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Biomedical subjects

H N Neufeld

Publications and source records attributed to H N Neufeld.

At least 109 records · Page 6Linked to original sources
PubMed1982

Intravenous isosorbide dinitrate in patients with refractory pump failure and acute myocardial infarction.

We studied the hemodynamic effects of isosorbide dinitrate administered by continuous i.v. infusion to 22 patients with chronic refractory pump failure and 18 with pump failure due to acute myocardial infarction. In patients with severe pump failure, i.v. ISDN markedly decreased pulmonary capillary wedge pressure (p less than 0.001), moderately increased cardiac output (p less than 0.01), and decreased systemic vascular resistance (SVR) (p less than 0.001). There were no deleterious effects on arterial pressure and heart rate. The effects obtained in acute and chronic left ventricular failure were similar. Patients with initial SVR levels lower than 1500 dyn-sec-cm-5 did not significantly increase their cardiac output (p less than 0.005). Cardiac output increased more than 25% only in patients with initial high SVR levels (greater than 2000 dyn-sec-cm(-)5). Positive correlations were found between high SVR and elevated plasma catecholamines (r = 0.53, p less than 0.05) and between the initial SVR and initial heart rate (r = 0.70, p less than 0.01). The i.v. administration of isosorbide dinitrate appears to be an efficient therapy, particularly in selected patients with ischemic pump failure.

Catecholamines↗
PubMed1982

Clinical presentation and natural history of mild discrete subaortic stenosis. Follow-up of 1--17 years.

We report 21 patients with discrete subaortic stenosis (DSS) causing mild obstruction with a peak systolic left ventricular outflow pressure gradients less than 50 mm Hg. They were followed 1--17 years (mean 6.5 years), and eight were recatheterized before surgery, 2--17 years after the first cardiac catheterization. Three patients (14%) had subacute bacterial endocarditis. Ten (48%) had aortic insufficiency, one of whom had no pressure gradient across the left ventricular outflow tract. In three of the 10 patients, aortic insufficiency was found only at the second catheterization. Nine patients (43%) had hyperactive, asymmetric left ventricular contraction; in three, this finding was present only at the second catheterization. Seven of the eight patients who were recatheterized (33% of the entire group) showed an increase in gradient. The increase was from a mean gradient of 35.2 mm Hg to 76.7 mm Hg. Seventeen patients (81%) had at least one of these four features. In view of these data, we suggest that surgical indications for DSS might be expanded, although definitive recommendations are not possible. All cases of DSS should be carefully followed. Surgery should be performed if signs of progressive complications develop.

Adolescent↗
PubMed1982

Coarctation of the aorta with congenital hemangioma of the face and neck and aneurysm or dilatation of a subclavian or innominate artery. A new syndrome?

Congenital cutaneous hemangioma associated with congenital heart disease is extremely rare. We report four infants with congenital cavernous hemangioma of the face and neck and coarctation of the aorta. Three also had congenital aneurysm of a subclavian or innominate artery. One patient also had mild congenital valvular aortic stenosis. The unusual combination of lesions may represent a new syndrome.

Aneurysm↗
PubMed1982

Impeded coronary flow in anatomic correction of transposition of the great arteries: prevention, detection, and management.

Six infants and a 3-year-old boy underwent primary anatomic repair (arterial switch) of their dextro-transposition of the great arteries (d-TGA). Three died: one on the operating table because of an irreducible kink in the left main coronary artery, one because of postoperative bleeding and tamponade, and one because of a postoperative management error. In the four survivors the preoperative left ventricular-to-right ventricular systolic pressure interrelationships were 35 to 115, 54 to 73, 30 to 80, and 70 to 90 mm Hg. While left ventricular inability to take over the systemic pressure did not appear to be a problem in any of our cases, reduced coronary perfusion seemed to be the rule rather than the exception in this operation. One approach to the problem of obstructed coronary flow is first to construct continuity of the "new" aorta, unclamp it, and mark the appropriate places for coronary anastomoses on the fully distended aorta. It is our conviction that further improvement in the operative technique and better understanding of the risk factors will eventually make the primary anatomic repair of d-TGA the operation of choice for most dextro-transpositions.

Child, Preschool↗
PubMed1981

Associations of serum high density lipoprotein and total cholesterol with total, cardiovascular, and cancer mortality in a 7-year prospective study of 10 000 men.

10 059 civil servants and municipal employees, aged 40--65, were examined in the Israeli Ischaemic Heart Disease Study. 475 (4.72%) died during a 7-year follow-up. High density lipoprotein (HDL) cholesterol levels were determined in the last 6562 men entering the study. 305 (4.65%) of these men died. Coronary heart disease (CHD) accounted for 37% of the total deaths. A "J" shaped relation which persisted after removing data on early mortality (first 2 years) was observed between total cholesterol and total mortality. An inverse relation was observed between HDL cholesterol and total mortality. Multivariate analysis of the data to adjust for possible confounding effects of additional mortality risk factors demonstrated that total cholesterol made no independent contribution to total mortality, but that the contribution of low HDL to mortality persisted after adjustment. CHD mortality consistently increased with rising concentrations of total cholesterol. CHD mortality rates decreased markedly with increasing HDL cholesterol concentrations. After adjustment for age and other risk factors the relation of coronary mortality to HDL cholesterol emerged as the dominant one. There was no clear-cut association between total of HDL cholesterol and cancer mortality. These results indicate that, particularly in older age-groups, measures designed to increase HDL cholesterol may prove as valuable in preventing CHD as those designed to reduce low density lipoprotein cholesterol.

Adult↗
PubMed1981

Use of labetalol in hypertensive patients during discontinuation of clonidine therapy.

Eleven hypertensive patients in whom clonidine therapy had to be discontinued, were treated prophylactically with labetalol, in order to avoid a possible hypertensive crisis. Most of the known side effects, which are consistent with the withdrawal phenomenon were observed, e.g. tremor, insomnia and apprehension, but headaches and flushing did not occur. Blood pressure levels remained unchanged, despite up to a 20-fold increase in plasma catecholamines. The lack of change in serial measurements of plasma cyclic AMP level appears to indicate that adequate adrenergic blockade was induced by labetalol. Since labetalol is a potent anti-hypertensive drug, and is also effective in avoiding a possible hypertensive crisis due to withdrawal of clonidine, we propose to use it as the drug of choice whenever discontinuation of clonidine therapy is indicated.

Adult↗
PubMed1981

"Complete-transposition-like" coronary arterial pattern in single ventricle with inverted infundibulum and transposition of the great arteries.

In 19 out of 28 cases of single ventricle with inverted infundibulum and 1-transposition of the great arteries the right coronary artery arose from the posterior aortic sinus, the right anterior aortic sinus being the noncoronary one. This coronary arterial pattern was described before only in association with d-transposition of the great arteries. We suggest that angiocardiographic demonstration of this coronary arterial pattern in association with an 1-positioned aorta favors the diagnosis of single ventricle.

Angiocardiography↗