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Biomedical subjects

R Roberts

Publications and source records attributed to R Roberts.

At least 469 records · Page 26Linked to original sources

Amnesia in a patient with bilateral lesions to the thalamus.

A case of anterograde amnesia is described in a 38-yr-old man with bilateral thalamic lesions. The patient appeared to have suffered no general intellectual loss and performed normally on standard memory tasks involving immediate recall of new material. There was, however, consistent impairment in recalling material, verbal and non-verbal, over delays as brief as a few seconds. Impairment was especially marked on tests involving free recall and partial cueing procedures; recognition memory was also impaired. Premorbid memory tested normally and susceptibility to interference was less than in other organic amnesics. Various interpretations of the patient's amnesia were considered but a deficit at the initial stages of information processing appeared to be indicated.

Adult↗

Influence of acute arterial hypertension on myocardial infarct size in dogs without left ventricular hypertrophy.

During acute myocardial infarction an increase in arterial pressure is common in patients who were previously normotensive and, therefore, do not have left ventricular hypertrophy. However, the effect of hypertension on infarct size in the absence of hypertrophy is uncertain. Thus, 32 open chest dogs underwent a 2 hour occlusion of the mid-left anterior descending coronary artery followed by 3 hours of reperfusion. Immediately after occlusion, 14 dogs were randomized to a hypertension group (intravenous phenylephrine infusion starting 5 minutes after occlusion and terminating at the time of reperfusion, with heart rate kept constant by atrial pacing) and 18 dogs to a control group (equivalent volumes of saline solution intravenously). Twelve of the 32 dogs were excluded from analysis because they developed ventricular fibrillation during coronary occlusion or reperfusion. In the hypertension group (n = 10), the mean arterial pressure increased significantly within 10 minutes of coronary occlusion (146 +/- 7 versus 109 +/- 11 mm Hg in 10 control dogs, p less than 0.01) and was maintained approximately 40 mm Hg higher than in the control group (p less than 0.01) throughout the ischemic period. Heart rate was similar in the two groups throughout the experiment. After the dogs were sacrificed, the region normally supplied by the occluded artery (anatomic "region at risk") was identified by simultaneous perfusion of the aortic root and the coronary artery distal to the occlusion. The heart was sectioned transversely and stained with triphenyltetrazolium-chloride. The infarcted area and the anatomic risk area were determined by video planimetry.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Microvascular deterioration: implications for reperfusion.

Beneficial effects of reperfusion or revascularisation on acute myocardial injury may be restricted to the initial few hours due in part to the development of myocardial haemorrhage and "no-reflow". In the present study, the severity of regional myocardial haemorrhage was assessed with Cr-51-RBC and compared with regional flow in the same areas assessed with labelled microspheres in 51 dogs to determine the temporal profile of reperfusion induced haemorrhage and "no-reflow" in relation to the duration of preceding ischaemia. Reperfusion was initiated after selected intervals of coronary occlusion (1 to 7 h) in 31 dogs, and results compared to those in 14 dogs with persistent occlusion and six dogs with no occlusion. Regions of decreased perfusion were outlined grossly with lissamine dye. Heart rate, blood pressure and left atrial pressures were monitored continuously. Haemorrhage was confirmed by histology. The amount of blood in normal regions of the heart was 3.2 +/- 0.4% of wet weight. In tissue ischaemic for 1 h without reperfusion, it was less, ie, 2.3 +/- 0.7; with occlusion of seven hours, it was reduced even further to 1.3%. in dogs subjected to reperfusion after selected intervals of ischaemia, haemorrhage (6.6 +/- 3.8 ml X 100 g-1) occurred in the endocardium after 3 h of ischaemia but in this epicardium only after 5 h of ischaemia (3.9 +/- 1). Regional flow was normal in the endocardium with reperfusion after 1 h of ischaemia (0.9 +/- 0.2 ml X min-1 X g-1) but decreased by 50% with ischaemia of 7 h prior to reperfusion. Thus, haemorrhage occurred earlier than "no-reflow". Results indicate that the severity of microvascular damage is a function of the duration of the interval of ischaemia prior to reperfusion and that it is evident earliest in the subendocardium. Since haemorrhage preceded "no-reflow" extravasation of blood may contribute to the "no-reflow" phenomenon. Adjunctive measures designed to delay microvascular deterioration may be useful to prolong the interval in which lysis or bypass surgery can be implemented effectively.

Animals↗

Inhibition by sodium cromoglycate of bronchoconstriction stimulated by respiratory heat loss: comparison of pressurised aerosol and powder.

The protective effect was examined of three doses (2, 10, and 20 mg) of sodium cromoglycate inhaled from a pressurised metered dose inhaler on the response to isocapnic hyperventilation of cold dry air in 10 asthmatic subjects. This was compared with the effect of cromoglycate powder (20 mg) inhaled from a Spincap and with placebo given on two occasions. The medications were inhaled on separate days, in random order and with the use of a double blind double dummy technique, 20 minutes before isocapnic hyperventilation of two fold increasing volumes of air (-15 degrees C, 0% humidity) to produce a 20% fall in the post-treatment FEV1. The response was expressed as the provocative dose of respiratory heat loss required to cause a fall in FEV1 of 15% (PD15, kcal/min). The mean baseline spirometric indices exceeded 85% of predicted normal values on each test day; both placebo treatments reduced the baseline FEV1 by comparison with all active treatments (p less than 0.0001). Comparison of the PD15 on the two placebo days confirmed excellent reproducibility. All doses of cromoglycate shifted the respiratory heat loss dose-response curve to the right of the placebo curve; PD15 after all active treatments exceeded PD15 after placebo (p less than 0.0001). There was no cromoglycate dose-response relationship between the three doses of aerosol (p greater than 0.05), or between any dose of aerosol and powder (p greater than 0.05). It is concluded that cromoglycate aerosol inhaled from a pressurised inhaler in a dose of 2 mg gives the same magnitude of protection against bronchoconstriction stimulated by airway cooling as 20 mg of pressurised aerosol or powder from a Spincap.

Adult↗

Comparative effect of disopyramide and ethmozine in suppressing complex ventricular arrhythmias by use of a double-blind, placebo-controlled, longitudinal crossover design.

This placebo-controlled, double-blind, longitudinal crossover study compares the efficacy of disopyramide and ethmozine, a new investigational drug, in suppressing frequent (40 or more per hour) ventricular premature depolarizations (VPDs) in 27 patients completing a 37 day protocol. Although both drugs significantly reduced VPDs relative to placebo, ethmozine was a superior antiarrhythmic drug in ach9eving near-total abolition of VPDs (30% of patients), which was never observed during disopyramide dosing (p less than .05). At the 80% VPD reduction level, ethmozine was effective in 56% of all patients compared with an effectiveness in only 22% of patients during disopyramide therapy (p less than .05). The mean peak plasma level of ethmozine was 0.66 +/- 0.8 micrograms/ml, which significantly fell to a trough level of 0.1 +/- 0.08 micrograms/ml (p less than .001). Mean peak and trough plasma levels of disopyramide exhibited less fluctuation (2.6 +/- 0.9 micrograms/ml vs 2.2 +/- 0.9 micrograms/ml). Ethmozine had no effect on the QT interval, whereas disopyramide prolonged it significantly. Importantly, while disopyramide produced serious side effects in 30% of patients, ethmozine was well tolerated with no statistically significant side effects compared with placebo.

Adult↗

Nifedipine therapy for patients with threatened and acute myocardial infarction: a randomized, double-blind, placebo-controlled comparison.

Preliminary clinical and laboratory observations suggest that nifedipine might prevent progression of threatened myocardial infarction by reversing coronary spasm or might limit necrosis during the course of acute myocardial infarction. We screened 3143 patients with ischemic pain of greater than 45 min duration and randomly assigned 105 eligible patients with threatened myocardial infarction and 66 with acute myocardial infarction to receive nifedipine (20 mg orally every 4 hr for 14 days) or placebo plus standard care. Treatment was started 4.6 +/- 0.1 hr after the onset of pain. Infarct size index was calculated by the MB-creatine kinase (CK) method and expressed as CK-geq/m2 +/- SE. The incidence of progression to infarction among patients with threatened myocardial infarction was not significantly altered by nifedipine (36 of 48 [75%] for placebo-treated and 43 of 57 [75%] for nifedipine-treated patients). Furthermore, infarct size index was similar among placebo- and nifedipine-treated patients (16.9 +/- 1.5 MB-CK-geq/m2, n = 65, and 17.0 +/- 1.5 MB-CK-geq/m2, n = 68, respectively) with threatened myocardial infarction who exhibited infarction and for those with acute myocardial infarction. Among the 171 eligible patients randomly assigned to drug or placebo, 6 month mortality did not differ significantly (8.5% for placebo vs 10.1% for nifedipine, NS), but mortality in the 2 weeks after randomization was significantly higher for nifedipine-treated patients (0% for placebo compared with 7.9% for nifedipine, p = .018).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Alteration of diastolic filling rate during exercise radionuclide angiography: a highly sensitive technique for detection of coronary artery disease.

Diastolic and systolic parameters of left ventricular performance were characterized from high-frequency time-activity curves obtained in 10 normal volunteers (mean age 29 +/- 4 yr), in 25 patients with normal coronary arteries, and in 50 patients with coronary artery disease (CAD) at rest and during three stages of exercise radionuclide angiography. In the normal volunteers ejection fraction was 65 +/- 5% (SD) at rest and 78 +/- 5% with exercise (p less than .001). In patients with normal coronary arteries ejection fraction was 64 +/- 5% at rest and 72 +/- 8% with exercise (p less than .0001). In patients with CAD resting ejection fraction was 60 +/- 10% and that during exercise was 61 +/- 13% (p = NS). Peak diastolic filling rate in the first half of diastole, peak systolic ejection rate, and times to peak rates and to end-systole were measured. In the normal subjects resting peak diastolic filling rate was 3.1 +/- 0.6 end-diastolic counts/sec and it increased in all subjects with exercise to 3.6 +/- 0.7 (p less than .05). In patients with normal arteries and those with CAD peak diastolic filling rate was 2.3 +/- 0.8 at rest and with exercise this parameter increased to 3.2 +/- 1.1 (p less than .001) in patients with normal arteries and fell to 1.7 +/- 0.6 in those with CAD (p less than .001). Peak systolic ejection rate decreased from 2.5 +/- 0.8 to 1.9 +/- 0.8 with exercise in patients with CAD (p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

An integrated approach to the treatment of panic disorder.

In this article I have reviewed the recent literature on the etiology, phenomenology, and treatment of panic disorder. The panic episodes, which form the core of this disorder, are probably of biologic etiology. However, over time, the psyche of the patient becomes markedly affected and a wide array of secondary reactions including phobia, depression, and dysfunctional personality traits develop, often becoming chronic. A strategy of treatment that recognizes both the complexity and distinctness of this syndrome has yet to appear in the literature. This article attempts to fill this need by presenting a multidimensional and integrated approach to treatment of panic disorder.

Adolescent↗

The role of beta-blockers in the treatment of patients after infarction.

Several large, prospective, randomized, clinical trials involving more than 11,500 patients testing five beta-blockers with respect to efficacy in reducing mortality after myocardial infarction as well as in preventing recurrent infarctions have been completed. The majority of the studies demonstrated significant mortality reduction when patients were begun on oral beta-blocker therapy prior to discharge from the hospital and maintained on the drug for at least 1 year. Similar benefit has not yet been demonstrated when beta-blockers are instituted parenterally during the early hours of infarction. Most patients should receive, routinely, a beta-blocker at the time of discharge from the hospital after infarction.

Adrenergic beta-Antagonists↗

The influence of the site and locus of myocardial damage on prognosis.

The overall management and prognosis of patients with acute myocardial infarction must take into account not only infarct size but also the site and locus of involvement as determined by electrocardiography. Transmural versus nontransmural infarction is discussed in relation to therapy and prognosis.

Electrocardiography↗

Carboxypeptidase-catalyzed hydrolysis of C-terminal lysine: mechanism for in vivo production of multiple forms of creatine kinase in plasma.

Human myocardial creatine kinase isoenzyme MM is present as a single form in tissue, but upon its release into plasma two additional forms, with faster anodal migration, are apparent on polyacrylamide electrophoresis. We designate the three forms as MM3, MM2, and MM1 in increasing order of anodal mobility. When tissue creatine kinase isoenzyme MM (MM3) is incubated with either carboxypeptidase N or carboxypeptidase B it is converted into the two additional forms, MM2 and MM1. The carboxy terminal amino acid of human, canine, and rabbit tissue MM3 was determined to be lysine, a specific substrate for carboxypeptidases N and B. Evidently the mechanism for the production of multiple forms of creatine MM in human plasma is the hydrolysis of a positively charged C-terminal lysine residue from one M subunit (MM2), followed by hydrolysis of the C-terminal lysine from the other subunit (MM1).

Animals↗

Deaths in early childhood in west Cumbria.

Investigation of deaths in early childhood is one method of assessing the quality of child care in a district. This paper describes a study carried out in one health district, on children in the age group one week to five years: 28 deaths occurred over a two-year period, 25 of these in the first year of life. The deaths are classified according to potential preventable factors. The study gave a more detailed picture of mortality patterns in the district than was previously available. Parents found the home interview in the study helpful in allowing them to explore their worries about the child's death.

Child, Preschool↗

Unmasking artifactual increases in creatine kinase isoenzymes in patients with renal failure.

Previous reports have suggested that creatine kinase isoenzymes are elevated in patients with chronic renal failure and thus are less useful in the evaluation of chest pain in such patients. Our data in 88 patients with chronic renal failure receiving maintenance dialysis confirm this observation for total plasma creatine kinase. However, elevations in MB and BB creatine kinase, although statistically significant, were biologically unimpressive (5.9 +/- 0.05 [SEM] IU/L compared with 4.8 +/- 0.04 IU/L for MB creatine kinase [p less than 0.02], and 5.5 +/- 0.08 ng/ml compared with 3.2 +/- 0.05 ng/ml for BB creatine kinase [p less than 0.0002] ), and were unlikely to cause diagnostic confusion. In 92% of patients with chronic renal failure, plasma MB creatine kinase activity was within the normal range (less than 13 IU/L). Eight percent of patients manifested abnormal MB creatine kinase values; the highest was 20 IU/L. The glass bead method for measuring MB creatine kinase was used to avoid the potential confusion induced by non-creatine kinase-mediated fluorescence, which occurs in the region of MB and BB creatine kinase on electrophoresis. The infrequent and modest increases in plasma MB creatine kinase observed in patients with chronic renal failure should be appreciated, but it should not cause diagnostic confusion, because acute myocardial infarction usually results in more substantial elevations of MB creatine kinase.

Clinical Enzyme Tests↗

Purification and characterization of human mitochondrial creatine kinase. A single enzyme form.

Purification of human mitochondrial creatine kinase has been difficult and procedures that were highly successful in purifying canine enzyme failed for human mitochondrial creatine kinase. In the present study, we employed ultracentrifugation to remove the lipid, urea to prevent aggregation, followed by a final step of chromatofocusing which yielded a preparation of human mitochondrial creatine kinase with a specific enzyme activity of greater than 400 IU/mg. Biochemical and immunological characterization showed the preparation to be highly pure and free of even trace amounts of other creatine kinase isoenzymes. Antiserum specific for mitochondrial creatine kinase was developed which exhibited no cross-reactivity to cytosolic creatine kinase and mitochondrial creatine kinase did not cross-react with antiserum to the cytosolic forms. Marked differences were noted, both biochemically and immunologically, between mitochondrial creatine kinase and the cytosolic forms. Human mitochondrial creatine kinase was shown to have a molecular weight of around 82,000 and to be composed of two subunits of equal molecular weights around 41,000. Aggregates of mitochondrial creatine kinase were observed with molecular weights of around 200,000 in the absence of urea or if isolated from material after having undergone proteolysis. Isolation from fresh material or in the presence of urea inhibited aggregate formation for both canine and human mitochondrial creatine kinase. Despite claims of several investigators that mitochondrial creatine kinase exhibits two to three forms with varying molecular weights, our data indicate a single enzyme form made up of a subunit with a molecular weight of 41,000 and the high molecular weight aggregates appear to be induced artifacts. A radioimmunoassay was developed for human mitochondrial creatine kinase which, with appropriate modifications, should detect mitochondrial creatine kinase in human plasma.

Amino Acids↗

Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3,697 patients.

Over a 34.5-month period, all admissions to 5 university hospital coronary care units were screened for eligibility for the Multicenter Investigation of the Limitation of Infarct Size (MILIS), an ongoing study of the effects of hyaluronidase, propranolol and placebo on myocardial infarct (MI) size. Of 3,697 patients with greater than or equal to 30 minutes of discomfort that was thought to reflect myocardial ischemia who were assessed for the presence or absence of certain electrocardiographic abnormalities at the time of hospital admission, the electrocardiogram was considered predictive of acute MI if greater than or equal to 1 of the following abnormalities was present: new or presumably new Q waves (greater than or equal to 30 ms wide and 0.20 mV deep) in at least 2 of the 3 diaphragmatic leads (II, III, aVF), or in at least 2 of the 6 precordial leads (V1 to V6), or in I and aVL; new or presumably new ST-segment elevation or depression of greater than or equal to 0.10 mV in 1 of the same lead combinations; or complete left bundle branch block. In the screened population, the diagnostic sensitivity of the electrocardiographic criteria was 81%, whereas the overall infarct rate in the total population screened was 49%. The diagnostic specificity of these entry criteria was 69% and the predictive value 72%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗