Monitoring cancer therapy by NMR spectroscopy.
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Biomedical subjects
Publications and source records attributed to R J Morgan.
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A 49 year old man presented with near-fatal, fulminant, haemorrhagic cardiac tamponade. He responded well to emergency pericardiocentesis and subsequent investigation revealed the cause to be an unknown squamous carcinoma of the bronchus with pericardial involvement. He died 13 weeks later. Such a dramatic presentation of this type of tumour in a male patient has not been previously described.
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To assess the effect of beta blockade on left ventricular (LV) performance in patients with LV dysfunction and stable angina pectoris, 18 subjects taking a placebo followed by incremental doses of the cardioselective beta-adrenergic blocking agent betaxolol (5, 10, 20, 40 and 80 mg/day) were studied. The study ended with the achievement of optimal clinical beta blockade (heart rate at rest 50 to 60 beats/min, a 20% or smaller increase in heart rate during stage 1 of symptom-limited treadmill exercise using the modified Bruce protocol). Optimal clinical beta blockade produced a decrease in mean frequency of angina, from 6.8 +/- 1.7 to 0.7 +/- 0.8 episodes per week (p less than 0.0005) and an increase in mean treadmill exercise capacity, from 3.1 +/- 1.7 to 7.7 +/- 2.8 minutes (p less than 0.0005). LV systolic function was assessed at rest and during symptom-limited exercise with radionuclide left ventriculography. Mean LV ejection fraction (EF) during therapy with placebo was 39 +/- 7% at rest and 40 +/- 8% at peak exercise. Mean LVEF during optimal clinical beta blockade was 43 +/- 11% at rest and 45 +/- 10% at peak exercise. Neither of these changes was statistically significant. No patient had clinical or radiographic signs of LV failure. The results suggest that optimal clinical beta blockade with betaxolol, in doses sufficient to significantly reduce the frequency of angina and improve exercise capacity in patients with stable angina pectoris and mild to moderate LV systolic dysfunction, does not cause significant deterioration of LV systolic function or produce LV failure.
The present study demonstrates that human corpus cavernosum tissue has the capacity to produce prostacyclin (PGI2), a vasodilator and potent inhibitor of platelet aggregation. The release of PGI2 was stimulated by cholinergic (muscarinic) but not adrenergic agents. Since penile erection in man is dependent upon parasympathetic stimulation, the vasodilatory action of PGI2 may contribute to the initiation and maintenance of erection.
Seven consecutive patients with total anomalous pulmonary venous drainage were operated at the Medical College of Ohio at Toledo and long-term follow-up is reported on their rhythm status. The patients were generally under 3 months of age at operation. All patients are alive at the present time. The median length of follow-up is 4 years. Five of the 7 patients demonstrated ectopic pacemaker activity and 2 exhibited episodes of nodal rhythm as well. In general, these were not apparent on standard screening electrocardiography. There was no correlation between the presence or absence of this arrhythmia and the type of repair. It is concluded that arrhythmias may be present in these patients, but that they are unrelated to the type of surgery performed. The ectopic atrial focus may be of no clinical significance but there is more cause for concern in those patients with nodal rhythm.
Patients complaining of impotence were investigated through a multi-disciplinary approach to define the factors involved. Radioisotope phallography was performed on all the patients using 99Tcm-labelled red blood cells (RBCs) and dynamic records of the variation in activity over the penis were obtained. During the course of the study an intravenous injection of a vasodilator (isoxsuprine HCl) was administered. An analysis of the data provided quantitative parameters for measuring the changes in penile blood flow and penile blood volume in response to the vasodilator injection. The results indicate that the radioisotope phallogram is useful both in the diagnosis of vasculogenic impotence and in indicating the method of treatment.
To assess the effects of beta-blockade on right ventricular performance in patients with and without right ventricular dysfunction due to coronary artery disease, we performed radionuclide ventriculography on eight patients with normal right ventricular ejection fraction (RVEF greater than or equal to 35%) and 14 patients with mild to moderate right ventricular dysfunction (RVEF less than 35%) at rest. All patients had chronic stable angina pectoris, and nine patients had prior myocardial infarction. Radionuclide ventriculography was performed on placebo and during clinical beta-blockade (heart rate, 50 to 60 beats per minute and less than or equal to 20% increase in heart rate over baseline during stage I treadmill exercise, Bruce protocol) with the oral, cardioselective beta-blocking agent, betaxolol. The resting RVEF (mean +/- 1 SD) was 33% +/- 7% on placebo and 34% +/- 7% during clinical beta-blockade. Mean exercise RVEF was 40% +/- 8% on placebo and 39% +/- 8% during clinical beta-blockade. These differences were not statistically significant. Resting left ventricular ejection fraction ranged from 22% to 60% (mean, 42% +/- 8%). On placebo, one of eight patients with a resting RVEF greater than or equal to 35% had a normal exercise RVEF response (greater than or equal to 5% increment) whereas nine of 14 patients with resting RVEF less than 35% had normal exercise response. The discordant relationship between baseline RVEF and exercise response on placebo became less marked during clinical beta-blockade. We conclude that beta-blockade does not produce significant deterioration of right ventricular systolic function or right ventricular reserve either in patients with normal or in those with mild to moderately impaired resting right ventricular systolic function.
The dural sheath may be transected in the course of a posterior thoracic procedure. If air is introduced into the subarachnoid space, a cranial nerve palsy may result. Computed tomographic scanning establishes the diagnosis. The condition resolves without treatment.
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