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Biomedical subjects

D Broudy

Publications and source records attributed to D Broudy.

11 recordsLinked to original sources

Terminal ballistics of the 9mm with Action Safety bullet or Blitz-Action-Trauma (BAT) ammunition.

Specialty ammunition creating atypical gunshot wounds of entrance can create confusion and may be misinterpreted by pathologists unfamiliar with the terminal ballistics of these projectiles. The previously unreported wound ballistics caused by the 9mm with Action Safety bullet described in a homicide highlights the atypical entrance wound(s) and wounding capacity of this novel ammunition. Manufactured by Geco division of Dynamit Nobel, the bullet consists of a nonjacketed solid copper alloy bullet body without a conventional lead core. The large deformation well and part of the smaller central channel is filled with a hard plastic core and post that creates a round nose bullet. The internal ballistics and unique design allow the plastic nose cap and post to separate from the copper alloy base while still in the barrel. The radiolucent nose cap leaves the bullet's path but can still penetrate tissue giving the appearance of a separate but smaller entrance wound. The sharp leading edge of the deformation well and relative high velocity of the bullet body creates a punched out entrance wound with minimal marginal abrasion. When the plastic nose cap or fragments of the plastic post impact the subject, test firings may allow an inference to the muzzle-target distance even in the absence of soot deposition or stippling.

Adult↗

Hemodynamic effects of PN 200-110 (isradipine) in congestive heart failure.

PN 200-110 (isradipine), a dihydropyridine derivative, is a newly available calcium antagonist with potent vasodilatory properties. To determine if PN 200-110 might benefit patients with congestive heart failure (CHF), its acute hemodynamic effects were evaluated in a group of 12 patients with severe CHF. Measurements of cardiac performance were obtained after oral administration of placebo and 15 mg of PN 200-110. Placebo resulted in no significant changes in any of the variables. PN 200-110 decreased mean arterial pressure from 94 +/- 14 (mean +/- standard deviation) to 77 +/- 7 mm Hg (p less than 0.001) and increased both cardiac index from 2.1 +/- 0.4 to 2.8 +/- 0.6 liters/m2 (p less than 0.01) and stroke volume index from 26 +/- 7 to 36 +/- 10 ml/m2 (p less than 0.001). Systemic vascular resistance was reduced from 1,726 +/- 563 to 1,099 +/- 370 dynes s cm-5 (p less than 0.01). Neither heart rate nor pulmonary artery wedge pressure changed significantly. Of the 7 patients discharged receiving PN 200-110, 6 improved clinically and there was evidence of a substantial reduction in cardiothoracic ratio on chest x-ray in some patients. No serious side effects were encountered. Vasodilation with PN 200-110 can improve cardiac performance acutely in patients with CHF. Although this clinical experience is encouraging, carefully performed long-term trials must be done to determine the value of this drug in the management of patients with CHF.

Adult↗

Prognostic value of programmed electrical stimulation in patients with a recent episode of unstable angina.

Patients with a recent episode of unstable angina have a 10% 1-year risk of sudden cardiac death. To determine prospectively whether electrophysiologic testing might be useful in predicting sudden death, 20 patients admitted to our hospital underwent programmed electrical stimulation as part of their evaluation. None had persistent angina, severe congestive heart failure, or sustained arrhythmias at the time of testing. Because of their long-term benefits, beta-blocking agents were continued whenever possible (18 of 20 patients). Ten of 20 patients (50%) had inducible ventricular tachycardia. In 19.5 months' mean follow-up, three patients (15%) either died suddenly or survived an episode of ventricular fibrillation. Programmed electrical stimulation was an insensitive (33%) and nonspecific (47%) predictor of sudden death in these patients. Programmed ventricular stimulation soon after admission for unstable angina is not a useful prognostic indicator for sudden death. Such patients do have a frequent induction of ventricular arrhythmias which appears to be a nonspecific marker of underlying coronary disease.

Actuarial Analysis↗

Hospitalization on the high-risk maternity unit. A pilot study.

Women hospitalized for high-risk pregnancy appear to be at high risk for adverse reactions to hospitalization. Nine pregnant women remaining in hospital for 1 week or more were studied prospectively with a semistructured questionnaire, standard self-administered measures, and staff rating. Six women presented serious problems of compliance or psychic functioning. Women who suffered these adverse reactions tended to be poor, unemployed, younger, less educated, Catholic, unmarried, and to have children at home, when compared to the three women not experiencing difficulty. Women subsequently manifesting problems were significantly likelier on admission to appear as "cases" on the SCL-90-R and to have higher scores on the POMS. On the basis of pilot results, hospitalization for high-risk pregnancy appears to be a particularly stressful event. Women most at risk for problems can probably be identified prospectively.

Female↗

Sudden death prediction by programmed electrical stimulation following myocardial infarction.

To determine prospectively whether electrophysiologic testing is prognostically useful following a myocardial infarction, 38 patients were studied. Ventricular tachycardia was induced in 32 of 38 (84%) patients (sustained in 12) and was significantly increased with the use of three or four extrastimuli. In 17 months' mean follow-up, 4 patients died suddenly or survived an episode of sustained ventricular tachycardia. Programmed ventricular stimulation was a sensitive but not a specific predictor of these events with an overall 24% predictive accuracy. The use of one or two extrastimuli substantially improved specificity but was insensitive in predicting sudden death or ventricular tachycardia. Programmed ventricular stimulation soon after uncomplicated myocardial infarction was not a useful prognostic indicator for sudden death or subsequent ventricular tachycardia.

Adult↗

Association between the exercise ejection fraction response and systolic wall stress in patients with chronic aortic insufficiency.

We studied the exercise ejection fraction response in 56 patients with chronic aortic insufficiency. All had left ventricular dilatation but preserved resting ejection fraction and minimal or no symptoms. The exercise ejection fraction increased by 0.05 units or greater in 18 (32%) patients (group I), remained within 0.05 units of the resting value in 18 (32%) patients (group II), and fell by 0.05 units or greater in 20 (36%) patients (group III). There were no significant differences among the groups in left ventricular end-diastolic dimension, end-systolic dimension, or fractional shortening by echocardiography or in resting left ventricular volumes and ejection fraction by radionuclide angiography. Left ventricular end-systolic wall stress was significantly higher in group III than in either group I or group II (89 +/- 20 vs 70 +/- 18 and 69 +/- 17 X 10(3) dyne/cm2; p less than .005). At peak exercise there were no differences among groups in systolic blood pressure. However, end-systolic volume increased from 65 +/- 28 to 77 +/- 36 ml/m2 in group III and fell from 50 +/- 21 to 28 +/- 18 ml/m2 in group I during exercise. Thus, at peak exercise end-systolic volume was nearly three times greater in group III than in group I. Although stress could not be determined directly during exercise, the directional changes in its determinants suggest that it also would have been higher in group III patients. A highly significant inverse correlation was present between the ejection fraction response and the change in end-systolic volume (r = -.87, p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Surgical fertility regulation among women on the Navajo Indian reservation, 1972-1978.

Changes in the rates of induced abortions, bilateral tubal ligations, and hysterectomies on the Navajo Indian Reservation have been examined for the years 1972-1978. While the incidence of abortions and tubal sterilizations is still considerably lower among Navajo women than among the total United States population of women, it has risen, especially among those in the prime of the reproductive cycle, i.e., ages 20-34. The rate of hysterectomy has not changed substantially. Regression analyses performed on the data indicate that the utilization of surgery for fertility regulation in women on the Navajo Reservation, unlike other surgical procedures, is not affected by access to hospitals which provide surgery. Rather measures of involvement in the wage work economy are of primary importance. Those areas of the Reservation having the highest levels of such involvement exhibit the highest rates of such surgery.

Abortion, Induced↗

EEG sleep and affective psychosis.

EEG sleep changes in delusional depression have been reported previously but no attempt has been made to examine sleep profiles among specific delusional subtypes. In 29 psychotically depressed patients, those patients with delusions of guilt or sin demonstrated both increased sleep discontinuity and decreased REM sleep, especially during the first REM period, while patients with somatic delusions showed increased REM activity, especially in the first REM period. The implications of these findings are discussed.

Affective Disorders, Psychotic↗

EEG sleep and affective psychoses: I. Schizoaffective disorders.

The sleep electroencephalogram (EEG) was studied in 41 depressed inpatients. EEG sleep records were compared for two diagnostic subgroups; patients with psychotic depression (n = 29) or with schizoaffective disorders (n = 12). As was true in the previous pilot study, no major EEG sleep variables distinguished the patients with psychotic depression from those with schizoaffective disorders. These data are consistent with the theory that all psychotic depressive states may have certain common psychobiologic features such as shortened rapid eye movement (REM) sleep latency.

Depressive Disorder↗