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At least 343 records · Page 19Linked to original sources
PubMed1991

Cardiomyopathy of ruminants induced by the litter of poultry fed on rations containing the ionophore antibiotic, maduramicin. I. Epidemiology, clinical signs and clinical pathology.

The epidemiological, clinical and clinical pathological findings in 20 cattle and 4 sheep from 15 outbreaks of poultry litter toxicity in South Africa over the past 6 years are documented. In 6 outbreaks, the litter emanated from batteries where maduramicin had been incorporated into rations of broilers. According to circumstantial evidence the litter involved in the 9 other outbreaks was also derived from broilers which had been fed on rations containing an ionophore. The litter was fed ad libitum to the affected stock or constituted 30-80% by volume of their rations. The principal sign manifested was sudden mortality of up to 70% of the herd or flock, usually within 20-40 days of commencement of feeding of poultry litter. A few cattle developed signs of congestive heart failure, and stiffness was commonly seen in sheep. In a dosing trial with poultry litter involving 1 steer and 6 sheep, the steer and a sheep died suddenly and a second sheep was destroyed in extremis. Tachycardia and/or cardiac arrythmia were recorded in 5 sheep, and the activity of aspartate transaminase (AST) and/or lactate dehydrogenase (LD) in the sera of 4 was elevated. Since the cardiac lesions in field cases were similar to those of ionophore poisoning and broiler rations containing maduramicin was a common factor in several outbreaks, toxic litter from some of these outbreaks were tested for the presence of this compound. Analysis by high performance liquid chromatography of litter from 2 specimens of outbreaks revealed that they contained 2.5 ppm and 6.1 ppm maduramicin.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Feed↗
PubMedDate not supplied

[Serum digoxin in children treated with beta methyl digoxin].

Concentrations of serum digoxin were measured by the polarized immunofluorescence Abbot TDx11 method in 59 samples from 53 children under treatment with mean beta methyl digoxin doses of 8.9 +/- 2.0 micrograms.kg.day. The therapeutic range for serum digoxin concentration was estimated to be 0.9 to 2.25 ng/ml. Simultaneous Na, K and creatine serum concentrations were measured. In 36 samples mean serum digoxin level was 1.52 +/- 0.45 ng/ml -within therapeutic range- and in only one of these cases clinical evidence of toxicity was apparent. In 15 samples digoxin level was above the therapeutic range and 11 patients of this group (73%) showed clinical signs of toxicity, consisting in arrythmias (six cases: supraventricular in 5 patients, ventricular in one child) and gastrointestinal symptoms (eight patients). Six patients with digoxin levels over therapeutic range and signs of digitalis toxicity had coincidental acute renal failure, which in 4 cases was subclinical--in 2 of these late it was pre-renal- and, in spite of this, all were inadvertently given the usual dosage of beta methyl digoxin. Almost invariably there was clinical evidence of toxicity when digoxin serum levels were above 2.4 ng/ml, so established maximal therapeutic level at 2.25 ng/ml seems adequate. Signs of digitalis toxicity must be looked on systematically in children treated with such drugs. In the critically ill or in children with acute renal failure it is necessary to monitor serum digoxin concentration. Among the clinical signs of toxicity, gastrointestinal symptoms are more frequent in children. An oral dose from 7 to 10 micrograms.kg.day of beta methyl digoxin in recommended.

Acute Kidney Injury↗
PubMed1991

Treatment of essential hypertension with auriculoacupressure.

Auriculoacupressure was used in the treatment of 291 cases of essential hypertension, in comparison with 51 similar cases treated with Fufang Jiangya (composite hypotensive) Tablets. Analysis of results showed that the therapeutic effects in the 2 groups were similar, while the rate of marked efficacy in the acupressure group was higher than that of the medication group, and the level of blood lipids also significantly dropped (P less than 0.01); there was only minor improvement in blood rheology. In addition, acupressure manifested biphasic regulatory effects on sinus arrythmia. The curative effect of acupressure on essential vascular hypertension was good.

Acupuncture Points↗
PubMedDate not supplied

[Effects of flecainide in patients with non-sustained ventricular tachycardia and impaired left ventricular function].

Anti-arrythmia efficacy and effects on left ventricular function of flecainide have been evaluated in 9 patients with symptomatic non sustained ventricular tachycardia (NSVT) and left ventricular ejection fraction (LVEF) lower than 30%, respectively detected by Holter monitoring and radionuclide angiocardiography in basal conditions. Seven to eleven days after starting flecainide therapy (100 mg b.i.d.), Holter and radionuclide angiocardiography were repeated. In 56% of patients a ventricular premature beats (VPB) reduction more than 70% was obtained and total VPB suppression was achieved in 33% of patients. Total suppression of NSVT was obtained in 67% of patients; LVEF did not show significant changes. Thus, antiarrhythmic efficacy of flecainide resulted in agreement with the previous reports, whereas no patient developed signs or symptoms of heart failure or pro-arrhythmia.

Aged↗
PubMed1991

Dobutamine stress testing in chronic heart failure--dose-response effects assessed by echo-Doppler.

In patients with cardiac failure, data on haemodynamic function at rest may indicate impaired cardiac function but do not assess the capacity of the heart to respond to stress which may be useful in determining prognosis. Inotropic challenge with dobutamine has been shown to be at least as effective as exercise testing in assessing cardiac pumping capability. One of the limitations of dobutamine stress testing has been the need for invasive haemodynamic measurements. A new non-imaging echo-Doppler cardiac output device, incorporating the principle of attenuated compensation volume flow (ACVF), has been shown to be accurate, reproducible and useful in pharmacodynamic studies. In this study we examined the dose-response effects of dobutamine in 8 patients with chronic heart failure. Dobutamine was infused at 2, 5, 10 and 15 micrograms/kg/min with the dose being increased at 5 minute intervals and haemodynamics being determined (using the echo-Doppler) in the final 2 minutes of infusion. Our results were comparable to previous studies. There were dose-related increases in heart rate (P less than 0.05), cardiac output (P less than 0.05), and cardiac power output (work done by the heart per unit time) (P less than 0.05). Systolic blood pressure increased (P less than 0.001) and there were modest increases in mean arterial blood pressure without change in diastolic blood pressure. Time averaged mean velocity increased significantly with a trend to increase in flow acceleration. Three patients developed arrythmias during the early recovery period. The echo Doppler attenuated compensated volume flow method of determining haemodynamics proved useful but in view of the high incidence of dysrhythmia we feel that dobutamine testing in severe heart failure should be employed cautiously.

Aged↗
PubMed1991

Effects of RA642, a new central pressor agent, on renal sympathetic nerve activity and blood pressure during hemorrhagic shock in rabbits.

This experiment was designed to evaluate effects of RA642, a pyrimido-pyrimidine derivative, on renal nerve activity (RNA), mean blood pressure (MBP), central venous pressure (CVP), and heart rate (HR) during hemorrhagic shock in anesthetized rabbits. Hemorrhagic hypotension of 30 mmHg was induced by rapid bleeding and was controlled by a servocontrolled pump. Following the onset of hemorrhagic hypotension, RNA response showed a triphagic pattern: an initial increase in RNA and a secondary increase followed by a profound decline in RNA. In all animals, decreases in RNA occurred within approximately 30 min after bleeding in association with significant decreases in heart rate. When RNA fell to near noise level, the effects of RA642 (0.25 mg/kg, iv, N = 10), physiological saline (N = 7), epinephrine (10 micrograms/kg, iv, N = 6), and dopamine (10 micrograms/kg, iv, N = 5) were then tested. Intravenous injection of saline produced no significant improvements of hypotension nor of reduction in RNA. However, treatment with RA642 produced a significant increase in MBP simultaneously with an increase in RNA. During the hypovolemic hypotensive phase, tachycardia did not occur after the treatment with RA642. Twenty-five minutes after the retransfusion, MBP and RNA in the RA642-treated group were at significantly higher levels than in the saline group. HR did not significantly change with the RA642 treatment after the retransfusion. In another six animals, when RNA fell to near noise level, epinephrine caused a transient increase in MBP and HR. Ventricular arrythmias occurred in 50% of epinephrine-treated animals. However, the level of MBP as improved by epinephrine was significantly lower than that by RA642 at 25 min after the retransfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

The efficacy and safety of nalbuphine (NUBAIN) in balanced anesthesia. A double blind comparison with fentanyl in gynecological and urological surgery.

In a prospective double blind study the efficacy and safety of nalbuphine as an analgesic in balanced anesthesia has been compared to fentanyl. In 63 patients, ASA class I-III, major gynecological or urological surgical procedures were performed under balanced anesthesia. Analgesia could be satisfactory maintained in all cases, but in cases of nalbuphine more hypnotics were necessary to keep the patients unconscious. The ratio of fentanyl and nalbuphine consumption was 1:200 (by weight). The nalbuphine cases can be distinguished by: more stable but higher arterial pressures and absence of arrythmia; lower incidence of nausea and vomiting in the postoperative period; less respiratory depression at the end of anesthesia, not needing antagonists, as compared to 11 patients needing antagonization in the fentanyl group; and a larger incidence of minor local allergic reactions at the injection site. Awareness was not observed in any patient of either group. Although nalbuphine has a weaker analgesic and hypnotic effect, it is perfectly possible to provide balanced anesthesia in combination with a hypnotic and a muscle relaxant. Advantages are the absence of respiratory depression as well as nausea and vomiting in the postoperative period.

Adolescent↗
PubMedDate not supplied

[Withdrawal effects following interruption of antihypertensive drugs. II. Coronary rebound phenomenon with antihypertensive drugs used in coronary heart disease therapy (author's transl)].

Treatment of hypertension is still primarily relevant of drug therapy. Prolonged use of antihypertensive agents is undoubtedly efficient but may induce when discontinued occasionally or intentionally a true rebound phenomenon i.e. exacerbation or aggravation of the pretreatment morbid condition. Hypertensive rebound occurs almost exclusively after clonidine withdrawal, usually abrupt but sometimes gradual. It consists of an acute clinical syndrome together with well defined biological findings, related to reactional enhanced sympathetic activity and necessitating an emergency treatment. A different rebound phenomenon is observed on withdrawal of some antihypertensive drugs when used in the management of coronary heart disease, namely beta adrenergic receptors blockers and specially propranolol. An acute exacerbation of coronary symptoms with or without severe arrythmias and eventually sudden deaths have been reported. The mechanisms responsible of this event are described, mainly the modifications recently observed at the level of the adrenoreceptors themselves. These two rebound phenomena although rare should be considered seriously by the practitioner while prescribing antihypertensive or antiangorous drugs otherwise very efficient but alble to induce catastrophic symptoms when interrupted in certain circumstancy.

Antihypertensive Agents↗
PubMed1990

Blunt cardiac injury: is this diagnosis necessary?

The diagnosis of blunt cardiac injury in traumatized patients is problematic and the implications of such a diagnosis are not clear. Although cardiac selective creatine kinase (CK-MB) assays and electrocardiograms (EKG) are the most widely available laboratory investigations, they often correlate poorly with diagnoses made on clinical grounds, or by other laboratory methods. We therefore retrospectively studied the Montreal General Hospital experience with 342 consecutive blunt trauma patients admitted to our surgical intensive care/trauma unit. Using clinical criteria, cardiac injury was diagnosed in 44 patients (13%). Twenty-seven of these patients (61%) developed arrythmias or cardiogenic hypotension, half of which required treatment. Heart injuries contributed to six of the 12 deaths in this group. Many of the patients maintained normal CK-MB levels and/or had normal admission EKG's despite the clinical diagnosis of cardiac injury. However, using our criteria for CK-MB positivity, there was a strong correlation between CK-MB elevation and the development of cardiac complications, and very high CK-MB levels (greater than 200 mu/L) were associated with a 100% incidence of such complications. Focusing on patients who developed cardiac complications serious enough to require treatment, we found combined CK-MB/EKG positivity in all cases (100% sensitivity). This method also provided a negative predictive value of 100%. We conclude that although blunt cardiac injury is an important source of morbidity and mortality its 'diagnosis' is not the issue. Rather, it is more important to recognize which of these clinically identified 'high-risk' patients will actually develop cardiac complications. We feel our approach will enable clinicians to do this.

Adult↗
PubMed1988

[Long-term electrocardiography (quality standards and guidelines for the documentation of findings].

Indications for a Holter-ECG-recording are dizzy-spells, syncopes, ischemic attacks, dyspnoea, ischemia of the myocardium, arrythmias after myocardial infarction and with different types of cardiomyopathies, the sick-sinus-syndrome and a-v-blocks; furthermore recording of cardiac situations and the effect of drugs. The report should mention the basic rhythm, ventricular and supraventricular arrhythmias as well as temporary blocks and pauses.

Arrhythmias, Cardiac↗
PubMed1989

[Blood replacement in heart transplantation].

Transfusion of blood and blood products in orthotopic heart transplantations were analysed in a series of 31 consecutive patients operated upon between September 1985 and December 1987. Mean age of the 29 men and 2 women was 41 +/- 12 years (range: 15-63). All patients had to be assigned to NYHA functional class IV before operation and their mean left ventricular fraction was 20%. The etiologies of cardiac disease leading to transplantation in this series were: cardiomyopathy in 19/31 patients (61%), ischemic heart disease in 7/31 (23%), valvular disease in 2/31 (6%), life threatening arrythmias in 2/31 (6%) and primary cardiac tumor in 1/31 (3%). Previous cardiac surgery had been performed in 6/31 patients (19%). Full anticoagulation with coumarines was observed in 24/31 patients (77%) at the time of surgery when mean PT was 33 +/- 12% and mean hematocrit was 40 +/- 4%. Mean blood products transfusion requirements in patients receiving an orthotopic heart transplant were 24.2 +/- 14.7 units (range 7-67 units) during the entire hospital stay. These figures are even higher if compiled in function of the number of donors of the transfused blood products: 29.2 +/- 22.4 (range 7-105). The following mean number of blood and blood components was perfused per patient: Red cells (hematocrit 50 +/- 10%) 4.4 +/- 3.9, concentrated red cells (hematocrit 70 + 10%) 5.9 +/- 4.3, fresh frozen plasma 7.4 +/- 3.3, platelets 3.9 +/- 4.1, and others (factor 8, 9 etc) 0.6 +/- 1.6. In-hospital mortality was 1/31 patients (3%) and actuarial survival is 27/31 (87%) at 33 months of follow-up (mean 17 +/- 7 months). However, 7/27 survivors (26%) had to be treated for cytomegaly acquired during or after the heart transplantation. Therefore transfusion of cytomegaly free blood products has to be recommended.

Adult↗
PubMed1989

Cardiovascular regulation in the mudpuppy Necturus maculosus at rest and during short term exercise.

Prebranchial blood pressure (Pva), heart rate (fH) and plasma catecholamine concentration were measured in the mudpuppy Necturus maculosus at rest and during exercise. During exercise, both fH and Pva increased, as did the plasma noradrenaline concentration. There was no significant effect on Pva after injection of the adrenergic neuron blocker, bretylium, in resting animals, neither did bretylium affect the exercise-induced increase in Pva. This suggests that there is no adrenergic nervous tone on the vasculature at rest or during exercise. The alpha-adrenoceptor antagonist yohimbine had no effect on the resting Pva in the bretylium-treated animals, but it abolished the increase in Pva during exercise. This is compatible with the view of no influence on Pva by the plasma catecholamines at rest, while during exercise the increase in plasma noradrenaline concentration is responsible for the increase in Pva. Injection of atropine elevated resting fH, and reduced or abolished cardiac arrythmia, indicating an inhibitory cholinergic tone on the heart at rest, and that variations in this tone are responsible for the intrinsic variation seen in untreated animals. After the atropine treatment, there was still an increase in fH during exercise. The beta-adrenoceptor antagonist sotalol decreased fH in resting atropinized animals, and inhibited the exercise-induced tachycardia, implying that there is an additional beta-adrenoceptor-mediated adrenergic tone, affecting the heart both at rest and during exercise. The cholinergic tone decreased during exercise with a concomitant increase in adrenergic tone. Falck-Hillarp fluorescent histochemistry was used to study the presence of adrenergic nerve fibres and other catecholamine-storing cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[Diagnostic value of the submaximal treadmill exercise test in the subacute phase of myocardial infarct].

OBJECTIVES: To assess the diagnostic value of treadmill submaximal exercise testing (TSET), early after myocardial infarction (MI) under medical treatment, evaluating the ST changes predominantly. MATERIALS AND METHODS: 65 patients, 62 males and 3 females, mean age 52 years with demonstrated MI under clinical, electrocardiographic and enzymatic criteria were evaluated with TSET before hospital discharge. Thrombolytic therapy in acute phase of MI was done in 45 of the patients. All patients underwent angiographic studies with left ventriculography and selective coronariography. RESULTS: Of all TSET variables considered (Treadmill time, ST segment, presence of chest pain, systolic pressure, double product and presence of ventricular arrythmias) the single most important predictor for high-risk groups like left main disease and three vessels disease, was ST changes alone or associated with exercise precordial pain, with a sensitivity of 100% to left main and 83% to three vessels disease. In the thrombolytic group we did not find any differences related with reperfusion. IN CONCLUSION: TSET is a useful, noninvasive, and safe method for risk stratification after MI mainly when ST segment changes are considered alone or with stress precordial pain, predicting high risk groups, namely left main or three vessels disease patients.

Adult↗
PubMed1989

[Time-related degeneration of Carpentier-Edwards bioprosthesis in mitral position].

Carpentier-Edwards bioprostheses have been shown to provide a low incidence of valve-related complications, especially thromboembolism, but the durability has caused the serious concern. This report suggests that Carpentier-Edwards prostheses have been gradually degenerative, and stenotic degeneration and the year after operation are well correlative. In Osaka National Hospital, Carpentier-Edwards prostheses were implanted in 89 patients in mitral position from 1973 to 1981. Of all the patients, 50 patients were undertaken to single valve replacement in mitral position and could be followed up in our department. For a total of 50 patients, materials are 30 patients who could be detected by clinical findings, pulsed Doppler echocardiography, cardiac catheterization and soft X-ray evaluation in explanted prostheses at reoperation. Follow-up duration was ranged 4.2 to 12.1 years with a mean duration of 7.94 years. The age ranged from 32 to 71 years of age. The initial diagnosis of the time-related degeneration was the appearance of newly acoustic rumbiling murmur. Furthermore, regurgitant murmur, arrythmia (atrial fibrillation) and cardiac enlargement were followed in addition to rumbling murmur. The assess of the transmitral flow such as pressure half time and peak pressure gradient by pulsed Doppler echocardiography was the easy way to evaluated the time-related degeneration. Time-related stenotic change by pulsed Doppler was expressed as a linearized curve. At 6 years and below valve function seemed not to be impaired but stenotic dominant degeneration with the cusp tear was prominent beyond 7 years. Cardiac catheterization data could make sure of the pulsed Doppler findings by assessing mitral valve gradient and mitral valve area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Accidental hypothermia. Physiopathology, clinical manifestations and treatment].

The article reviews pathophysiology and clinical problems. During deep hypothermia, criteria for death are obscured. Prehospital treatment should be vigorous resuscitation on broad indications. Asystole or ventricular fibrillation is common. Drugs are contraindicated, with the possible exception of bretyllium. Electro-conversion of the heart is usually impossible below 28-30 degrees Centigrade. Hypothermic victims must be handled with the utmost care. Rewarming may cause life-threatening arrythmias, afterdrop and "rewarming collapse". Rewarming should take place in hospital only. Different methods of rewarming are discussed. Probably the best way to treat deeply hypothermic victims is by cardiopulmonary bypass.

Accidents↗
PubMed1987

[Prophylactic and therapeutic use of a low molecular weight heparin fraction, CY 216].

The aim of our work was to study in a population of high risk patients with hemorrhagic and or thrombotic disease, the preventive or therapeutic effect of a low molecular weight heparin fraction, CY 216 (Choay, France), particularly in surgery. CY 216 was given to 9 patients for the treatment of a thrombosis (pulmonary embolism, acute ischemia, deep venous thrombosis) and to 40 patients in prevention of thrombosis. In this second group, 28 had a high thromboembolic risk such as valvular prosthesis, cardiac arrythmia, coronary artery bypass, etc. For all the patients, CY 216 was injected sub-cutaneously twice or three times a day at the mean dose of 1.5 mg/kg/d, equivalent to 300 U anti-Xa Choay/24 h, and always injected 24 hours before surgery. The biological tests used were: blood cells count, platelet count, prothrombin time, activated partial thromboplastin time, heparinemia levels by two technics: anti-factor-Xa activity and anti-factor IIa activity. None thrombotic complication was observed in the 40 patients prophylactically treated and a constant improvement of thrombosis was noted for the 9 patients with thrombo-embolic disease. In 3 patients, bleeding complications were observed: for 2 patients, all the coagulation tests were normal and anti-Xa activities were less than 0.55 U/ml; in one patient, the bleeding time was prolonged (15 minutes Ivy Incision) and returned to normal when the CY 216 was stopped. Concerning the biology, there was no modification except for anti-Xa activity which mean was 0.30 U/ml (01-07). However, this test is unable to predict either thrombotic or hemorrhagic events.

Adolescent↗
PubMed1989

Effects of coronary flow, pacing rate, isoprenaline and diltiazem on ischemic ventricular arrhythmias in guinea pig hearts.

Although the Ca++ channel blockers can reduce early ischemic ventricular arrhythmias, the mechanisms are unclarified. The antiarrhythmic action of Ca++ antagonists may either be due to vasodilation and negative chronotropism or to trans-sarcolemmal Ca++ influx inhibition. In these studies we investigated the possible individual and additive effects of coronary flow, heart rate and Ca++ antagonism on ventricular arrythmia development in isolated, paced, globally underperfused guinea pig hearts. When the coronary flow during ischemia was raised from 5 to 7% of control and/or the stimulation frequency was decreased from 6 to 4 Hz, ATP and creatine phosphate levels were conserved and intraventricular conduction slowing leading to ventricular tachycardia (VT) was delayed. In contrast, when the coronary flow and pacing rates were fixed at 7% and 6 Hz and diltiazem (10(-6) M) was included in the perfusion medium, there was no effect on tissue high-energy phosphate depletion and development of VT. Even when the breakdown of ATP and the onset of VT were accelerated by isoprenaline (10(-6) M), diltiazem was not antiarrhythmic at this flow rate. Only when the coronary flow was reduced to 5% of control, in the absence and presence of isoprenaline, did diltiazem delay ventricular arrhythmias through a mechanism that was independent of changes in coronary flow and heart rate.

Animals↗
PubMed1989

Some clinical and technical aspects of circular stapled anastomoses of rectum and oesophagus.

A complete 8-year experience using the circular stapling instrument is described; 109 rectal and 59 oesophageal anastomoses were performed. Intra-operative problems included two suspected rectal leaks, damage to the tissues in two patients when using too large an instrument, cardiac arrythmias in one patient, precipitated by contact between the heart and the instrument, one instrument/operator failure, and inversion of the muscle layer was incomplete in three oesophageal anastomoses. Postoperative complications included two leaks, seven strictures, seven abscesses and one patient required reoperation. There were no deaths attributable to the use of the instrument or the method of anastomosis. The instrument has allowed satisfactory anastomoses to be performed in relatively inaccessible sites.

Anastomosis, Surgical↗