Short- and long-term effects of digitalis on resting and posthandgrip hemodynamics in patients with coronary artery disease.
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Biomedical subjects
Publications and source records attributed to R Vogel.
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In 62 men with open parent coronary arteries who underwent saphenous vein aortocoronary bypass to either the right or left anterior descending coronary artery, or both, left ventricular ejection fraction and wall motion of the anterior and inferior segments of the left ventricle were measured before and after (average 11 months) the operation. Of 34 left ventricular segments with open vein grafts and open parent coronary arteries, 91 percent were unaltered by the operation, none were in worse condition and 9 percent showed improved wall movement. Among 33 segments with open grafts but new total occlusion of the parent coronary arteries, 67 percent were unaltered, whereas the condition of 18 percent was worse and of 15 percent was improved. Among 21 segments with closed grafts but patent parent arteries, the condition of 29 percent was unchanged and of 71 percent was worse; among 14 segments with occlusion of both grafts and parent arteries the condition of 29 percent was unchanged and of 71 percent was worse. In 10 men with patency of all vein grafts and parent arteries, left ventricular ejection fraction was not altered (0.55 +/- 0.03 to 0.53 +/- 0.04 [average +/- standard error of the mean]) and in 11 with all grafts open but all parent arteries occluded left ventricular ejection fraction was unchanged (0.51 +/- 0.02 to 0.54 +/- 0.03). Left ventricular ejection fraction was decreased in eight men with occlusion of all vein grafts whether or not occlusion of the parent coronary arteries had occurred. The results suggest that occlusion of the parent coronary arteries in the presence of a patent vein graft does not unfavorably alter left ventricular ejection fraction or segmental wall motion, whereas graft occlusion is associated with deterioration of left ventricular ejection fraction and segmental motion whether or not the parent artery is also occluded.
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Digitalis has been shown to improve the impaired ventricular function associated with coronary artery disease as well as to increase myocardial oxygen consumption and produce coronary vasoconstriction. To elucidate the net result of these contrasting effects, six patients with coronary artery disease and left ventricular ejection fractions less than 0.50 had 1.0 mCi thallium-201 injected intravenously at rest and during three minutes of 33% of maximal handgrip, off and on 0.25 mg daily maintenance digoxin. Thallium-201 scintigram images were taken 30 minutes later and were computer processed with orthogonal linearly interpolated background subtraction and maximal count density equalization. Processed images were visually graded on a 0, 1, or 2 scale for 18 sectors--nine from the AP projections and nine from the 40 degrees left anterior oblique projections. A score resulting from the summation of the 18 sector grades was made for each study, the maximum score being 36. Off digitalis, patients performing handgrip exercise decreased their scintigram scores from 25.7 +/- 1.5 (mean +/- SEM) to 23.0 +/- 1.0, P less than 0.05. When patients were on maintenance digoxin, scores did not change significantly during handgrip exercise. Post exercise scores were significantly higher on digoxin than off (P less than 0.05), whereas, resting scores were unaffected by digoxin. These data suggest that myocardial perfusion, as measured by thallium-201 uptake, is improved in patients on digitalis who have coronary artery disease and left ventricular dysfunction.
Four children with lymphoproliferative malignant disease, two with acute lymphocytic leukemia in remission and two with Hodgkin's disease, were treated with a Thymic Hormone, THF, for disseminated varicella infecition. It is suggested that THF increased significantly the number of peripheral blood lymphocytes and T-rosette forming lymphocytes in 3 out of 4 children, who developed the varicella at the time of impaired cellular immunity. On the other hand, in the fourth child, with Hodgkin's disease, who had a normal number of T-rosettes, a decreased absolute number of lymphocytes as well as T-rosettes was observed over a course of 14 days THF treatment, although the percent of T-cells has not changed significantly. All of the four children recovered, including the child who was at high risk, with a marked lymphopenia, severe bilateral pneumonitis, hepatitis secondary infected skin lesions and psudomonas sepsis. It is indicated that THF therapy may restore the depressed cellular immunity in immunosuppressed children with malignant disease, and has its value as a supportive immunotherapy in life-threatening disseminated varicella infection.
The investigation of 72 samples of human subcutaneous fat tissue stored in closed small bottles at room temperature showed that every third sample decomposed with the formation of unknown metabolites. The presence of these compounds could already be recognized in the crude lipid extracts by characteristic 1H-NMR signals, increasing in intensity with time of storage. After isolation, the unknown metabolites could be identified as di- or mono fatty acid esters of propane-diol-(1.3). Thus, the known scheme of postmortal breakdown of triglycerides is to be supplemented by a further remarkable pathway.
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The dynamics of the central circulation were measured by a radionuclidic technique in 18 men with high-risk preinfarctional angina who received therapy with isosorbide dinitrate (n equals 18), intra-aortic balloon pumping (n equals 8), or both (n equals 8). Administration of 5 mg of isosorbide dinitrate sublinqually was associated with a reduction in stroke volume index (SVI), cardiac index (CI), systemic arterial blood pressure, and left ventricular end-diastolic volume (LVEDV) and with increased left ventricular ejection fraction (LVEF). Intra-aortic balloon pumping did not alter SVI or CI, but decreased systolic blood pressure and LVEDV and increased LVEF and diastolic blood pressure. The combination of therapy with isosorbide dinitrate and intraaortic balloon pumping resulted in decreased SVI, systolic blood pressure, and LVEDV and increased LVEF. Thus, therapy with isosorbide dinitrate reduced left ventricular preload, and intra-aortic balloon pumping reduced blood pressure, which resulted in a decreased LVEDV and an increase in LVEF. Therapy with isosorbide dinitrate and intra-aortic balloon pumping act to alter central circulatory dynamics in favor of reducing myocardial oxygen demand.
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Tumor-like proliferative lesions were discovered on cystourethrography and cystoscopy in two children, one with severe bacterial urinary tract infection and the other with painless terminal hematuria. Histologically, these lesions were characterized by inflammatory infiltration and proliferative changes of the bladder epithelium. Appropriate treatment, including antibiotics, resulted in complete disappearance of the bladder lesions in both patients. The development of such lesions is related to the potential for nonneoplastic proliferation and metaplasia of the bladder epithelium and is considered to be the result of irritation associated with infection or other chemical and physical factors. The known malignant potential of such bladder pathology indicates a need for careful, long-term follow-up in such patients, including children.
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Five pigeons were trained to perform a discrimination task allowing variability of reinforced response patterning. The task consisted of moving a stimulus light within an 4x4 matrix of lights from the top left position to the bottom right position by pecking on two keys in succession in order to obtain a reinforcement. A peck on one key moved the light one position to the right and a peck on the other key moved it one position down. After preliminary training on alternating fixed-ratio 3 schedules of reinforcement, the birds could peck on either key in any order, but more than three responses on a key resulted in a blackout followed by the return of the stimulus light to the start position. Results indicate that initially the birds used a wide variety of response patterns to obtain reinforcement, but with continued practice, response patterns became more stereotyped.
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