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Biomedical subjects

L S Malmud

Publications and source records attributed to L S Malmud.

At least 55 records · Page 3Linked to original sources
PubMed1982

High-dose, brief intravenous streptokinase early in acute myocardial infarction.

An acute thrombus at the proximal border of a high-grade atherosclerotic obstruction is the usual cause of myocardial infarction. Although intracoronary thrombolysis is potentially an exciting new therapy for reducing the extent of myocardial infarction by lysing coronary clot, a number of major difficulties limit its widespread application. It is a complex procedure requiring intracoronary visualization and infusion within a few hours of onset of symptoms. Since intravenous streptokinase could be widely applied if effective, we and others have wondered whether high-dose, brief-duration intravenous streptokinase infusion given early in myocardial infarction would lyse coronary clots without bleeding. To date we have treated 13 patients within 6 hours of onset of symptoms and with ECG and angiographic evidence of typical myocardial infarction caused by coronary clot. Clot lysis and angiographically proved coronary reperfusion were achieved in 6 patients within 1 hour of starting a systemic intravenous infusion of 850,000 IU of streptokinase. Schroeder et al., in Berlin, West Germany, achieved angiographically proved coronary reperfusion in 11 of 21 patients with acute myocardial infarction following a 30-minute intravenous streptokinase infusion of 500,000 IU. Neuhaus et al., in Göttinen, West Germany, achieved angiographically proved coronary reperfusion in 24 of 39 similar patients within 48 minutes by intravenous infusion of 1,700,000 IU of streptokinase. In these three studies, no serious bleeding occured; left ventricular function was improved in patients who achieved coronary reperfusion. We conclude that rapid intracoronary clot lysis and coronary reperfusion can be achieved early in myocardial infarction by brief-duration systemic intravenous infusion of high-dose streptokinase without a high incidence of serious bleeding.

Clinical Trials as Topic↗
PubMed1982

Radionuclide studies of esophageal transit and gastroesophageal reflux.

Esophageal scintigraphy is a sensitive test for evaluating esophageal emptying. Use of this test in combination with gastroesophageal scintigraphy should provide useful information about esophageal and gastroesophageal function, which should be of great clinical value to both the clinician and the investigator. Gastroesophageal scintigraphy is the most sensitive noninvasive test for detecting gastroesophageal reflux; its permits quantitation of reflux; the technique is simple and rapid, and can be completed in 5 minutes in any nuclear medicine section equipped with a gamma camera. It is the first quantitative test of reflux and is useful in measuring the effectiveness of various therapies. Variations of the technique have been applied to detecting reflux and pulmonary aspiration in infants and children.

Adult↗
PubMed1982

Scintigraphic evaluation of gastric emptying.

There has been recent, renewed interest in studies of gastric emptying due in part to the introduction of new therapies for peptic ulcer diseases and attempts to better understand gastric physiology. Of the methods available for studying gastric emptying patterns, nuclear medicine techniques are optimal due to their noninvasive character, reproducibility and quantitative ability. The modulation of gastric emptying is multifactorial, and includes motor control, electrical activity, hormonal influences, and the composition of the meal itself: liquid vs solid; protein, carbohydrate and fat content; fiber or particle size; osmolality; pH; and pharmacologic agents. Because of the ease of performing gastric emptying studies using radiolabeled physiologic meals, these tests are being employed with increasing frequency in the evaluation of patients with disorders such as diabetic gastroparesis, postgastrectomy gastroparesis or dumping syndrome, and in the study of normal gastric physiology in man. Present data suggests that combined liquid-solid, dual radionuclide studies afford the greatest information regarding simultaneous gastric emptying patterns of liquid and solid components of a meal, and that single radionuclide, solid tests of gastric emptying are the more sensitive technique for determining subtle abnormalities of gastric emptying, when only a single tracer is employed.

Gastric Emptying↗
PubMed1982

Advanced breast cancer with bone-only metastases: a chemotherapeutically responsive pattern of metastases.

Twenty-one patients, presenting with metastases only to bone from a primary adenocarcinoma of the breast having previously undergone mastectomy, tolerated aggressive cytotoxic chemotherapy (CAF--cyclophosphamide 500 mg/m2, Adriamycin 50 mg/m2, 5-fluorouracil 500 mg/m2 q 3 weeks) without significant clinical morbidity. Sixteen of the 21 achieved total clinical symptomatic improvement (pain, performance status). Eleven of these 16 patients tolerated and received between 75% and 100% of the original prescribed dose every 3 weeks, completing a total cumulative course dose of 450 mg/m2 of Adriamycin within 36 weeks, and remained clinically free of disease for an average of 26 months despite cessation of therapy. Their median survival is greater than 3 1/2 years. Those patients tolerating and receiving a dose of 50% or less developed early progression and had a relatively short survival. In general, patients with metastatic disease limited to bone have a relatively good prognosis and are tolerant of and benefit from aggressive cytotoxic therapy. In these patients an excellent clinical response can be achieved with a prolonged disease-free treatment-free period of life.

Adenocarcinoma↗
PubMed1982

Gastric emptying of a physiologic mixed solid-liquid meal.

The purposes of this study were to use a noninvasive scintigraphic technique to measure gastric emptying of liquids and solids simultaneously, to study the interactions between emptying of the liquid and solid components of meals in normal subjects, and to employ dual isotope gastric scintigraphy to evaluate gastric emptying of liquids and solids in patients with clinical evidence of gastric outlet obstruction. The solid component of the test meal consisted of chicken liver, labeled in vivo with Tc-99m sulfur colloid, and the liquid component was water mixed with In-111 DTPA. The rates of emptying were quantitated using a gamma camera on line to a digital computer. Twenty normal subjects were studied using this combined solid-liquid meal. Ten of them also ingested a liquid meal alone and ten a solid meal alone. Liquid emptied from the stomach significantly more rapidly than did solids. The emptying curve for liquids was exponential compared to a linear emptying curve for solids. The gastric emptying rate of the liquid component was slowed significantly by simultaneous ingestion of solids, but the emptying rate of solids was not affected by liquids. Several patients with clinical gastric outlet obstruction were evaluated. Both combined and selective abnormalities for gastric emptying of liquids and solids were demonstrated.

Adult↗
PubMed1982

Gastric stasis and vomiting: behavioral treatment.

A patient is described in whom gastric stasis and vomiting of 28-yr duration were successfully treated with behavior therapy. Failure of conventional medical treatment in the face of continued vomiting led to consideration for surgery. The need for surgery was obviated by the successful application of exposure and response prevention, which resulted in a complete elimination of vomiting. Changes were produced, not only in the overt behavioral manifestation (vomiting) but in gastrointestinal motility as well. Although there was a lag, gastric emptying returned to normal. The improvements were maintained at over 1-yr follow-up study.

Behavior Therapy↗
PubMed1982

Effect of bolus composition on esophageal transit: concise communication.

The technique of esophageal scintigraphy was developed as a sensitive, quantitative, noninvasive test of esophageal transit. Esophageal scintigraphy was performed in 40 asymptomatic normal volunteers in order to determine the effect on esophageal transit of the following: body posture (sitting vs. supine), liquid vs. solid, the solid being either a standard #4 gelatin capsule of the size used for antibiotic capsules, or a cube of solid food such as cooked chicken liver. The results showed that liquids emptied completely from the esophagus after one swallow, whether supine or sitting. Capsules or liver cubes, when ingested without water, frequently remained in the esophagus for up to two hours without the subject's having any sensation that the solid had not left the esophagus. Both capsules and liver cubes cleared the esophagus better in the upright than in the supine position. When gelatin capsules were swallowed with as little as 15 ml of water, but after a preliminary sip of water, there was complete transit in each case. The study suggests that the practice of assisting patients into a sitting position and instructing them to take a sip of water before attempting to swallow a capsule will assure better transit of the capsule even when swallowed with as little as 15 ml of water. This may reduce the incidence of esophagitis following oral antibiotics, and of esophageal erosions from aspirin-containing medications.

Capsules↗
PubMed1981

Point by Point Examination of the equilibrium gated radionuclide left ventricular time activity curve; validation by biplane angiography.

Examination of the time course of left ventricular ejection has been found useful in several clinical applications. Equilibrium gated radionuclide angiography provides non-invasive means to obtain the ventricular ejection curve. To evaluate the accuracy of the equilibrium gated radionuclide left ventricular volume curve we compared equilibrium gated radionuclide date with biplane cine-angiography in 16 patients examining each set of data on a point by point basis. The cine-angiographic data consisted of 60 frame per second biplane cineangiograms and the radionuclide data consisted of 28 points spanning the cardiac cycle. All data was normalized for the patient's heart rate and stroke volume. The equilibrium gated radionuclide angiographic data accurately reproduced the contrast angiographic data at each point on the curve. This result justifies using the equilibrium gated radionuclide time activity curve to evaluate parameters such as early systolic ejection rates or rates of maximum ventricular ejection.

Cardiac Output↗
PubMed1981

The evaluation of gastroesophageal reflux before and after medical therapies.

Gastroesophageal scintigraphy is a quantitative technique that can be employed to detect and quantitate gastroesophageal reflux before and after the application of therapeutic modalities, including change in body position, bethanechol, atropine, antacids, and antacid-alginate compounds. Five groups of 10-15 patients each were studied before and after using each therapeutic modality and before and after atropine. The results were compared to the patient's symptomatology and to the acid reflux test. Gastroesophageal scintigraphy was performed following oral administration of 300 microCi 99mTc-sulfur colloid in 300 ml acidified orange juice. Thirty-second gamma camera images were obtained as the gastroesophageal gradient was increased from approximately 10 to 35 mm Hg at 5 mm Hg increments using an inflatable abdominal binder. Data were processed using a digital computer. Reflux was reduced by change in position from recumbent to upright, and by the use of subcutaneous bethanechol, oral antacid, or oral antacidalginate compound. Atropine increased reflux. Gastroesophageal scintigraphy is more sensitive than fluoroscopy, correlates well with clinical symptomatology, and is a reliable and convenient technique for the quantitative estimation of reflux before and after therapy.

Administration, Oral↗
PubMed1981

Scintigraphic evaluation of disorders of the esophagus, stomach, and duodenum.

Gastrointestinal nuclear medicine procedures have progressed from the stage of anatomic imaging alone to their present applications in studying gastrointestinal function and pathophysiology. These tracer techniques have several specific advantages over other procedures. Scintigraphy requires no intubation, has excellent patient acceptance, is quantitative, and delivers lower radiation burdens to the patient than does the contrast radiographic study. Currently, nuclear medicine functional scintigraphy in gastroenterology is being applied clinically in many medical centers throughout the world.

Duodenal Diseases↗
PubMed1981

Cholinergic effects on esophageal transit and clearance.

Modern manometric and scintigraphic techniques were employed in an effort to determine the relationships between esophageal contractions and esophageal transit and clearance. The effects of direct cholinergic stimulation with bethanechol and blockade with atropine were evaluated in a total of 20 normal subjects and 13 patients with symptomatic gastroesophageal reflux. Bethanechol increased the amplitudes of deglutition-induced and distention-induced esophageal contractions, but diminished their propagation velocities. Both esophageal transit and clearance were decreased in patients with reflux, but both were improved after bethanechol. Atropine sulfate decreased the amplitudes of contractions, accelerated their propagation velocities, and delayed esophageal transit and clearance. Both transit and clearance were diminished significantly when reflux patients were compared with normal subjects. The amplitudes of esophageal contraction were significantly lower in patients with reflux than in normal subjects. Neither bethanechol nor atropine affected the incidence of deglutition-induced esophageal contractions. These studies suggest that the efficiency of esophageal emptying may be determined by the amplitudes of esophageal contractions.

Adult↗
PubMed1980

Gastroesophageal scintigraphy.

The technique of gastroesophageal scintigraphy was developed in order to quantitatively detect reflux from the stomach into the esophagus. The scintigraphic technique was compared to previous diagnostic tests including barium esophagography, fluoroscopy, endoscopy, esophageal biopsy, the acid perfusion test, esophageal manometry, and the acid reflux test. None of the other techniques is as sensitive as gastroesophageal scintigraphy for the detection of reflux, in comparison to the acid reflux test. Gastroesophageal scintigraphy is able to detect gastroesophageal reflux accurately, rapidly, noninvasively, and more sensitively than other diagnostic techniques. In addition, it is able to be employed to quantitate reflux and is suitable for studying the effects of various therapeutic modalities.

Adult↗
PubMed1980

Gastroesophageal scintigraphy to assess the severity of gastroesophageal reflux disease.

Thirty-six (36) patients with symptomatic gastroesophageal reflux were studied. Symptoms of heartburn, regurgitation and dysphagia were scored as to their severity and compared to quantitative tests of gastroesophageal reflux. Patients were studied with the acid reflux test, fiberoptic endoscopy, esophageal mucosal biopsy with a pinch forceps, esophageal manometry and radioisotopic gastroesophageal scintigraphy. Symptoms were scored according to an arbitrary grading system as mild, moderate, or severe. There were significant correlations between symptoms scores and both the degree of endoscopic esophagitis and the gastroesophageal reflux indices as measured by the radioisotopic scintiscan, but not with the degree of histologic esophagitis or lower esophageal sphincter pressure. Review of the findings suggests the following profile for patients who might require antireflux surgery: severe symptoms, presence of endoscopic esophagitis; resting lower esophageal sphincter pressure below 10 mmHg; and gastroesophageal reflux index above 10%.

Adult↗
PubMed1980

Evidence for splenic sequestration of in vivo-labeled erythrocytes.

Some of the erythrocytes labeled using an in vivo technique are sequestered by the spleen and thus lost from the circulation. Allowance for this loss must be made if calculations regarding relative changes in ventricular volumes are being made over extensive periods of time.

Cardiac Volume↗