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Biomedical subjects

B Kamm

Publications and source records attributed to B Kamm.

8 recordsLinked to original sources
PubMed1992

Prevention of stroke with ticlopidine: who benefits most? TASS Baseline and Angiographic Data Subgroup.

We examined the baseline characteristics of patients in the Ticlopidine Aspirin Stroke Study (TASS) to determine if the effects of the two treatments in preventing stroke differed in various subgroups. Patients with the following characteristics did less well on aspirin: elevated creatinine, hypertension or diabetes requiring treatment, or treatment with anticoagulant or antiplatelet drugs prior to their qualifying TIA or stroke. Women and patients with vertebrobasilar symptoms did particularly well on ticlopidine. We performed arteriography in 1,188 patients with carotid qualifying events. The frequency of stroke in patients with abnormal arteriograms ipsilateral to their symptoms was slightly higher than in those with normal carotid arteries. Ticlopidine was more effective in patients without carotid stenosis. Ticlopidine is more effective than aspirin in preventing strokes in patients having warning TIAs. The patients who benefit most from ticlopidine may be women, those who have vertebrobasilar symptoms, those with cerebral ischemic symptoms while on aspirin or anticoagulant therapy, and patients with diffuse atherosclerotic disease rather than high-grade carotid stenosis.

Aspirin↗
PubMed1979

Spirometry in amyotrophic lateral sclerosis.

Clinical evaluation and pulmonary function tests were performed in 218 patients with motor neuron disease, mainly amyotrophic lateral sclerosis (ALS). Serial studies were obtained in 103 patients, in 31 until death from ALS. Most patients, regardless of the pattern of motor neuron involvement, had characteristic abnormalities in pulmonary function, including reduced forced vital capacity (FVC) and maximum voluntary ventilation (MVV). Reductions in the FVC and MVV to as low as 50% were commonly missed by clinical evaluators. Spirometry is therefore of value in detecting early involvement of respiratory neurons. Progressively greater reductions in the FVC and MVV in all the fatal cases indicate that serial spirometry has prognostic value in ALS.

Adult↗
PubMed1979

Use of treadmill score to quantify ischemic response and predict extent of coronary disease.

In this study we assessed whether various responses to exercise testing could be quantified in order to derive the probabilities of presence of coronary disease, and if present, to assess its severity. A treadmill score based on the exercise response was determined in 405 patients who had both treadmill tests and coronary angiograms. The score was derived using discriminant function analysis, by weighting and combining depth and configuration of ST depression (downsloping, horizontal or slowly upsloping), timing onset and duration of ischemia, grading ventricular arrhythmias, heart rate and blood pressure change, coexistence of exercise-induced chest pain and sex. The treadmill score was effective in detecting coronary disease (lesions with an greater than or equal to 50% narrowing), with a predictive accuracy (PA) (probability that a subject manifesting a positive test has disease) of 87%, a true negative rate (TNR) (probability of a subject with a negative test having no disease) of 80%, and sensitivity of 94%. The treadmill score also detected severe disease (triple-vessel, main left and/or greater than 90% proximal occlusion of the left anterior descending artery), with a PA of 73%, TNR of 79% and sensitivity of 82%. We conclude that the exercise response, expressed numerically as a treadmill score, permits analysis of most of the relevant data from exercise testing, increases test accuracy by 10-15% compared with standard criteria for treatmill test interpretation, and enables the derivation of probability statements for presence and severity of coronary disease. The validity of any prediction on the basis of exercise performance may thus be quantitatively judged.

Analysis of Variance↗
PubMed1978

Thromboembolic complications after mitral valve replacement with Hancock xenograft.

Case histories of 140 patients who had mitral valve replacement with the Hancock xenograft were reviewed according to the incidence of thromboembolic complications. There were 16 patients with preoperative and/or postoperative low-output syndrome (Group A.) Eight of these patients died, and six had autopsies which showed major thrombi on the heterograft valve. In 126 long-term survivors (followed 1 to 33 months) nine thromboembolic events occurred (thromboembolic incidence 5.3 percent per patient-year). All patients with emboli were in atrial fibrillation. Additional predisposing factors included a history of systemic emboli and the presence of atrial clots at the time of surgery. The majority (7/9) of emboli occurred during the first 3 postoperative months. Two emboli occurred immediately following the operation (before oral anticoagulation therapy could have been begun). Five occurred in patients who were not on anticoagulation (Group B) and two occurred under warfarin treatment (Group C). There was no thromboembolic event in patients taking aspirin (Group D). It is concluded that hemodynamically stable patients have a decreased risk of thromboembolism and do not require anticoagulation. Patients with atrial fibrillation have an increased thromboembolic risk and should be on a regimen of warfarin for 3 months postoperatively and then on aspirin therapy.

Adolescent↗
PubMed1975

Pathophysiology of adult respiratory distress syndrome.

We have studied 45 patients with adult respiratory distress syndrome (ARDS). Pathological studies were performed on 30 open lung biopsies and 15 autopsies. Concomitantly the physiologic characteristics of the hypoxemia in response to different inspired oxygen fraction (FIO2) and Positive End Expiratory Pressure (PEEP) were determined. These studies allowed categorization of ARDS into 3 groups. Group I had the most severe hypoxemia and a severe fixed shunt at all PEEP and FIO2. Pathologically, there was extensive acute edema, hemorrhage, and exudation to the point of consolidation. Group II had less severe hypoxemia which improved moderately but slowly in response to PEEP and shunt increased with decrease in FIO2 indicating diffusion disturbances or severe ventilation-perfusion abnormalities. Pathology showed severe fribrosis. Group III had least hypoxia which rapidly and markedly improved with PEEP. Shunt also increased with decrease in FIO2. Pathology showed acute changes similar to but less severe than group I. Prognosis was best for group III with 10 of 21 long term survivors (one after ECMO or extracorporeal membrane exygenation). In group I only 2 of 11 survived after prolonged periods of ECMO. In group II, 3 of 13 survived (one required ECMO) with satisfactory pulmonary function despite biopsy evidence of severe fibrosis during the acute illness. These pathological and physiologic studies are useful to better understand ARDS, to optimize respiratory care and for prognosis.

Adolescent↗