Biomedical subjects
S Goldman
Publications and source records attributed to S Goldman.
Abnormal myocardial capillary perfusion with normal coronary arteries and valvular heart disease.
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Response of atrial fibrillation to therapy: role of etiology and left atrial diameter.
Left atrial diameter was measured by echocardiography in 107 patients in atrial fibrillation. The etiology of atrial fibrillation was rheumatic heart disease with predominant mitral valve involvement (RHD) in 51 patients and idiopathic atrial fibrillation (IAF) in 56. The left atrial diameter was correlated to the patient's response to therapy. The mean left atrial diameter was 3.4 cm in patients with paroxysmal atrial fibrillation, 3.8 cm in those requiring direct current (DC) cardioversion, and 4.4 cm in patients with persistent atrial fibrillation. However, in each of these therapeutic response groups, the left atrial diameter was signficantly smaller in patients with idiopathic atrial fibrillation. In the group with paroxysmal atrial fibrillation, the mean left atrial diameter was 4.3 +/- .7 cm in patients with RHD, compared to 3.1 +/- .6 cm in those with IAF (p less than .001). In the group requiring DC cardioversion, the left atrial diameter was 4.7 +/- .8 cm in patients with RHD compared to 3.6 +/- .5 cm in those with IAF (p less than .01). In patients with persistent atrial fibrillation, the left atrial diameter was 5.2 +/- .9 cm in patients with RHD and 4.0 +/- 1.0 cm in IAF (p less than .001). Left atrial diameter as well as the etiology of the heart disease are important in determining the response of atrial fibrillation to therapy.
Effect of quinine on digoxin kinetics.
Six subjects were evaluated for the effect of quinine, the l-isomer of quinidine, on digoxin pharmokinetics. A 1.0-mg intravenous digoxin dose was given before and during quinine administration, followed by the measurement of digoxin serum and urine concentrations for 96 hr after each dose. Quinine reduced digoxin total body clearance by 26% from 2.98 to 2.22 ml/min/kg (p < 0.03). Digoxin elimination half-life (t 1/2) was lengthened from 34.2 to 51.8 hr, reflecting a 32% decrease in digoxin elimination rate constant (p < 0.003). Quinine did not reduce digoxin renal clearance or any volumes of distribution. The amount of digoxin excreted into the urine increased from x = 628. 29 micrograms to x = 772.52 micrograms (p < 0.02). Digoxin nonrenal clearance decreased an average of 55% from 1.2 to 0.55 ml/min/kg (p < 0.05). These results suggest that quinine alters digoxin metabolism or biliary secretion, reducing digoxin total body clearance by a mechanism that is qualitatively similar, but quamtitatively different, from quinidine.
A new approach to vital root resection.
This report deals with ten cases in which periodontal surgery was performed followed by immediate resection of one of the vital buccal roots on maxillary molars. The resultant pulpal opening was treated with calcium hydroxide, zinc oxide and eugenol then sealed with an amalgam alloy. Two additional cases were treated in reverse order by first resecting the vital root followed by immediate periodontal surgery. All cases were evaluated over a 1 to 3 year period. The results indicate that vital root resection at the same time as periodontal surgery compares favorably with cases treated in which periodontal surgery was completed at a prior appointment.
Digitoxin-quinidine interaction: pharmacokinetic evaluation.
The effect of quinidine on digitoxin single-dose pharmacokinetics was evaluated in five healthy adults. Blood was collected for 3 weeks, and a complete urine collection was obtained for 4 days, after a single intravenous dose of digitoxin. The protocol was conducted once while each subject was taking oral quinidine, for 3 weeks, and then repeated 10 days after discontinuing quinidine treatment. Quinidine induced the following changes in digitoxin pharmacokinetics: Elimination half-life was prolonged from 174 +/- 25 to 261 +/- 58 hours (p less than 0.02); total body clearance decreased from 1.54 +/- 0.40 to 1.09 +/- 0.31 mL/h . kg (p less than 0.05); renal clearance decreased from 0.65 +/- 0.07 to 0.46 +/- 0.17 mL/h . kg (p less than 0.05). Digitoxin volume of distribution and protein binding were unaltered by quinidine. Quinidine caused a rise in serum digitoxin levels. Digitoxin total body clearance was decreased by quinidine to an extent comparable to that reported for digoxin; however, the mechanism of the interaction with the two digitalis glycosides may, in part, be different.
Metabolism and rate of elimination of digoxigenin bisdigitoxoside in dogs before and during chronic azotemia.
The purpose of this study was to evaluate the metabolism and rate of elimination of digoxigenin bisdigitoxoside (bis) before and during chronic azotemia in dogs. Bis was eliminated primarily by nonrenal mechanisms. The half-life of bis was 18.5 hr, compared to 31.6 hr for digoxin, and was not significantly increased in azotemic dogs. The oral bioavailability of bis in azotemic dogs relative to an intravenous dose was approximately 46%.
Digoxin-quinidine interaction Pharmacokinetic evaluation.
Several recent reports have shown that plasma concentrations of digoxin increase when quinidine is administered along with digoxin; the present study was designed to explore the pharmacokinetics of this digoxin-quinidine interaction in six subjects. The elimination half-life of digoxin, although variable, did not change appreciably (42 vs. 44 hours) when quinidine was administered. Other pharmacokinetic values were substantially reduced in the presence of quinidine: total body clearance (from 3.08 to 1.96 ml per minute per kilogram), renal clearance (from 1.64 to 1.09 ml per minute per kilogram) and volume of distribution (from 10.87 to 7.35 liters per kilogram). The results may be explained by the displacement of digoxin from binding sites in tissue by quinidine, causing a rise in the plasma concentration of digoxin. The reduction in renal clearance of digoxin may result also from inhibition of renal secretion of digoxin by quinidine.
Pharmacokinetics of furosemide in patients with congestive heart failure.
Since patients vary in their response to furosemide, a pharmacokinetic study of this drug was undertaken in 7 patients with severe congestive heart failure. The extent of oral availability, determined by the ratio of areas under the oral to intravenous plasma concentration-time curve, averaged 61%, but varied widely from patient to patient, from 34 to 80%. Absorption of the drug was often delayed, with a lag time before appearance in the plasma averaging 28 +/- (SD) 15 min. The volume of distribution of furosemide (averaging 114 ml/kg) was not diminished in the presence of congestive failure; likewise, drug clearance and elimination half-lives are similar to values reported in normal subjects. Urinary flow rates 1--2 h following dosing were significantly less after oral than intravenous dosing, but flow rates over 4, 8 or 24 h after dosing were similar for both routes of administration.
Unusual complication of the Hancock porcine heterograft: strut compression in the aortic root.
A 65-year-old man underwent aortic valve replacement and triple coronary artery bypass grafting which were followed by gradual late postoperative thrombosis of his 25 mm. Hancock porcine aortic heterograft. At reoperation, the valve struts were noted to be angled centrally into the aortic lumen and dense thrombus completely filled all three sinuses. After valve removal and extensive debridement of the aortic anulus, including relaxing incisions, a diameter of only 23 mm. was obtained. A 23 mm. Björk-Shiley aortic prosthesis was inserted and the patient's recovery was uneventful. This previously unreported complication resulted from the insertion of a too-large Hancock porcine heterograft into a relatively small aortic root, resulting in circumferential strut compression, impedance of central flow, and subsequent valve thrombosis.
Complete heart block with hyperthyroidism.
Thyrotoxicosis developed in a patient while receiving thyroid hormone therapy for clinical hypothyroidism. The development of second-degree heart block of Mobitz type 1 variety was followed by third- and then first-degree heart block. We conclude that the varying degrees of heart block were secondary to hyperthyroxinemia caused by Graves' disease and exogenous thyroid hormone.
Clinical value of the thallium-201 stress test sensitivity and specificity in the detection of coronary artery disease.
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Rheumatoid pericarditis presenting as a mass lesion.
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Difficulties in the diagnosis of unusual manifestations in sarcoidosis. Significance of the Kveim test.
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Advances in cardiovascular nuclear medicine.
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The treatment of hirsutism with cyproterone acetate (an anti-androgen).
The rationale of anti-androgen treatment for hirsutism is explained. The results are presented of treatment with cyproterone acetate of idiopathic hirsutism or hirsutism associated with polycystic ovarian disease. Ten out of 14 patients showed a good response after six months treatment. The response was dramatic in two patients.
[Ureteral diverticulosis (author's transl)].
We report here two new cases of ureteral diverticulosis. This condition is found usually in the man of the fifties who has most frequently an urinary tract infection or a prostatic adenoma. The roentgen findings are multiple out-poutchings of the lumbar ureter. Several factors are combined (constitutionnal, urinary tract infection, disordered ureteral-motility) to explain the creation of diverticules in the areas of weakness of ureteral wall, where penetrate the vessels.
[Precision bone densitometry using films without screens (author's transl)].
The new method of indirect bone densitometry proposed evaluates a coefficient of reduction related to the minerals of bone tissue (M.C.R.) by measurement of the blackness of a film without creen exposed to a well-defined monochromatic ray. The M.C.R. is closely related (R=0.98) to the mineral content measured experimentally in bone fragments. It represents a precise evaluation of the "quality" of bone tissue. A.M.C.R. less than normal is seen in hyperosteoidosis syndromes or in the case of increased intraosseous resorption. This relatively simple and cheap method is particularly useful in the detection and observation of osteomalacia, and in bone disorders associated with haemodialysis and hyperparathyroidism.