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Biomedical subjects

S Stern

Publications and source records attributed to S Stern.

At least 181 records · Page 10Linked to original sources
PubMed1982

Atypical ventricular tachycardia (torsade de pointes) induced by amiodarone: arrhythmia previously induced by quinidine and disopyramide.

A 44-year-old woman is described in whom amiodarone, disopyramide, and quinidine, administered alone separately, induced atypical ventricular tachycardia (AVT, torsade de pointes). Following a closed mitral valvotomy, she received quinidine, 1.2 g/day, without interruption for 17 years. Because of a recurrence of paroxysmal atrial fibrillation, the dose of the drug was increased to 1.4 g/day; 24 hours later AVT with syncope developed but responded promptly to atropine. Two years later, 24 hours following an increase in the dose of disopyramide from 300 to 600 mg/day, AVT with syncope occurred; isoproterenol abolished the arrhythmia instantly. Amiodarone was the third drug to induce AVT in this patient; she received 200 mg/day six days per week for six months. The dose was subsequently increased to 200 and 400 mg/day on alternate days, six days per week, and two months later AVT occurred. That time the only effective treatment was ventricular pacing.

Adult↗
PubMed1981

Ventricular pacing in atypical ventricular tachycardia.

Ventricular pacing was effective in controlling recurrent bouts of atypical ventricular tachycardia (Torsade de Pointes), in four patients. This arrhythmia was induced by quinidine or disopyramide therapy. Isoproterenol, which is the usually recommended therapy, was ineffective in two of the patients and was considered hazardous in two others. We consider ventricular pacing as a safe and reliable method for treatment of AVT, which should be applied if isoproterenol is ineffective or contraindicated.

Aged↗
PubMed1981

Anorexia Nervosa: the hospital's role in family treatment.

When an anorexia nervosa patient requires hospitalization for her medical condition the treatment team faces the problem of integrating the individual focus of inpatient care with the systems focus of family therapy. In this paper we propose a family-systems model of hospitalization, the aim of which is to facilitate such integration. The model draws on current theories of anorexia nervosa, as well as general concepts from psychodynamic, developmental, and family systems theories. The major hypothesis of the model is that all members of the anorexic family are developmentally arrested in the area of separation-individuation. On this assumption, we propose that the entire treatment team (including medical professionals and therapist) needs to function as "parents" to the anorexic family in much the same way that two cotherapists become parental figures in a family therapy. Specifically, the team needs to provide those parenting the responses that facilitate the family's individuation process.

Adolescent↗
PubMed1981

MMPI prediction of imipramine response: a replication study.

18 hospitalized male depressives were treated with imipramine hydrochloride for 28 days. Prior to initiating treatment, each patient completed the Minnesota Multiphasic Personality Inventory (MMPI). At the end of the treatment period, the patients were divided into groups of responders and nonresponders based on the change in their Hamilton Depression Rating Scale scores. The Imipramine Response Scale - Male (IRS-M) was scored for each patient and the ability of the scale to predict response or nonresponse in our sample of patients was examined. There was no evidence that the IRS-M was better than chance in its ability to predict response.

Adult↗
PubMed1981

Relationship between ventricular arrhythmias detected by ambulatory ECG monitoring and subsequent sudden cardiac death.

During the years 1971-1974, ambulatory ECG monitoring (AEM) during everyday activities was done in 888 consecutive subjects. Half of them were patients who suffered from chronic ischemic heart disease (IHD), while in the others no symptoms or signs of this disease were found. Ventricular arrhythmias (VA) were detected in 196 subjects of the former and in 190 of the latter group. The Bureau of Statistics provided information concerning the individuals who died before December 31, 1976, the cause of their death and whether or not the death occurred in hospital or was 'sudden'. We found that during the follow-up period, the rate of sudden cardiac death among the patients with IHD in whom AEM detected VA was higher than in subjects without VA. In the former group, there were 12 sudden cardiac deaths among 196 patients, while in the latter there were only 4 out of 248, a statistically significant difference. Sudden cardiac death was more frequent in individuals without IHD if AEM disclosed VA (4 sudden cardiac deaths among 190 subjects), as compared to individuals without VA (no sudden cardiac deaths among 254 subjects).

Adult↗
PubMed1981

Etiology, warning signs and therapy of torsade de pointes. A study of 10 patients.

Torsade de pointes, also called atypical ventricular tachycardia (AVT), was diagnosed in 10 patients, nine on antiarrhythmic therapy and one with acute central nervous system damage. Four patients received quinidine and five disopyramide, either alone or in combination with amiodarone. AVT was dose-dependent in some, but in others, it started shortly after initiation of drug therapy (idiosyncrasy). All patients had QT prolongation longer than 0.60 second immediately before the onset of AVT. This measurement appeared to be a more sensitive predictor of the development of AVT than QTc prolongation or QRS widening. All patients also showed bradycardia before AVT onset. After therapy, the QT immediately decreased, while QTc and QRS remained prolonged for longer periods. Isoproterenol was effective in five of seven patients, but was contraindicated in two others. Ventricular pacing was used in four patients, including the two who did not respond to isoproterenol, and this abolished AVT promptly. Isoproterenol or pacing appear to be the therapy of choice for AVT, while the conventional drugs used to treat the usual form of ventricular tachycardia are not only ineffective, but even contraindicated.

Adult↗
PubMed1981

Disopyramide-induced Torsade de Pointes.

Recurrent ventricular tachycardia (torsade de pointes) is a serious and sometimes fatal arrhythmia occurring usually with quinidine therapy. Four patients experienced ventricular tachycardia after receiving conventional doses of disopyramide phosphate (600 mg/day) for recurrent atrial fibrillation-two of them in combination with amiodarone hydrochloride. Isoproterenol hydrochloride infusion was effective in three patients, while ventricular pacing promptly abolished ventricular ectopic beats and the ventricular tachycardia in the fourth patient. Torsade de pointes is more likely to occur in patients with severe repolarization delay and sinus bradycardia or atrioventricular block, and its appearance in four patients within a period of nine months after the introduction of disopyramide treatment in our service raises the possibility that this is not a rare complication of this drug, especially if used in combination with other QT interval-prolonging agents.

Aged↗
PubMed1980

Electrocardiographic characteristics of neurocirculatory asthenia during everyday activities.

We describe the electrocardiographic changes during everyday activities recorded by ambulatory electrocardiographic monitoring in 67 patients with neurocirculatory asthenia. The findings were compared with the results of ambulatory monitoring in 33 healthy controls. We observed episodes of sinus tachycardia > 120/min unrelated to effort in 60 of the patients, 35 had frequent episodes of pronounced sinus arrhythmia, 16 showed transient ST depression, and six transient ST elevation. All these changes appeared during the patients' routine activities, without any unusual exertion and frequently at rest. Periods of sinus tachycardia and sinus arrhythmia were recorded from the patients during sleep. Cardiac arrhythmias, especially ventricular premature beats, were also much more common in those with neurocirculatory asthenia than in the control subjects. These findings indicate that ambulatory electrocardiographic monitoring provides important information on the electrocardiographic characteristics of patients with neurocirculatory asthenia and helps to establish this diagnosis in obscure cases.

Activities of Daily Living↗
PubMed1980

The pathway of enamel rods at the base of cusps of human teeth.

Enamel increases in volume and surface area with distance from the dentin-enamel junction, particularly at cusps, while the number of rods remains constant. Our results indicate that the increase in volume may be due to the increased rod diameter near the tooth surface, a circumferential winding of rods in the parazone orientation of Hunter-Schreger bands, and the migration of rods from a mid-coronal origin at the dentin surface to a cuspal terminaton at the tooth surface. Increased surface area can be explained by the increased rod diameter and the oblique approach of rods to the tooth surface.

Acid Etching, Dental↗
PubMed1980

Adult respiratory distress syndrome in the course of acute myocardial infarction.

The diagnosis of adult respiratory distress syndrome (ARDS) has been made in our intensive coronary care unit in four patients during the course of acute myocardial infarction (AMI). In all four patients, the syndrome manifested itself either after resuscitation or after a transient hypotensive state. In two of the patients none of the conditions known to be possible etiologies of ARDS was present; in the third, smoke inhalation preceded; and in the fourth, aspiration followed the AMI. The clinical and x-ray pictures were indistinguishable from acute left heart failure, the PaO2 levels were about 40 mm Hg, and a low pulmonary arterial wedge pressure was measured in all cases. Positive end-expiratory pressure was used successfully, combined with other therapeutic measures, and three patients recovered from the ARDS. The association of ARDS and AMI carries a grave risk in view of the additional damage that may be caused by the severe hypoxemia to the already compromised myocardium. The AMI, if complicated by circulatory arrest, cardiogenic shock, or hypotension, seems to be an etiologic factor in the development of ARDS and it should be added to the growing list of conditions that may give rise to this new syndrome.

Aged↗
PubMed1980

Shaping the location of a pigeon's peck: effect of rate and size of shaping steps.

For several pigeons, pecking at particular locations within a ten-inch-wide response area was reinforced by grain presentations. The reinforced locations changed systematically to "shape" response location back and forth across the area. The rate and size of these shifts in reinforced locations were varied in both between-subject and within-subject comparisons to evaluate the influence of these variables on the shaping process. Larger step sizes produced larger shifts in location for all sizes inspected, with all sizes from .5 to 3.0 inches effective in shaping behavior. More rapid steps were approximately as effective as slower steps for all rates of shift inspected from 25 reinforcers to 400 reinforcers per step. These data suggest that shaping peck location proceeds most efficiently with rapid, relatively large shifts in criterion performance.

Animals↗
PubMed1980

Right atrial pacing soon after myocardial infarction for assessment of residual myocardial ischemia.

To assess the presence of residual myocardial ischemia, right atrial pacing was performed in 30 patients with 31 episodes of acute myocardial infarction (AMI) on the day before their discharge from the hospital. Ten patients had anterior, 11 inferior, and 10 subendocardial AMI. The atrial pacing was performed in the intensive care unit. The electrode was introduced by direct puncture of the antecubital vein and positioned under intracavitary ECG control. No complications occurred in any of the patients. Ischemic ST depression was observed in 14 patients. Only 1 of 10 with anterior AMI had a positive test, compared with 7 of 11 with inferior AMI and 6 of 10 with subendocardial AMI. It is concluded that right atrial pacing can be performed safely in patients soon after AMI, and that the procedure is sensitive in detecting residual myocardial ischemia. It is expected that this method will provide a tool for identifying high-risk patients, thus enabling better treatment and possibly a reduction in the rates of reinfarction and sudden death.

Adult↗
PubMed1980

Behavioral effects of microwaves.

Microwaves can produce sensations of warmth and sound in humans. In other species, they also can serve as cues, they may be avoided, and they can disrupt ongoing behavior. These actions appear to be due to heat produced by energy absorption. The rate of absorption depends on the microwave parameters and the electrical and geometric properties of the subject. We, therefore, cannot predict the human response to microwaves based on data from other animals without appropriate scaling considerations. At low levels of exposure, microwaves can produce changes in behavior without large, or even measureable, changes in body temperature. Thermoregulatory behavior may respond to those low levels of heat, and thereby affect other behavior occurring concurrently. There are no data that demonstrate that behavioral effects of microwaves depend on any mechanism other than reactions to heat. Our interpretation of whether a reported behavioral effect indicates that microwaves may be hazardous depends on our having a complete description of the experiment and on our criteria of behavioral toxicity.

Absorption↗
PubMed1979

Microwaves: effect on thermoregulatory behavior in rats.

Rats, with their fur clipped, pressed a lever to turn on an infrared lamp while in a cold chamber. When they were exposed to continuous-wave microwaves at 2450 megahertz for 15-minute periods, the rate at which they turned on the infrared lamp decreased as a function of the microwave power density, which ranged between 5 and 20 milliwatts per square centimeter. This result indicates that behaviorally significant levels of heating may occur at an exposure duration and intensities that do not produce measurable changes in many other behavioral measures or in colonic temperature. Further study of how microwaves affect thermoregulatory behavior may help us understand such phenomena as the reported "nonthermal" behavioral effects of microwaves.

Animals↗