Persistent foetal circulation syndrome.
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Humans↗
Biomedical subjects
D B Rao
Publications and source records attributed to D B Rao.
Multiple primary malignancy in the elderly.
The longer a patient lives, the more predisposed he is to become host to primary malignant neoplasms at various sites. Hence the importance of follow-up clinics in long-term care facilities. Data on multiple malignancies at Oak Forest Hospital are presented. Among 34 such patients (average age, 72 years), 28 had malignant lesions at two primary sites, and 6 at three primary sites.
Age Factors↗
The second heart sound in old age.
The second heart sound was studied by phonocardiography and carotid tracings in 103 elderly subjects without overt evidence of heart disease. Their ages ranged from 60 to 99 years. A normal type of splitting was found in 55.3%, and a single sound in 41.7%. The difference between these percentages and those found in 60 normal younger persons was not significant. Thus, a single second sound should not be considered a typical finding in old age. However, a reverse type of splitting, noted in only 3 patients, should be regarded as evidence of severe latent heart disease.
Adult↗
Cyclandelate in the treatment of senile mental changes: a double-blind evaluation.
The treatment of cerebrovascular insufficiency and its many symptoms in the ever-increasing numbers of the aged, is of major concern to physicians engaged in such care. Despite past skepticism as to the degree of efficacy of cerebral vasodilators, there is renewed interest in this form of therapy. Our investigation was designed to assess the effectiveness of cyclandelate, under strict double-blind conditions, in 58 geriatric patients. The cyclandelate and placebo groups (32 and 26 patients respectively) received either 1,600 mg/day of cyclandelate in fractional doses, or identical-appearing placebo capsules--over a period of 12 weeks. During the initial examination and every four weeks thereafter, patients were assessed for possible changes in vital signs and for evidence of adverse reactions. In addition, the Sandoz Clinical Assessment-Geriatric (SCAG) and the Nurses Observation Scale for Inpatient Evaluation (NOSIE) were completed, with particular attention to symptom clusters. A final global assessment was made in which the physician rated patients according to their overall clinical condition. The results of our study and analysis indicate that cyclandelate is a safe and effective agent for treating certain symptoms of senility in properly selected patients, provided the therapy is carried on for at least eight weeks and, if indicated, for a longer period. Clinical evidence suggests that the prudent use of this drug may definitely delay deterioration.
Aged↗
What is "normal" blood pressure in the aged?
Blood pressure was studied in two groups of institutionalized subjects ranging in age from 50 to over 100 years. The first group comprised 199 selected normal subjects; subjects with any disease, including systemic hypertension, were excluded. The second group consisted of 947 unselected subjects; those with acute illness were excluded. In the first group, systolic pressure increased slightly, but diastolic pressure did not change with increasing age. The blood pressures were still within the limits that were considered normal for younger persons. In the second group, both the systolic and the diastolic pressures progressively decreased with age, so that the former fell below normal limits.
Aged↗
The team approach to integrated care of the elderly.
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Aged↗
Incidence of murmurs in the aging heart.
One hundred patients aged 60 or older were studied clinically after excluding those with cardiac enlargement, definite valvular lesions or electrocardiographic (ECG) evidence of left ventricular hypertrophy. In 30 of the the 100 patients a significant systolic murmur was heard on auscultation. Phonocardiograms (PCGs), mitral echograms and pulse tracings were obtained in 28 of these 30 patients (2 had died meanwhile), and the ECGs and chest roentgenograms were reviewed. In 23 PCG patients there was an early or midsystolic murmur, best recorded at the base of the heart and often transmiteed to the apex. Mitral valve echograms and carotid and jugular pulse tracings were normal in all cases. Chest roentgenograms revealed aortic enlargement in 83 percent of the 23 patients. In the elderly with no evidence of organic heart disease, a basal systolic murmur is probably an aortic flow phenomenon caused by either moderate aortic dilatation or minimal fibrotic fusion of one or more commissures of the aortic valve.
Age Factors↗
Importance of aortic dilatation in the genesis of the innocent systolic ejection murmur of the aged.
Aortic systolic murmurs and aortic dilatation were studied in a randomized sample of 100 hospital patients over the age of 60. Clinical, phonocardiographic, radiologic and carotid-pulse data provided the basis for graphic characterization of the murmurs. Senile aortic dilatation was common (66 patients). In a high percentage (39 patients), dilatation of the ascending aorta (and sometimes of the arch) was associated with an aortic systolic murmur. The "innocent" type was always associated with aortic dilatation. This "innocent murmur of the aged", even though caused by structural alterations, should be considered in the same light as the "innocent murmur of children", as it is not associated with dynamic embarrassment of the circulation.
Aged↗
Tachyarrhythmias in old age.
The electrocardiograms of 1,171 patients above the age of 65 in a predominantly geriatric institution were reviewed to determine the incidence of tachyarrhythmias. Data on the overall incidence and the individual types of arrhythmias are presented. Atrial fibrillation was the most common arrhythmia observed, followed by atrial flutter and supraventricular tachycardia. Atrial fibrillation often was associated with other evidence of myocardial damage. The significance of sinus bradycardia and grade I A-V block in the pathogenesis of atrial fibrillation and the significance of the tachyarrhythmias are discussed.
Aged↗
Correlates of the echocardiographic waves of the mitral valve in normal subjects of various ages.
A cardiographic study was performed on 71 subjects including 14 children, 42 young and middle-aged adults, and 15 old persons without evidence of heart disease. The echocardiogram of the mitral valve was recorded in the A mode by an analog method and was compared with the electrocardiogram, phonocardiogram, apex cardiogram, and carotid and jugular tracings, simultaneously obtained. The intervals between the various waves recorded by these methods were measured and the results were compared with those reported in the literature. A comparison of the duration of the intervals in the various age groups showed statistically significant differences. In particular, the intervals between the second heart sound and the peak of the E-wave and the E-F intervals in the echogram were longer in adults than in children and also longer in old persons than in younger adults. This important age difference should always be taken into account before attributing any echocardiographic deviations to disease.
Adolescent↗
Collagenase in the treatment of dermal and decubitus ulcers.
The current management of decubitus ulcers, factors in wound healing and the role of enzymes in treatment are discussed. The therapeutic benefits of collagenase (Santyl) ointment in 21 patients are described, supplemented by serial color photographs. Statistical evidence is provided for the conclusion that collagenase ointment is an excellent adjunct to therapy.
Adult↗
Ventricular relaxation and mitral opening time in various ventricular conditions of old age.
This phonocardiographic-echocardiographic study was based on measurement of the interval between the aortic component of the second sound (IIA) and the peak of the E wave of the mitral echogram. The study was performed in 20 cases of left bundle branch block (LBBB), 10 cases of right bundle branch block (RBBB), 10 cases of old myocardial infarct (MI), and 10 cases of systemic hypertension (HY). All patients were above 60 years of age, and their data were compared with those of old persons without evidence of heart disease serving as controls. The IIA-E interval was found markedly prolonged in LBBB, less prolonged in MI and RBBB, and was shortened in HY. A dynamic analysis revealed that this interval results from the isovolumic relaxation period (IRP) of the left ventricle plus the "opening time" of the mitral valve. The changes observed were explained as resulting from a modification of the IRP that should be correlated with a similar modification of the isovolumic contraction time. Myocardial fibrosis would cause prolongation of IRP through structural lesions while hypertension would cause abbreviation of IRP through hormonal effects modifying both contraction and relaxation.
Aged↗
Interaction of muscle relaxants and local anesthetics at the neuromuscular junction.
The effects on neuromuscular (NM) function of combinations of relaxants (d-tubocurarine, pancuronium, and succinylcholine) and local anesthetics (cocaine, procaine, lidocaine, etidocaine, and a quaternized derivative of procaine, procaine methobromide) were investigated using the rat's phrenic nerve--hemidiaphragm preparation. Combinations of ineffective concentrations of NM blocking agents with ineffective concentrations of local anesthetics caused a greater than 90% NM block. Preliminary administration of ineffective concentrations of local anesthetics significantly ( p less than 0.001) decreased the ED50 of NM blocking agents. The administration of ineffective concentrations of NM blocking agents caused a similar decrease of the ED50 of local anesthetics. Concentrations of d-tubocurarine and pancuronium which alone produced partial NM block had additive effects. These findings suggest that the interaction of NM blocking agents and local anesthetics consists of true potentiation caused by the different sites of action of the two types of compounds at the NM junction. The degree of potentiation may be enough to cause clinically significant NM block in patients who at the same time receive high enough doses of both agents. In vitro the NM block caused by the combinations of local anesthetics and NM blocking agents can be reversed by 4-aminopyridine.
Anesthetics, Local↗
Alterations in cardiovascular function during neurolept anesthesia for surgery on the coronary vessels.
Induction of anesthesia for aortocoronary bypass surgery was accomplished by the administration of droperidol, morphine, oxygen and nitrous oxide-oxygen in 20 patients. They ranged from 40 to 69 years of age. Premedication consisted of diphenhydramine and morphine. Cardiovascular stability was the most important aspect of the technique. Heart rate changes were insignificant. Cardiac index increased substantially after droperiodol and remained unchanged after morphine. It stayed around control levels for the rest of the induction. A substantial decrease was observed while using mechanical ventilation. Mean arterial pressure dropped significantly after droperidol and again after morphine, then rose about 17% after oxygen to near control levels, where it stayed thereafter. Peripheral vascular resistance dropped substantially after droperidol. A significant increase occurred after oxygen, reaching almost control levels at this point. Mechanical ventilation caused a significant increase, similar to the decrease in the cardiac index. Decreased oxygen availability was compensated for by decreased oxygen consumption. Induction of neurolept anesthesia in the manner described appears to be void of the undesirable effects of either large doses of morphine, or nitrous oxide-oxygen following such morphine doses. Amnesia was complete in every patient.
Adult↗