Biomedical subjects

D J Goodman

Publications and source records attributed to D J Goodman.

At least 37 records · Page 2Linked to original sources

PubMed1993

Right atrial catheters: reliable, immediate and durable vascular access for haemodialysis and plasma exchange.

This paper prospectively evaluates 33 dual lumen, right atrial catheters inserted into either an external or internal jugular vein by open operation in 29 patients, of whom 15 required haemodialysis and 14 required temporary plasma exchange. The median (range) catheter survival in the haemodialysis and plasma exchange groups was 108 days (7-334 days) and 61 days (10-116 days), respectively. Life table analysis demonstrated that overall catheter survival was 58% at 200 days. The main causes of catheter failure were infection (four cases), poor flow (three cases) and accidental removal (one case). Another nine catheters were removed electively because of maturation of alternative methods of vascular access (five cases), completion of plasma exchange treatment (three cases), or successful renal transplantation (one case). Long-term silastic catheters, inserted into the right atrium via a jugular vein, have distinct advantages over temporary subclavian vein catheters and external arteriovenous (AV) shunts; this form of access is the method of choice for haemodialysis and plasma exchange patients who require immediate and short- to medium-term vascular access.

Adolescent↗

PubMed1991

Recurrent haemolytic uraemic syndrome in a transplant recipient on orthoclone (OKT 3).

Recurrence of haemolytic-uraemic syndrome (HUS) after renal transplantation may occur in both cyclosporin A (CyA) and non-CyA-treated patients, and in patients receiving anti-lymphocyte globulin. We report a case of recurrent HUS in an 8-year-old boy who received Orthoclone (OKT3) combined with prednisolone and azathioprine therapy on receipt of his first cadaveric renal allograft. Despite avoidance of CyA therapy irreversible HUS occurred.

Antibodies, Monoclonal↗

PubMed1991

Structure and expression of mouse germline immunoglobulin gamma 3 heavy chain transcripts induced by the mitogen lipopolysaccharide.

Germline immunoglobulin heavy chain gene transcription is though to direct isotype switching by modulating the accessibility of specific switch regions to a recombinase. In this study, cloned cDNA copies of mouse germline Igh-8 RNAs have been used to characterize the Igh-8 transcription unit. The 5' end of these transcripts are derived from an exon denoted Ig3, located 1 kilobase 5' of the Igh-8 switch region. Sequence analysis of cDNA and genomic clones reveals that these RNAs are noncoding. In splenic B cell cultures treated with lipopolysaccharide (LPS), germline Igh-8 transcript levels are upregulated after 8 h due to increased transcription. This induction is consistent with the identification of a putative binding site for the LPS inducible transcription factor NF-kappa B approximately 150 nucleotides upstream of the sites of transcript initiation. Furthermore, nucleotide sequence comparisons reveal that the region encompassing the site of germline Igh-8 transcription initiation is highly homologous to part of the Ig2b exon, and is also conserved upstream of the Igh-1 switch region. The implications of these findings for the control of germline Igh-8 transcription is discussed.

Animals↗

PubMed1990

Peritonitis caused by Campylobacter jejuni and serologically confirmed in a patient being treated with continuous ambulatory peritoneal dialysis.

A case of Campylobacter jejuni peritonitis in a patient being treated with continuous ambulatory peritoneal dialysis is described. The significance of the organism isolated from our patient was initially doubtful because of a rapid defervescence of symptoms with minimal specific antibiotic therapy, lack of a preceding diarrhoeal illness and the time taken to isolate and identify the organism. Serial serum IgM, IgA and IgG antibody estimations clearly showed an acute seroconversion confirming that the strain of C. jejuni isolated was the causative organism in this case.

Campylobacter Infections↗

PubMed1978

Electrophysiologic findings in patients with idiopathic hypertrophic subaortic stenosis.

Thirteen patients with catheterization-proved idiopathic hypertrophic subaortic stenosis underwent intracardiac electrophysiologic study. There was a large incidence of arrhythmias and a strikingly large incidence of conduction system abnormalities among these patients. The P-A and A-H intervals were normal in all patients. Atrial pacing resulted in Mobitz type 1 block proximal to the His bundle at an abnormal rate (less than 140/min) in 2 of 12 patients (17 percent). H-V intervals were prolonged (greater than 50 msec) in 10 of 12 patients (83 percent) and were greater than 60 msec in 7 patients (58 percent). The atrial effective refractory period was prolonged in 3 of 12 patients and was markedly prolonged in 1 of them. Effective refractory period of the atrioventricular (A-V) node, determined in five patients, was prolonged in three. Dual responses of the A-V node to atrial extrastimuli were found in seven patients. Dual A-V nodal repsonses were evoked with propranolol in three patients and persisted in the other four patients with dual responses despite propranolol administration.

Adult↗

PubMed1977

Propranolol for patients with mitral valve prolapse.

This study evaluates propranolol's effect on symptoms, arrhythmias, and exercise tolerance in 16 patients with mitral valve prolapse. Three patients (19 per cent) experienced symptomatic deterioration with propranolol therapy, seven (44 per cent) were unchanged, and six (37 per cent) noted an over-all symptomatic improvement, primarily due to a reduction in palpitation. Symptomatic improvement continues in these six patients an average of 12.5 months after beginning propranolol therapy. Treatment with propranolol alleviated chest pain in only two of eight patients and it did not improve the ability to perform treadmill exercise. Fatigue did not improve, and in three patients appeared for the first time during propranolol therapy. Premature ventricular contractions were reduced by at least 75 per cent in five of nin patients (56 per cent), and paroxysmal ventricular tachycardia was eliminated in three of four patients. We conclude that propranolol is not uniformly effective in patients with mitral vale prolapse. A trial of propranolol may be instituted fro patients with mitral valve prolapse who have severe symptoms and/or arrhythmias, but the drug should only be continued in those who demonstrate clinical and/or antiarrhythmic response.

Adult↗

PubMed1976

The effect of cycle length on cardiac refractory periods in the denervated human heart.

We have previously demonstrated that the transplanted human heart is functionally denervated. With the use of the extra stimulus technique during His bundle electrocardiography, refractory periods of the arterioventricular (A-V) conduction system were determined at several heart rates after pacing-induced changes in cycle length in eight patients who had previously undergone cardiac transplantation. Shortening of the cycle length was accompanied by a decrease in both the effective and functional refractory periods of the atrium. No consistent change in A-V nodal effective refractory period or functional refractory period could be demonstrated. Because A-V conduction was limited at shorter cycle lengths by the functional refractory periods of the atrium and A-V node, bundle branch refractory periods could be determined in three patients only at the longest cycle length studied. In four of the eight patients, atrial arrhythmias were produced at short cycle lengths with the introduction of early atrial extra stimuli. This may be due to a lack of vagal innervation of the atrium. These results contribute to our understanding of atrial arrhythmias.

Adult↗

PubMed1976

Echocardiographic evaluation of propranolol therapy for mitral valve prolapse.

This study evaluates the effect of propranolol on the echocardiogram of 8 patients with late systolic mitral value prolapse. Echocardiograms were performed with the patients on no medication and again while on oral propranolol therapy. Propranolol caused a statistically significant increase in left ventricular volume; however, neither the echocardiographic pattern nor the timing of mitral valve prolapse was altered by propranolol. These findings suggest that factors in addition to left ventricular volume play a role in regulating valvular dysfunction in this condition.

Cardiac Volume↗

PubMed1976

Echocardiographic evaluation of the stent mounted aortic bioprosthetic valve in the mitral position. In vitro and in vivo studies.

Echocardiograms were performed on 20 clinically stable patients following mitral valve replacement with glutaraldehyde-preserved porcine aortic heterografts and three patients with antibiotic sterilized aortic homografts mounted in the mitral position. Such valves were evaluated in a test chamber at varied flow rates resulting in improved understanding of movements seen with the echocardiogram in vivo. The technique for recording the valvular stent and leaflets is described and a method for measuring several parameters is demonstrated. Initial diastolic slope averaged 2.4 +/- 0.5 cm/sec (range 1.9 to 3.3 cm/sec). Left ventricular outflow tract measured from the anterior portion of the stent to the interventricular septum averaged 1.5 +/- 0.5 cm at end-diastole and 1.3 +/- 0.6 cm at end-systole. Leaflet excursion averaged 1.5 +/- 0.3 cm (with a range from 1.0 to 2.1 cm). The ratio of internal to external stent diameters averaged 0.66 +/- 0.05 (with a range from 0.56 to 0.74).

Animals↗

PubMed1976

Echocardiographic and phonocardiographic confirmation of suspected caged mitral valve malfunction.

Seven patients studied by echocardiography with and without simultaneous phonocardiography for suspected malfunction of a caged mitral valve prosthesis are presented. In case 1, with inaudible prosthetic clicks, thrombosis of the cage and immobility of the ball were suggested by echocardiographic studies and confirmed at surgery. In case 2, simultaneous echocardiographic and phonocardiographic studies demonstrated wide and variable intervals between the aortic second sound the the opening click and also "sticking" of the ball. In case 3 a thrombus prevented full motion of the ball to the apex of the cage, which was seen on the echocardiogram, while in case 4, with a thrombus within the ventricle and prosthesis, the prosthetic opening click was present intermittently and was associated with only subtle echocardiographic changes. In case 5, echocardiographic studies demonstrated abnormal rocking of the cage secondary to severe prosthetic dehiscence. In case 6, dul prosthetic clicks were to be secondary to a low cardiac-output state. In case 7, with multiple valve prostheses, simultaneous echocardiographic and phonocardiographic studies allowed identification of individual valve sounds and abnormal timing of valve opening. Based on these studies, we believe that echocardiography and simultaneous phonocardiography can yield very useful information in the evaluation of patients with suspected malfunction of a caged mitral valve prosthesis.

Adult↗

PubMed1976

Noninvasive diagnosis of complications of the mitral bioprosthesis.

The echophonocardiographic diagnoses of valvular and paravalvular insufficiency, calcific stenosis, and thrombolic occlusion of the stent-mounted aortic homograft or heterograft in the mitral position are described. Paravalvular and valvular insufficiency were associated with apical systolic murmurs which decreased in intensity after amyl nitrite inhalation and with echocardiograms which showed initial diastolic slopes of the stents in excess of the normal range (1.9 to 3.3 cm. per second). In clinically improved and stable patients, amyl nitrite inhalation resulted in increased intensity of the commonly heard systolic ejection type murmur at the left sternal border and echocardiographic evidence of further narrowing of the outflow tract measured between the interventricular septum and the anterior portion of the stent. Calcific homograpft stenosis was associated with a decreased diastolic stent slope (0.4 cm. per second) and increased echo density from the tissue leaflets. Thrombus formation on the sewing ring caused fatal inflow occlusion in 2 patients. The condition was characterized by an echocardiogram showing decreased ratio of internal-to-external stent diameter, 0.47 (normal range 0.56 to 0.74), decreased diastolic stent slope, and decreased leaflet excursion.

Adult↗

PubMed1975

A-V conduction disturbances in Reiter's syndrome.

High grade atrioventricular (A-V) block is a rarely described complication of Reiter's syndrome. This 65 year old man had recurrent episodes of arthritis, conjunctivitis and urethritis beginning at age 16. A prolonged P-R interval was first noted at age 32. The conduction distrubance progressed to intermittent episodes of high grade and complete heart block by age 65. His bundle electrograms located the site of block above the level of the bundle of His. Atrial pacing to rates of 150/min produced 5:1 A-V block, whereas exercise and atropine administration resulted in 1:1 A-V conduction. In view of these results, artificial pacemaker therapy is not indicated. The association of conduction disorders and Reiter's syndrome is reviewed.

Aged↗

PubMed1975

Sinus node function in the denervated human heart. Effect of digitalis.

Evaluation of sinus node function was performed in 5 patients with an intact cardiac autonomic nervous system (group I), and in 8 patients with a transplantated, denervated heart (group 2). After baseline data were recorded, the electrophysiological studies were repeated in all group I patients and in 6 of the 8 group 2 patients, 45 to 60 minutes after the administration of digoxin 1.25 mg intravenously. Baseline cycle length, sinus node recovery time, and sinoatrial conduction time were significantly shorter in the transplanted heart than in those with intact autonomic innervation, but correction of the sinus node recovery time and sinoatrial conduction time for heart rate abolished these differences. Digoxin produced a small increase in cycle length, sinus node recovery time, and sinoatrial conduction time which did not reach statistical significance in this small study group of patients with innervated hearts. In the denervated, transplanted patients, no change in cycle length occurred after digoxin in any patient. The sinus node recovery time was unaffected by glycoside administration in 3 of 6 patients, while the sinoatrial conduction time was unchanged in 4 of 6. In one group 2 patient, digoxin produced first degree sinoatrial node exit block, and in a second patient, 2:1 sinoatrial nodal exit block developed. The mechanisms responsible for these effects in the denervated heart are not clear.

Adult↗

PubMed1975

Effect of digoxin on atioventricular conduction. Studies in patients with and without cardiac autonomic innervation.

The effect of digoxin on atrioventricular (a-v) conduction was compared in five patients with an intact cardiac autonomic nervous system (Group I) and seven patients who had undergone cardiac transplantation (Group II), in whom we have previously shown the transplanted heart to be completely denervated. Small decreases in the atrial effective refractory period (ERP) (from 262 plus or minus 12 to 254 plus or minus 11 msec) and atrial functional refractory period (FRP) (from 304 plus or minus 12 msec) were observed in Group I patients after digoxin, but these changes were not significant. However, significant increases in the A-V nodal ERP (from 315 plus or minus 18 msec to 351 plus or minus 17 msec, P less than 0.05), and A-V nodal FRP (from 426 plus or minus 42 to 460 plus or minus 46 msec, P less than 0.01) were produced by digoxin and were unrelated to changes in cycle length. In Group II patients with denervated hearts, changes in atrial ERP (from 246 plus or minus 4 to 243 plus or minus 6 during spontaneous sinus rhythm; from 204 plus or minus 10 to 216 plus or minus 8 msec during atrial pacing) and atrial FRP (from 311 plus or minus 12 to 316 plus or minus 11 msec during spontaneous sinus rhythm; from 254 plus or minus 12 to 260 plus or minus 10 msec during atrial pacing) were not significant. However, in contrast to the Group I patients, the digoxin-induced changes in A-V nodal ERP (from 280 plus or minus 22 to 297 plus or minus 18 msec during atrial pacing) and FRP (from 368 plus or minus 18 to 377 plus or minus 18 msec during spontaneous sinus rhythm; from 334 plus or minus 13 to 346 plus or minus 16 msec during atrial pacing) were also statistically insignificant. Our results demonstrate that the electrophysiologic effects of digoxin on atrioventricular conduction in man are most marked in the atrioventricular node and are dependent on cardiac innervation

Adult↗

PubMed1975

Simultaneous echocardiographic phonocardiographic recordings at rest and during amyl nitrite administration in patients with mitral valve prolapse.

Simultaneous electrocardiograms, phonocardiograms, and echocardiograms were recorded in 21 patients with mitral valve prolapse. Four patients with holosystolic mitral valve prolapse on echocardiogram had smaller resting end-diastolic volumes than the remaining 17 patients with late systolic echocardiopraphy prolapse (p greater than 0.01). Thirteen of the 17 patients with late systolic prolapse had phonocardiograhically recorded auscultatory phenomena. The initial vibrations of the auscultatory phenomena occurred after the onset of echocardiographic prolapse, but prior to maximal echocardiographic mitral valve prolapse. Amyl nitrite was administered to all patients. Three of the 17 patients with late systolic prolapse developed holosystolic prolapse, while the remaining 14 retained the late systolic prolapse pattern during amyl nitrite inhalation. In these 14 patients, the onset of mitral prolapse occurred earlier in systole due to decrease in the duration of systole prior to onset of mitral valve prolapse (p greater than 0.001). This corresponded with the occurrence of auscultatory phenomena earlier in systole. Twelve patients had left ventricular volumes recorded during amyl nitrite inhalation and all showed a decrease in left ventricular volumes (greater than) 0.001). These findings confirm the temporal relationship of mitral valve prolapse and onset of auscultatory phenomena in these patients. It suggests that the movement of auscultatory phenomena earlier in systole during amyl nitrite inhalation is related to earlier prolapse of the mitral valve, and that a decrease in ventricular valume is a tenable explanation for the earlier onset of prolapse.

Administration, Intranasal↗

PubMed1975

Arrhythmias in patients with mitral valve prolapse.

Resting ECGs, exercise treadmill tests and 24-hour ambulatory ECGs were recorded and analyzed in 24 unselected patients with mitral valve prolapse. Arrhythmias were frequent. There were three distinct groups of patients, defined on the basis of total number of premature ventricular contractions (PVCs) during the 24 hours; there were no PVCs in 25%, and frequent PVCs in 50%. Complex ventricular arrhythmias, including ventricular tachycardia in five patients, were found almost exclusively in the group with frequent PVCs. Fifteen of the 24 patients demonstrated atrial premature contractions (APCs) during the 24 hours. Complex atrial arrhythmias were found among patients with infrequent, as well as those with frequent, APCs. Supraventricular tachycardia was detected in seven of these patients. The incidence of ACPs decreased during sleep in 67% of the patients and showed no change during sleep in 33%. A poor correlation was found between symptoms recorded in patient diaries and changes noted on 24-hour ECG recordings. The peak PVCs/15 min and peak ACPs/15 min during a 24-hour period of monitoring was found to be an excellent guide to the total number of PVCs and APCs occurring during that period. This permits an accurate prediction of the total number of PVCs in 24 hours after performing an exact PVC count on only 15 minutes of ECG data. Finally, the 24-hour ambulatory ECG was sensitive than the treadmill test and both were superior to the 12-lead ECG for detecting arrhythmias in these patients.

Adult↗

PubMed1975

Ostium primum defect in the adult: postoperative follow-up studies.

Twelve adult patients with ostium primum atrial septal defects (incomplete endocardial cushion defect) who underwent surgical repair of their lesions were evaluated in the late postoperative period. All had closure of the low-lying atrial septal defect, with suturing of the mitral valve cleft in 11 patients. Although the patients benefited symptomatically from the surgery, all had residual cardiac murmurs. Postoperative cardiac catheterization and left ventriculography in eight revealed successful closure of the atrial septla defect, but three demonstrated residual mitral insufficiency. In spite of the successful surgical repair in these patients, bacterial indocarditis prophylaxis should be continued in view of the residual murmurs and valvular abnormalities.

Adolescent↗

PubMed1975

Treadmill arrhythmias in patients with idiopathic hypertrophic subaortic stenosis.

Treadmill tests were performed in 19 patients with previously documented idiopathic hypertrophic subaortic stenosis (IHSS). Arrhythmias occurred in 79 percent (15) of the patients, and new arrhythmias not previously documented occurred in over 50 percent (10) of the patients. Paroxysmal supraventricular tachycardia (PSVT), ventricular premature beats (VPBs) (two or more per minute) or atrial premature beats (APBs) (three or more per minute) occurred in 10 of 19 patients. There was no association between treadmill arrhythmias and clinical symptoms, hemodynamic data, or electrocardiographic features. Propranolol administration resulted in failure of exercise to induce PSVT in one patient and had no effect on PSVT in two others, nor any effect on maximum frequency of APBs or VPBs. Treadmill testing is more productive than retrospective analysis of ECGs for characterizing arrhythmias in IHSS.

Adult↗