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Biomedical subjects

B Sobel

Publications and source records attributed to B Sobel.

10 recordsLinked to original sources
PubMed1998

Haemodynamic stability and ketamine-alfentanil anaesthetic induction.

We have determined if alfentanil could obtund the haemodynamic instability commonly seen at induction of anaesthesia with ketamine. Five groups of ASA I and II patients received ketamine 1 mg kg-1 i.v., preceded by saline (group 1) or alfentanil 10, 20, 30 or 40 micrograms kg-1 (groups 2-5, respectively). Heart rate (HR), mean arterial pressure (AP), postoperative patient complaints and dysphoria were noted. All groups showed increases (P < 0.05) in both HR and AP after administration of ketamine, which were progressively smaller as the dose of alfentanil increased. After tracheal intubation, all groups showed further increases in HR and AP, with groups 3-5 (alfentanil 20-40 micrograms kg-1) showing significant obtundation (P < 0.05) of these increases compared with group 1. No patient in any group reported postoperative dysphoria or dissatisfaction with their anaesthetic. Ketamine 1 mg kg-1 with alfentanil 20-40 micrograms kg-1 provided statistically significant obtundation of the haemodynamic instability that is common with ketamine alone.

Adolescent↗
PubMed1996

Usefulness of fibrinogenolytic and procoagulant markers during thrombolytic therapy in predicting clinical outcomes in acute myocardial infarction. TIMI-5 Investigators. Thrombolysis in Myocardial Infarction.

Thrombin activity is increased in the setting of acute myocardial infarction (AMI) and has been shown to increase further after the administration of thrombolytic therapy for acute infarction. This increase in thrombin activity may play an important role in the 15% to 25% rate of failure to achieve initial reperfusion and in the 5% to 15% rate of early reocclusion after initially successful thrombolysis. To investigate potential mechanisms of thrombin formation in vivo, to understand better the balance of coagulation and fibrinolysis during treatment with recombinant tissue-type plasminogen activator (rt-PA), and to investigate the role of hemostatic markers as predictors of clinical events, we measured 3 markers of procoagulant activity: fibrinopeptide A (FPA), thrombin-antithrombin III complexes (TAT), and prothrombin fragment 1.2 (F1.2), and a marker of fibrinogenolytic activity (B beta 1-42) in patients enrolled in the Thrombolysis in Myocardial Infarction (TIMI)-5 study. This trial was a randomized, dose-ranging, pilot trial of hirudin versus heparin as adjunctive antithrombotic therapy with rt-PA administered to patients with AMI. Correlation of markers at 1 hour with clinical outcomes revealed that increased FPA and TAT levels were associated with increased mortality and TIMI grades 0, 1, or 2 flow at 90 minutes; increased F1.2 levels were associated with TIMI grade 0 or 1 flow at 90 minutes; and increased levels of all 3 procoagulant markers were associated with hemorrhagic events. Late (12 to 24 hours) increases in F1.2, TAT, and B beta 1-42 may be predictive of recurrent ischemia. These results suggest that selected markers of procoagulant and fibrinogenolytic activity may be useful in predicting clinical outcomes in patients treated with thrombolytic therapy for AMI.

Antithrombin III↗
PubMed1996

Amelioration of the inhibition of fibrinolysis in elderly, obese subjects by moderate energy intake restriction.

A possible cause of accelerated atherothrombosis in the syndrome of insulin resistance appears to be an elevated blood concentration of plasminogen activator inhibitor type-1 (PAI-1). Insulin resistance occurs with aging, attributable partly to increased adiposity. Scarce information exists regarding the effects of weight loss in elderly, obese individuals on PAI-1 concentrations. Consequently, weight loss (9 +/- 1 kg) was induced by energy intake restriction in 19 elderly, obese individuals, and its effect on fibrinolytic system peptides was measured. Initially elevated PAI-1 concentrations decreased by 50%, with a simultaneous decrease in the concentration of tissue-type plasminogen activator (t-PA)/PAI-1 complexes but no significant change in t-PA suggested a decrease in inhibition of the fibrinolytic system. The concentration of plasmin/antiplasmin complexes (PAP complex) increased by approximately 20%, indicating augmented fibrinolytic system activity. The decline in PAI-1 correlated with that of the decrease in body weight (r = 0.5, P < 0.05) and fat mass losses (r = 0.46, P < 0.05). The increase in PAP complexes correlated with weight and fat mass losses (r = 0.4 and r = 0.46, respectively; P < 0.05 for both). No correlation was seen between fibrinolytic system variables and baseline concentrations of substrates or insulin, but the change in PAI-1 correlated with the change in plasma triacylglycerols (r = 0.58, P < 0.05). Results indicate that energy restriction sufficient to induce moderate weight loss leads to diminution of elevated plasma PAI-1 and relief of inhibition of the fibrinolytic system in elderly, obese subjects. To the extent that these changes are associated with a decrease in the progression of vasculopathy, weight loss in elderly, obese individuals may be a useful means to reduce cardiovascular morbidity and mortality.

Aged↗
PubMed1985

Complete nucleotide sequence of dog heart creatine kinase mRNA: conservation of amino acid sequence within and among species.

Creatine kinase (CK; EC 2.7.3.2) plays an important role in energy metabolism in brain and muscle. Expression of CK isoenzymes is regulated during development and is tissue specific. To define the structures of canine CK isoenzymes and to elucidate the mechanism of regulation in their expression, CK cDNA clones from dog myocardium were isolated. Myocardial CK mRNA is predicted to encode a protein of 381 amino acids. The nontranslated regions of the mRNA comprise at least 38 bases at the 5' end and exactly 345 bases before the poly(A) tail. Partial protein sequences of dog muscle (M) CK and brain (B) CK subunits were determined and compared with the derived amino acid sequence of the myocardial enzyme and of M CK subunits of other species. The M CK subunits from different species share a very high degree (83-96%) of sequence identity. Dog M and B subunits share extensive sequence identity (74%), a degree of similarity not previously suspected. Southern blot analysis suggests that a CK gene family exists. These observations imply that evolutionary changes in the M CK subunit structure are constrained by the need for preservation of functional properties other than the kinase activity. This conservation is consistent with the possibility that the M subunit plays a structural role in cardiac and skeletal muscle.

Animals↗
PubMed1980

Hydrostatic mechanism in the roll-over test.

The roll-over test has been reported to predict pregnancy-induced hypertension. The arm used to record blood pressure has never been specified. Since the level of the arm with reference to the heart is of great importance in the interpretation of blood pressure, we recorded the roll-over response (blood pressure change from left lateral to supine position) first in the right and then in the left arm of 9 men and 8 nonpregnant women. In addition, blood pressure was measured simultaneously in both arms in 10 pregnant primigravidas. In the men and nonpregnant women the mean diastolic blood pressure after rolling over rose when the right arm was used and fell when the left arm was used. The difference in the roll-over response (right versus left arm) was accounted for by the hydrostatic effect produced by the vertical distance between the corresponding brachial arteries with the subject in the left lateral recumbent position. In the pregnant subjects as well, there was a difference between the roll-over response in the right versus left arm, accounted for by hydrostatic factors. However, the increase in blood pressure was greater for both arms, suggesting a real change in central blood pressure.

Adult↗