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Biomedical subjects

H W Moses

Publications and source records attributed to H W Moses.

32 records · Page 2Linked to original sources
PubMed1986

Early and late results of operation after thrombolytic therapy for acute myocardial infarction.

Recent reports have established the efficacy of thrombolytic therapy in limiting myocardial infarction. Between September 1981 and September 1984, 355 patients were treated with intracoronary (87) or intravenous (268) streptokinase within 6 hours of acute myocardial infarction. Thrombolysis was successful in 63% of patients receiving intracoronary streptokinase and 81% of those receiving intravenous streptokinase. Because residual critical stenosis is usually present and predisposes the patient to reinfarction, revascularization procedures were investigated as an extension of thrombolytic therapy. One hundred ninety-one patients aged 56 +/- 10 (25 to 77) years underwent early surgical revascularization 4.1 +/- 3.6 days after intracoronary or intravenous streptokinase for acute myocardial infarction. Results of this treatment were successful in 89% (170/191) of the patients. Thirteen patients (6.8%) underwent emergency coronary artery bypass grafting for failed percutaneous angioplasty. There were 3.2 +/- 1.4 grafts per patient and 3.8 +/- 2.9 units of blood were administered in the perioperative period. Operative mortality was 4.2% (8/191) with a 15.4% mortality (2/13) in the group in which angioplasty failed. Mean hospitalization time after operation was 10.9 +/- 6.8 days. Follow-up was 27 +/- 8 (12 to 48) months and was obtained on all patients. Late cardiac mortality was 1.0% (2/183). Ninety percent of the follow-up group was without angina and only 1.7% showed no improvement after operation. Reinfarction occurred in four patients (2.2%), with graft failure documented by coronary arteriography in two of these patients. This experience indicates that early revascularization after thrombolytic therapy may be performed with low operative mortality and morbidity and is associated with excellent late results.

Aged↗
PubMed1985

Comparative cost of myocardial revascularization: percutaneous transluminal angioplasty and coronary artery bypass surgery.

A consecutive series of 78 patients having percutaneous transluminal coronary angioplasty for single vessel coronary artery disease and 85 patients having single vessel coronary artery bypass graft surgery were followed up prospectively for 1 year. Days in hospital and angiographic and revascularization procedures were counted in the two groups of patients and total cost of care for 12 months was calculated using current billing levels. Angioplasty was initially successful in 74% of patients; because of initial failure in 26% and late restenosis in 18%, bypass surgery was ultimately needed in 23 of 78 patients having coronary angioplasty. Nevertheless, total cost of care per patient was 43% lower for those having angioplasty as an initial procedure for single vessel coronary artery disease.

Adult↗
PubMed1985

Early operative intervention after thrombolytic therapy for acute myocardial infarction.

Thrombolytic therapy effectively interrupts acute myocardial infarction but does not correct the underlying plaque causing acute thrombosis. Early operation and treatment of the residual coronary artery disease has therefore been evaluated. Over 29 months, 184 patients with acute myocardial infarction of less than 6 hours duration were treated with intracoronary (IC) or intravenous (IV) streptokinase (SK). Angiography was performed early and thrombolysis found to be successful in 70% of the IC-SK group and 82% of the IV-SK group. One hundred six patients with successful thrombolysis had early revascularization surgery performed 3.3 +/- 2.1 days following SK treatment (range 0 to 11 days). These patients were compared with 110 consecutive patients who underwent coronary artery bypass grafting for standard indications. The SK group had an average of 3.0 +/- 1.4 grafts, 4.3 +/- 3.1 units of blood, and 10.8 +/- 5.3 days in the hospital postoperatively per patient and had an operative mortality rate of 2.7%. The control group averaged 3.6 +/- 1.3 grafts, 4.0 +/- 2.4 units of blood, and 9.6 +/- 3.5 days in the hospital postoperatively per patient with an operative mortality rate of 2.7%. This experience indicates that early operation following SK therapy can be performed with low operative risk and without prolonged hospitalization.

Adult↗
PubMed1984

Intravenous versus intracoronary streptokinase therapy for acute myocardial infarction in community hospitals.

A consecutive series of 184 patients with acute myocardial infarction (AMI) received thrombolytic therapy. The first 63 were treated in the catheterization laboratory with intracoronary streptokinase (IC-STK), and 44 (70%) had successful thrombolysis. One hundred twenty-one patients received intravenous (IV) STK immediately after diagnosis of AMI, and 99 (82%) were found to have an open infarct artery. Only 58% of patients (14 of 24) who required transfer from out-of-town hospitals for IC-STK treatment had successful thrombolysis; in contrast, IV-STK given in the local hospital resulted in an 85% (72 of 85) rate of thrombolysis (p = 0.005). IV-STK thus appears at least as effective as IC-STK for AMI and is more effective for patients treated in hospitals without catheterization facilities.

Aged↗
PubMed1982

Heart block and idiopathic pulmonary hemosiderosis.

A young woman with idiopathic pulmonary hemosiderosis (IPH) and advanced heart block below the atrioventricular node requiring pacemaker therapy is discussed. Thirteen years after the onset of IPH she is free of pulmonary symptoms despite having never received steroid or antimetabolite therapy.

Adolescent↗
PubMed1980

Real time two-dimensional echocardiography in the diagnosis of left atrial myxoma.

A patient with a left atrial myxoma is reported in whom M-mode echocardiography was atypical and misleading since in most transducer positions, no tumor echoes were found in the left atrium. Real time two-dimensional echocardiography provided a definitive diagnosis, demonstrating a large left atrial mass with multiple areas of calcification. One such calcified area was located adjacent to the posterior aortic wall, and the tumor echoes were sparsely imaged directly behind it due to incomplete penetration of the ultrasound beam through dense calcification (acoustic shadowing). Difficulty in M-mode diagnosis appeared to result from this acoustic shadowing effect. In our patient, two-dimensional echocardiography was superior to the M-mode in making a definitive diagnosis of left atrial tumor because of the difficulty visualizing tumor echoes in the left atrium.

Calcinosis↗
PubMed1979

Surgical management of an aneurysm of the left main coronary artery.

A 28-year-old woman underwent cardiac catheterization three months after sustaining an acute anterolateral myocardial infarct. An aneurysm of the left main coronary artery was found at angiography and also was visualized by two-dimensional echocardiography. The patient had no evidence of atherosclerotic vascular disease. At operation, vein grafts were placed to bypass the aneurysm and the orifice of the left coronary artery was oversewn to exclude the aneurysm from the coronary circulation.

Adult↗
PubMedDate not supplied

Comparison of the effects of dopamine, hydralazine, and isosorbide dinitrate on myocardial hemodynamics in patients with refractory heart failure.

Nine patients with refractory congestive heart failure underwent hemodynamic study first with dopamine and then with oral hydralazine and sublingual isosorbide dinitrate. Although hemodynamic improvement was achieved with both forms of therapy, the beneficial effects of hydralazine alone or with isosorbide were superior to those of dopamine, as manifested by a greater reduction of wedge pressure and greater increase in stroke index. Six patients who demonstrated an increased wedge pressure during dopamine infusion were observed to manifest a louder apical systolic murmur and/or V wave in the wedge pressure tracing suggestive of enhanced mitral regurgitation. The rise in wedge pressure on dopamine could also be a consequence of increased myocardial ischemia and resultant decrease in ventricular compliance. It is possible that a subgroup of patients with heart failure are made worse by dopamine, and in these cases vasodilator therapy may be more beneficial.

Aged↗
PubMedDate not supplied

The primary care physician and thrombolytic therapy for acute myocardial infarction: comparison of intravenous streptokinase in community hospitals and the tertiary referral center.

From September 1982 through December 1987, 1012 patients were treated with intravenous streptokinase within 6 hours of acute myocardial infarction. Most of them (816/1012, 81 percent) were treated in community hospitals by primary care physicians. The remaining 196 (19 percent) were treated in the referral center, usually by a cardiologist. Cardiac catheterization within 2 days showed an open infarct artery in 87 percent of the community hospital and 83 percent of the referral center patients (P = NS). Predischarge ejection fraction was similar for community hospital and referral center patients (49 percent +/- 14 percent versus 51 percent +/- 14 percent, respectively), and there was a similar rate of bleeding complications (10 percent versus 13 percent, respectively). We conclude that primary physicians can use intravenous streptokinase effectively and safely in the treatment of patients in community hospitals.

Academic Medical Centers↗