PubMed Health⌕ Search

Biomedical subjects

I J Schatz

Publications and source records attributed to I J Schatz.

At least 19 recordsLinked to original sources
PubMed1996

Mean red cell volume as a correlate of blood pressure.

BACKGROUND: Clinical studies suggest that hypertensives have lower mean corpuscular volume (MCVs) than do normotensives. Epidemiological studies show no relation or higher MCVs. In the present study of elderly men (71 to 93 years of age) of the Honolulu Heart Program, elements of both findings are confirmed. METHODS AND RESULTS: Three groups are identified: (1) those receiving no hypertension treatment, (2) those receiving treatment with any diuretic, and (3) those receiving treatment with nondiuretics only. MCV is lower in group 3 than in group 1 (-0.85 fL, P<.001) but the same in groups 1 and 2. Within groups 1 and 3, inverse relations of -0.22 and -0.09 mm Hg/fL (P<.05) are noted for systolic (SBP) and diastolic (DBP) blood pressures. No relations are observed in group 2. MCV and red blood cell count (RBC) are inversely correlated (r=-.45). In group 2, adjustment for RBC unmasks a direct relation between MCV and SBP (0.5 mm Hg/fL, P=.02) and DBP (0.3 mm Hg/fL, P=.02). In groups 1 and 3, relations between SBP and MCV are lost after adjustment for RBC (0.005 mm Hg/fL). For DBP, adding RBC plus an MCV x RBC interaction is significant (P<.001). DBP is 5 mm Hg greater in the highest RBC quartile than in the lowest. A +3 mm Hg difference between extreme MCV quartiles is noted only at high RBC levels. CONCLUSIONS: The relation between blood pressure and red cell measures is probably mediated by whole blood viscosity. Hematocrit is a determinant of whole blood viscosity. Viscosity affects peripheral resistance to blood flow, and peripheral resistance affects DBP. At high RBC levels, MCV may be "downregulated." This may lower whole blood viscosity and partially reduce DBP without compromising flow.

Aged↗
PubMed1996

Family practice, internal medicine, and pediatrics as partners in the education of generalists.

The generalist of the future will play an integral role in the health care delivery system, yet the three recognized generalist specialties have developed and functioned along largely separate tracks. No matter what form of generalism evolves, family practice, internal medicine, and pediatrics must begin to cooperate and collaborate in developing new graduate medical education programs that are sufficiently flexible to meet whatever emerges in the future. They must devote their energies to working together, rather than competing; to emphasizing those parts of their programs that have similarities; and to sharing their knowledge, skills, attitudes, and perspectives about the care of patients. They must develop training experiences in which residents will obtain maximum contact with a wide variety of problems and patients in many different settings; a substantial portion of such training should be generic and virtually interchangeable among the three specialties. As the health care system evolves, so should these disciplines; they must begin to "train physicians to provide continuing, comprehensive and coordinated medical care to a population undifferentiated by gender, disease or organ system," as urged by the American Boards of Family Practice and Internal Medicine.

Education, Medical, Graduate↗
PubMed1995

Empathy and medical education.

Spiro has said, "computed tomographic scans offer no compassion and magnetic resonance imaging has no human face. Only men and women are capable of empathy." Empathy is an essential and required part of our roles as caregivers. We must enhance this natural emotion that exists in each of us; we can do so by carefully designing a curriculum, much as we would for learning about the physiology of the liver. The roots of our need for detachment and equanimity go back to Sir William Osler, but the pendulum has swung too far, and the need for retention of millions of data bits overwhelms our souls. Although excessive emotion is destructive and counter-productive, we must not suppress our passion--but control it. The best physician both feels with the patient and prescribes for the patient at the same time. To do one without the other is inadequate care. As medical educators our task is clear.

Bioethics↗
PubMed1991

Invasive treatment for coronary artery disease in the elderly.

The widespread availability of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty presents important treatment options for the older patient. The findings from a number of surgical series of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty are summarized. Certain trends are evident. Perioperative mortality, cardiovascular morbidity, and other complications, while declining, remain somewhat higher in elderly patients. However, the impact of age alone is slight. In both coronary artery bypass grafting and percutaneous transluminal coronary angioplasty, complications are more closely correlated with the presence of serious concomitant disease. Long-term survival and pain relief after coronary artery bypass grafting are excellent in older patients, and percutaneous transluminal coronary angioplasty may be the treatment of choice in some elderly patients with coronary artery disease. As in younger patients, prolongation of survival should not be the exclusive goal. Rather, a focus on quality of life and freedom from dependency should be seriously considered.

Aged↗
PubMed1990

Orthostatic hypotension, catecholamines, and alpha-adrenergic receptors in mitral valve prolapse.

The reported association of mitral valve prolapse with autonomic dysfunction and neuroendocrine abnormalities is derived from studies of patients selected because of symptoms or specifically referred for investigation. To determine whether such associations occur in nonreferred and unselected women with mitral valve prolapse, we measured blood pressure, heart rate, and norepinephrine response to standing in 13 volunteers with mitral valve prolapse and in 11 control subjects. Platelet alpha-adrenergic receptor quantity and affinity on standing also were determined in all persons. No significant differences were found between the groups in any of these measurements. Although small subsets of women with mitral valve prolapse may indeed have associated neuroendocrine epiphenomena and autonomic dysfunction, it is probably incorrect to generalize these findings to the vast spectrum of those with mitral valve prolapse.

Adolescent↗
PubMed1988

Successful treatment of ciguatera fish poisoning with intravenous mannitol.

Twenty-four patients with acute ciguatera fish poisoning were treated with intravenous mannitol, and each patient's condition improved dramatically. All exhibited marked lessening of neurologic and muscular dysfunction within minutes of the administration of mannitol. Gastrointestinal symptoms disappeared more slowly. Two patients in coma and one in shock responded within minutes, with full recovery after infusion. Although these observations were empiric and uncontrolled and the mechanism of action of mannitol in this disease is unclear, mannitol should be considered for initial use in patients with significant illness and morbidity from ciguatera fish poisoning.

Adolescent↗
PubMed1988

Understanding mitral valve prolapse (MVP).

In asymptomatic or symptomatic patients with an audible click and late systolic murmur, mitral valve prolapse can be assumed to be present, the pathologic-anatomical substrate of which is characterized by myxomatous changes in the mitral valve leaflets and collagen degeneration of the chordae tendineae. The conclusion that all persons with a systolic click have a diseased mitral valve and are at risk of complications is probably excessive. In the presence of an unequivocally-audible click and/or late systolic murmur, an echocardiogram for confirmation of the diagnosis is not necessary. If the auscultatory findings are uncertain, an M-mode recording and, because of its high sensitivity and specificity, a two-dimensional display from the parasternal long-axis view should be obtained. From the apical four-chamber view, false-positive findings may be incurred. A small percentage of patients with mitral valve prolapse have complaints which can be assumed attributable to disturbances in the neuroendocrine system (Tables 1 and 3). To what extent a relationship actually exists between autonomic dysfunction and mitral valve prolapse and whether or not this is coincidental, remains unclear. Treatment of the symptoms with anxiolytic drugs or beta-adrenergic receptor blocking agents is only indicated for disabling complaints if reassurance and psychological support are ineffective. Complaints of chest pain are atypical for angina pectoris. Supraventricular and ventricular arrhythmias may be observed (Table 3), the initial step in the management of which is to advise avoidance of irritants such as coffee, tobacco and emotional stress. Medical treatment is only indicated for hemodynamically-meaningful arrhythmias and in those patients in whom an increased risk of sudden death is present.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography↗