properly supported, and by attention to patient position.

Aged↗
PubMed1984

Effect of digoxin on ejection fraction in elderly patients with congestive heart failure.

To assess the effect of oral digoxin on left ventricular systolic function in elderly patients, radionuclide angiography was performed on 20 patients 74 years old or older before and after several weeks of oral digoxin. The mean age was 83.8 years. All had congestive heart failure or cardiomegaly, and all were in sinus rhythm. The ejection fraction was 0.36 +/- 0.10 (mean +/- SD) before digoxin; 0.45 +/- 0.09 after digoxin (P less than 0.01). A comparison group that did not receive digoxin had no significant improvement in ejection fraction. In ten patients serial radionuclide angiograms were repeated after increasing serum digoxin concentrations. Six demonstrated maximal improvement in ejection fraction at serum digoxin concentrations of 0.4-1.0 ng/ml. It is concluded that oral digoxin improves left ventricular ejection fraction in elderly patients with congestive heart failure or cardiomegaly who are in sinus rhythm. Some of these patients achieve maximal improvement in ejection fraction at serum digoxin concentrations of less than 1.0 ng/ml.

Administration, Oral↗
PubMed1983

A comparison of placement outcomes of geriatric cohorts receiving care in a geriatric assessment unit and on general medicine floors.

To assess whether care in a geriatric assessment unit using a multidisciplinary team approach with rehabilitative emphasis impacted on patient placement outcomes, a historical prospective study was initiated using records of geriatric assessment unit patients admitted during a one-year period (n = 62). A second, diagnostically similar general medicine unit cohort was also sampled (n = 62). Placement outcomes of the two groups were compared. All study patients were 75 years of age or older, stratified by source of admission, and controlled for comparability using diagnostic grouping. The geriatric assessment unit admitted 92 per cent of its patients from home; the general medicine unit, 82 per cent. As a result of expanded rehabilitative, respite, and terminal care promoted by the geriatric assessment unit staff, mean length of stay was 36 days, whereas it was 13 days in the general medicine unit (P less than 0.001). There was no significant difference between the two units with respect to hospital deaths, post-hospitalization discharges to home or nursing homes, or patient locations (home versus nursing home) six months after admission. Although improvements in patient independence may have been achieved through the efforts of a multidisciplinary team approach utilizing the geriatric assessment unit, they were not sufficient to significantly increase the proportion of patients placed at home. Superiority in placement outcome may be demonstrated only by geriatric assessment unit use of selective admission criteria.

Aged↗
PubMed1982

Effects of digoxin on left ventricular function in coronary artery disease patients.

To assess whether digitalis modifies or prevents the deterioration of the left ventricular ejection fraction and wall motion during acute ischemia, we performed gated blood pool radionuclide ventriculograms in 15 patients with angiographically documented coronary artery disease. All patients were studied in the resting state and during maximal supine bicycle exercise, both before and 1 hour after 1 mg intravenous digoxin. There was no significant difference, pre-digoxin vs post-digoxin, in exercise tolerance (415 +/- 84 vs 418 +/- 107 seconds), number of segments with abnormal resting wall motion (12 vs 11) or exercise wall motion (21 vs 19). Ten patients developed angina during the same exercise load, irrespective of digoxin administration. Twelve patients had subnormal left ventricular ejection fraction during exercise pre-digoxin, vs 13 patients post-digoxin (P = ns). In the resting state, the left ventricular ejection fraction was higher after digoxin (53 +/- 14% pre vs 58 +/- 14% post, P less than 0.05). During exercise, however, the left ventricular ejection fraction was not significantly improved after digoxin (50 +/- 16% pre vs 53 +/- 17% post, P = ns). These data indicate that although acute administration of digoxin improves the resting left ventricular function, it does not improve exercise tolerance to angina. Furthermore, intravenous digoxin does not appear to prevent the deterioration of left ventricular wall motion and ejection fraction during exercise induced ischemia.

Blood Pressure↗
PubMed1982

Left ventricular function in hospitalized geriatric patients.

Left ventricular ejection fraction was measured by gated wall motion in 62 patients, 75 years old or older, admitted to a Geriatric Acute Assessment Ward. From this group, 42 patients not taking digitalis or other cardioactive medication were selected for analysis. Thirty of them had clinically identifiable heart disease, whereas 12 did not. Resting left ventricular ejection fractions in the 12 patients without clinically identifiable heart disease averaged 0.60 +/- 0.09. None had an ejection fraction below 0.50. In the 30 patients with clinically identifiable heart disease, mean ejection fraction was 0.49 +/- 0.15 (range 0.17-0.84), P less than 0.01. In the patients with heart disease, reduction of ejection fraction was correlated with either cardiac enlargement or congestive heart failure. Neither age nor electrocardiographic abnormalities added to the strength of this correlation. Fifty-eight per cent of patients with congestive heart failure had ejection fractions greater than or equal to 0.40, suggesting that congestive heart failure in this age group is frequently related to diastolic left ventricular dysfunction unaccompanied by major systolic dysfunction. The prognosis of patients with congestive heart failure and ejection fractions above 0.35 was significantly better than of patients with congestive heart failure and ejection fractions below 0.35. From these data and other data available in the literature, it is proposed that the lower limit for ejection fraction be 0.50 for patients 75 years old or older. Congestive heart failure in patients 75 years old or older appears to be associated with relatively higher ejection fractions or even with ejection fractions within the normal range. In these patients, digitalis may not be indicated, and short term-prognosis is relatively favorable.

Aged↗
PubMed1982

Null cell senescence and its potential significance to the immunobiology of aging.

The null cell compartments of human bone marrow and mouse spleen were arbitrarily divided into three subpopulations based upon the ability of cells to acquire T or B cell membrane markers when incubated with poly A:U or ubiquitin. There was an accumulation of T cell precursors with congenital absence of the thymus. In contrast, T cell precursors were reduced and there was an accumulation of uninduced null cells with old age. These observations suggest that there is an intrinsic defect of null cell differentiation with a drift towards more differentiated precursors in T cell differentiation with aging. This could result in a diminution in the range of responses by their progeny, mature T lymphocytes.

Adult↗
PubMed1980

Exercise-induced coronary arterial spasm: angiographic demonstration, documentation of ischemia by myocardial scintigraphy and results of pharmacologic intervention.

Exercise-induced coronary arterial spasm is an infrequently recognized phemonemon whose mechanism and management are not well established. In two patients with reproducible exercise-induced S-T segment elevation and angina pectoris thallium-201 scintigraphy showed areas of reversible anteroapical hypoperfusion, and gated radionuclide ventriculography revealed anteroapical hypokinesia with a decrease in left ventricular ejection fraction at peak exercise. During coronary arteriography supine exercise provoked occlusive spasm of the left anterior descending coronary artery, which at rest had only minimal plaques. Consequently, treadmill testing was performed with five different pharmacologically provoked interventions: direct vasodilatation (nitrates), alpha adrenergic blockade (phenmoxybenzamine), beta adrenergic blockade (propranolol), calcium flux blockade (verapamil), and prostaglandin inhibition (indomethacin). Exercise-induced coronary arterial spasm, manifested as S-T segment elevation and angina, was prevented by nitrates, but was not eliminated by short-term oral administration of an alpha or beta blocking agent, a calcium antagonist or a prostaglandin inhibitor. Further, beta adrenergic blockade appeared to be detrimental. Thus, this study demonstrates (1) that coronary arterial spasm may be the underlying mechanism of at least some cases of exertional angina associated with transient perfusion deficits and left ventricular dysfunction, and (2) that it may be prevented by oral nitrates.

Angina Pectoris, Variant↗