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Biomedical subjects

E L Kinney

Publications and source records attributed to E L Kinney.

At least 55 records · Page 3Linked to original sources
PubMed1985

Classification of left ventricular thrombi by their history of systemic embolization using pattern recognition of two-dimensional echocardiograms.

Although one can diagnose left ventricular (LV) thrombi by two-dimensional echocardiography (2DE), the factors associated with peripheral embolization, given a 2DE with LV thrombi, have not been well delineated. Therefore we looked at 2DE and clinical variables that included texture features in the 2DE of 38 patients whose 2DE had LV thrombi and questioned these patients to see if clinical embolization had occurred in the 8.9 +/- 6.1 month (+/- SD) average follow-up period. Eight patients, four with acute myocardial infarction (AMI) and four with dilated LV and decreased LV systolic wall motion, had clinically apparent leg or brain emboli, whereas the remaining patients did not. Emboli occurred within a week of obtaining the 2DE in question. The variables considered were the age of the patient, the type of heart disease present, warfarin administration, exercise tolerance, standard M-mode measurements, LV dyssynergy by 2DE, clot size and mobility, and gray scale statistics which include run length, Sobel edge points followed by 50% gradient thresholding, gray level second-order statistics, offset 1 and gray level difference statistics, offset 1. The values of the variables were then entered into an expert system (Expert Ease) in order to achieve classification of patients into emboli versus no emboli groups, while using a minimal number of variables. The only variables that were needed included run length, long runs emphasis, gray level difference statistics (entropy, contrast, mean, and angular second moment), gray level second-order statistics (contrast), and warfarin status. When probability statistics were applied to this schema, its accuracy was predicted to be at least 96%.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography↗
PubMed1985

Prediction of survival in progressive systemic sclerosis by multivariate analysis of clinical features.

The records of 64 patients with progressive systemic sclerosis (PSS) were reviewed. More than 100 items from the patient's history, physical examination, and laboratory tests were encoded. A two-tailed Gehan's test was used to evaluate the effect of each variable on patient survival. Variables significant at the 0.05 level were then analyzed simultaneously, using the Cox regression model, in order to determine which clinical features are most predictive of survival in PSS. By Cox regression, the presence of an S3 gallop and advanced age at onset of PSS related negatively to survival. The relative risk of death for a patient with an S3 gallop was 5.44 (ratio of risk) times that for a patient without an S3 gallop, and the risk of death for a 70-year-old patient at disease onset was 20 times that of a 20-year-old patient at disease onset. In addition, when patient selection was taken into account, corticosteroid administration had a significant effect, and seemed to actually shorten survival. Although one of the factors, age at onset, is not modifiable, the presence of either variable should alert the clinician to the patient being at high risk for short survival. The application of this technique should also prove helpful in analyzing the efficacy of various proposed therapies.

Adolescent↗
PubMed1985

Widened E point septal separation in a normal pediatric population.

To determine the age and gender distribution of the E point septal separation (EPSS), M-mode echocardiograms were obtained from 121 normal subjects aged four months to 82 years. A small but consistent age factor was found. In subjects less than age 20, EPSS was 3.0 +/- 2.6 mm, whereas in those greater than 20 years, EPSS was 1.4 +/- 1.8 (p less than .001). In females EPSS did not vary appreciably at different ages. By contrast, in males EPSS increased with age, peaking between ages 15 and 19 and then decreasing. Between ages 10 and 19, EPSS was significantly wide in males than in females. Thus, EPSS is wide in male adolescents than in adults. The cause for this phenomenon is unclear, but judging from its age and gender distribution, it may be related to the effect of androgens on the myocardium.

Adolescent↗
PubMed1983

Amrinone-mediated thrombocytopenia.

Amrinone, a new cardioactive drug, was administered for, on average, 27.9 d to 12 patients in severe congestive heart failure. Thrombocytopenia occurred in 4 patients, while a progressive decline in platelet numbers developed in 3 additional patients. The mechanism for these adverse effects of amrinone is unclear, but merits further study because of its frequency.

Aminopyridines↗
PubMed1982

The pharmacokinetics of diltiazem in healthy American men.

Plasma diltiazem concentration was determined for 24 hours after oral administration of 30, 60, 90 and 120 mg (sustained release tablets) in healthy adult white men. The plasma concentration was too low after the 30 mg dose to calculate pharmacokinetic variables. After administration of 60 mg (n = 12), 90 mg (n = 10), and 120 mg (n = 4), peak plasma concentrations were 72, 117, and 152 ng/cm3 and time to peak concentrations were 3.9, 3.3, and 4.0 hours, respectively. Half-lives for clearance from the plasma were 4.1, 5.1, and 5.6 hours and areas under the concentration-time curve were 514, 984, and 1258 ng/hour per cc, respectively. There was wide variability among patients after the administration of a single dose. The area under the curve also tended to increase more than the multiple of the dose administered. If the plasma diltiazem concentration is quantitatively related to efficacy and toxicity, then these data suggest that dosage requirements may vary considerably from patient to patient. Therefore, if a patient fails to respond sufficiently, the plasma drug concentration should be determined to see if adequate concentration has been attained. Alternatively, if the drug should prove to have a high therapeutic index, one might simply administer more than the usually required dose of diltiazem.

Administration, Oral↗
PubMed1982

Clinical experience with amrinone in patients with advanced congestive heart failure.

To examine the efficacy of chronic amrinone therapy, the drug was administered to 12 patients with advanced congestive heart failure on average for 27.9 days. The majority of patients had a persistent increase in cardiac index and a persistent decrease in systemic vascular resistance. A decrease in pulmonary arterial diastolic pressure was observed after oral amrinone administration in three patients. However, changes in pulmonary arterial pressure were not consistent in response to intravenous administration of the drug. Thrombocytopenia occurred in four patients, hypogeusia was noted by three patients, and dysosmia developed in two patients. The cumulative survival of the amrinone patients was significantly poorer than that of a second group of patients with congestive heart failure having similar symptoms. These findings indicate that there is a subset of patients with congestive heart failure who do not benefit from chronic amrinone administration and that in such patients its use (especially when given concomitantly with potentially toxic and hypotensive drugs) should be extremely guarded.

Administration, Oral↗
PubMed1982

The treatment of severe Raynaud's phenomenon with verapamil.

Verapamil was evaluated in 16 patients with severe Raynaud's phenomenon. Fifty per cent of patients experienced subjective improvement by history, but only one patient had a substantial reduction in the frequency of Raynaud's phenomenon as assessed by diary analysis. We conclude that verapamil is not effective in most patients with severe Raynaud's phenomenon.

Clinical Trials as Topic↗
PubMed1982

Multiclinic controlled trial of diltiazem for Prinzmetal's angina.

To assess the efficacy of a new calcium entry blocker, diltiazem (Cardizem), for prophylaxis of Prinzmetal's angina, 48 patients were studied in randomized, multiple crossover multiclinic study (2 weeks single-blind, 8 weeks double-blind). Diltiazem dosage in one crossover phase was 120 mg per day; in the other, 240 mg per day. Therapeutic response was measured by patients' diary records of angina frequency and nitroglycerin tablet consumption. Treatment with 120 mg of diltiazem per day reduced angina by 41 percent from the entry placebo period and 20 percent from the paired placebo period (p less than 0.005). Treatment with 240 mg of diltiazem per day reduced angina frequency by 68 percent from the entry placebo period and 43 percent from the paired placebo period (p less than 0.01). There were similar reductions in nitroglycerin consumption. Adverse experiences that may have been related to the medication were noted in only 5 percent of patients. There were no alterations in blood pressure or heart rate. The PR interval increased 3 percent at the 240 mg dosage level. We conclude that diltiazem is an effective and safe agent for control of symptoms of Prinzmetal's angina.

Adult↗
PubMed1981

Plasma 6 keto PGE1 alpha concentration in Raynaud's phenomenon.

To examine the possibility that prostaglandin metabolism is pathophysiologically important in Raynaud's phenomenon, peripheral venous 6-keto prostaglandin F1 alpha (6-keto PGF1 alpha) and thromboxane B2 (TXB2) concentrations were measured in 45 patients with severe Raynaud's phenomenon. Patients with Raynaud's phenomenon had a significantly higher plasma concentration of 6-keto PGF1 alpha compared to controls (p less than .001), although their plasma TXB2 concentration was not statistically different from control patients. Subgroup analysis revealed that only patients with progressive systemic sclerosis (PSS) had an elevated plasma 6-keto PGF1 alpha concentration. To gauge the functional significance of the 6-keto PGF1 alpha elevations, seven patients with Raynaud's phenomenon were chronically administered indomethacin (50 mg P.O. b.i.d.); six of the seven patients noted no improvement in their Raynaud's phenomenon. Three of the patients developed pedal edema shortly after starting indomethacin. This study suggests that the increased plasma 6-keto PGF1 alpha concentration in Raynaud's phenomenon may be due to a compensatory release of prostacyclin and that the pathophysiologic defect does not involve the thromboxane mechanism.

6-Ketoprostaglandin F1 alpha↗