PubMed Health⌕ Search

Biomedical subjects

M A Greenberg

Publications and source records attributed to M A Greenberg.

At least 19 recordsLinked to original sources
PubMed2001

Myoglobin levels at 12 hours identify patients at low risk for 30-day mortality after thrombolysis in acute myocardial infarction: a Thrombolysis in Myocardial Infarction 10B substudy.

OBJECTIVE: We sought to identify, by use of serum cardiac markers, patients at low risk for 30-day mortality after ST-segment elevation myocardial infarction. BACKGROUND: Baseline cardiac markers are currently used to identify patients at increased risk for short-term events. We hypothesized that serum markers measured after treatment could identify patients at low risk for 30-day mortality. METHODS: A total of 839 patients from the Thrombolysis in Myocardial Infarction (TIMI) 10B study had myoglobin, cardiac-specific troponin-I, creatine kinase (CK)-MB measurements at the following time points; baseline, 90 minutes, and 3 and 12 hours after thrombolysis. By use of receiver operating characteristic analysis, thresholds were derived to predict 30-day mortality with at least 95% negative predictive value. RESULTS: Ninety minutes after thrombolysis myoglobin was superior to troponin-I or CK-MB in identifying patients at low risk for mortality. The 30-day mortality for 12-hour myoglobin < or = 239 ng/mL was 1.4% compared with 9.1% for levels > 239 ng/mL (P < .001). For 12-hour troponin-I (threshold 81.5 ng/mL), mortality was 1.9% versus 6.6% (P = .001) if above threshold; similarly for CK-MB at 12 hours (threshold 191 ng/mL) it was 3.3% versus 7.9% (P = .02). Multivariate analysis of baseline and posttreatment cardiac markers, age, sex, infarct artery location, and 90-minute TIMI flow grade identified only 12-hour myoglobin among the cardiac markers as independently predicting a low 30-day mortality (odds ratio 0.11, 95% confidence interval 0.02-0.50, P < .004). CONCLUSION: Serum cardiac markers can identify greater than two thirds of patients at low risk for 30-day mortality. A low 12-hour myoglobin level (< or = 239 ng/mL in this substudy) identifies such patients at low risk and could potentially assist in early risk stratification and triage after ST-segment elevation myocardial infarction.

Aged↗
PubMed2000

Low-dose enoximone improves exercise capacity in chronic heart failure. Enoximone Study Group.

OBJECTIVES: This study was designed to evaluate the effects of low-dose enoximone on exercise capacity. BACKGROUND: At higher doses the phosphodiesterase inhibitor, enoximone, has been shown to increase exercise capacity and decrease symptoms in heart failure patients but also to increase mortality. The effects of lower doses of enoximone on exercise capacity and adverse events have not been evaluated. METHODS: This is a prospective, double-blind, placebo-controlled, multicenter trial (nine U.S. centers) conducted in 105 patients with New York Heart Association class II to III, ischemic or nonischemic chronic heart failure (CHF). Patients were randomized to placebo or enoximone at 25 or 50 mg orally three times a day. Treadmill maximal exercise testing was done at baseline and after 4, 8 and 12 weeks of treatment, using a modified Naughton protocol. Patients were also evaluated for changes in quality of life and for increased arrhythmias by Holter monitoring. RESULTS: By the protocol-specified method of statistical analysis (the last observation carried-forward method), enoximone at 50 mg three times a day improved exercise capacity by 117 s at 12 weeks (p = 0.003). Enoximone at 25 mg three times a day also improved exercise capacity at 12 weeks by 115 s (p = 0.013). No increases in ventricular arrhythmias were noted. There were four deaths in the placebo group and 2 and 0 deaths in the enoximone 25 mg three times a day and enoximone 50 mg three times a day groups, respectively. Effects on degree of dyspnea and patient and physician assessments of clinical status favored the enoximone groups. CONCLUSIONS: Twelve weeks of treatment with low-dose enoximone improves exercise capacity in patients with CHF, without increasing adverse events.

Adolescent↗
PubMed1997

Cardiac cephalgia: a treatable form of exertional headache.

We report two patients with exertional headaches beginning with vigorous exercise and relieved by rest. Neurologic evaluation and neuroimaging were normal in both. During exercise stress testing, the onset of the patients' typical headaches correlated with ECG changes indicative of myocardial ischemia. In both patients coronary angiography revealed three-vessel disease, and myocardial revascularization procedures were followed by complete resolution of headaches. Based on these patients, and a review of prior similar reports, we conclude that myocardial ischemia is a rare and treatable cause of exertional headache. Accurate diagnosis is critical to controlling headaches and preventing myocardial infarction.

Aged↗
PubMed1996

Emotional expression and physical health: revising traumatic memories or fostering self-regulation?

Health benefits derived from personal trauma disclosure are well established. This study examined whether disclosing emotions generated by imaginative immersion in a novel traumatic event would similarly enhance health and adjustment. College women, preselected for trauma presence, were randomly assigned to write about real traumas, imaginary traumas, or trivial events. Yoked real-trauma and imaginary-trauma participants wrote about real-trauma participants' experiences. Imaginary-trauma participants were significantly less depressed than real-trauma participants at immediate posttest, but they were similarly angry, fearful, and happy. Compared with control group participants, both trauma groups made significantly fewer illness visits at 1-month follow-up; however, real-trauma participants reported more fatigue and avoidance than did the other groups. Imaginary-trauma group effects could reflect catharsis, emotional regulation, or construction of resilient possible selves.

Adaptation, Psychological↗
PubMed1994

Dobutamine echocardiography and resting-redistribution thallium-201 scintigraphy predicts recovery of hibernating myocardium after coronary revascularization.

The value of dobutamine echocardiography and resting thallium-201 scintigraphy to predict reversal of regional left ventricular wall motion dysfunction after revascularization in patients with chronic coronary artery disease was assessed. Improvement in wall motion during dobutamine echocardiography and normal or mildly decreased uptake on thallium-201 scanning are strong predictors of reversible left ventricular dysfunction. Dobutamine echocardiography and resting thallium-201 scanning are simple and safe methods of assessing hibernating myocardium.

Angioplasty, Balloon, Coronary↗
PubMed1994

Should all patients undergoing cardiac catheterization or percutaneous transluminal coronary angioplasty receive oxygen?

BACKGROUND: Supplemental oxygen is routinely administered to patients with acute coronary syndromes. The risk of significant morbidity during cardiac catheterization or coronary angioplasty has been well described; however, to our knowledge, the need for routine oxygen supplementation in these patients has not been investigated. METHODS: In phase 1, we prospectively studied 142 patients undergoing diagnostic cardiac catheterization (n = 94) or percutaneous transluminal coronary angioplasty (PTCA) (n = 48) to determine the incidence of procedure-related hypoxemia (pulse oximetry derived oxygen saturation [SpO2] < 90 percent of > 1 min duration) while breathing room air (RA). In phase 2, 134 patients undergoing diagnostic cardiac catheterization (n = 78) or PTCA (n = 56) were randomly allocated to breathe either RA or supplemental oxygen (O2, 6 L/min by nasal cannula) to determine the effect of oxygen administration on procedure-related hypoxemia. Oximetry results were compared with pertinent clinical and procedural data that might predispose patients to develop hypoxemia. RESULTS: Phase 1--Moderate to severe hypoxemia occurred in 36 percent (34/94) of patients undergoing diagnostic catheterization and in 56 percent (27/48) of patients undergoing PTCA. In the diagnostic catheterization group, there were a total of 25 episodes of moderate hypoxemia (SpO2 85 to 89 percent) lasting 4.0 +/- 4.3 min and 11 episodes of severe hypoxemia (SpO2 < 85 percent) of greater duration, 11.7 +/- 7.5 min (p < 0.008). In the PTCA group, there were 24 episodes of moderate hypoxemia and six episodes of severe hypoxemia lasting 4.8 +/- 4.3 min and 8.2 +/- 3.8 min, respectively. A history of chronic lung disease was associated with hypoxemia (p < 0.05) in the diagnostic group. In addition, 11 patients undergoing diagnostic catheterization who had baseline SpO2 < 95 percent all developed hypoxemia during the procedure. In this subset of patients, there was a higher incidence of cigarette smoking (p = 0.02), chronic lung disease (p = 0.04), higher left ventricular diastolic pressure (p = 0.02), and lower ejection fraction (p = 0.002) when compared with the 83 remaining patients undergoing diagnostic catheterization with a baseline SpO2 > 95 percent. Phase 2--Oxygen therapy was associated with a reduction in the incidence of hypoxemia from 42 percent to 5 percent (RA vs O2, p < 0.001) in the diagnostic catheterization group and 39 percent to 11 percent (RA vs O2, p < 0.03) in the PTCA group. CONCLUSIONS: Significant hypoxemia is a common finding among patients undergoing cardiac catheterization or angioplasty despite the absence of predictive risk factors. Severe and prolonged hypoxemic episodes occurred in 10 percent (14/142, phase 1) of patients breathing room air. Patients undergoing diagnostic catheterization with history of chronic lung disease or a baseline SpO2 < 95 percent are at high risk to develop moderate-severe hypoxemia. Oxygen therapy significantly reduced the incidence and severity of procedure-induced hypoxemia in both groups. Our data support the use of both pulse oximetry and oxygen supplementation in patients undergoing cardiac catheterization and PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1993

Potentially misleading bone scan findings in patients with hepatoblastoma.

Eleven patients who underwent nuclear medicine bone scanning were reviewed to determine the incidence of bone scan abnormalities associated with hepatoblastoma. Of these, six patients had abnormal bone scan findings--four with focal involvement. Correlating plain radiographs and/or follow-up nuclear bone scans were available for three of these four. All plain films indicated the presence of osteoporosis. Follow-up scans showed improvement or resolution of abnormalities. None of the patients had documented metastatic bone disease. While there has been no prior reported association, the authors attribute the abnormal bone scan findings to a paraneoplastic syndrome of osteoporosis associated with this primary tumor. They conclude that bone scanning is not routinely indicated in the initial diagnostic staging of hepatoblastoma.

Bone Neoplasms↗
PubMed1992

Magnetic resonance imaging of suspected atrial tumors.

Two-dimensional echocardiography has become the standard technique for evaluation of cardiac and paracardiac mass lesions. We have used magnetic resonance imaging (MRI) as an independent assessment of cardiac-associated masses in patients with echocardiograms demonstrating sessile atrial tumors. MRI was performed in seven patients, ages 33 to 84, whose echocardiographic diagnoses included left atrial mass (five), right atrial mass (one), and interatrial mass (one). In four of the patients with a diagnosis of left atrial mass, MRI showed extracardiac compression of the atrium, simulating a tumor (hiatal hernia, tortuous descending aorta, bronchogenic cyst). MRI was entirely normal in one patient with an apparent left atrial mass. MRI elucidated extension of an extracavitary mass into the interatrial septum in two patients. One of these patients with an echocardiographic right atrial mass had extension of a lipoma into the interatrial septum without atrial tumor. MRI confirmed the echocardiographic diagnosis of an interatrial mass in the other patient. We conclude that MRI, because of its ability to define anatomic relationships and tissue characteristics, is a powerful noninvasive tool for evaluating suspected cardiac mass lesions. Although echocardiography remains the primary screening test for the detection of cardiac masses, MRI is a more specific modality for precise diagnosis. Correct MRI interpretation may obviate the need for invasive studies or surgery.

Adult↗
PubMed1992

Emotional disclosure about traumas and its relation to health: effects of previous disclosure and trauma severity.

This study sought to replicate previous findings that disclosing traumas improves physical health and to compare the effects of revealing previously disclosed versus undisclosed traumas. According to inhibition theory, reporting about undisclosed traumas should produce greater health benefits. Sixty healthy undergraduates wrote about undisclosed traumas, previously disclosed traumas, or trivial events. Contrary to expectations, there were no significant between-groups differences on longer term health utilization and physical symptom measures. However, Ss who disclosed more severe traumas reported fewer physical symptoms in the months following the study, compared with low-severity trauma Ss, and tended to report fewer symptoms than control Ss. Results suggest that health benefits occur when severe traumas are disclosed, regardless of whether previous disclosure has occurred.

Adaptation, Psychological↗
PubMed1992

Coronary angioplasty performed within the thrombolysis in Myocardial Infarction II study.

BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related artery was performed within 42 days of recombinant tissue-type plasminogen activator (rt-PA) administration in 1,414 of the 3,534 patients who participated in the Thrombolysis In Myocardial Infarction (TIMI) II study. Primary angiographic success was obtained in 88.7%, with bypass surgery within 24 hours in 3.3% and death within 24 hours in 0.7% of patients. By 1 year, 25.1% of the 1,414 patients had sustained one or more adverse outcomes including death (3.6%), reinfarction (8.4%), or the need for further revascularization (20%). METHODS AND RESULTS: Despite these generally favorable results, multivariate testing identified several anatomic and clinical subgroups as having an increased risk ratio (RR) for adverse outcome: Unsuccessful PTCA was more common in patients undergoing protocol-assigned PTCA within 2 hours of rt-PA administration (RR, 2.7; p less than 0.001) and in patients over age 70 years (RR, 1.7; p = 0.034). The need for further revascularization within 1 year was increased in the 30.4% of patients with multivessel disease (RR, 2.5; p less than 0.001), patients with prior angina (RR, 1.4; p less than 0.006), or those undergoing ischemia-driven PTCA within 15 hours of rt-PA administration (RR, 1.7; p = 0.022). The risk of death or recurrent infarction within 1 year was increased by the presence of multivessel disease (RR, 1.6; p = 0.007) or prior angina (RR, 1.5; p = 0.014). CONCLUSIONS: These observations do not necessarily apply to patients undergoing primary PTCA (or PTCA after other thrombolytic agents); however, they do offer a unique yardstick against which to evaluate the results of PTCA in myocardial infarction.

Angioplasty, Balloon, Coronary↗
PubMed1992

One-year results of the Thrombolysis in Myocardial Infarction investigation (TIMI) Phase II Trial.

BACKGROUND: The Thrombolysis in Myocardial Infarction (TIMI) Phase II Trial randomized 3,339 patients to either an invasive (INV, n = 1,681) or a conservative (CON, n = 1,658) strategy after intravenous recombinant tissue-type plasminogen activator (rt-PA) for acute myocardial infarction. METHODS AND RESULTS: The patients assigned to the INV strategy routinely underwent cardiac catheterization, and when anatomically appropriate, percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting 18-48 hours after infarction. CON patients had these procedures only in response to the occurrence of spontaneous or provoked ischemia. One-year follow-up data are available in 3,316 patients (99.3%). The primary trial end point, death and nonfatal reinfarction, occurred in 14.7% of INV patients and in 15.2% of CON patients (p = NS). When analyzed individually, there was no difference (p = NS) in death (INV, 6.9%; CON, 7.4%) or recurrent infarction (INV, 9.4%; CON, 9.8%) between the two groups. Anginal status at 1 year was also similar. Cardiac catheterization and PTCA were performed more often in INV (98.0% and 61.2%, respectively) compared with CON (45.2% and 20.5%, respectively) patients. At 1 year, the cumulative number of patients who underwent coronary bypass surgery (INV, 17.5%; CON, 17.3%) was similar in the two groups. CONCLUSIONS: The INV and CON strategies resulted in similar favorable outcomes at 1 year of follow-up. In particular, the rates of mortality and reinfarction were not different and were impressively low in both groups. One possible advantage of the INV strategy was detected in subgroup analyses. In patients with a history of myocardial infarction, the data are suggestive that 1-year mortality was lower in INV patients (10.3%) than in CON patients (17.0%) (p = 0.03).

Angioplasty, Balloon, Coronary↗
PubMed1991

Self-report, situation-specific coping questionnaires: what are they measuring?

Self-report, situation-specific assessments of coping, such as the Ways of Coping Scale (WOC), have been used frequently in recent years. Several potential issues in the development and use of these questionnaires have been identified, including the applicability of coping items to different kinds of stressful events, the definition of the period for which Ss report coping efforts, and the meaning of the "extent" response key that is used for reporting coping items. In this study, 91 college students completed the WOC and were then interviewed about their responses; interview questions were focused on the 3 issues stated above. The hypothesized concerns about the WOC were supported. Many of the coping items were not applicable to certain kinds of stressful events. Also, how the coping report period was defined varied across Ss and the way in which the extent response key was interpreted differed across both Ss and WOC items.

Adaptation, Psychological↗