Coronary artery disease: part 2. Treatment.
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Biomedical subjects
Publications and source records attributed to W Slater.
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OBJECTIVE: To determine the effects of body temperature, ethanol use, electrolyte status, and acid-base status on the electrocardiograms (ECGs) of hypothermic patients. METHODS: Prospective, two-year, observational study of patients presenting to an urban ED with temperature < or =95 degrees F (< or =35 degrees C). All patients had at least one ECG obtained. Electrocardiograms were interpreted by a cardiologist blinded to the patient's temperature. J-point elevations known as Osborn waves were defined as present if they were at least 1 mm in height in two consecutive complexes. RESULTS: 100 ECGs were obtained in 43 patients. Presenting temperatures ranged between 74 degrees F and 95 degrees F (23.3 degrees C-35 degrees C). Initial rhythms included normal sinus (n = 34), atrial fibrillation (n = 8), and junctional (n = 1). Osborn waves were present in 37 of 43 initial ECGs. Of the six initial ECGs that did not have Osborn waves present, all were obtained in patients whose temperatures were > or =90 degrees F > or =32.2 degrees C). For the entire group, the Osborn wave was significantly larger as temperature decreased (p = 0.0001, r = -0.441). The correlation between temperature and size of the Osborn wave was strongest in six patients with four or more ECGs (range r = -0.644 to r = -0.956, p = 0.001). No correlation could be demonstrated between the height of the Osborn waves and the serum electrolytes, including sodium, chloride, potassium, bicarbonate, BUN, creatinine, glucose, anion gap, and blood ethanol levels. CONCLUSIONS: The presence and size of the Osborn waves in hypothermic patients appear to be a function of temperature. The magnitude of the Osborn waves is inversely correlated with the temperature.
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"The article examines the threefold immigration problem currently facing Russia: the influx of refugees from the developing world who hope eventually to reach the West, and the large numbers of non-Russians and ethnic Russians entering the country from the other former Soviet republics. The institutions established recently to tackle immigration are insufficiently funded and often find themselves in conflict with other agencies, both Russian and international. Legislation on the status of immigrants is also confused. The most pressing issue, however, is that of Russian immigration into Russia. This has implications for domestic policies: the immigrants are regarded as a potential solution to the problem of rural depopulation and are prevented from entering densely populated regions. The exodus of ethnic Russians from the other former Soviet republic may also affect Russia's relations with these countries, which it has accused of discriminating against their Russian populations." (SUMMARY IN ENG)
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The activity of a new water-soluble molecule, SCH 38057, against picornaviruses is described. SCH 38057 inhibited plaque formation of selected entero- and rhinoviruses in a range of 10.2 to 29.1 microM (50% endpoint) and had a therapeutic index of 10 against poliovirus type 2 (polio 2) in HeLa cells. When administered orally or subcutaneously, SCH 38057 protected mice infected with either coxsackievirus B3 (CVB3) or echovirus-9 from mortality. The molecule provided a low level of protection against thermal inactivation of virus, indicating that SCH 38057 interacts with the picornavirus capsid. Binding studies with [3H]SCH 38057 revealed that the molecule binds to CVB3 and human rhinovirus 14 (HRV14) in a ratio of 29 and 19 molecules per viral particle, respectively. The affinity constant for SCH 38057 binding to CVB3 was 7.0 x 10(-4) M. When added to cultures of infected cells at 3 h after infection, SCH 38057 markedly inhibited viral RNA synthesis. This finding with lack of inhibition of attachment and loss of infectious virus after attachment were interpreted to indicate that, although SCH 38057 binds to the viral capsid, the molecule exerts its antiviral effect after the initial stage of picornavirus uncoating, i.e., after conversion of the 156S infectious viral particle to smaller subviral species.
Previous studies of late potentials have not standardized the autonomic milieu at the time of testing. We studied the effects of autonomic manipulation in seven patients with previous Q wave myocardial infarction. Late potentials were evaluated using standard temporal (TD) and spectral temporal mapping techniques (STM) in the drug free state, and during separate intravenous administration of each of the following: isoproterenol, esmolol, and atropine. Isoproterenol was titrated to achieve a heart rate of 130% of baseline. Esmolol was infused at a rate of 250 micrograms/kg per minute, after a loading dose of 500 micrograms/kg. Atropine was given as a 2-mg bolus. In addition, five patients who received no drug infusions acted as controls, undergoing four serial signal-averaging studies in the baseline state: a "baseline" study, and then three additional studies at time intervals similar to those incurred by the study patients. Therefore, a total of 21 TD and 21 STM tests were done in the study group (seven patients; three drugs per patient) during the drug infusions, and 15 TD and 15 STM tests were done in the control group (five patients; three "nonbaseline" tests per patient). A change (normal to abnormal, or vice versa) in TD during a drug infusion occurred in 24% of the tests. No such change occurred in the control group (P < 0.01). A change in STM during a drug infusion occurred in 38% of tests, versus 13% of tests in the control group (P = 0.14). Overall, six of seven patients had a change in TD and/or STM diagnosis with infusion of one or more of the study drugs.(ABSTRACT TRUNCATED AT 250 WORDS)
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Encainide and flecainide are two recently released class IC antiarrhythmic agents that have been reported to be highly effective for suppressing all forms of ventricular arrhythmias. Both drugs are potent blockers of the sodium channel and produce marked slowing of conduction within the His-Purkinje system and myocardium. To establish if the response to one agent predicts the response to the other, the antiarrhythmic effect of the two drugs was compared in a group of 18 patients with malignant ventricular arrhythmia. Fourteen patients had sustained ventricular tachycardia and four patients had ventricular fibrillation. The average ejection fraction of this group was 37%. All patients had a high density of spontaneous ventricular arrhythmia and were evaluated noninvasively. Both drugs significantly reduced all forms of spontaneous arrhythmia. By Holter monitoring criteria, the effect of the two drugs was concordant in 61% (p = NS). By exercise criteria, the concordance rate was 50% (p = NS). Overall, 12 patients (67%) responded to encainide and eight (44%) patients responded to flecainide (p = NS). Only 10 of 18 (56%) patients had the same response to both agents (p = NS). There was no significant difference in ejection fraction or in average daily dose of drug between responders and nonresponders. Thus despite their similar electrophysiologic profile, the clinical antiarrhythmic effect of these two agents was different. For the noninvasive management of patients the response to one agent should not be used to predict the response to the other.