Biomedical subjects
Publications and source records attributed to S C Smith.
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At present a large number of patients with atherosclerotic disease are not receiving aggressive cholesterol-lowering therapy. Consequently they are being deprived of a cost-effective, risk-reducing treatment. Every physician who treats patients with clinical atherosclerotic disease should become fully informed about the results of cholesterol-lowering trials in patients at high risk. All physicians who care for high-risk patients should take responsibility for cholesterol management, including primary care physicians and cardiovascular specialists. Highly effective and generally safe drugs for cholesterol lowering are available. The benefits of therapy for reducing recurrent CHD and prolonging life are considerable. There is no justification for unduly delaying institution of therapy for the majority of patients. The many advantages of nonpharmaceutical therapy call for its use in almost all patients, but drug treatment should not be postponed if the target for LDL cholesterol lowering (< or = 100 mg/dL) is unlikely to be achieved in the near term by a nonpharmaceutical approach alone. The view that patients with CHD or other forms of atherosclerotic disease do not receive substantial clinical benefits from aggressive cholesterol-lowering therapy is no longer warranted. Intensive cholesterol reduction, initiated immediately, has the potential to significantly reduce both morbidity and mortality. Cholesterol-lowering therapy thus should become a routine part of clinical management to reduce risk of future coronary events and to prolong life in patients with CHD or other forms of atherosclerotic disease.
Patients with cardiovascular disease can derive significant benefit from the implementation of risk reduction therapies. Until recently, management of patients with coronary heart disease has centered on the use of angioplasty, bypass surgery and medical therapy for severe fixed obstructions. Several large randomized clinical trials now demonstrate the importance of medical risk reduction therapies in these patients. A consensus panel of the American Heart Association recommends that health care providers use a group of risk reduction therapies, which can significantly extend overall survival, improve quality of life, decrease the need for interventional procedures such as angioplasty and bypass grafting, and reduce the incidence of subsequent myocardial infarction. Since a minority of patients with cardiovascular disease now benefit from these strategies, changes in our health care delivery systems are recommended. Risk reduction case management by nursing staff can assist physicians and improve implementation of and patient adherence to these therapies. Programs are being discussed to develop support by third-party insurers for risk reduction therapies. Application of these therapies should be a routine part of care for patients with cardiovascular disease.
BACKGROUND: Endomyocardial biopsy is currently the standard method used to diagnose myocarditis. However, it is invasive and has a low diagnostic yield. Because the histological diagnosis of myocarditis requires the presence of myocyte injury, we sought to determine whether measurement of cardiac troponin I (cTnI), which is a serum marker with high sensitivity and specificity for cardiac myocyte injury, could aid in the diagnosis of myocarditis. METHODS AND RESULTS: To validate this approach, cTnI values were first measured in mice with autoimmune myocarditis. cTnI values were elevated in 24 of 26 mice with myocarditis but were not elevated in any of the control animals (P < .001). Next, cTnI values were measured in the sera from 88 patients referred to the Myocarditis Treatment Trial and were compared with creatine kinase-MB (CK-MB) values measured in the same patients. cTnI values were elevated in 18 (34%) of 53 patients with myocarditis and in only 4 (11%) of 35 patients without myocarditis (P = .01). In contrast, CK-MB values were elevated in only 3 (5.7%) of 53 patients with myocarditis and 0 of 35 patients without myocarditis (P = .27). Thus, elevations of cTnI occurred more frequently than did elevations of CK-MB in patients with biopsy-proven myocarditis (P = .001). Importantly, elevations of cTnI in patients with myocarditis were significantly correlated with < or = 1 month duration of heart failure symptoms (P = .02), suggesting that the majority of myocyte necrosis occurs early, and thus the window for diagnosis and treatment may be relatively brief. CONCLUSIONS: cTnI was superior to CK-MB for detection of myocyte injury in myocarditis, and cTnI elevations were substantially more common in the first month after the onset of heart failure symptoms.
Intravascular stents are successfully used during coronary revascularization. Subacute stent thrombosis is a rare complication, associated with a 40-60% risk of myocardial infarction, and occurs 5-10 days after implantation. We describe a case of late stent thrombosis potentially due to delayed endothelialization from cancer chemotherapy.
The clinical significance of myocardial bridges (MBs) is variable, and most patients are asymptomatic. However, angina, myocardial infarction, and sudden death have been reported in association with MBs. Here we describe the use of intracoronary stenting for the treatment of a patient with an anterior myocardial infarction due to an MB.
OBJECTIVES: Our purpose was to investigate a possible role for apoptosis in the pathophysiologic mechanisms of intrauterine growth restriction. STUDY DESIGN: Placental samples were obtained from 43 uncomplicated third-trimester pregnancies and from 26 pregnancies complicated by intrauterine growth restriction. The definition used to identify cases of intrauterine growth restriction depended on three criteria: clinical evidence of suboptimal growth, ultrasonographic evidence of deviation from an appropriate growth percentile, and individualized birth weight ratios <10th percentile. Light microscopy was used to quantify the incidence of apoptosis. Electron microscopy and TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling) staining were used to confirm the occurrence of apoptosis. RESULTS: Quantification of apoptosis (medians and interquartile ranges) resulted in the following values: normal third trimester (n = 43) 0.14% of cells (0.08% to 0.20%) and intrauterine growth restriction third trimester (n = 26) 0.24% of cells (0.16% to 0.29%). The incidence of apoptosis was significantly higher in placentas from pregnancies with intrauterine growth restriction compared with normal third-trimester placentas (p < 0.01, Mann Whitney U test). CONCLUSIONS: These results suggest that apoptosis may play a role in the pathophysiologic mechanisms of intrauterine growth restriction.
OBJECTIVES: The study aims were to conclusively demonstrate apoptosis in the human placenta and to quantify its incidence at different stages of pregnancy. STUDY DESIGN: Placental samples were obtained from 28 first-trimester pregnancies and 38 uncomplicated third-trimester pregnancies. Light microscopy, electron microscopy, and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate marker nick end-labeling staining were used to identify apoptosis. Light microscopy was used to quantify its incidence. RESULTS: Apoptosis has been conclusively demonstrated within placental tissue. Quantification of apoptosis (medians and interquartile ranges) was as follows: first trimester (n = 28), 0.07% of cells (0.05% to 0.14%); third trimester (n = 39), 0.14% of cells (0.09% to 0.20%). The incidence of apoptosis was significantly higher in the third trimester than in the first trimester (p < 0.01, Mann-Whitney U test). CONCLUSIONS: Placental apoptosis increases significantly as pregnancy progresses, suggesting that it may play a role in the normal development and aging of the placenta.
As health care continues its rapid and seemingly unending helix of change, I am uncomfortably mindful that I must be ever vigilant to convince the many evaluators of health care services that ophthalmic registered nurses are a vital and unique part of the team. I continually ask myself the question: what is it about nursing that is so unique and necessary to health care, whether it is at the bedside, in the community, operating theater, or clinic? And what is it that ophthalmic nurses bring to the "table" that other providers of ophthalmic health care services don't or at least, should not? When I look again at this second question, the should not really grabs me. Ophthalmology battles optometry over scope of practice issues and takes them all the way to the courts of law in order to obtain backup. It's time for ophthalmic nurses to stand for what they believe is their rightful scope, even if we do not have the power or money to take it to our judicial system.
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The purpose of this study was to determine if there were differences between children identified in a clinical setting as having Central Auditory Processing Disorder (CAPD), an age-matched peer group, and young adults when tested using a vocal reaction time (VRT) format. The children with CAPD were matched by gender and age to peers between the ages of 8 and 10 years. All speakers were presented visually with printed third-grade-level one- and two-syllable words (e.g., boy, mother) as well as the syllable "uh". Participants spoke each word according to the criteria of seven separate conditions, which included immediate naming tasks (0 s delay), a short delay before speaking (M = 1.5 s), and a longer delay before speaking (M = 4.0 s). Speakers VRTs were measured, and production errors were recorded. All speakers took longer to respond in the immediate-response conditions than the delayed-response conditions. Statistically significant differences were found for the immediate-response conditions, with means for the children with CAPD reflecting slower performance than that of their peers. The peer group was slower than the adults. For the delayed conditions, both groups of children responded with significantly longer VRTs than the adults. The two groups of children did not differ for these tasks. The children with CAPD produced a significantly greater number of errors than their peers, specifically for the long-delay conditions. The adults showed no performance differences across the immediate response conditions nor across the delayed conditions. These results suggested that children with CAPD may have processing difficulties with visual stimuli.
Sulfolobus sulfataricus ATCC 35091, Haloferax volcanii, and Methanosarcina thermophila TM-1, representing the Euryarchaeota and Crenarchaeota subdomains of the Archaea, contain proteins which are phosphorylated on tyrosine. These data raise fundamental questions as to the origin and evolution of tyrosine phosphorylation, a protein modification that is of pivotal importance in the regulation of the physiology of eukaryotic cells.
BACKGROUND: Patients who suffer with gastroesophageal reflux Disease (GERD) endure a worsening of symptoms as their weight increases. When medical treatment of this condition in the morbidly obese patients fails, surgical intervention may be indicated. Choosing a procedure which not only helps achieve weight control but which also relieves symptoms and complications of GERD is the goal. We present a review of patients who have undergone Roux-en-Y Gastric Bypass (RYGBP) and related procedures for this disease. METHODS: One hundred eighty-eight patients undergoing surgery for morbid obesity and for GERD in 1992-1996 were contacted by mail or phone. All of these patients had undergone preoperative esophagogastroduodenoscopy to grade the severity of their disease. Their preoperative symptoms were compared to those experienced postoperatively. RESULTS: One hundred thirty patients underwent a RYGBP with modified Hill fundopexy, 22 patients underwent a distal gastrectomy with modified Hill fundopexy, 8 patients underwent distal gastrectomy alone and 28 patients underwent RYGBP alone. There have been no deaths. There were nine surgical complications, eight early and one at 2.5 years postoperation. Follow-up is 4-48 months. The average BMI dropped from 43 to 30.2 kg/m2. Whereas all patients were on some form of medical therapy before surgery, only 14 reported the need for medication postoperatively. CONCLUSIONS: Surgical intervention for weight control and treatment of GERD has been highly successful in our experience both with respect to weight control and to the reduction of reflux symptoms. Depending upon endoscopic and operative findings a RYGBP with or without an antireflux procedure can provide dramatic improvement. Gastrectomy with antireflux modifications is appropriate in selected cases.
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Serial sampling from the coronary sinus is an attractive technique for drawing blood samples to be used in the characterization of procoagulant activity during coronary interventions. We have developed a modified Simmons catheter for rapid cannulation of the coronary sinus from the femoral approach. The catheter design incorporates heparin bonding and distal side-holes to minimize blood sampling artifacts. Coronary sinus cannulation was performed via the femoral approach in 186 patients by use of a multipurpose catheter (n = 8), an unmodified Simmons I or II catheter (n = 64), or the modified Simmons catheter (n = 114). The coronary sinus was cannulated successfully with the modified Simmons catheter in 97% of patients; the success rate with the unmodified Simmons II catheter was 87% (P = 0.02). The modified Simmons catheter represents an improved technique for cannulation of the coronary sinus from the femoral vein.
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