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Biomedical subjects

B Tilley

Publications and source records attributed to B Tilley.

At least 19 recordsLinked to original sources
PubMed1999

Lower thrombolytic use for African Americans with myocardial infarction: an influence of clinical presentation?

BACKGROUND: After myocardial infarction, African Americans have been reported to undergo fewer catheterization and revascularization procedures than whites, but few studies have addressed racial variations in the delivery of thrombolytic therapy. METHODS: We conducted a retrospective analysis of data prospectively collected on consecutive patients admitted with acute myocardial infarction to the 16-bed coronary care unit of a large, urban teaching hospital. RESULTS: Over a 5-year period, 1948 consecutive patients were admitted with acute myocardial infarction to a single coronary care unit. Thrombolysis was administered to 19% of 1024 African Americans and 29% of 924 whites (P <.01). The initial diagnostic impression on admission was "definite" infarction less often in African Americans (30%) than in whites (43%, P <.001), a difference that appeared to largely account for the difference in thrombolytic administration in a multivariable model. Mortality adjusted for age and concomitant illnesses was similar in African Americans compared with whites (relative risk 1.0, 95% confidence interval 0.78 to 1.51). CONCLUSIONS: Much of the racial variation in thrombolytic administration could be accounted for by differences in clinical presentation, an issue that requires further study.

Black or African American↗
PubMed1996

HLA-DRB1 genes and disease severity in rheumatoid arthritis. The MIRA Trial Group. Minocycline in Rheumatoid Arthritis.

OBJECTIVE: To examine the effect of alleles encoding the "shared"/"rheumatoid" epitope on rheumatoid arthritis (RA) disease severity in patients who participated in the minocycline in RA (MIRA) trial. METHODS: Of 205 patients with a week-48 visit, blood was available for typing of HLA-DRB1 and HLA-DQB1 in 174 (85%) and successfully completed in 169 (82%). Baseline erosions were used to assess disease severity and new erosions at the last visit served as a proxy for progression. RESULTS: At baseline, there was no association between the presence of erosive disease or rheumatoid factor status and the dose of rheumatoid epitope (homozygous, heterozygous, none) or the specific alleles identified. At the final visit, a gradient was observed for the 3 allelic subgroups (and their gene doses) in the occurrence of new erosions among the Caucasian placebo-treated, but not the minocycline-treated, patients. A treatment group/HLA-DR4 epitope interaction was demonstrated in multivariate analyses. Approximately two-thirds of African-American patients did not have the rheumatoid epitope. CONCLUSION: HLA-DRB1 oligotyping may be useful in predicting the progression of disease in some Caucasian patients. Our study corroborates the infrequency of the epitope among African-American patients with RA.

Alleles↗
PubMed1996

Rib enlargement in patients with chronic pleural disease.

OBJECTIVE: The purpose of this study was to assess the width of ribs in patients with chronic pleural disease. MATERIALS AND METHODS: On posteroanterior radiographs, we measured the horizontal width of ribs in the midaxillary line of four groups of patients: 41 selected patients with widened ribs and chronic pleural disease (group I), 30 consecutive patients with the clinical diagnosis of tuberculosis for 5 or more years who had radiographs that showed unilateral pulmonary or pleural disease (group II), 25 consecutive patients with the clinical diagnosis of empyema who had radiographs that showed unilateral pleural and often pulmonary parenchymal disease (group III), and 60 consecutive persons who received routine preemployment examinations that revealed no pulmonary or pleural disease (control subjects). Available clinical data were reviewed. RESULTS: We found a significant difference between the size of the ribs on the side of disease and the nondiseased side for groups I and II (p = .0008 and p = .045, respectively). We found no such difference for group III or the control group. The mean absolute values of the different widths of ribs on the side of disease and the nondiseased side were greater for groups I, II, and III than the absolute values of the different widths for the right and left ribs of the control subjects (p < .05). We identified tuberculosis, nontubercular empyema, thoracic surgery, blunt trauma, and metastatic tumor as causative agents in 24 (59%) of the 41 patients in group I. CONCLUSION: Rib enlargement is occasionally displayed radiographically in cases of chronic pleural disease and is confirmed by comparison of the two sides. In our selected patients (group I) with rib enlargement, tuberculosis was the most common cause of pleural disease, but nontubercular empyema, thoracic surgery, blunt trauma, and metastatic tumor were also found. Conversely, we found no rib enlargement in association with pleural disease of short duration. We have shown that rib enlargement can indicate the chronicity of pleural disease.

Aged↗
PubMed1994

Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group.

BACKGROUND AND PURPOSE: Despite the frequent use of clinical rating scales in multicenter therapeutic stroke trials, no generally acceptable method exists to train and certify investigators to use the instrument consistently. We desired to train investigators to use the National Institutes of Health Stroke Scale in a study of acute stroke therapy so that all examiners rated patients comparably. METHODS: We devised a two-camera videotape method that optimizes the visual presentation of examination findings. We then measured the effectiveness of the training by asking each investigator to evaluate a set of 11 patients, also on videotape. We tabulated the evaluations, devised a scoring system, and calculated measures of interobserver agreement among the participants in this study. RESULTS: We trained and certified 162 investigators. We found moderate to excellent agreement on most Stroke Scale items (unweighted kappa > 0.60). Two items, facial paresis and ataxia, exhibited poor agreement (unweighted kappa < 0.40) and should be revised in future editions of the scale. Performance improved with video training compared with previous studies. Inclusion of the motor rating of the unaffected limbs in the total score did not affect reliability. CONCLUSIONS: Video training and certification is a practical and effective method to standardize the use of examination scales. Two cameras must be used during the taping of patients to accurately present the clinical findings. This method is easily adapted to any study in which a large number of investigators will be enrolling patients at multiple clinical centers.

Cerebrovascular Disorders↗
PubMed1993

Prognostic significance of electrocardiographic persistent ST depression in patients with their first myocardial infarction in the placebo arm of the Beta-Blocker Heart Attack Trial.

The prognostic significance of ST segment depression in patients with their first acute myocardial infarction was investigated in 1444 patients with an acute myocardial infarction, who were randomly assigned to the placebo arm of the Beta-Blocker Heart Attack Trial (BHAT). Patients were divided retrospectively into three groups based on the presence or absence of > or = 1 mm ST segment depression in two contiguous leads of a 12-lead electrocardiogram obtained during the first few days after admission and at the time of randomization, which occurred at 9.7 +/- 3.3 days after the index myocardial infarction. Group 1 included 392 patients with no ST segment depression, group 2 comprised 713 patients with transient ST segment depression in the first few days after admission or at the time of randomization, and group 3 included 339 patients with persistent ST segment depression in the first few days after admission and at the time of randomization. At a median follow-up of 26 months, the mortality rate was 4.9% in group 1, 7.6% in group 2, and 13.6% in group 3. When Cox regression was used to adjust for baseline differences in other variables, the differences between the three groups continued to be highly significant (p = 0.005; 95% confidence intervals [0.6 and 1.4]). We conclude that persistent and transient ST segment depression in patients with their first myocardial infarction are strong predictors of increased long-term mortality when compared to patients without ST segment depression. These findings should be taken into consideration when stratifying patients at risk in the post-myocardial infarction period.

Electrocardiography↗
PubMed1991

Natural history of the first non-Q wave myocardial infarction in the placebo arm of the Beta-Blocker Heart Attack Trial.

Despite extensive investigation, the prognostic significance of the first non-Q wave acute myocardial infarction (AMI), when compared with Q wave AMI, remains controversial. The placebo arm of the Beta-Blocker Heart Attack Trial (BHAT) provides a unique opportunity to compare the long-term cardiac events in patients suffering from their first and uncomplicated Q wave or non-Q wave AMI. Of a total 3837 patients enrolled in the BHAT, 3375 were classifiable in terms of appearance or absence of Q waves during the prerandomization period. Of these, 1444 patients with their first AMI were randomized to placebo. Of these, 1186 experienced a Q wave AMI; the remaining 258 suffered a non-Q wave AMI. At 36 months of follow-up, the mortality was 8.4% in the Q wave AMI group and 7.4% in the non-Q wave AMI group. Sudden death was 5.4% in the Q wave AMI group and 4.7% in the non-Q wave AMI group. The reinfarction rate was 5.5% in the Q wave AMI patients and 7.4% in the non-Q wave AMI patients. More patients developed angina (44.6%) in the non-Q wave AMI group compared with 35.2% in the Q wave AMI group. Despite similar long-term cardiac event rates within the two groups, the 1-year mortality rate for patients with Q wave AMI appeared higher than in the non-Q wave AMI group, 5.2% versus 3.1%, respectively. In contrast, the rate of reinfarction appeared higher at the 12-month follow-up period in the non-Q wave AMI group, 4.7% versus 3.4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)c

Double-Blind Method↗
PubMed1990

Effects of propranolol in non-Q-wave acute myocardial infarction in the beta blocker heart attack trial.

Although the beneficial effects of long-term therapy with beta-adrenergic blocking agents in patients recovering from acute myocardial infarction (AMI) are established, the effect of this therapy on the cardiac event rate in patients recovering from a non-Q-wave AMI is unknown. This post hoc analysis of the Beta Blocker Heart Attack Trial (BHAT) evaluates the effects of daily administration of propranolol 180 or 240 mg/day after non-Q-wave AMI. The study population consisted of 601 patients with enzymatically proven non-Q-wave AMI, which represented 17% of the BHAT patients. Of these, 310 patients were randomized to receive propranolol and 291 patients to placebo. There were no significant baseline differences between groups. The median follow-up was 24.6 months. Mortality was 7.8% (sudden death 4.8%) in the propranolol group and 7.9% (sudden death 4.8%) in the placebo group (p greater than 0.99, log rank test). Reinfarction rate was 7.4% in the propranolol group and 6.5% in the placebo group (p greater than 0.63, log rank test). The need for coronary bypass surgery was similar in the 2 groups. However, more patients randomized to placebo developed angina. In this post hoc group analysis of the BHAT, propranolol was not shown to be beneficial in reducing the cardiac event rate in patients recovering from a non-Q-wave AMI.

Double-Blind Method↗
PubMed1990

Measurement of vertebral area on spine x-rays in osteoporosis: reliability of digitizing techniques.

Much of the clinical research in osteoporosis is directed toward documenting a reduction in vertebral fracture rate, but there is considerable disagreement about defining and quantifying vertebral fractures. We have evaluated the technique of digitizing landmarks identified on lateral radiographs of thoracic and lumbar vertebrae and computing vertebral body area. Reduction in area indicates that fractures occurred. Radiographs from 10 patients with osteoporosis and vertebral fractures were obtained from each of two centers. Henry Ford Hospital (HFH) and Mayo Clinic (MC), and vertebral area for each individual in the complete set of 20 radiographs was calculated at each center. Measurements at the two centers differed by a multiplicative constant related to the method of recording landmarks on the radiographs that was estimated using 300 x-rays from HFH. After adjusting the MC areas for this multiplicative relationship, the average ratio of the HFH areas to the transformed MC areas of individual vertebrae (T4-L5) ranged from 0.98 to 1.06. The correlation between HFH and transformed MC areas for individual vertebrae averaged 0.85, with slopes between 0.87 and 1.00, intercept average -0.57. Within-patient rank correlation averaged 0.97. We conclude that radiographic digitization is a reliable and reproducible method of determining vertebral body dimensions that is suitable for evaluating radiographs obtained at different clinical sites and for comparison with normal data. This technique should prove useful for documenting the presence of a vertebral fracture that may not be readily apparent on visual inspection of radiographs and for monitoring serial changes in vertebral body dimensions in long-term epidemiologic and therapeutic studies.

Aged↗
PubMed1990

A meta-analysis of exposure to phenoxy acid herbicides and chlorophenols in relation to risk of soft tissue sarcoma.

This analysis combines the results of the epidemiologic studies which appeared in the literature from 1979-1987 concerning the associations between phenoxy acid herbicides (PH) and chlorophenols (CP) and the occurrence of soft tissue sarcoma. Cohort studies and case-control studies are considered separately. After specifying criteria for inclusion, the total number of deaths due to cancer occurring in selected cohorts of people exposed to PH or CP was determined. The proportion of soft tissue sarcoma cases observed versus expected in the cohort studies, calculated using United States SEER registry data, resulted in a proportional mortality ratio of 3.5 (95% confidence interval of 0.7-10.3). Excluding the initial reports, the selected case-control studies had homogeneous risk estimates with a summary odds ratio of 1.1 (95% confidence interval of 0.9-1.4). Other attempts to assess the combined data did not yield results indicating an association. These meta-analyses do not provide strong support for an association between the specified herbicides and soft tissue sarcoma.

Case-Control Studies↗
PubMed1989

Identification of women at risk for developing postmenopausal osteoporosis with vertebral fractures: role of history and single photon absorptiometry.

Putative risk factors for the development of postmenopausal osteoporosis (PMO) with vertebral fractures were examined in a retrospective study of 663 postmenopausal white females aged 45-75 years (266 women with non-traumatic vertebral compression fractures (VF+), 134 non-fractured women from a general medicine clinic (controls) and 263 non-fractured women who were evaluated when they presented specifically for osteoporosis screening (VF-]. The VF+ women differed from control women in several respects. The VF+ group reported a higher prevalence of a positive family history of osteoporosis, and a higher prevalence of a history of medical or surgical conditions known to be independently associated with metabolic bone disease, had fewer children, were smaller (weight, height) and were slightly older. The two groups, VF+ and controls, did not differ with respect to cigarette smoking, alcohol consumption, exercise habits, menstrual or menopausal history, dietary intake of milk and cheese or in amount taking calcium supplements during pregnancy. The VF+ group also differed in certain respects from the VF- group. The VF+ group were smaller (weight, height) and were older. The VF+ group had lower cortical bone mass (measured by single photon absorptiometry of the non-dominant forearm) than either the control or VF- groups. The latter two groups did not differ from each other with respect to this measurement. These markers demonstrated limited sensitivity and specificity as estimated from a confirmatory data set, particularly for the historical and anthropometric variables. We conclude that an assessment of the risk of developing PMO with vertebral fractures cannot be based on the putative risk factors as measured in our study, but must be based on measurement of bone mass.

Absorptiometry, Photon↗
PubMed1989

Role of kinin in regulation of rat submandibular gland blood flow.

In tissues rich in kallikrein, vasodilator kinins, acting as paracrine hormones, may play a role in the local regulation of blood flow. We studied the role of kinins in the regulation of blood flow in the rat submandibular gland using a kinin analogue with antagonistic properties, [DArg0]Hyp3-Thi5-8[DPhe7]bradykinin. When infused into the carotid artery (20 micrograms/min/rat), this antagonist blocked the effect of bradykinin (25-250 ng/kg, intracarotid injection) on glandular blood flow. In nephrectomized rats, the antagonist also blocked the increase in glandular blood flow caused by enalaprilat, a kininase II converting enzyme inhibitor. At a dose of 20 micrograms/min/rat, the antagonist produced no detectable change in basal glandular blood flow; however, at a higher dose (100 micrograms/min/rat), it caused a significant decrease (p less than 0.001). In eight of 10 rats, blood flow decreased by 75% or more; this effect was not blocked by the alpha-adrenergic receptor antagonist phentolamine. After antagonist infusion was stopped, blood flow returned toward normal. Sympathetic nerve stimulation of the gland induced vasoconstriction followed by poststimulatory vasodilatation. In rats displaying severe vasoconstriction after the antagonist, postsympathetic vasodilatation was abolished even when stimulation was performed after the antagonist infusion had been stopped and blood flow returned toward normal. Although a direct vasoconstrictor effect of the kinin antagonist cannot be completely ruled out, these data suggest that, in the rat submandibular gland, kinins may play a role in regulation of basal blood flow and vasodilatation after converting enzyme inhibitor or sympathetic stimulation.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1988

Risk identification at the time of admission to coronary care unit in patients with suspected myocardial infarction.

The in-hospital clinical course was evaluated in 2,162 consecutive patients admitted with a diagnosis of suspected myocardial infarction. Of these, 1609 patients were considered to be in the high-risk group, based on the presence of 16 clinical criteria present at the time of admission. The remaining 553 patients were classified as low risk. The overall rate of complications in the coronary care unit was greater in the high-risk group, 64%, compared to 26% in the low-risk group (p less than 0.001). Similarly life-threatening events (occurrence or recurrence of ventricular fibrillation, sustained ventricular tachycardia, complete heart block, asystole, or cardiogenic shock) were more common in the high risk-group compared to the low-risk group, 11% and 0.9%, respectively (p less than 0.001). The high-risk group required significantly more interventions, such as electrical cardioversion, temporary pacing, pulmonary artery catheterization, and intraaortic balloon counterpulsation, compared to the low-risk group (20% vs 2%, respectively; p less than 0.001). Myocardial infarction was confirmed in 892 patients in the high-risk group (55%) compared to 90 (16%) in the low-risk group (p less than 0.001). The coronary care unit mortality rate was greater in the high-risk group compared to the low-risk group (8.2% vs 0.4%, respectively; p less than 0.0002). It is concluded that based on readily available clinical criteria at the time of admission, a subgroup of patients at low risk for developing life-threatening complications requiring coronary care unit interventions can be identified and admitted directly to an intermediate-care unit.

Coronary Care Units↗
PubMed1988

Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease.

Ambulatory electrocardiograms obtained in 69 patients enrolled in the nocturnal oxygen therapy trial group were examined for frequency and significance of arrhythmias in patients with stable chronic obstructive lung disease. Ventricular premature beats occurred in 83 percent, ventricular bigeminy in 68 percent, paired ventricular premature beats in 61 percent, and nonsustained ventricular tachycardia in 22 percent of the patients. Supraventricular tachycardia occurred in 69 percent. Repetitive ventricular arrhythmia occurred in 64 percent of the patients, and was significantly more frequent in men and in patients with edema or elevated PCO2. Ventricular premature beats greater or equal to 25 per hour occurred in 35 percent of the patients. Univariate and multivariate Cox proportional hazards analysis showed that a history of coronary heart disease, increased sinus heart rate and decreased maximum work load (measured by maximal treadmill exercise test)--but not arrhythmias--were predictors of death.

Aged↗
PubMed1987

Efficacy of propranolol therapy after acute myocardial infarction related to coronary arterial anatomy and left ventricular function.

The effect of the beta-adrenergic blocking agent propranolol on morbidity and mortality risk after acute myocardial infarction was studied relative to coronary anatomy and left ventricular (LV) ejection fraction in a subset of 406 patients participating in a randomized study of 3,837 patients in the Beta Blocker Heart Attack Trial (BHAT). Median follow-up for this subset of patients was 28 months. The mortality rate was 2% (2 of 100) in patients with 2- and 3-vessel coronary artery disease taking propranolol and 10% (12 of 126) in those taking placebo (p less than 0.02). In patients with 2- and 3-vessel coronary artery disease with decreased LV function (defined as ejection fraction less than 50%), no patient taking propranolol died, whereas 17% (7 of 42) taking placebo died (p less than 0.04). The salutary effect of propranolol on mortality in the larger BHAT after acute myocardial infarction also was evident in this population studied in regard to their coronary and LV anatomy and function.

Coronary Vessels↗