Elevated endothelin 1 levels in critical illness.
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Biomedical subjects
Publications and source records attributed to S Ehrlich.
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PURPOSE: To determine the clinical significance of fluid in the acromioclavicular (AC) joint. MATERIALS AND METHODS: A total of 108 patients with clinical shoulder problems and 16 volunteers underwent MR imaging with a 1.5-T unit. Coronal T1- and T2-weighted images were evaluated for the presence of AC joint fluid, glenohumeral joint fluid, and AC joint osteophytes. Medical records were reviewed for the presence of clinical signs and symptoms. RESULTS: AC joint fluid was commonly seen in the patients (67%) but was rare in the volunteers (12%). The presence of AC joint fluid was associated with advancing patient age, presence of osteophytes, and fluid in the glenohumeral joint. AC joint fluid was not associated with focal tenderness, prior corticosteroid injections, history of trauma, findings of impingement, evidence of rotator cuff tear on MR images, or gender. CONCLUSION: AC joint fluid appears to be an asymptomatic manifestation of osteoarthritis.
In patients with history of sustained ventricular tachycarrhythmias, the efficacy and safety of moricizine have not been systematically evaluated by electrophysiological studies. We performed electrophysiological testing in these patients in the drug-free state and then after moricizine loading, and evaluated the safety profile of moricizine during in-hospital loading and follow-up. The study population comprised of 31 patients with clinically sustained ventricular tachyarrhythmia. The underlying heart disease was coronary in 25 patients, cardiomyopathy in 5 patients, and none in 1 patient. The left ventricular (LV) ejection fraction ranged from 15%-69% (mean 39 +/- 15%). During the baseline drug-free electrophysiological testing, sustained ventricular tachycardia was inducible in 27 patients, ventricular fibrillation in 1 patient, and reproducible, nonsustained ventricular tachycardia (15-25 sec) in 3 patients. All 31 patients received moricizine to the maximum tolerated dose (851 +/- 185 mg) over a period of 2-7 days. Six patients developed ventricular proarrhythmia within the first 4 days. Proarrhythmia required multiple cardioversions in three patients, was not associated with QT prolongation, and spontaneously resolved 6-24 hours after withdrawal of moricizine. Of the remaining 25 patients, 24 underwent electrophysiological testing on moricizine and 4 patients (16%) were rendered noninducible. The VT cycle length in the other 20 patients slowed from 243 +/- 30 msec to 299 +/- 60 msec (P < 0.09). Four noninducible patients, two patients with inducible but slowed VT and one patient who had refused further testing were discharged on moricizine.(ABSTRACT TRUNCATED AT 250 WORDS)
UNLABELLED: Selection of an optimal pacemaker tachycardia reversion algorithm is generally performed utilizing programmed electrical stimulation (PES). Multiple tachycardias are induced and various tachycardia termination protocols are tested for reversion success. However, PES may induce nonclinical tachycardia and result in an inaccurate assessment of subsequent reversion effectiveness for spontaneous tachycardia. To investigate this question, we compared tachycardia reversion protocol success for PES-induced tachycardia versus spontaneously occurring tachycardia in 16 patients with atrially placed Intermedics 262-12 antitachycardia pacemakers. The pacemaker has tachycardia response counters, and the reversion success was calculated from these counters. This was performed by comparing the percent of time 1 degree versus 2 degrees modality use occurred; crossover to the 2 degrees modality implied failure of the 1 degree modality to convert the tachycardia. PES was used to induce multiple episodes of tachycardia and spontaneous episodes of tachycardia were recorded over time by pacemaker counters. The pacemaker 1 degree modality success was then compared for spontaneous and induced arrhythmias. RESULTS: A total of 53 discrete data comparisons of PES versus spontaneous tachycardia counters were performed in the 16 patients. PES reversion success occurred 85% +/- 22% of the time versus a spontaneous reversion success of 88% +/- 22%. However, the Spearman rank correlation coefficient test demonstrated nonsignficant overall correlation (P < 0.01), and Pearson correlation on an individual patient basis varied widely (r value from < 0.1 to 1.0). CONCLUSIONS: When utilizing the same termination algorithm, the percentage conversion of tachycardias occurring spontaneously and induced by PES is similar but does not correlate well overall. This suggests that PES may not be a good linear predictor of the long-term success of antitachycardia pacing algorithms.
To determine the optimal daytime dietary regimen for type 1 glycogen storage disease (GSD), we used uncooked cornstarch (UCS) at a basal glucose production rate (GPR) in single and divided doses, with mixed meals at 0700 and 1700 h. This regimen was compared with a 1.5 times larger single dose of UCS at 0700 h, and with dextrose at GPR at 1200 h. Two-hour UCS loads (amount equal to GPR in 2 h) given with a mixed meal at 0700 h and 180 min later maintained mean blood glucose (BG) concentrations at greater than or equal to 4.2 mmol/L for 300 min. BG was significantly greater from 240 to 300 min compared with a single 4-h UCS load, and at 300 min compared with a single 6-h UCS load. Similar effects were noted when the divided UCS regimen was given with a mixed meal at 1700 h, but not when isoenergetic amounts of dextrose were given on the same schedules with a mixed meal at 1200 h. A daytime schedule of six UCS feedings (with the three main meals and 180 min later) at GPR maintains BG at concentrations that should minimize biochemical abnormalities and optimize clinical outcome in patients with GSD.
This report documents how intravascular ultrasound imaging was used to diagnose a short "napkin-ring" stenosis that was missed by coronary angiography. Intravascular ultrasound revealed a lumen of 2.6 x 2.5 mm in diameter and 5.0 mm2 in cross-sectional area, with a residual atheroma that occluded 63% of available cross-sectional area at the stenosis.
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The current study investigated over time variation of Positive and Negative Affect and the relation between mood level and personality characteristics. 68 male undergraduate volunteers completed the Multidimensional Personality Questionnaire and then recorded mood ratings daily over a 29-day period. Spectra time series analyses showed a distinct and significant seven-day cycle for Positive Affect and Negative Affect, with the peak in Negative Affect occurring approximately three days after that of Positive Affect. Positive Affect was significantly correlated with scores on Well-being, Social Closeness, Social Potency, and Absorption scales of the questionnaire, while Negative Affect was significantly related to scores on the Stress-Reaction, Alienation, and Aggression scales.
Knowledge of the length of the uterine end of the fallopian tube and the presence of tubal adhesions and fistulas is important when surgical reversal is undertaken in patients who have had tubal ligation. We retrospectively studied hysterosalpingograms in 127 such patients to determine their value in providing this information. The ligation was performed by using the Pomeroy technique in 57 patients. Sixty-one patients had bipolar electrocautery, six had Falope rings inserted, and three had Hulka clips applied. In all cases, the uterine ends of the tube were visualized to a point of obstruction. The sites of occlusion after Pomeroy ligation were midtubal (46%), cornual (16%), proximal ampullary (16%), proximal isthmic (14%), and intramural (8%). After the electrocautery procedure, the sites of occlusion were proximal isthmic (45%), intramural (20%), midtubal (19%), cornual (15%), and proximal ampullary (1%). When Falope rings and Hulka clips were used, the most frequent site of occlusion was midtubal (50%). Tubal adhesions, consistent with successful occlusion, were detected in 16 patients on the basis of a small confined area of extravasation of contrast material at the site of ligation. Tuboperitoneal fistulas, identified by the presence of contrast material spilled from the uterine end of the tube into the peritoneal cavity, were detected in five patients. Our results show that hysterosalpingography is a useful technique for determining the status of the uterine end of the fallopian tube after ligation when reversal of ligation is planned.
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Maternal drug abuse during pregnancy exposes the fetus to the possibility of toxic or addicting effects. At a methadone hydrochloride maintenance program providing medical care to drug-dependent women and their infants, ophthalmologic examinations of all infants born during a 36-month period were performed. Twenty-nine infants prenatally exposed to psychoactive drugs were seen at birth and on follow-up. The 24% prevalence of strabismus found in the drug-exposed infants was significantly greater than that of 2.8% to 5.3% reported in the general population. These data suggest that maternal drug abuse and increased methadone dosage during pregnancy may predispose infants to the development of strabismus.
Twenty subjects identified filtered pictures of previously learned target stimuli. Five filters were utilized: 3 two-octave wide band-pass and 2 complementary (same cutoff) high- and low-pass. Response times and per cent errors were used to assess performance. The filtered pictures were presented at two sizes: to ten subjects at twice the size presented to the other ten. The results indicated that higher spatial frequencies contribute more to the identification task than do the low spatial frequencies, but also that neither low nor very high frequencies are redundant for identification. It was also seen that both the proximal (c/deg) and the distal (c/picture) scales of spatial frequency measurement are involved in the identification process.
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