Key trends and political issues facing AAHA.
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Aged↗
Biomedical subjects
S Goldberg
Publications and source records attributed to S Goldberg.
[Cocaine and toxicity of endogenous neurotransmitters].
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Animals↗
Improved stability and visualization during coronary artery angioplasty using a double catheter technique.
Guiding catheters used in coronary angioplasty can make coronary angioplasty potentially hazardous when they become positionally unstable, induce myocardial ischemia, or impair angiographic visualization. In order to avoid this problem, a double catheter technique was employed in seven patients involving nine procedures consisting of a standard 8 or 9 French angioplasty guiding catheter and a standard 7 French angiographic catheter to prevent coronary flow reduction and to permit improved coronary artery visualization. In two of the procedures, the second diagnostic catheter also permitted the prevention of potential plaque disruption by the guide catheter in the proximal right coronary artery. The predilatation stenosis was 88 +/- 12%; the postdilatation stenosis was 28 +/- 9%. The use of the diagnostic catheter as a second catheter prevented damping and permitted the stable disengagement of the guiding catheter from the coronary artery. This technique is most useful in patients who have proximal right coronary artery stenoses because it provides optimal visualization of the segment undergoing dilatation, avoids the potential for ischemia in more distal stenoses, and thereby allows the procedure to be performed in a controlled, unhurried manner.
Adult↗
Temperament in preterm infants: style and stability.
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Female↗
Patterns of temperament variation in three groups of developmentally delayed preschool children: mother and father ratings.
Patterns of temperament variation in the developmentally delayed preschool population have not been adequately studied. The present paper reports temperament data for children 2 to 4 1/2 years old: 32 with Down's syndrome, 29 with neurological problems, and 35 with delays of unknown etiologies, as reported by their mothers and fathers. Results indicate that children in the total delayed sample are more approaching, less intense, less persistent, and have higher thresholds for stimulation than those in the normative sample. There were differences among the three groups in activity level, approach/withdrawal, and distractibility. Furthermore, on these three dimensions, mothers scored their children as more difficult than did fathers. These data highlight the need for adequate norms for subgroups of delayed children, and suggest that inclusion of temperament assessment can be a useful part of the clinical care of delayed children and their parents.
Child, Preschool↗
Maternal behavior and attachment in low-birth-weight twins and singletons.
Early mother-infant interaction and later security of attachment were assessed for 17 pairs of twins, 5 singleton survivors of twin pairs, and 20 singletons, all low-birth-weight preterm infants. Mother and infant behavior during home observations at 6 weeks and 3, 6, and 9 months was rated on scales developed by Ainsworth and Egeland and Brunquell. A, B, and C patterns of behavior in the Strange Situation conformed to the frequencies predicted from prior full-term samples and were not affected by twinship. However, the proportion of B1 and B4 dyads in the B group significantly exceeded that predicted from normative data. Mothers in B2 and B3 dyads were rated more sensitive and responsive than all others at all 4 observations. Contrary to our expectations that mothers in A and C dyads would receive the lowest ratings, this occurred only at 6 weeks. At later observations mothers in B1 and B4 dyads consistently received the lowest ratings. The discussion focuses on possible reasons for this unexpected finding.
Birth Weight↗
Myocardial protection during transient coronary artery occlusion in man: beneficial effects of regional beta-adrenergic blockade.
The goal of this study was to verify whether myocardial protection could be achieved via the intracoronary administration of propranolol in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Accordingly, 21 patients undergoing PTCA were randomly assigned to receive either intracoronary placebo (group A, n = 10) or intracoronary propranolol (group B, n = 11). Three balloon inflations (i.e., coronary artery occlusions) were performed in each patient. Inflations I and II (maximum duration 60 sec) served as control occlusions. Inflation III (maximum duration 120 sec) was performed either after intracoronary administration of saline (2 ml) or propranolol (1.1 +/- 0.2 mg). The following electrocardiographic index of myocardial ischemic injury were measured: (1) time to development of ST segment elevation equal to 0.1 mV and (2) magnitude of ST segment elevation after 60 sec of coronary artery occlusion. Both indexes did not differ significantly between the groups during inflations I and II. In group A the time to development of ST segment elevation of 0.1 mV remained unchanged between the second and third occlusions (25 +/- 5 and 26 +/- 4 sec during inflations II and III, respectively). In group B subselective injection of propranolol into the affected coronary artery significantly prolonged the time to ST segment elevation of 0.1 mV from 19 +/- 4 sec (inflation II) to 53 +/- 9 sec (inflation III; p less than .001). Administration of placebo did not change the magnitude of ST segment elevation 60 sec after coronary artery occlusion between the second and third occlusion in group A (0.16 +/- 0.02 and 0.18 +/- 0.03 mV, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenergic beta-Antagonists↗
Family responses to developmentally delayed preschoolers: etiology and the father's role.
Parents of 59 developmentally delayed preschoolers (18 with Down syndrome, 19 with neurological problems, and with 22 unknown etiologies) responded to questionnaires and structured interviews to assess parental stress and support, locus of control, and self-esteem. There were group differences in maternal reports of positive experience with the child, self-esteem, reported support, and relations with grandparents. With the exception of self-esteem, all comparisons favored the Down syndrome group. Fathers reported fewer distress symptoms, higher self-esteem, more internal locus of control, and less support than did mothers. These findings indicate a need to understand individual differences among families of delayed children and illustrate that the effects of a child's handicap on fathers differ from those upon mothers.
Adult↗
Acute aortic regurgitation: pathophysiology and management.
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Acute Disease↗
VA Cooperative Study on Alcoholic Hepatitis. IV. The significance of clinically mild alcoholic hepatitis--describing the population with minimal hyperbilirubinemia.
As part of a large multicenter Veterans Administration Cooperative Study of Alcoholic Hepatitis, 89 patients with clinically mild biopsy-proven disease were followed for at least 30 months. Although clinical and laboratory abnormalities were minimal, cirrhosis was present in 38%, and mortality was 22% at 30 months. Clinical features suggesting more advanced disease (i.e., ascites and encephalopathy) and laboratory parameters for the diagnosis of alcoholic hepatitis and/or cirrhosis were imprecise and frequently misleading. The histologic diagnosis of cirrhosis correlated best with changes in immunoglobulin A, prothrombin time, and SGOT/SGPT. However, by using logistic discriminant analysis on 26 commonly available laboratory tests to diagnose cirrhosis, only a 72% sensitivity and 88% specificity could be obtained. Mortality in the patients with cirrhosis (10/34) was significantly higher at 1 and 2 yr compared with patients without cirrhosis (10/55, p less than 0.01). The high mortality in noncirrhotics may have resulted from progression to cirrhosis subsequent to the initial evaluation. Thus, liver biopsy in this population with minimal disease seems necessary to establish both an accurate diagnosis and the reversibility of the disease.
Ascites↗
Relation of myocardial salvage to size of myocardium at risk in dogs.
Infarct size varies in untreated animals subjected to coronary artery occlusion at the same anatomic site. The relation between the hypoperfused zone and the magnitude of myocardial salvage when different pharmacologic interventions are used remains to be established. Thus, in 95 anesthetized dogs, 1 minute after left anterior descending coronary occlusion, technetium-99m-labeled albumin microspheres (8 mCi) were injected into left atrium for the assessment of the hypoperfused zone. Fifteen minutes after coronary occlusion 42 dogs were randomized into a control group and 53 into a treated group. In the treated group, 6 dogs received nifedipine, 0.35 micrograms/kg followed by 2.4 micrograms/kg/hour; 7 received diltiazem, 0.2 mg/kg followed by 0.9 mg/kg/hour; 13 received bepridil, 2.5 mg/kg; 9 received cytochrome C, 2.5 mg/kg; 8 received rutosides, 200 mg/kg; and 10 received nifedipine plus cytochrome C. All drugs were administered intravenously. At 6 hours the dogs were killed and their hearts were cut into 3-mm-thick slices. Infarct size was determined by triphenyltetrazolium chloride staining; the hypoperfused zone was delineated by autoradiography. The dogs were retrospectively subgrouped as follows: those with small hypoperfused zones, i.e., less than 15% of the left ventricle (controls n = 8, treated n = 7) and those with large hypoperfused zones, i.e., more than 15% of the left ventricle (controls n = 34, treated n = 46). In dogs with large hypoperfused zones, treatment salvaged 42 +/- 3% of the myocardium destined to undergo necrosis, whereas in those with small hypoperfused zones 78 +/- 10% of myocardium was salvaged (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
31P NMR study of cerebral metabolism during prolonged seizures in the neonatal dog.
The effects of prolonged bicuculline-induced seizures on cerebral blood flow and metabolism were determined in paralyzed, mechanically ventilated neonatal dogs. Transient changes occurring early in the course of status epilepticus included significant arterial hypertension, hypocarbia, elevation of plasma norepinephrine levels, and decline in brain glucose concentration. Cerebral blood flow remained elevated throughout the 45 minutes of seizure. Determination of cerebral metabolite values by in vivo phosphorus 31 nuclear magnetic resonance spectroscopy and by in vitro enzymatic analysis of frozen brain samples showed significant decreases in the level of phosphocreatine and relatively less change in ATP values. Progressive intracellular acidosis occurred, coincident with elevation of brain lactate concentrations. We conclude that the physiological and metabolic alterations that occur during prolonged seizures are not uniform, but change with time. Any hypothesis advanced to explain the mechanism of neuronal injury during prolonged seizures must take into account these temporally related changes.
Adenosine Triphosphate↗
Unstable angina and evolving myocardial infarction following coronary bypass surgery: pathogenesis and treatment with interventional catheterization.
Effective therapy for patients with unstable angina or evolving myocardial infarction following coronary bypass surgery requires accurate delineation of the pathoanatomy and prompt intervention. We therefore performed cardiac catheterization in 10 consecutive patients: four with acute myocardial infarction and six with refractory unstable angina (NYHA class IV). All patients with acute myocardial infarction were found to have completely thrombosed vein grafts supplying totally occluded native coronary arteries. In three patients with evolving myocardial infarction occurring within 4 weeks of coronary bypass surgery, graft thrombosis was caused by venous valves in two patients and a suboptimal anastomosis in a third. The fourth patient sustained a myocardial infarction 7 years after coronary bypass surgery with atherosclerotic plaque rupture causing vein graft thrombosis. Therapy with intragraft streptokinase resulted in complete clearing of thrombus, pain relief, and control of injury current in all four patients. Rest angina with concomitant ST and T wave changes occurred in six patients. In two patients symptoms occurred early (within 6 months), whereas angina developed 4 to 10 years after coronary bypass graft surgery in four patients. In the two patients with early recurrence of symptoms suboptimal anastomosis was found in one, while the other patient had a venous valve in the vein graft in conjunction with a stenosis in the native coronary artery. In three of four patients with late recurrence of angina, symptoms developed as a result of atherosclerotic stenosis in their vein grafts; in the fourth patient an occluded graft was found to supply a stenosed native coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Surgical staff recognition of psychopathology in trauma patients.
This study investigated the recognition of psychopathology by the surgical team in 56 trauma patients independently evaluated by the authors for current psychiatric diagnosis using research criteria. Thirty-four per cent of patients (N = 19) met criteria for one or more psychiatric disorder, with alcohol abuse/dependence the most frequent diagnosis (N = 16). Examination of medical records showed no mention of psychopathology or related treatment plan for 13 of 19 patients (68%). Three patients' charts had brief comments related to the psychopathologic diagnosis, and three charts documented requested psychiatric consultation. This study demonstrates that substantial treatable psychopathology was undocumented and untreated in a trauma surgery patient population.
Adult↗
Attempts at gene therapy in beta-thalassemic mice.
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Animals↗
Observations on the chemical and physiological properties of urodiolenone, an urinary compound found in hypertension.
Urodiolenone is a substance that appears as the glucuronide in the urine of 1 in 3 hypertensive subjects. It is a potent inhibitor of Na+, K+-ATPase in kidney tissue of the guinea pig, as measured by cytochemical assay. Chemical and mass spectrometric evidence is presented, from which it is concluded that urodiolenone is a sesquiterpenoid substance, is a bicyclic enone with a vicinal diol side chain, and has molecular formula C15H24O3.
Female↗
Myocardial protection via coronary sinus interventions: superior effects of arterialization compared with intermittent occlusion.
It has been reported that infarct size can be reduced by several interventions, by which arterial blood is delivered retrogradely to the ischemic myocardium through the cardiac veins or alternatively the cardiac venous system is intermittently occluded. Accordingly, we studied several modalities of myocardial protection that used the cardiac venous system and compared them by means of a quantitative technique for measuring infarct size. Thus 73 anesthetized dogs with coronary arterial occlusion were randomized into the following groups: group I (n = 9), 6 hr of occlusion without any intervention; group II (n = 11), venovenous shunt (60 ml/min) to the great cardiac vein; group III (n = 11), arteriovenous shunt to the anterior interventricular vein; group IV (n = 12), high flow arteriovenous shunt to the anterior interventricular vein (60 ml/min); group V (n = 11), arteriovenous shunt to the great cardiac vein (60 ml/min); group VI (n = 10), arteriovenous shunt to the great cardiac vein (60 ml/min) combined with diastolic occlusion of the great cardiac vein; group VII (n = 9), intermittent pressure-controlled occlusion of the great cardiac vein without arterialization. The arteriovenous shunt (groups III to VI) or venovenous shunt (group II) was done by selective catheterization of the anterior interventricular vein or the great cardiac vein, advancing a catheter from the jugular vein through the right atrium and coronary sinus under fluoroscopic control. This catheter was then connected to a cannula located either in the carotid artery (groups III to VI) or in the right atrium (group II). One minute after occlusion, 99mTc-labeled albumin microspheres (8 mCi) were injected into the left atrium for the subsequent assessment of the hypoperfused zone, which is the area at risk for infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗