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Biomedical subjects

S Goldberg

Publications and source records attributed to S Goldberg.

At least 145 records · Page 8Linked to original sources
PubMed1988

Protection of the ischemic myocardium during percutaneous transluminal coronary angioplasty.

Therapeutic balloon coronary angioplasty provides a useful model for studying the effects of epicardial coronary artery occlusion in conscious humans. In addition, it is a potent model in which the effectiveness of interventions designed to ameliorate ischemia can be evaluated. Whereas intravenous beta-adrenergic blocking drugs and nitrates appear to have a limited protective effect, the regional (i.e., intracoronary) use of beta-adrenergic blocking drugs and calcium antagonists seem more potent. Currently, coronary venous retroperfusion with arterial blood does not appear practical, and the intraaortic balloon is a useful adjunctive measure in relatively few patients undergoing percutaneous transluminal coronary angioplasty. In contrast, the direct anterograde delivery of oxygen-rich blood or fluorocarbons holds promise as a reliable means of providing local myocardial protection. If ischemia could be markedly reduced, percutaneous transluminal coronary angioplasty might be applied safely in more high-risk clinical settings. In addition, if prolonged balloon inflation could be performed, there might be an increase in primary success rate and possibly a reduction in restenosis rate.

Adrenergic beta-Antagonists↗
PubMed1988

Recurrent ischemia in the zone of prior myocardial infarction: results of coronary angioplasty of the infarct-related artery.

We studied the efficacy of coronary angioplasty (PTCA) of the infarct-related artery in 54 patients with recurrent myocardial ischemia in the zone of prior infarction. Our patients had recurrent ischemia 10 +/- 7 days after infarction, with 75% experiencing rest angina and 15% having evidence of reinfarction. Angiography of the infarct-related artery demonstrated a critical stenosis in 35 of 54, a subtotal occlusion in 5 of 54, and a total occlusion in 14 of 54. PTCA was successful in 94% of critical stenoses, 80% of subtotal occlusions, but in only 50% of total occlusions. Complications related to PTCA included a 3.7% rate of emergency surgery, but no deaths or infarctions. During the clinical follow-up period of 11 +/- 7 months, there was one reinfarction and no deaths. Although 27% of our 44 patients with a successful initial PTCA required a second revascularization procedure for recurrent angina, 40 patients (91%) remained symptomatically improved with angioplasty alone (including successful repeat PTCA in eight patients). We conclude that PTCA of the infarct-related artery is beneficial for selected patients with recurrent ischemia in the zone of prior infarction.

Adult↗
PubMed1988

The effects of phospholipase A2 inhibition on experimental infarct size, left ventricular hemodynamics and regional myocardial blood flow.

It has been reported that activation of phospholipase A2 and the subsequent degradation of membrane phospholipids are responsible for irreversible myocardial injury. Thus, we examined whether a phospholipase A2 inhibitor 1-(benzylmethyl-amino)-3-[(alpha, alpha, alpha-trifluoro-m-tolyl)oxy]-2- propanol hydrochloride, can reduce myocardial necrosis after coronary artery occlusion. In 14 anesthetized dogs, 1 minute after coronary occlusion, 99mTc-labeled albumin microspheres (8 mCi) were injected into the left atrium for future assessment of the hypoperfused zone. After 15 minutes, the dogs were randomized to a control group (n = 7) and a treated group (n = 7, 2 mg/kg i.v.). After 6 hours, infarct size and hypoperfused zones were measured using triphenyltetrazolium chloride staining and autoradiography, respectively. The hypoperfused zone, as a percentage of the left ventricle, was 26 +/- 3% and 23 +/- 1% in the control and the treated groups (NS), respectively. The percentage of the hypoperfused zone that evolved to necrosis was 98 +/- 4% in the control group and 45 +/- 10% in the treated group (P less than 0.001) showing a reduction of 54%. By weight, in the control group, necrosis involved 26 +/- 4 g of the left ventricle while in the treated group it was 9 +/- 2 g (P less than 0.005). In 6 additional dogs, left ventricular hemodynamics and regional myocardial blood flow were studied before and after treatment i.e., 15 and 30 minutes after coronary occlusion, respectively. Phospholipase A2 inhibitor did not acutely change heart rate, aortic pressure, left ventricular end-diastolic and systolic pressures, left ventricular dP/dt and regional myocardial blood flow. Thus, phospholipase A2 inhibitor salvaged the acutely ischemic myocardium, reducing necrosis by over 50% in the canine model. It is postulated that since this effect was not related to the studied hemodynamic parameters and regional myocardial blood flow, it may be related to the preservation of membrane integrity.

Animals↗
PubMed1988

Chronic illness and early development. The parent's perspective.

While many chronic illnesses are diagnosed in infancy, there is little systematic study of the impact of chronic illness on early social development and how parental adjustment to a chronically ill infant contributes to subsequent outcomes. This paper outlines some of the factors which affect parents' ability to care for chronically ill infants and preschoolers. It draws upon studies of infants with other medical problems, ongoing longitudinal study of infants with cystic fibrosis and congenital heart disease by the authors; and the authors' clinical experience.

Child↗
PubMed1988

Chronic illness and infant-mother attachment: cystic fibrosis.

In order to evaluate the effects of a chronic potentially lethal illness on infant-mother relationships, we assessed 23 infants diagnosed with cystic fibrosis (CF) in the first year of life and 23 healthy controls in Ainsworth's "strange situation" paradigm for attachment at 12-18 months of age. There were no differences in distribution of attachment patterns between the CF infants and the controls, or between either group and published norms. Comparisons between securely and insecurely attached infants in the CF group indicated that, although they did not differ in measures of initial severity of illness, the insecure group was diagnosed significantly earlier and had significantly lower weight and weight for height at 12-18 months. Although the sample is small, these findings point to the possible psychosocial impact of illness and the role that psychosocial factors can play in the health and growth of infants.

Child Development↗
PubMed1987

The effects of cytochrome C on the extent of myocardial infarction and regional function of the ischemic myocardium.

The effects of cytochrome C, an electron carrier in the process of oxidative phosphorylation, on infarct size and regional left ventricular function after a coronary artery occlusion were investigated. Thus, in 30 dogs, 1 minute after left anterior descending coronary artery occlusion, 99mTc-labeled albumin microspheres (8 mCi) were injected into the left atrium for subsequent assessment of the hypoperfused zone, that is, the area at risk of infarction. Fifteen minutes after coronary artery occlusion, dogs were randomized into a control group (n = 15) and a cytochrome C-treated group (n = 15). The latter immediately received cytochrome C, 2.5 mg/kg intravenously. Six hours after coronary artery occlusion the dogs were sacrificed and their left ventricles were cut into 3 mm thick slices. Infarct size was determined by triphenyltetrazolium chloride staining and measured by planimetry. The same slices were then submitted to autoradiography and the hypoperfused zone was then measured by planimetry. The hypoperfused zone was 22 +/- 2% and 23 +/- 2% of the left ventricle in the control and treated groups, respectively (NS), indicating that the extent of myocardium at risk before treatment was similar. The extent of the hypoperfused zone which evolved to necrosis was 90 +/- 3% in the control group but only 50 +/- 7% in the treated group (p less than 0.001). Myocardial salvage in the treated group was paralleled by improvement in systolic wall thickness of the ischemic segment as measured by two-dimensional echocardiography. Thus, cytochrome C reduced the extent of myocardial necrosis by 44% and improved systolic function of the ischemic myocardium.

Animals↗
PubMed1987

Percutaneous transluminal coronary angioplasty in patients with prior myocardial infarction: angioplasty at a distance from the prior infarct zone.

Patients undergoing coronary angioplasty who have had a prior transmural myocardial infarction in the distribution of a contralateral coronary artery are considered a high-risk group because of potentially severe left ventricular dysfunction if an ischemic complication occurs. The purpose of this study was to evaluate the safety and efficacy of coronary angioplasty in 28 patients with prior myocardial infarction remote from the artery undergoing dilatation. Prior myocardial infarction was defined by the presence of pathologic Q waves on ECG or segmental akinesis on ventriculography. Angioplasty was successful in 30 of 33 lesions (91%) and in 25 of 28 patients (89%). Mean stenosis diameter was reduced from 91% +/- 7% to 28% +/- 16%; mean translesional gradient after angioplasty was 6 +/- 5 mm Hg. No patient developed severe hemodynamic deterioration from transient coronary occlusion during balloon inflation or from an acute ischemic complication. Three patients underwent coronary artery bypass surgery after unsuccessful angioplasty. There were no new Q wave infarctions or deaths. The results of coronary angioplasty in patients with prior infarction were compared with those of 203 patients without prior remote infarction. Primary success and occurrence of major complications were comparable in both groups. At a mean follow-up of 12 +/- 6 months, 18 of the 25 patients (72%) who underwent initially successful dilatation have remained symptom free with angioplasty alone. Therefore, coronary angioplasty is a suitable therapeutic procedure in carefully selected patients with angina pectoris and prior myocardial infarction at a distance from the site of angioplasty.

Adult↗