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Biomedical subjects

W Shapiro

Publications and source records attributed to W Shapiro.

At least 73 records · Page 4Linked to original sources
PubMed1976

Technetium stannous pyrophosphate myocardial scintigrams in the recognition of myocardial infarction in patients undergoing coronary artery revascularization.

Myocardial imaging using technetium 99m stannous pyrophosphate (99mTc-PYP) has been utilized preoperatively and three to five days postoperatively to detect myocardial infarction in 48 patients undergoing aortocoronary bypass grafting, including 7 having valve replacement (5 aortic, 2 mitral) in addition to revascularization. In the total group of patients operated on there were 3 deaths (6%). Preoperatively, 26 patients had unstable angina and 10 had severe left main coronary artery disease. Eleven of the 48 (23%) were women. ECG and enzyme-proved infarctions occurred in 6 of the 48 patients (12%), but the addition of 99mTc-PYP myocardial imaging demonstrated scintigraphic evidence of infarction in 15 patients (31%), including 2 who died in the operating room. The 99mTc-PYP myocardial imaging technique, which has proved safe, simple, and relatively inexpensive in these patients, suggests that the incidence of infarction after coronary bypass operations is somewhat higher than has been previously recognized from just ECG and enzyme changes. This technique also has been of value in helping to exclude myocardial infarction in difficult clinical situations such as postoperative arrhythmias and the postpericardiotomy syndrome.

Adult↗
PubMed1976

Differences between supine and sitting Frank-lead electrocardiograms.

Frank-lead electrocardiograms (ECGs) were recorded from 59 adult males with suspected coronary artery disease. Three records were recorded consecutively on frequency modulated tape for each patient in (1) supine position, (2) sitting position with arms relaxed, and (3) sitting position on bicycle with arms on bicycle handles. Electrodes were applied at the level of the fifth intercostal space with patients in the sitting position. Computer measurements of electrocardiographic amplitudes were averaged over ten seconds of each record with these results: (1) QRS spatial amplitudes and R amplitudes in lead z were significantly higher and R amplitudes in lead y lower for sitting than for supine positions. (2) Except for slightly higher R and S amplitudes in lead x for sitting with arms on bicycle, no significant differences were observed between the two sitting positions. (3) These postural differences are significantly greater than those resulting from day-to-day variability of electrode locations. It is hypothesized that electrode level shifts with postural changes are responsible for the observed x- and z-lead changes. For the y-lead changes, it is hypothesized that shifting blood volumes with postural changes are the cause. It is concluded that reference electrocardiographic measurements for stress testing should be obtained from resting ECGs with the patient in the same postural position as that maintained during exercise.

Electrocardiography↗
PubMed1976

Effects of digitalis and calcium on papillary muscles in normal and hypoxic states.

The effects of digoxin and ouabain in 2.5 and 4.0 mM extracellular calcium were studied in well-oxygenated and hypoxic isolated, isometrically contracting cat papillary muscles. Muscle digoxin content was measured at the conclusion of the digoxin experiments. In the well-oxygenated environment muscles in the higher Ca bathing media reached peak glycoside inotropic effect sooner and contained 2.7 times more digoxin. During hypoxia and reoxygenation muscles contracting with glycosides performed no differently than those without a glycoside present. Muscle digoxin content was lowered at the end of hypoxia (P less than 0.05) in 2.5 mM Ca; after reoxygenation digoxin content was significantly greater than either before or after hypoxia (P less than 0.001). Hypoxic depression of muscle performance was attenuated in 4.0 mM Ca but muscles in 2.5 mM Ca showed greater improvement during reoxygenation even though the muscles in 4.0 mM Ca had significantly greater digoxin content at the end of reoxygenation (P less than 0.02). It therefore is concluded that, although altered extracellular calcium can alter performance during hypoxia and reoxygenation, muscle performance is not aided by the presence of digitalis and under these conditions performance cannot be correlated with muscle digoxin levels.

Animals↗
PubMed1976

Perioperative myocardial infarction diagnosed by technetium 99m stannous pyrophosphate myocardial scintigrams.

Two groups of patients have been studied using 99mTc stannous pyrophosphate myocardial imaging prior to and 3-5 days after myocardial revascularization. The first group consisted of 48 patients undergoing revascularization, including 26 with unstable angina and seven with concomitant valve replacement. There were 3 deaths (6%), and the incidence of perioperative infarction by electrocardiogram (ECG) and enzyme analysis was 6/48 (12%), while 15 of 48 (31%) had positive myocardial scintigrams. The second group of 29 patients included one nonischemic death (3%) that was excluded. The operative technique was changed (optical magnification used, silastic tapes avoided, venting avoided, while aortic cross clamping was used frequently). In this latter group two of 29 (7%) had ECG evidence of infarction while four of 28 (14%) had positive scintigrams, compared to the pervious incidence of 31%. The imaging technique is simple, reliable, and probably more sensitive in the postoperative setting than ECG and enzyme analysis. It appears useful in evaluating the influence of changes in operative technique on myocardial preservation.

Female↗
PubMed1975

Serum digoxin levels using an 125I-labelled antigen: Validation of method and observations on cardiac patients.

1. Determinations of serum digoxin levels utilizing commercially available kits with an 125I-labelled antigen were precise and not materially different from results obtained with a 3H-labelled antigen. 2. In order to approximate the steady state level, serum digoxin levels should be drawn either before or at least six hours following the administration of an oral tablet. 3. Concomitantly given thiazide diuretics did not interfere with the absorption of a tablet of digoxin. 4. In the digitalized patient, slow alterations in serum levels after oral administration appeared well correlated with, at least, the negative chronotropic effects of the drug. 5. Maximal exercise testing, a maneuver often applied to cardiac patients, does not significantly alter the serum digoxin level.

Administration, Oral↗
PubMed1975

Altered tissue digoxin uptake after a toxic dose.

Tissue distribution and left ventricular (LV) effects of digoxin were studied after intravenous administration of low and high doses to dogs. LV dP/dt was increased by 0.03 mg/kg digoxin in nine, group A, and digoxin-induced arrhythmias or death occurred after 0.14 mg/kg in nine others, group B. Two hours after dosing during the slow excretion phase confirmed by serial serum sampling, the animals were killed. Serum and tissue extract digoxin determinations were performed by radioimmunoassay. Digoxin levels in group A were serum 3.9 ng/ml, kidney 428 ng/gm wet wt, liver 41, pancreas 39, diaphragn 21, apex, freewall, and septum LV 117-122, right ventricle (RV) 105, left atrium (LA) 51, right atrium (RA) 50, and the serum to apex LV ration was 1:32. The tissue contents and distribution were similar to previous [3H]digoxin data. The concentrations were higher in B; for all p less than 0.001. The toxic to therapeutic concentration ratios were serum 10, kidney 2.8, liver 5.5. pancreas 5,4, diaphragm 6.5, LV 4.3, RV 4.0, LA 3.5, RA 3.4. The serum to LV ratio was lower at 1:13, p less than 0.001. Myocardial toxicity was associated with marked but apparently limited increases in tissue digoxin content in this preparation. The disproportionately high serum level suggests paralysis or saturation of kidney and other tissue binding resulting in lower serum to tissue concentration ratios. Whenever serum to tissue ratios vary from expected values, serum digoxin levels may not be linearly related to tissue content or cardiac effects.

Animals↗
PubMed1970

Cerebrovascular response to acute hypocapnic and eucapnic hypoxia in normal man.

Alterations in human cerebral blood flow and related blood constituents were studied during exposure to acute hypoxia. Observations were made during serial inhalation of decreasing O(2) concentrations with and without maintenance of normocarbia, during 8 min inhalation of 10% O(2), and after hyperventilation at an arterial P(O2) of about 40 mm Hg. In the range of hypoxemia studied, from normal down to arterial P(O2) of about 40 mm Hg, the magnitude of the cerebral vasodilator response to hypoxia appeared to be largely dependent upon the coexisting arterial CO(2) tension. The mean slope of the increase in cerebral blood flow with decreasing arterial O(2) tension rose more quickly (P < 0.05) when eucapnia was maintained when compared with the slope derived under similar hypoxic conditions without maintenance of eucapnia. When 12 subjects inhaled 10% oxygen, cerebral blood flow rose to more than 135% of control in four whose mean decrease in arterial CO(2) tension was - 2.0 mm Hg. The remaining eight had flows ranging from 97 to 120% of control, and their mean decrease in CO(2) tension was - 5.1 mm Hg. When mean arterial P(O2) was 37 mm Hg, hyperventilation was carried out in 10 subjects. Arterial P(O2) increased insignificantly, arterial P(CO2) declined from 34 to 27 mm Hg (P < 0.05), and cerebral blood flow which had been 143% of control decreased to 109%, a figure not significantly different from control.These data demonstrate the powerful counterbalancing constrictor effects of modest reductions in CO(2) tension on the vasodilator influence of hypoxia represented by arterial P(O2) reductions to about 40 mm Hg. Indeed, mild hyperventilation completely overcame the vasodilator effect provided by an arterial O(2) tension as low as 40 mm Hg. The effects of hypoxia on the control of the cerebral circulation must be analyzed in terms of the effects of any associated changes in CO(2) tension.

Adult↗