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Biomedical subjects

J T Hanlon

Publications and source records attributed to J T Hanlon.

68 records · Page 4Linked to original sources
PubMed1983

Hemodynamic responses to combined therapy with captopril and hydralazine in patients with severe heart failure.

The hemodynamic benefits and safety of combined therapy with captopril and hydralazine were studied during invasive hemodynamic monitoring in 14 patients with severe heart failure. In eight patients, the individual effects of both drugs were evaluated before the administration of combined therapy, whereas hydralazine was added to maintenance captopril therapy in the other six patients. In the first group, captopril alone produced a marked decrease in pulmonary wedge pressure (28 +/- 4 to 18 +/- 5 mm Hg) and mean arterial pressure (85 +/- 20 to 69 +/- 13 mm Hg) (both p less than 0.001) without a significant increase in cardiac index. Hydralazine alone produced a marked increase in cardiac index (1.6 +/- 0.4 to 2.7 +/- 0.5 liters/min per m2) (p less than 0.001), but with a minimal decrease in pulmonary wedge pressure (28 +/- 4 to 23 +/- 4 mm Hg) (p less than 0.05) and without a significant change in mean arterial pressure. The combination of captopril and hydralazine produced an increase in cardiac index similar to that of hydralazine alone and decreases in pulmonary wedge pressure and mean arterial pressure similar to those with captopril alone. Most important, when hydralazine was added to captopril in the entire group of 14 patients, cardiac index increased markedly with little additional decrease in mean arterial pressure and no significant increase in heart rate. The one patient who experienced symptomatic hypotension with combination therapy also had dizziness with captopril alone. Seven of the nine patients maintained on long-term treatment experienced symptomatic improvement. Thus, in patients with severe chronic heart failure, the combined use of captopril and hydralazine is feasible and produces acute hemodynamic improvement superior to that from either drug alone.

Aged↗
PubMed1982

An evaluation of the sensitivity of five home pregnancy tests to known concentrations of human chorionic gonadotropin.

A study was conducted to evaluate the sensitivity of the five commercially available home pregnancy testing kits. Known amounts of human chorionic gonadotropin (hCG) were diluted in pooled, sterile male urine. Varying concentrations of hCG were randomly assigned to 100 kits of each of the five brands. The test results were read independently by three individuals who were blinded to the hCG concentrations. Statistical analysis were based on the majority vote of the readers. The rank-ordered sensitivity of the five home pregnancy tests, expressed as the proportion of positive results for the range of hCG concentrations studied, was as follows: (1) Predictor, (2) e.p.t., (3) Acu-Test, (4) Answer, and (5) Daisy 2. Overall, Predictor and e.p.t. appear to be more accurate than Acu-Test or Answer. Only Daisy 2 was found to be significantly different from the other brands. However, the currently marketed Daisy 2 pregnancy test is manufactured by a different company.

Chorionic Gonadotropin↗
PubMed1982

Beneficial hemodynamic effects of intravenous diazoxide in refractory congestive heart failure.

Despite the growing popularity of vasodilator therapy for acute and chronic congestive heart failure (CHF), no single agent has been uniformly effective and well tolerated. Therefore, we investigated the acute hemodynamic response to diazoxide, a potent and long-acting arteriolar dilator, in nine patients with severe CHF refractory to conventional treatment and, in seven of nine, other vasodilators. Diazoxide was administered intravenously in successive 300 mg infusions, each over 10 minutes, until a satisfactory response in cardiac and output occurred or a fall in arterial blood pressure or increase in heart rate was noted. The mean dose of diazoxide was 670 mg (range 450 to 900 mg). Systemic vascular resistance fell immediately, by a maximum of 44%. Arterial pressure was not changed significantly, but cardiac and stroke volume indices rose by 64% and 49%, respectively, from 2.0 +/- 0.5 to 3.3 +/- 0.6 L/min/m2 and from 24 +/- 10 to 36 +/- 9 ml/m2 (each p less than 0.001). Pulmonary capillary wedge pressure declined more gradually, by a mean of 8 mm at 4 and 6 hours after drug infusion. This hemodynamic improvement was sustained for a mean of 9.7 hours (range 6 to 12 hours). Our findings indicate that intravenous diazoxide may be useful in the management of acute heart failure and that a trial of oral diazoxide in chronic normotensive CHF is warranted.

Adult↗
PubMed1981

Contrast enhancement of thallium-201 myocardial scintigrams: improved sensitivity with diminished specificity in coronary disease detection.

Thallium-201 myocardial scintigraphy (TMS) has become an increasingly popular noninvasive technique with a high diagnostic specificity, but a somewhat lower sensitivity for coronary disease (CAD) detection. Many centers now routinely employ computer techniques to contrast enhance scintigrams, but the resulting changes in sensitivity and specificity have not been carefully evaluated. In the present study, three observers with different levels of experience blindly interpreted both unprocessed and enhanced exercise TMS from 40 patients with CAD and from 15 without significant obstructions. The sensitivity for CAD achieved by each observer was higher with the enhanced scintigrams (increase from an average of 80% to 93%), but there was concomitant loss of specificity (from 93% to 73%). Similarly, significant changes were present in the sensitivity and specificity with which ischemic regions were diagnosed. In addition, contrast enhancement facilitated interpretation of TMS studies, particularly in making comparisons between exercise scintigrams and subsequent rest or redistribution images. Contrast enhancement affected the interpretations of the inexperienced observer most significantly. We conclude that contrast enhancement improves TMS sensitivity but results in some loss of specificity. The variable effect of enhancement on observers with different levels of experience suggests that laboratories should critically evaluate their own results before routinely employing computer processing.

Computers↗
PubMed1981

Myocardial lactate metabolism: evidence of lactate release during net chemical extraction in man.

Myocardial blood flow has been recognized to be heterogeneous in patients with coronary artery disease. Traditional arterial-coronary sinus sampling methods cannot demonstrate comparable heterogeneity of myocardial metabolism. In this study we used a tracer technique to investigate possible heterogeneity of myocardial lactate metabolism. Twenty-one patients with symptoms of ischemic heart disease were studied. We injected 14C-1-lactate intravenously as a constant infusion after a priming dose. Coronary sinus and arterial samples were obtained for chemical and radioisotopic analyses. At rest, myocardial lactate extraction by chemical analysis was 24.6 +/- 8.5% (mean +/- SD). By radioisotopic analysis, the lactate extraction was 41.0 +/- 10.2% (p less than 0.001). Thus, certain areas of the myocardium were releasing lactate despite global net extraction of lactate. In the 12 patients with significant left main or both left anterior descending (LAD) and left circumflex (LCX) lesions, the calculated amount of lactate released at rest was 0.136 +/- 0.045 mumol/ml of blood (mean +/- SD). In contrast, the amount released in the six patients with a significant lesion in only the LAD or LCX was 0.076 +/- 0.019 mumol/ml, and in the three patients without left coronary arterial lesions it was 0.039 +/- 0.004 mumol/ml. Using a tracer method, myocardial lactate metabolism was demonstrated to be heterogeneous at rest in patients with ischemic heart disease. A significant amount of lactate can be released by the myocardium at a time when chemical arterial-coronary sinus analysis indicates global myocardial extraction. The amount of lactate released appears to be related to the severity of the coronary artery disease.

Adult↗
PubMed1981

Rapidly progressive coronary artery bypass graft atherosclerosis. Report of a case documented by serial coronary arteriograms and pathologic examination.

Atherosclerosis occurred in a coronary artery saphenous vein bypass graft. Serial angiograms are presented documenting subtotal occlusion of this graft which occurred over a nine-month period. Pathologic examination of graft material obtained at surgery demonstrated ulcerating atherosclerotic plaque. The occurrence of early saphenous vein graft atherosclerosis is discussed with particular reference to the possible effects of hyperlipidemia, which was present in this patient.

Arteriosclerosis↗
PubMedDate not supplied

Echocardiographic recognition of partial papillary muscle rupture.

Acute papillary muscle rupture complicating acute myocardial infarction represents a potentially lethal complication of acute myocardial infarction. Survival depends on prompt recognition and institution of immediate medical and surgical therapy. We present two cases of partial papillary muscle rupture in the setting of acute myocardial infarction and describe the echocardiographic features that may allow early recognition of this condition before complete rupture.

Aged↗
PubMedDate not supplied

Use of medications with potential oral adverse drug reactions in community-dwelling elderly.

Prevalence and indicators of medication use with potential oral health implications among 4,163 people from the Duke Established Populations for Epidemiologic Studies of the Elderly were studied. Medications were grouped into seven potential oral adverse drug reaction (POADR) categories. Eighty percent of participants were taking at least one medication from any of the seven categories. Drugs with the potential to cause xerostomia were taken by 56.1%, abnormal hemostasis by 51.7%, soft tissue reactions by 23.4%, taste changes by 11.0%, alteration in host resistance by 8.7%, gingival overgrowth by 5.0%, and movement disorders by 2.4% of participants. Race-stratified analyses revealed that medication use with any POADR was significantly associated (p < 0.001) with being female for both races. Among nonblacks, being > or = 75 years old was associated with higher POADR use. Blacks who had a dental visit in the previous six months were more likely to take medications with POADR than those who did not. POADR medication use was not related to place of residence. Elderly often take medications with potential oral health impact.

Black or African American↗
PubMedDate not supplied

Factors associated with suboptimal analgesic use in community-dwelling elderly.

OBJECTIVE: To examine patterns and factors associated with overall and suboptimal analgesic use among community-dwelling elderly. DESIGN: Cross-sectional survey. SETTING: Five-county urban and rural region in Piedmont, NC. PARTICIPANTS: A stratified random sample from the Duke Established Populations for Epidemiologic Studies of the Elderly of 3973 participants aged 65 years or older. MAIN OUTCOME MEASURES: Use of any analgesic medication, suboptimal analgesic use (taking 2 or more analgesics from the same class, using 3 or more analgesics concurrently, or use of an analgesic that has a major interaction with another drug). RESULTS: Analgesics were used by 60.4% of the participants. Use was more likely for those who had physical functional impairment, a history of cardiovascular disease, one or more health visits in the previous year, or were female. Use was less likely for older participants and for African-Americans with adequate financial status. Suboptimal use occurred in 9.2% of analgesic users. Therapeutic duplication was more likely in those who were depressed, needed help with basic activities of daily living, or used alcohol, and was less likely in those with adequate financial status. Multiple analgesic use was more likely in those who were depressed, had impaired physical functional status, had one or more health visits in the previous year, were African-American (of either sex), or were white women. Only two persons had a potential major analgesic-drug interaction. CONCLUSIONS: Suboptimal analgesic use is common in community-dwelling elderly, and its risk in consistently increased in those who are depressed or have impaired physical functional status.

Aged↗
PubMedDate not supplied

Predictors of nutritional supplement use by the elderly.

We conducted a population survey to describe patterns and determine predictors of the use of nutritional supplements and single-ingredient vitamins and minerals among elderly living in five adjacent urban and rural counties in the Piedmont area of North Carolina. The stratified random sample consisted of 3939 black and white participants age 65 or older from the Duke Established Populations for Epidemiologic Studies of the Elderly. The use of nutritional supplements within the previous 2 weeks was determined during an in-home interview. Multivariate analyses, using weighted data adjusted for sampling design, were conducted to assess the association between nutritional supplement use and predisposing, need, and enabling factors. Nutritional supplement use was reported by 26.2% of participants and was more likely for those who were white women, were high school educated, were underweight, took prescription drugs, had five or more health visits in the previous year, and had supplemental health insurance. It was less likely for those with poor self-rated health. The majority (71.5%) of nutritional supplement users took at least one single-ingredient supplement. Use of such products was more likely in those who were white, born and raised in an urban area, and high school educated, and was less likely in those with impaired functional status. Nutritional supplement use is prevalent in community-dwelling elderly and is more commonly associated with demographic factors and access to health care than with need factors.

Aged↗
PubMedDate not supplied

The cost-effectiveness of a clinical pharmacist intervention among elderly outpatients.

We estimated the cost and cost-effectiveness of a clinical pharmacist intervention known to improve the appropriateness of drug prescribing. Elderly veteran outpatients prescribed at least five drugs were randomized to an intervention (105 patients) or control (103) group and followed for 1 year. The intervention pharmacist provided advice to patients and their physicians during all general medicine visits. Mean fixed and variable costs/intervention patient were $36 and $84, respectively Health services use and costs were comparable between groups. Intervention costs ranged from $7.50-30/patient/unit change in drug appropriateness. The cost to improve the appropriateness of drug prescribing is thus relatively low.

Aged↗