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Biomedical subjects

H J Gelberg

Publications and source records attributed to H J Gelberg.

9 recordsLinked to original sources
PubMed1999

Polymyalgia, hypersensitivity pneumonitis and other reactions in patients receiving HMG-CoA reductase inhibitors: a report of ten cases.

Ten patients who take hydroxy-methylglutaryl coenzyme A reductase inhibitors, or statin medications, and experience adverse reactions are described. All patients experienced various manifestations of hypersensitivity while receiving the drugs. One patient is described with hypersensitivity pneumonitis, which was graphically demonstrated by both high resolution computerized axial tomography and open lung biopsy.

Aged↗
PubMed1983

Rapid method for determination of shunt ratio using a thermodilution technique.

A new technique using thermodilution by which shunt ratio can be rapidly and conveniently determined in patients with left-to-right intracardiac shunts is described. A flow-directed balloon-tip thermistor catheter was positioned in the pulmonary artery to measure cardiac output in 20 patients with left-to-right intracardiac shunts. Shunt ratio measured by the Fick technique (Qp:QSF) varied between 1.3:1 and 3.6:1. Early recirculation was seen on the downslope of the thermodilution curves (TC). The first-pass curve before the point of early recirculation was extrapolated to the baseline and the area inscribed by this portion of the TC (A) was measured by planimetry. The area inscribed by the entire TC (A + B) was also measured by planimetry. Shunt size was determined by calculating the ratio (A + B):A. Shunt ratio determined by this technique (Qp:QSTh) correlated well with Qp:QSF (r = 0.89). The thermodilution technique provides a simple, rapid, and accurate method for determining the magnitude of left-to-right intracardiac shunts.

Cardiac Catheterization↗
PubMed1979

Paradox of improved exercise but not resting hemodynamics with short-term prazosin in chronic heart failure.

In patients with chronic heart failure exercise allows the simultaneous observation of the cardiovascular pathophysiology and the symptoms of these patients. We administered short-term, oral prazosin to 10 patients with severe chronic heart failure. Prazosin increased cardiac output and stroke volume significantly during exercise (both P less than 0.05) but not at rest (both P greater than 0.10). Prazosin decreased the arteriovenous oxygen difference and left ventricular filling pressure significantly during exercise (both P less than 0.05) but not at rest (both P greater than 0.10). There was no significant correlation between prazosin-induced changes at rest and during exercise in cardiac output (r = 0.12), stroke volume (r = 0.02), arteriovenous oxygen difference (r = 0.33) or left ventricular filling pressure (r = 0.43). Prazosin predominantly affects hemodynamics during exercise because its pharmacologic activity as an alpha-adrenergic blocking agent is most prominent during exercise. The full evaluation of prazosin-induced changes in the hemodynamics of patients of patients with chronic heart failure requires evaluation during exercise.

Aged↗
PubMed1979

Detection of left ventricular functional reserve by supine exercise hemodynamics in patients with severe, chronic heart failure.

Hemodynamic changes during exercise were evaluated in 20 patients with severe, chronic congestive heart failure. Two groups were identified by their stroke work response to maximal exercise. Group I (eight patients) showed an increase in stroke work index. This occurred because the stroke volume increased and the difference between mean systolic pressure and left ventricular filling pressure increased. Group II (12 patients) showed a decrease in stroke work index. This occurred because stroke volume decreased while the difference between mean systolic pressure and left ventricular filling pressure did not change. Despite hemodynamic differences, the groups could not be distinguished by the usual clinical criteria for heart failure including etiology, New York Heart Association functional class, heart size on chest X-ray film or duration of heart failure. Clinical criteria are relatively insensitive in predicting the exercise hemodynamics of any given patient with chronic severe heart failure. Determining the exercise hemodynamics may be helpful as a means of assessing left ventricular functional reserve in heart failure. Prognostic implications, drug therapy and prescription of activities may require adjustment based on this spectrum of hemodynamic response to exercise in patients with chronic heart failure.

Adult↗
PubMed1979

Influence of short-term oral hydralazine therapy on exercise hemodynamics in patients with severe chronic heart failure.

Changes in left ventricular performance were evaluated in 14 patients with functional New York Heart Association class III or IV chronic heart failure before and after the addition of oral hydralazine to conventional therapy. With conventional therapy, cardiac output increased from 3.4 +/- 0.8 (mean +/- 1 standard deviation) at rest to 4.7 +/- 1.4 liters/min during exercise. This increase in cardiac output on exercise during conventional therapy was mainly due to an increase in heart rate. After the addition of hydralazine, cardiac output at rest increased to 5.0 +/- 1.4 liters/min. The increase in cardiac output was essentially due to an increase in stroke volume. This enhanced stroke volume after hydralazine therapy was maintained during exercise. Hydralazine therapy did not change either the left ventricular filling pressure at rest or the magnitude of increase in left ventricular filling pressure during exercise. Nevertheless, increased cardiac output and stroke volume with similar changes in left ventricular filling pressure during exercise indicated improved left ventricular performance after hydralazine therapy. After short-term hydralazine therapy, symptom-limited peak exercise work load, duration of exercise and maximal oxygen consumption during exercise did not increase. Clinical follow-up at 2 months after long-term therapy revealed subjective improvement in exercise tolerance in 13 of the 14 patients.

Administration, Oral↗
PubMed1979

Quantitative left ventricular wall motion analysis: a comparison of area, chord and radial methods.

We were interested in divising a relatively simple quantitative technique that could be used on a routine clinical basis for wall motion analysis. Three quantitative methods of left ventricular (LV) regional analysis were compared in the 30 degrees right anterior oblique and 60 degrees left anterior oblique projection. The control group consisted of 17 patients with qualitatively normal LV wall motion; the abnormal group comprised 17 patients with at least one region of severe, qualitative wall motion abnormality. Normal regional values were determined for area, chord and radial methods by applying the techniques to the ventriculograms of the control group. Each technique was then applied to the abnormal group's ventriculograms to determine the percentage of qualitatively abnormal regions not detected by each method. The area method had the lowest failure rate (p less than 0.001) and the best separation of measured normal and abnormal regions' ejection changes (p less than 0.001), and best reflected symmetric uniform motion of the ventricular silhouette. We conclude that the area method, of the techniques examined, was best for the quantitative analysis of LV wall motion abnormalities.

Angiocardiography↗
PubMed1975

Neisseria meningitidis: a cause of nosocomial pneumonia.

A 24-year-old man developed coma and many neurologic abnormalities for 2 weeks after ingesting phencyclidine. On admission, pulmonary aspiration occurred, for which he was given large doses of methylprednisolone, clindamycin, and gentamicin. These antimicrobial drugs were continued for 2 weeks until new pulmonary infiltrates were recognized. Neisseria meningitidis was subsequently isolated from cultures of conjunctival discharge, sputum, and blood and found to be resistant to clindamycin and gentamicin. N. meningitidis as a cause of nosocomial pneumonia in the setting of broad spectrum antimicrobial drugs is discussed.

Adult↗