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Biomedical subjects

I Hutton

Publications and source records attributed to I Hutton.

At least 55 records · Page 3Linked to original sources
PubMed1986

Modern management of heart failure.

The biochemistry and pathophysiology of ventricular dysfunction leading to cardiac failure, and the importance of abnormal peripheral haemodynamics and altered neurohumoral mechanisms, are now better understood. Treatment has been rationalised and the place of vasodilators, particularly converting-enzyme inhibitors, has been established. There is no evidence that prognosis has been improved despite symptomatic improvement in the patient with heart failure.

Heart Failure↗
PubMed1986

Gated xenon scans for right ventricular function.

The complex geometry of the right ventricle makes the use of radionuclides an attractive method for assessing right ventricular function. The use of the gated 133Xe technique for this purpose offers several advantages. A short i.v. infusion over 20 sec of 133Xe permits scans to be obtained, gated to the electrocardiogram at rest and during maximal exercise using a standard gamma camera. The method is both reproducible (3.5%) and repeatable (2.8%), and because of the short half-life within the patient with most of the radioisotope being excreted by the lungs, scans may be repeated within a few minutes and the radiation dose to the patient is small. Right ventricular ejection fraction obtained from gated xenon scans is shown to correlate well with measurements obtained from both standard gated technetium scans and first-pass studies.

Female↗
PubMed1985

Comparative clinical efficacy of bepridil, propranolol and placebo in patients with chronic stable angina.

A randomised double-blind parallel group study was performed to compare the clinical efficacy of bepridil, a new calcium slow channel blocker, with that of propranolol and placebo in patients with chronic stable angina of effort. Efficacy was assessed objectively by dynamic exercise testing using an upright bicycle ergometer and subjectively by patient documentation of anginal frequency and nitrate consumption. The administration of bepridil resulted in a significant improvement in physical work capacity expressed as calculated maximal oxygen uptake (Vo2 max) and exercise time. This was associated with subjective improvement in terms of reduced anginal frequency. Despite baseline differences in exercise performance and anginal frequency between the three treatment groups, the beneficial effects of bepridil were statistically significant when compared to propranolol. Although minor electrocardiographic changes were noted, no adverse effects were evident when bepridil was prescribed in doses of up to 400 mg/day over a 10 week period.

Adult↗
PubMed1985

Clinical value of Doppler echocardiography in the assessment of adults with aortic stenosis.

Continuous wave Doppler echocardiography was used to study 41 adults with clinically suspected aortic stenosis undergoing cardiac catheterisation. Non-invasive assessment of the severity of stenosis was made before catheterisation using electrocardiograms, chest radiographs, and cross sectional echocardiography in addition to clinical examination and assessment modified, where appropriate, by the result of the Doppler examination. Catheterisation gradients were obtained in 33 patients and correlated well with those obtained by Doppler examination particularly when simultaneous recordings were obtained. All patients with surgically significant stenoses were identified by non-invasive assessment including Doppler examination and overestimation was not found in any patient with a less than significant stenosis. Thus surgery can be recommended in patients with aortic stenosis without the need for previous cardiac catheterisation.

Adolescent↗
PubMed1985

Serum oestradiol and ischaemic heart disease--relationship with myocardial infarction but not coronary atheroma or haemostasis.

Elevated oestradiol (E2) levels may be a risk factor for ischaemic heart disease in men, although the mechanisms for the elevation of oestrogen and for its adverse effects remain unclear. We have studied 100 Caucasian males undergoing elective coronary angiography for ischaemic chest pain and measured serum oestradiol, a profile of haemostatic tests, extent of coronary artery disease and evidence of previous myocardial infarction in order to assess any relationships which could explain the effect of elevated serum oestradiol levels. Levels were significantly higher in men with a history of myocardial infarction compared to those without (p less than 0.01), but were unrelated to the extent of coronary disease or to the haemostatic tests. These results suggest that the association of oestradiol with coronary events relates to myocardial infarction, not to atherogenesis, and is not due to any currently measurable alterations of haemostasis. Current beta-adrenoceptor blocker treatment was associated with lower oestradiol and thromboxane B2 concentrations (both, p = 0.06). These incidental findings suggest that further studies of the effects of beta-blockade on oestradiol and thromboxane metabolism are indicated.

Adrenergic beta-Antagonists↗
PubMed1984

Acylated streptokinase--plasminogen complex in patients with acute myocardial infarction.

BRL 26921 is the p- anisoyl derivative of the primary streptokinase-human plasminogen complex in which the acyl group is specifically located at the catalytic centre of the enzyme. Doses of BRL 26921 ranging from 5 mg to 25 mg were given intravenously or into a coronary artery to 12 patients with acute myocardial infarction. The complex was well tolerated and produced no serious bleeding. Coronary artery reperfusion was demonstrated angiographically in three patients. In most patients, fibrinogen, plasminogen, alpha 2 antiplasmin and alpha 2 macroglobulin levels fell and the level of fibrinogen degradation products increased acutely post treatment indicating systemic fibrinolytic activation. The degree of this activation was variable but was profound in some. It appeared to be dose related and modified by the presence of streptokinase antibodies. BRL 26921 appears less "selectively" thrombolytic in patients than had been expected from animal models.

Adult↗
PubMed1984

Cold pressor induced changes in regional left ventricular wall motion: specific but insensitive for coronary artery disease.

The incidence of new regional abnormalities of left ventricular wall motion induced by a peripheral cold stimulus has been examined in 75 patients who all underwent coronary arteriography. When analysis was carried out from a cine loop display a new wall motion abnormality had a sensitivity of 12% and a specificity of 100% for coronary artery disease. From stroke volume images the sensitivity was 35% and the specificity 87%. It is concluded that cold pressor induced wall motion changes are too insensitive to be a useful method of screening for coronary artery disease.

Adult↗
PubMed1983

The systemic and coronary haemodynamic effects of felodipine in patients with coronary heart disease.

The cardiovascular effects of felodipine, a new arteriolar vasodilator, were studied in 22 patients with coronary heart disease. There were significant falls in blood pressure and systemic vascular resistance of 16 and 38% respectively (P = 0.001), thus affecting after-load. Cardiac index and stroke index increased by 35 and 12% respectively. There was reflex tachycardia--from 75 +/- 3 to 85 +/- 3 b.p.m. (P = 0.005). Coronary sinus blood flow increased from 134 +/- 9 to 191 +/- 17 ml/min (P less than 0.005) and myocardial arterio-venous oxygen difference narrowed from 12.1 +/- 0.5 to 9.0 +/- 0.4 vols% (P less than 0.001) indicating less oxygen usage. With the heart rate held constant by atrial pacing, cardiac index and stroke index increased by 30 and 26% (P less than 0.001), whilst systolic blood pressure and systemic vascular resistance fell by 20 and 29% (P less than 0.001). This would suggest that the improved haemodynamics were largely secondary to after-load reduction.

Adult↗
PubMed1983

Prophylaxis of primary ventricular fibrillation with tocainide in acute myocardial infarction.

Within six hours of suspected acute myocardial infarction, 791 patients entered a randomised double blind study of combined intravenous and oral tocainide for the prophylaxis of primary ventricular fibrillation. Acute myocardial infarction was confirmed in 559 patients, of whom 278 had received tocainide. The study was terminated on the basis of a sequential statistical analysis which showed that in these patients tocainide was unlikely to reduce the incidence of primary ventricular fibrillation by as much as 50%, primary ventricular fibrillation having occurred in 4% of the tocainide and 2% of the placebo patients. Significantly fewer tocainide treated patients were withdrawn for other serious ventricular arrhythmias. Mortality (1% in the tocainide group and 2% in the placebo group) was low with no statistically significant differences between the active and placebo groups. Unwanted effects of treatment were infrequent and rarely troublesome both in patients with and without acute myocardial infarction. These results suggest that in the dosage used in this study tocainide does not exert an antifibrillatory action in the early phase of acute myocardial infarction.

Anti-Arrhythmia Agents↗
PubMed1982

Cardiovascular effects of prenalterol on rest and exercise haemodynamics in patients with chronic congestive cardiac failure.

?The cardiovascular effects of the cardioselective beta, agonist prenalterol have been studied in nine patients with severe chronic congestive cardiac failure and in six patients with left ventricular dysfunction resulting from previous myocardial infarction. In the patients with cardiac failure intravenous prenalterol in a dosage of 1.5 microgram/kg bodyweight increased the cardiac index from 1.8 +/- 0.1 to 21.+/- 0.1 1/min per m2 and the left ventricular ejection fraction from 22 +/- 3 to 28 +/- 3%. There was a modest but significant increase in heart rate from 76 +/- 3 to 87 +/- 4 beats/min. Systemic vascular resistance fell from 2285 +/- 51 to 2041 +/- 534 dynes s-1 cm-5. On exercise, the left ventricular filling pressure fell from 33 +/- 6 to 26 +/- 3 and both cardiac index and stroke index increased by 13% and 16%, respectively. There was no significant change in heart rate or systemic blood pressure. In the patients with left ventricular dysfunction, coronary sinus blood flow increased from 107 +/- 11 to 133 +/- 12 ml/min but the increase in myocardial oxygen consumption was small and not significant (11.6 +/- 1.2 and 14.5 +/- 1.9 ml/min). In all patients there was no evidence that prenalterol was arrhythmogenic.

Adrenergic beta-Agonists↗
PubMed1980

Haemodynamic effects of prenalterol in patients with coronary heart disease.

The haemodynamic effects of prenalterol, a new selective beta-1 adrenoreceptor agonist, have been studied in patients with coronary heart disease. The drug was administered intravenously in a dosage of 0.5 to 2.5 micrograms/kg body weight to 20 patients undergoing coronary angiography and to 10 patients with a recent myocardial infarction, who had clinical evidence of left ventricular dysfunction. Left ventricular performance was enhanced in both groups of patients--left ventricular dP/dt (max) increased by 33 per cent and the systolic time intervals, pre-ejection period, and the ratio of pre-ejection period and left ventricular ejection shortened by 28 and 21 per cent, respectively. Cardiac output and stroke volume increased with no change in heart rate nor in left ventricular filling pressure. These results indicate that prenalterol enhances the contractile state of the myocardium without altering heart rate, and suggest that prenalterol could be of value in the management of patients with coronary heart disease, who have impaired left ventricular function.

Adrenergic beta-Agonists↗
PubMed1978

The pharmacokinetics of slow-release procainamide.

Procainamide was given to 20 patients with normal renal function as an i.v. bolus of 500 mg followed by 1.0 or 1.5 g eight-hourly by mouth in the form of a slow release preparation (Durules). 97.6 +/- 27.1 (SD)% of the oral procainamide was absorbed, the absorption half life being 1.54 h. The elimination half life following the oral formulation was 6.0 +/- 0.8 h, compared to a mean of 3.4 +/- 0.4 h following i.v. administration. Elimination half life following i.v. administration was slightly related to acetylator status, being 2.75 +/- 0.9 h in fast acetylators, and 4.4 +/- 2.4 h in slow acetylators. This dependence on acetylator status was not seen in half life following oral administration. Total body clearance, steady state plasma procainamide and N-acetylprocainamide were not significantly dependent on acetylator status, although a few patients who are slow acetylators had unexpectedly low clearance and high steady state procainamide concentrations when given the higher dose.

Biological Availability↗
PubMed1978

Magnesium metabolism in patients with coronary heart disease.

1. The oral absorption of magnesium, its myocardial uptake and exchangeable magnesium have been studied in patients with coronary heart disease and controls using the radioactive isotope magnesium-28. 2. No significant difference in oral absorption or myocardial uptake was found between patients and controls. 3. The exchangeable magnesium per kg body weight was significantly lower in the patients than in the controls.

Adult↗
PubMed1977

Chemotherapy of sarcomas of the limbs by regional perfusion.

From 1957 to 1975, 113 patients with sarcoma of the extremities have been treated with chemotherapy by regional perfusion, either alone or as an adjunct to excisional surgery. Perfusion alone in 54 patients was associated with an early response rate of 83%, but only four patients had complete regression of tumor for longer than three months. When perfusion was followed by immediate or delayed excision, better results were obtained. In 49 Stage I patients and in 24 Stage II patients, cumulative survivals of 66% and 59% were obtained at five years and 66% and 51% at 10 years. The procedure has also been useful in saving functional limbs by converting tumors to operability, and in the palliation of pain and ulceration.

Adolescent↗