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Biomedical subjects

C A Pierach

Publications and source records attributed to C A Pierach.

At least 55 records · Page 3Linked to original sources
PubMed1988

Relation between serum digoxin concentration and the electrocardiogram.

The relation between serum digoxin concentration and the electrocardiogram was assessed by correlating computerized measurements of electrocardiographic parameters (PR, QRS, QT and QTc intervals, ST segment, and T-wave amplitude) with the serum digoxin concentration in 97 patients on digoxin maintenance therapy and in 40 nondigitalized control subjects. None of the patients had unstable ischemic heart disease, electrolyte disorders, medication known to influence the ST segment, and/or the presence of a bundle-branch block or ventricular hypertrophy. We found a trend toward lengthened PR interval and shortened QT and QTc intervals in digitalized versus nondigitalized patients. Increasing serum digoxin concentrations were associated with progressive depression of the ST segment and decreased T-wave amplitude (p less than 0.001). A normal ST segment in four leads (I, aVF, V5, V6) excluded the presence of a serum digoxin concentration greater than 1.3 ng/ml in our patients, whereas severe ST-segment depression with a J point of greater than or equal to 100 microV was a strong indicator for the presence of a serum digoxin concentration greater than 2.0 ng/ml in our selected patient population (specificity 99%, sensitivity 30%, predictive accuracy 85%). We conclude that computerized electrocardiographic analysis of the ST segment may provide clinically useful information for the management of selected patients on digitalis therapy and may therefore increase the diagnostic yield of the electrocardiogram in predicting the presence of higher serum digoxin concentrations in a small but significant percentage of patients.

Adult↗
PubMed1987

Red blood cell porphobilinogen deaminase in the evaluation of acute intermittent porphyria.

We measured the activity of the enzyme porphobilinogen deaminase in red blood cells of 222 persons. Ninety-seven of 107 patients with acute intermittent porphyria had enzyme activity below the normal range, whereas 55 of 56 patients with other types of porphyria had normal activity. This underscores the utility of this test in confirming the diagnosis of acute intermittent porphyria. Measurement of enzyme activity in 41 families with acute intermittent porphyria demonstrated that deficient activity is inherited as an autosomal dominant trait. Many latent carriers of the genetic defect were identified by family studies, permitting appropriate precautions to avoid potentially lethal porphyric attacks.

Acute Disease↗
PubMed1984

[Pruritus].

Pruritus is an annoying skin disturbance which is often amenable neither to diagnostic nor to therapeutic interventions. Occasionally, generalized pruritus can be ameliorated by treating the underlying disease (e.g. iron deficiency, hyperthyroidism). The good response to ultraviolet radiation opens new possibilities which should be tried in patients with chronic renal insufficiency or cholestasis. The existence of a UV-sensitive pruritogen could explain a multitude of findings and phenomena.

Antipruritics↗
PubMed1984

Pseudo-porphyria in a patient with hepatocellular carcinoma.

An elderly woman was found to have hepatocellular carcinoma and, incidental to this, markedly elevated levels of porphobilinogen in urine and serum. The delta-aminolevulinic acid levels in urine and serum were normal, but there was a distinct increase of porphyrins in urine and feces. Neither the patient nor her family gave a history suggestive of a clinical porphyria. The patient died from the carcinoma without ever exhibiting porphyric symptoms. It is assumed that the hepatocellular carcinoma produced the excessive amounts of porphobilinogen.

Abdominal Neoplasms↗
PubMed1982

Effects of sulfinpyrazone on early graft closure after myocardial revascularization.

The effect of sulfinpyrazone on the incidence of early postoperative closure of saphenous vein bypass grafts was compared with placebo in a prospective randomized study of 255 eligible patients. Treatment with sulfinpyrazone (800 mg/day) was started 24 hours after operation in 130 patients; 125 patients received placebo. Graft blood flow was measured at operation in 96 percent of all patients. Graft angiography was performed between the 7th and 14th postoperative days. There was no significant difference between the two groups in graft blood flow, number and diameter of the grafted arteries, left ventricular filling pressure or ejection fraction. During the study 73 patients (41 on sulfinpyrazone, 32 on placebo therapy) were excluded because graft angiography was contraindicated or because of concomitant use of anticoagulant or antiplatelet drugs. The incidence rate of early graft closure in the remaining 182 patients (43.1 grafts) was 3.8 percent (8 or 212) in the sulfinpyrazone group and 9.1 percent (20 of 219) in the placebo group (p less than 0.025). The incidence of graft closure for the sulfinpyrazone and placebo groups classified according to the recipient coronary arteries was: (1) left anterior descending artery; 3 of 98 versus 11 of 111; p less than 0.05; (2) left circumflex coronary artery: 3 of 50 versus 5 of 43; difference not significant; (3) right coronary artery: 2 of 64 versus 4 of 65; difference not significant. The incidence of closure in grafts with a flow of less than 30 ml/min did not differ significantly in the sulfinpyrazone and placebo groups (4 of 26 versus 6 of 22). These results suggest that sulfinpyrazone reduces the incidence of early graft closure in grafts with a flow rate greater than 30 ml/min.

Constriction, Pathologic↗
PubMed1981

Electrocardiographic changes after cervical laminectomy.

Striking T-wave inversions were observed in the postoperative electrocardiograms of a 64-year-old woman following an extensive cervical laminectomy. Except for the presence of a trace amount of CK-MB in a single serum specimen all her enzyme and isoenzyme studies were negative, and her clinical course was not suggestive of myocardial ischemia. Coronary angiography, including an ergonovine study, done 6 mth following the laminectomy were normal. Because of the nature of this patient's neurogenic origin of these T-wave changes is suspected.

Cervical Vertebrae↗
PubMed1980

Hematin therapy in porphyric attacks.

We report our experience with hematin in the treatment of 57 patients in porphyric attacks. The ratio of acute intermittent porphyria: variegate porphyria: hereditary coproporphyria was 43:11:3. More than 90% of the patients showed not only a decline in their porphyrin precursors, but also a favor able clinical response. Hematin was well tolerated and should be considered the treatment of choice in porphyric relapse.

Heme↗
PubMed1979

Electrocardiographic changes after bilateral carotid sinus denervation in the rat.

The effect of bilateral carotid sinus denervation (CSD) on the ECG and on the monophasic ventricular action potential (MAP) was studied in 28 and 4 rats, respectively. After CSD, T wave changes, similar to those seen in man after carotid endarterectomy, were observed and mean Q-T prolongations of 19 ms were recorded (P less than 0.001). Mean MAP increased by 10 ms (P less than 0.02). P-QRS and heart rate remained stable. Propranolol, 10 mg/kg iv, before CSD and 10 mg.kg-1.day-1 iv for 2 days prevented all ECG abnormalities. Atropine, 1 mg/kg iv, before CSD and 2.5 mg.kg-1.day-1 iv for 2 days had no effect. Isoproterenol, 0.02-0.06 microgram iv, after CSD produced further lengthening of the MAP and Q-T interval. Blood gases and electrolytes remained unchanged, and cardiac histology was unremarkable. These results suggest that CSD produces alterations in cardiac sympathetic activity in the rat leading to MAP and Q-T prolongations and to changes in the T wave form. Similar mechanisms may be operative after carotid endarterectomy in man.

Action Potentials↗