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Biomedical subjects

C Wolfe

Publications and source records attributed to C Wolfe.

At least 19 recordsLinked to original sources
PubMed1996

Hospital services for stroke care. A European Perspective. European Study of Stroke Care.

BACKGROUND AND PURPOSE: Stroke is a common cause of mortality and morbidity in Europe and a major consumer of healthcare costs. However, outcomes from stroke vary significantly across Europe, raising the issue of the extent to which the delivery of care varies across Europe. METHODS: A multicenter, multinational study collected data on hospital admission for stroke. These included patient baseline characteristics, clinical status, and use of inpatient services. RESULTS: Initial results examined inpatient services in nine hospitals in six countries. Statistically significant differences existed between hospitals in key processes of care, most notably in the areas of (1) mean length of stay (11 to 39 days) and median length of stay (8 to 21 days), (2) percentage of admissions receiving brain imaging (30% to 98%) and neurosurgery (0% to 31%), and (3) percentage of admissions with an identified "need" who received physiotherapy (44% to 90%) and occupational (0% to 65%) and speech (0% to 59%) therapy. Although there were significant hospital differences (P < .001) in the case mix of admissions in terms of level of consciousness, presence of incontinence, prestroke Rankin Scale score, and age, these did not explain the differences in care across sites. CONCLUSIONS: There is geographic inequity across Europe in the care a stroke patient can expect to receive. Ongoing analysis will examine the link between European variations in service use and outcomes, in terms of mortality, handicap, and functional ability, as a means of indicating which patterns of care are the most effective.

Aged↗
PubMed1995

The SF-36 health survey questionnaire: is it suitable for use with older adults?

An Anglicized version of the SF-36, a recently developed generic health status measure, was tested among people aged 65 years and over in hospital outpatient and general practice settings as both a self-completed and interview-administered instrument. The SF-36 was quick to complete, with 84% completed in 10 minutes or less (median time 8 minutes), while the distribution of scores provided further evidence of its sensitivity and validity. As an interview-administered instrument the SF-36 was acceptable among all age groups, although 32% of outpatients and 10% of general-practice patients, consisting predominantly of people aged 75 years and over with poor physical or mental health scores, felt unable to self-complete the questionnaire. In addition, 26% of respondents missed out at least one of the 36 statements, with missing items being significantly related to older age and self-completion. Missing responses were mainly concentrated on a small number of questions whose emphasis on work or vigorous activities meant that they were frequently regarded as not applicable by elderly people. Suggested modifications to these questions for elderly respondents are given. With these changes the SF-36 is regarded as suitable for use as a self-completed questionnaire among the younger age group of elderly people, although some assistance may often be required by people aged 75 years and over and especially those with poor physical or mental health.

Activities of Daily Living↗
PubMed1995

Stroke care in Europe. Can we learn lessons from the different ways stroke is managed in different countries?

Stroke is a major health care problem in the European Union and consumes significant resources. The mortality rates from stroke and treatment strategies vary significantly between member states. Only by comparison between centres in different member states with differing health care delivery can the effect of these varying approaches to the management of stroke on outcome be assessed. Conducting a study on a European wide basis in centres which are known to differ in terms of treatment strategies and outcomes allows an immediate analysis of the effectiveness, resource requirements and cost of different methods of managing stroke patients. This paper addresses the current burden of stroke and strategies for its management. An outline of a European Union project, assessing how stroke is managed in different countries, is provided with the aim of indicating a strategy for discovering and promoting more cost-effective services for stroke care in the future.

Aged↗
PubMed1994

Improved hemodynamic function and mechanical efficiency in congestive heart failure with sodium dichloroacetate.

OBJECTIVES: The purpose of this study was to determine whether sodium dichloroacetate improves hemodynamic performance and mechanical efficiency in congestive heart failure. BACKGROUND: Congestive heart failure is associated with impaired hemodynamic performance and reduced mechanical efficiency. Dichloroacetate stimulates pyruvate dehydrogenase activity by inhibition of pyruvate dehydrogenase kinase, which results in inhibition of free fatty acid metabolism and stimulation of high respiratory quotient glucose and lactate consumption by the heart. Facilitation of glucose and lactate consumption with dichloroacetate should improve mechanical efficiency of the failing ventricle. METHODS: Ten patients with New York Heart Association functional class III to IV congestive heart failure were studied. Dichloroacetate (50 mg/kg body weight) was administered intravenously for 30 min, with measurements of hemodynamic variables, coronary sinus blood flow and blood gas, glucose and lactate levels for 2 h. The same patients were also given dobutamine (5 to 12.5 micrograms/kg per min) for comparison. RESULTS: Therapeutic levels of dichloroacetate were achieved (100 to 160 micrograms/liter of plasma). Myocardial consumption of lactate was stimulated from 29% to 37.4%. Forward stroke volumes increased (+5.3 ml/beat, p < 0.02), as did left ventricular stroke work (+1.8 g-m/m2 per beat, p < 0.02) and left ventricular minute work (from 1.38 to 1.55 kg-m/m2 per min, p < 0.01). Myocardial oxygen consumption decreased (from 19.3 to 16.5 ml/min, p = 0.06) as left ventricular minute work increased. Left ventricular mechanical efficiency thus improved from 15.2% to 20.6% (p = 0.03). Dobutamine administration resulted in the opposite trend with respect to myocardial lactate extraction (from 34% to 15.3%, p < 0.02). Stroke volume increased (+7.4 ml/beat, p = NS vs. dichloroacetate), as did left ventricular minute work (from 1.29 to 1.59 g-m/m2 per min, p < 0.01 vs. dichloroacetate) and myocardial oxygen consumption (from 18.6 to 21.0 ml/min, p = 0.06 vs. dichloroacetate). Left ventricular mechanical efficiency did not change with dobutamine administration (from 16.4% to 15.8%, p = NS). CONCLUSIONS: Dichloroacetate administration stimulates myocardial lactate consumption and improves left ventricular mechanical efficiency. Forward stroke volume and left ventricular minute work increase significantly, with a simultaneous reduction in myocardial oxygen consumption. Dobutamine administration results in similar hemodynamic improvements but with no change in left ventricular mechanical efficiency and with opposite effects on lactate metabolism. The opposing metabolic actions, yet similar hemodynamic responses, of dichloroacetate and dobutamine suggest that these agents may be complementary in the treatment of congestive heart failure.

Dichloroacetic Acid↗
PubMed1993

Importance of oxygen-haemoglobin binding to oxygen transport in congestive heart failure.

OBJECTIVE: To assess the importance of 2,3-diphosphoglycerate (2,3-DPG) and oxygen-haemoglobin binding to oxygen transport in patients with congestive heart failure. METHODS: In 30 patients with severe congestive heart failure, arterial, mixed venous, and coronary sinus venous blood concentrations of 2,3-DPG were measured and systemic output and coronary sinus blood flow were measured by a thermodilution technique. Oxygen-haemoglobin affinity was expressed as the oxygen tension in mm Hg at which blood is 50% saturated with oxygen (P50). RESULTS: Compared with normal values, 2,3-DPG was high in arterial blood (2.58 mumol/ml, p = 0.01; 20.8 mumol/g haemoglobin, p < 0.0001). Significant gradients between arterial, mixed venous, and coronary sinus blood 2,3-DPG concentrations were also found (mixed venous = 2.40 mumol/ml, p = 0.05 v arterial blood; coronary sinus venous blood = 2.23 mumol/ml, p < 0.04 v arterial blood). P50 was correspondingly high compared with the accepted normal value (mean 29.7 mm Hg, normal 26.6 mm Hg, p < 0.001). Systemic oxygen transport (351 ml O2/min/m2) varied directly with the forward cardiac index (r = 0.89, p < 0.0001). There was no relation between systemic oxygen transport and arterial oxygen content. Similarly, myocardial oxygen transport was found to vary directly with coronary sinus blood flow. Calculations of changes in cardiac index and coronary sinus blood flow at normal oxygen-haemoglobin binding indicate that a considerable increase in cardiac index and coronary blood flow would be required to maintain similar systemic and myocardial oxygen transport. CONCLUSIONS: In patients with severe heart failure increased 2,3-DPG and reduced oxygen-haemoglobin binding may be compensatory mechanisms that maintain adequate systemic and delivery of oxygen to myocardial tissue.

2,3-Diphosphoglycerate↗
PubMed1992

First steps in the development of an information and counselling service for women with an abnormal smear result.

A study was conducted to develop and evaluate an information leaflet and to investigate the acceptability of a counselling service for women with an abnormal smear result. A newly constructed information leaflet which addressed concerns related to receipt of an abnormal smear result and its medical management was compared for ease of readability with five other leaflets in current use and found to be superior. 144 women were given the leaflet either prior to a colposcopy examination or outpatient ablative treatment and randomly assigned to two recruitment strategies to examine the acceptability of a counselling interview. There was no significant difference between the two strategies and an uptake rate of 80% suggested that women welcomed such an opportunity. An interview evaluation schedule yielded a 98% positive response rate which indicated that the women were satisfied with the counsellor and found the interview useful. Significant differences emerged before and after medical intervention. Patients reported less anxiety, improved mood, and less distress related to the smear result and subsequent medical procedures immediately after the medical interventions (P less than 0.001).

Anxiety↗
PubMed1991

Desmethylimipramine promotes recovery of self-stimulation from the prefrontal cortex following footshock.

Intracranial self-stimulation (ICSS) was assessed from the prefrontal cortex in CD-1 mice immediately (0 h), 24 h and 168 h following exposure to uncontrollable footshock. Marked reductions in ICSS rates were observed in all mice immediately following the stressor. Although the ICSS alterations were transient in some animals, ICSS rates were reduced in the majority of animals 24-h and 168-h poststressor. Mice of either the shock or no shock treatment groups were administered either saline or desmethylimipramine (DMI, 5 mg/kg x 2) for 20 consecutive days. Chronic DMI ameliorated the stressor-induced ICSS deficits from the prefrontal cortex. Potential explanations for the stressor-provoked variations in ICSS and the effects of DMI are discussed.

Animals↗
PubMed1990

Effects of nicardipine, a calcium antagonist, on myocardial salvage and high energy phosphate stores in reperfused myocardial injury.

The current study determined the effectiveness of nicardipine, a 1,4-dihydropyridine calcium antagonist, in preserving reperfused myocardium in a cat model of temporary coronary occlusion and ascertained if replenishment of myocardial phosphate stores during reperfusion as defined by phosphorus-31 nuclear magnetic resonance (NMR) spectroscopy was indicative of salvage. Twenty open chest, anesthetized cats were studied with use of a snare ligature around the proximal left anterior descending coronary artery, with a coil sutured to the epicardial surface overlying the distribution of the artery. Peak areas of phosphocreatine, inorganic phosphate and adenosine triphosphate (ATP) NMR signals were measured during 1 h of occlusion followed by 1.5 h of reperfusion. Infarct size and jeopardy area were determined in vitro by simultaneous infusion of phthalocyanine blue dye and triphenyltetrazolium chloride into the aorta and the left anterior descending coronary artery, respectively, after 5 h of myocardial reperfusion. Nicardipine-treated and control groups had similar jeopardy area values (41.2 +/- 1.6% versus 47.4 +/- 3.1% of the left ventricle), but infarct area was significantly reduced in the nicardipine-treated group (3.2 +/- 1.1% versus 24.9 +/- 7.5% of jeopardy area, p less than 0.01). High energy phosphate compounds remained markedly altered during reperfusion in both groups. No significant improvement in phosphocreatine or inorganic phosphate recovery was observed in animals pretreated with nicardipine despite an 87% reduction in infarct size. Myocardial ATP was greater during reperfusion in the nicardipine-treated compared with the control group (average over initial 90 min of reperfusion 58 +/- 6% versus 46 +/- 3% of baseline values, p less than 0.05), suggesting improved recovery of ATP. However, the measured levels of high energy phosphate compounds during reperfusion and their ratios did not correlate with infarct size and thus were not predictive of myocardial salvage.

Adenosine Triphosphate↗
PubMed1990

Interstudy reproducibility of dimensional and functional measurements between cine magnetic resonance studies in the morphologically abnormal left ventricle.

The validity of geometric formulas to derive mass and volumes in the morphologically abnormal left ventricle is problematic. Imaging techniques that are tomographic and therefore inherently three-dimensional should be more reliable and reproducible between studies in such ventricles. Determination of reproducibility between studies is essential to define the limits of an imaging technique for evaluating the response to therapy. Sequential cine magnetic resonance (MR) studies were performed on patients with dilated cardiomyopathy (n = 11) and left ventricular hypertrophy (n = 8) within a short interval in order to assess interstudy reproducibility. Left ventricular mass, volumes, ejection fraction, and end-systolic wall stress were determined by two independent observers. Between studies, left ventricular mass was highly reproducible for hypertrophied and dilated ventricles, with percent variability less than 6%. Ejection fraction and end-diastolic volume showed close reproducibility between studies, with percent variability less than 5% End-systolic volume varied by 4.3% and 4.5% in dilated cardiomyopathy and 8.4% and 7.2% in left ventricular hypertrophy for the two observers. End-systolic wall stress, which is derived from multiple measurements, varied the greatest, with percent variability of 17.2% and 15.7% in dilated cardiomyopathy and 14.8% and 13% in left ventricular hypertrophy, respectively. The results of this study demonstrate that mass, volume, and functional measurements are reproducible in morphologically abnormal ventricles.

Adult↗
PubMed1990

Depression and recovery of right ventricular function after cardiopulmonary bypass.

Transient left ventricular dysfunction is commonly described in association with cardiopulmonary bypass (CPB). We evaluated changes in right ventricular (RV) function after elective cardiac surgery in 24 patients with normal preoperative cardiac function. In all, irrespective of distribution of coronary artery disease or use of pharmacologic support, a transient depression of RV systolic function with respect to both preinduction and initial postoperative (Postop) values occurred 262 +/- 116 min post-CPB as represented by a decrease in RV stroke volume index (25.0 +/- 1.7 vs. 33.4 +/- 1.9 ml/m2 Postop) and RV ejection fraction (31.0 +/- 2.2 vs. 45.6 +/- 2.5% Postop), and an increase in RV end-systolic and end-diastolic volume indices. This depression responded readily to pharmacologic therapy within 2 h, resolved within 24 h, and had no adverse consequences in these otherwise healthy patients. Further studies are needed to identify the cause of this phenomenon and its importance in patients with preexisting cardiac dysfunction.

Aged↗
PubMed1990

[Three-dimensional analysis of the regional contractility of the normal and the cardiomyopathic left ventricle using cine-magnetic resonance imaging].

The left ventricular regional contractile pattern, global function and mass of normal subjects and patients with idiopathic dilated cardiomyopathy was compared using cine magnetic resonance imaging (MRI) in a short-axis imaging plane. Left ventricular ejection fraction and mass were 64.3 +/- 2.5% and 115 +/- 10 g in normal hearts and 23.5 +/- 3.1% and 194 +/- 20 g in dilated cardiomyopathic hearts (p less than 0.001 and p less than 0.002). Left ventricular end-diastolic wall thickness was homogeneous in normal hearts except for the posterior wall at the basal level, which was significantly thinner compared to the anterolateral wall and the septum (p less than 0.02). End-diastolic wall thickness in the cardiomyopathic group was significantly more heterogeneous and was thinner at the apical compared to the basal level (p less than 0.02) as well as in the segment of the posterior compared to the anterolateral and septal wall (p less than 0.005 and p less than 0.03). In normal hearts, left ventricular end-systolic wall thickness was progressively greater from base to apex for the anterolateral (p less than 0.01) and posterior wall (p less than 0.02) and the septum (p less than 0.02). Such a uniform gradient of end-systolic wall thickness was not present in hearts with dilated cardiomyopathy. It was even reversed for the anterolateral wall with decreasing thickness from base to apex (p less than 0.03). Left ventricular mean systolic wall thickening increased progressively from base to apex (p less than 0.005) in normal hearts, whereas there was no significant gradient from base to apex in hearts with dilated cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Noninvasive evaluation of global left ventricular function with use of cine nuclear magnetic resonance.

Previous reports have validated the accuracy of nuclear magnetic resonance (NMR) imaging for quantitating ventricular volumes and myocardial mass. In this study, a new rapid NMR imaging method, cine NMR imaging, was used to compare left ventricular volumes determined from the transverse plane and short-axis plane in healthy volunteers and patients with dilated cardiomyopathy. With use of the short-axis plane, left ventricular mass at end-systole and end-diastole were determined and left ventricular systolic wall thickening at three different levels was assessed. For validation in the current study, cine NMR imaging and two-dimensional echocardiographic measurements of left ventricular volumes were correlated. Left ventricular volumes of the normal volunteers (end-systolic volume = 34 +/- 3.8 ml, end-diastolic volume = 90.4 +/- 7.2 ml) and patients with cardiomyopathy (end-systolic volume = 173 +/- 28.3 ml, end-diastolic volume = 219.5 +/- 29.6 ml) obtained in the transverse plane were nearly identical to those obtained in the short-axis plane (normal volunteers, end-systolic volume = 30.3 +/- 3.5 ml, end-diastolic volume = 84.7 +/- 7.0 ml and patients with cardiomyopathy, end-systolic volume = 179.1 +/- 27.8 ml, end-diastolic volume = 227 +/- 30.9 ml) and correlated highly (r = 0.91) with volumes obtained by two-dimensional echocardiography. Assessment of left ventricular mass over a broad range using cine NMR imaging in a short-axis plane was identical at end-systole (normal volunteers, 117 +/- 10 g; patients with cardiomyopathy, 202 +/- 20 g) and end-diastole (normal volunteers, 115 +/- 10 g; patients with cardiomyopathy, 194 +/- 21 g).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Cyclosporine versus azathioprine: a review of 200 consecutive cadaver renal transplant recipients.

Most renal transplant centers report an increase in graft survival when cyclosporine is used as a primary immunosuppressant. We report the outcome of 200 consecutive cadaver renal transplant recipients among whom initial immunosuppression and risk factors were similar except for the substitution of cyclosporine for azathioprine in the second 100 recipients. Azathioprine-treated recipients had significantly increased (p less than 0.05) mean hospital stays (31.9 versus 18.3 days), incidence of first rejection episodes (85 versus 31) and methylprednisolone dose (3.38 versus 0.06 gm. per patient). Cyclosporine-treated recipients had a significantly higher 1-year mean serum creatinine level (1.85 versus 1.56 mg. per dl.) and 1-year actual graft survival (83 versus 58 per cent). Despite mild nephrotoxicity, cyclosporine is superior to azathioprine as a primary immunosuppressant in cadaver kidney transplantation.

Azathioprine↗
PubMed1989

Demarcation of myocardial ischemia: magnetic susceptibility effect of contrast medium in MR imaging.

Dysprosium diethylenetriamine-pentaacetic acid-bis (methylamide) (DTPA-BMA), a new nonionic contrast medium for magnetic resonance (MR) imaging, produces signal loss on T2-weighted images because of induced magnetic field gradients. The potential of this agent to delineate myocardial ischemia was investigated in 10 rats with acute (30 minutes) occlusion of the left coronary artery. T2-weighted MR images were acquired before and for 1 hour after intravenous administration of 1 mmol/kg of Dy-DTPA-BMA. Before administration of the contrast medium, signal intensity (SI) in the ischemic region was significantly greater than that in the normal myocardium; however, the borders of the ischemic region were not consistently distinct. The contrast medium caused marked decrease in SI of normal myocardium (18% +/- 3% of the control value), only slight decrease in the jeopardized region (76% +/- 6% of the control value), and no discernible effects on heart rate or blood pressure. Substantial contrast between normal and ischemic myocardium persisted for 1 hour. Moderate signal loss was observed in skeletal muscle. Dy-DTPA-BMA has the potential to demarcate the myocardial area in jeopardy as a region of high signal intensity because it erases signal preferentially in the normal myocardium.

Animals↗