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Biomedical subjects

A Battler

Publications and source records attributed to A Battler.

At least 55 records · Page 3Linked to original sources
PubMed1999

Is it safe to administer thrombolytic therapy to myocardial infarction patients soon after laparoscopic cholecystectomy?

Thrombolytic therapy is usually contraindicated after abdominal surgery because of the risk of bleeding. We report a case of a 73-year-old woman who was admitted because of anterior wall acute myocardial infarction (AMI) two weeks after laparoscopic cholecystectomy. She was treated with streptokinase, aspirin and heparin and subsequently developed a hematoma at the site of the removed gallbladder. Our observation suggests that thrombolytic therapy for anterior AMI, two weeks after laparoscopic cholecystectomy, should be considered as a relative contraindication and an optional treatment in this life-threatening situation.

Aged↗
PubMed1998

[Serotonin re-uptake inhibitors as primary therapy for carotid sinus hypersensitivity].

Carotid sinus syndrome is a well-recognized cause of unexplained syncope in older patients, and may, lead to significant morbidity due to trauma from falls. Dual chamber pacing has been shown to be effective in relieving symptoms due to bradycardia, but not due to vasodepressor response. We report an 84-year-old man with recurrent syncope due to carotid sinus hypersensitivity. He was treated only with a serotonin reuptake inhibitor and was symptom-free after 3 weeks of therapy. He has remained symptom-free for the past year.

Aged↗
PubMed1998

Stimulation of 42/44 kDa mitogen-activated protein kinases by arginine vasopressin in rat cardiomyocytes.

Vasoconstrictors, such as angiotensin II (Ang II), are involved in the regulatory mechanisms of post myocardial infarction (MI) hypertrophy. Arginine vasopressin (AVP), may be another vasoconstrictor that influences the mechanisms that lead to post MI hypertrophy. In these studies we investigated the possible activation of the 42/44 kDa mitogen-activated protein kinases (MAPKs), also referred as extracellular signal regulated kinases (ERKs), in cultured cardiomyocytes. Treatment of rat cardiomyocytes with AVP, Ang II and phorbol 12-myristate 13-acetate (PMA) increases the activation of ERKs. The activity of the 42/44 kDa MAPKs was tested using the phosphorylation of: (1) EGF receptor peptide (EGFR-P); (2) myelin basic protein (MBP) immobilized in poly acrylamide gels; and (3) T183 and Y185 residues of these proteins. The activity of the MAPKs, induced by AVP or PMA was inhibited by downregulation of protein kinase C (PKC), by the tyrosine kinase inhibitor genistein and by MAPK kinase (MEK) inhibitor, PD98059. In addition, the AVP-induced stimulation of MAPKs was shown to be mediated through a V1 receptor. We suggest that AVP activates the 42/44kDa MAPKs through a signal transduction pathway that involves stimulation of AVP-V1 receptor, tyrosine kinase, PKC and MEK. These results suggest that AVP may be involved in ERKs dependent regulatory functions of cardiomyocytes growth.

Amino Acid Sequence↗
PubMed1998

Ischemia detection after myocardial infarction: diagnostic value of exercise-induced QRS duration changes evaluated by a new computerized method.

A new computerized optical scanner was used to measure QRS complex duration during exercise stress testing, both pre- and postdischarge, as a means of ischemia detection after acute myocardial infarction. Thallium stress testing was used as a standard of comparison. Each patient underwent predischarge exercise testing (while receiving anti-ischemic drug therapy) and a postdischarge test 1 month later (without anti-ischemic drug therapy), as well as thallium stress testing within 4 months of infarction. In the population of 68 patients, 42 of the predischarge tests and 43 of the postdischarge tests showed an ischemic response of QRS prolongation. When compared with thallium testing for QRS prolongation criteria, the sensitivity was 95% with a specificity of 77% predischarge and 89% with a specificity of 65% postdischarge. According to ST-T criteria, only 12 of 68 patients were positive for ischemia predischarge; this number increased to 29 postdischarge (predischarge sensitivity 24% and specificity 90%, with postdischarge sensitivity 68% and specificity 87%), when compared with thallium testing. Measuring QRS duration during exercise increased the sensitivity of detection of ischemic patients over that of ST-T criteria by 71% predischarge and 21% postdischarge, with a 22-23% loss of specificity, and was apparently not influenced by anti-ischemic drug therapy.

Adult↗
PubMed1998

Ischemia detection in women: the diagnostic value of exercise QRS duration changes.

AIM: To compare the diagnostic accuracy of exercise electrocardiographic (ECG) ST-T changes and QRS duration changes as a means of ischemia detection in a female population. METHODS AND RESULTS: A total of 101 women from a pool of 318 referred for ECG stress testing underwent standard testing using ST-T criteria with the additional measurement of QRS duration before and at peak exercise using a new computerized optic scanner for precise QRS duration measurement. The diagnostic accuracy of the test was determined using planar thallium stress testing as a "gold standard." For the overall population, the sensitivity of ST-T criteria was 47% with a specificity of 58%. The sensitivity of QRS duration changes was 91% with a specificity of 89%. For Group 1 (age 27-50) the sensitivity of the ST-T criteria was 40% with a specificity of 58%. The sensitivity of the QRS duration changes was 80% with a specificity of 83%. For Group 2 (age 51-83), the sensitivity of the ST-T criteria was 43% with a specificity of 56%. The sensitivity of the QRS duration changes was 94% with a specificity of 90%. CONCLUSION: In our female population exercise, QRS duration changes using our computerized method were better markers of ischemia than standard ST-T criteria.

Adult↗
PubMed1998

The "door-to-needle blitz" in acute myocardial infarction: the impact of a CQI project.

BACKGROUND: A continuous quality improvement (CQI) project was conducted at Soroka Medical Center in Beer-Sheva, Israel, in an effort to identify and address causes of delays in thrombolytic therapy in patients arriving at a high-volume (160,000 patients per year) emergency department with acute myocardial infarction and thereby reduce the "door-to-needle time" (DTNT). The study had four phases: preintervention survey, peri-intervention process redesign, postintervention evaluation, and follow-up evaluation. CQI TEAM: The CQI team followed a seven-step protocol: problem definition, present-state screening, factors analysis, solution development, outcome evaluation, standardization, and conclusions. RESULTS: A DTNT of 45 minutes was considered acceptable for this data set, and accordingly, patients were divided into an "early" group (n = 50, DTNT < 45 minutes), and a "late" group (n = 50, DTNT > or = 45 minutes). After the CQI intervention, the mean DTNT decreased from 61.8 +/- 32.5 (mean +/- standard deviation) to 47.6 +/- 18.5 minutes (p < 0.029). The prolonged DTNT time intervals of the late versus the early groups was primarily due to extended decision-making time (36.0 +/- 22.7 versus 13.6 +/- 6.7 minutes, p < 0.003), followed by time until therapy was initiated (26.2 +/- 14.2 versus 11.1 +/- 5.8 minutes, p < 0.002). CONCLUSIONS: Results suggest that the 30-minute DTNT suggested by the American College of Cardiology/American Heart Association is appropriate for patients with a clear diagnosis and no contraindications for thrombolysis, but when the risk-benefit ratio of thrombolytic therapy raises concerns, a 45- to 60-minute DTNT may still be acceptable. Further CQI projects should address technical triage of simple cases and clinical estimation of risk-benefit ratio in complicated patients.

Emergency Service, Hospital↗
PubMed1997

Coronary stenting with AVE microstents in acute myocardial infarction.

Of 36 patients with acute myocardial infarction (AMI) who were referred for direct or rescue coronary angioplasty, 11 (31%) needed stent implantation. In 7 of them, the stent was implanted because of severe dissection and in 4, because of elastic recoil. All patients were discharged without clinical or electrocardiographic signs of reocclusion. No death, reinfarction or clinical evidence of ischemia occurred during up to 15 months of follow-up.

Aged↗
PubMed1997

Prolonged catheter-induced coronary artery spasm mimicking fixed stenosis.

Two cases of prolonged catheter-induced right coronary artery spasm, mimicking fixed stenoses, are presented. In one case, the spasm appeared at the same place in sequential catheterizations. This angiographic finding may be easily misinterpreted as a fixed lesion, leading to unnecessary attempts at angioplasty.

Adult↗
PubMed1997

An integrated noninvasive system for monitoring the microcirculatory effects of vasoactive drugs: an experimental study.

BACKGROUND: No information is available on the effects of vasoactive drugs on the microcirculation and on the correlation between their effects on the capillary and the systemic circulation. PURPOSE: To characterize the effects of nitroglycerin (NTG), nitroprusside (NP), and metaraminol infusion on microcirculatory variables using a noninvasive monitoring system. METHODS: Increasing doses of NTG (5-40 microg/kg/min) and NP (5-20 microg/kg/min) were intravenously infused to eight rabbits. The microcirculatory parameters were monitored by a combined noninvasive system which included laser Doppler flowmetry (LDF), photoplethysmograph (PPG), and transcutaneous oxygen tension (tc-PO2). Mean blood pressure (MBP) was measured simultaneously. RESULTS: At maximal rate of NTG infusion, the values of LDF, PPG, tc-PO2, and MBP were 72.2 +/- 23.9, 234.7 +/- 165.6, 103.5 +/- 37.4, and 82.7 +/- 7.4% of baseline, respectively. Following NP infusion the LDF, PPG, tc-PO2, and MBP reached 70.8 +/- 24.1, 190.5 +/- 68.9, 70.0 +/- 14.7, and 75.6 +/- 14.6% of baseline, respectively. The tissue oxygenation was significantly reduced during NP infusion compared to NTG (P < 0.05). The values gradually returned to the baseline 10 min after termination of NP infusion, but not after NTG. After injection of 1 mg metaraminol there was a steep decline in LDF, PPG, and tc-PO2 parallel to a significant increase in MBP. When metaraminol was administered after injection of 0.1 mg phenoxybenzamine, these changes were abolished. CONCLUSIONS: This noninvasive system effectively monitors microcirculatory hemodynamic changes induced by vasoactive drugs. NTG and NP cause similar changes in the systemic and microcirculatory bed, with the exception of peripheral oxygenation, which is reduced only during infusion of NP. The changes in the microcirculatory bed following metaraminol and phenoxybenzamine imply that their effects on the arterioles are mediated by adrenergic alpha-receptors.

Analysis of Variance↗
PubMed1996

[Direct percutaneous transluminal coronary angioplasty].

Early reperfusion in acute myocardial infarction (AMI) effectively reduces mortality. Direct. percutaneous. transluminal coronary angioplasty (PTCA) is a recognized alternative to intravenous thrombolytic therapy in early AMI. Of 289 PTCAs performed during a year, 29 (10%) were direct PTCAs. Indications for direct PTCA in 21 patients (72%) were large infarcts, and in 8 (28%) cardiogenic shock. The left anterior descending artery was involved in 15 patients (52%), the right coronary artery in 10 (34%), the left circumflex in 3 (10%), and the left main artery in 1 (3%). Satisfactory opening of the occlusion was achieved in 26 (90%); there was partial success in 2 (7%) and failure in 1 (3%). 4 patients required stent deployment for treatment of dissection. There was no major complication. A patient in whom success was only partial, and the one in whom PTCA failed, were sent for operation. These data do not differ from our success rate in elective PTCA. It is concluded that direct PTCA is a safe procedure with a high rate of successful reperfusion in AMI.

Adult↗
PubMed1996

Jaundice induced by streptokinase.

Streptokinase is the mainstream therapy for acute myocardial infarction. A fifty-seven-year-old man with acute MI was admitted to the intensive cardiac care unit and received streptokinase and heparin. At the time of admission, he was not receiving any drugs and denied any previous exposure to a hepatotoxic agent. Five hours later he developed a dramatic hypersensitivity reaction including high fever, pulmonary edema, cyanosis, and convulsions. Within twelve hours, his clinical state was stabilized. After forty-eight hours, he developed jaundice and transaminasemia, which subsided by the eighth day. Only a few reports of overt jaundice are associated with streptokinase.

Anticoagulants↗