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Biomedical subjects

M A Munger

Publications and source records attributed to M A Munger.

47 records · Page 3Linked to original sources
PubMed1986

Composition of cardioplegic solutions used in nine medical centers.

Eleven institutions that participated in the Coronary Artery Surgery Study (CASS) were surveyed to obtain information about the types of cardioplegic solutions used at these institutions. A short-answer questionnaire designed to obtain specific information about the composition and method of preparation of cardioplegic solutions was sent to each institution. Institutions that did not reply within four weeks were sent a second questionnaire. Nine institutions returned completed questionnaires. Four institutions used several different cardioplegic solutions, resulting in a total of 14 evaluable solutions. Six hospitals used a chemical-based cardioplegic solution, one used a blood-based solution, and two used a combination of blood and chemicals as a cardioplegic-solution base. Chloride and potassium were found in all 14 solutions, although the amounts varied widely. Dextrose was included in eight of the nine chemical-based solutions, and bicarbonate and sodium were each used in seven of the nine solutions. Centers using chemical-based cardioplegic solutions compounded them daily or froze them with a one-week expiration date; blood-based solutions had to be prepared daily. Although interinstitutional differences in dosage were evident, the cardioplegic solutions used in the institutions participating in the CASS had many similar components. Data on the composition of these solutions can be used as a guideline for developing a cardioplegic solution.

Academic Medical Centers↗
PubMedDate not supplied

Effect of long-term angiotensin-converting enzyme inhibitor therapy on arterial oxygen saturation in patients with mild to moderate heart failure.

STUDY OBJECTIVE: To evaluate the effects of angiotensin-converting enzyme (ACE) inhibition on continuous pulse oximetry recordings of arterial oxygen saturation (SpO2). DESIGN: Open-label study. SETTING: Cardiology clinics at two large teaching hospitals. PATIENTS: Eight patients with New York Heart Association Functional Class (NYHA FC) II-III heart failure. INTERVENTIONS: Patients were studied after an ACE inhibitor washout (baseline, B), and after 3 months following resumption of therapy (ACE). MEASUREMENTS AND MAIN RESULTS: Monitoring times for B and ACEI were approximately 22 hours. Reduction trends were observed for number (190 +/- 170 vs 125 +/- 67 B vs ACEI), magnitude (8.2 +/- 1.4% vs 7.5 +/- 1.8%), and duration (2.45 +/- 2.8 vs 1.35 +/- 0.8 min) of desaturations/monitoring period, and for nadir SpO2/desaturation (88.1 +/- 1.5% vs 89.9 +/- 3.3%). The B desaturation index [(cumulative desaturation time/monitoring period time) x 100, a measure of hypoxic stress or burden] decreased from 19.4 +/- 8.1% to 11.9 +/- 8.1% at ACEI (p = 0.024). CONCLUSION: Long-term ACE inhibitor therapy improves the profile of SpO2 values over time in patients with NYHA FC II-III heart failure.

Adolescent↗
PubMedDate not supplied

Effect of intravenous fructose-1,6-diphosphate on myocardial contractility in patients with left ventricular dysfunction.

STUDY OBJECTIVE: To examine the effects of fructose-1,6-diphosphate on myocardial performance using nuclear scintigraphy. DESIGN: Prospective, randomized, single-blind, parallel study. SETTING: Urban teaching hospital clinical research center. PATIENTS: Individuals with New York Heart Association functional class II-III heart failure (mild to moderate). INTERVENTIONS: Subjects received either intravenous fructose-1,6-diphosphate 125 mg/kg or normal saline 1.3 ml/kg every 12 hours over 10 minutes for four consecutive doses. Left ventricular performance was assessed by radionuclide ventriculography at baseline and within 60 minutes after the fourth infusion. Vital signs were monitored throughout the study period. MEASUREMENTS AND MAIN RESULTS: Fructose-1,6-diphosphate resulted in a modest 7% increase in left ventricular ejection fraction (p < 0.05). Peak ejection rate and peak diastolic filling rate did not change significantly. There were no changes in blood pressure or heart rate with either fructose-1,6-diphosphate or placebo. CONCLUSIONS: Fructose-1,6-diphosphate produces a modest but significant increase in left ventricular ejection fraction in patients with mild to moderate heart failure.

Adult↗
PubMedDate not supplied

Invasive pharmacodynamic characterization of combined ibopamine and calcium blocker therapy for heart failure.

STUDY OBJECTIVE: To determine the acute hemodynamic response of single-dose coadministration of ibopamine plus nifedipine or diltiazem in patients with New York Heart Association functional class (NYHA FC) II-III congestive heart failure. DESIGN: A single-blind, placebo-controlled, two-paired, crossover study. SETTING: Cardiology clinics at two large teaching hospitals. PATIENTS: Eight patients with NYHA FC II-III congestive heart failure who met the inclusion criteria were selected randomly. INTERVENTIONS: All patients underwent right heart catheterization. Day 1 consisted of concomitant calcium channel blocker plus placebo, with cardiac and peripheral hemodynamic recordings from 30 minutes-24 hours. The design was equivalent on day 2, with single-dose administration of ibopamine plus calcium channel blocker. MEASUREMENTS AND MAIN RESULTS: Single-dose nifedipine-diltiazem augmented cardiac output and stroke volume secondary to decreasing systemic vascular resistance. The nifedipine-ibopamine and diltiazem-ibopamine subgroups demonstrated relatively equal hemodynamics, augmenting cardiac index (nifedipine 43%, p < 0.05; diltiazem 40%, p < 0.05 vs baseline) while decreasing systemic vascular resistance (nifedipine 41%, p < 0.05; diltiazem 28%, p NS vs baseline) 30 minutes after the dose. In contrast to single-dose diltiazem, the diltiazem-ibopamine subgroup exhibited an increased left ventricular filling pressure (122%, p < 0.05 vs baseline) and mean pulmonary artery pressure (43%, p < 0.05 vs baseline) at 30 minutes after the dose. One patient experienced a transient episode of chest pain associated with increased heart rate and blood pressure with diltiazem-ibopamine. CONCLUSION: Diltiazem and ibopamine should be coadministered with caution in patients with coronary artery disease and left ventricular dysfunction.

Adult↗
PubMedDate not supplied

Angiotensin II receptor blockers: novel therapy for heart failure?

Heart failure is a severe, disabling disease that portends a short life expectancy. This grave prognosis may be explained by growth-promoting effects of angiotensin II implicated in heart failure that mediate a genetic response called programmed cell death. The effects of angiotensin II are inhibited by angiotensin-converting enzyme (ACE) inhibitors, which improve exercise performance and quality of life, attenuate disease progression, and modestly lengthen survival. Unfortunately, mortality remains exceedingly high and may be partly attributable to augmented production of angiotensin II from a non-ACE chymase pathway. Angiotensin II production may therefore increase despite treatment with ACE inhibitors. The angiotensin II receptor antagonists are a new class of nonpeptide-reversible inhibitors that may offer clinical promise in heart failure through blockade of angiotensin II actions, whether produced from ACE or non-ACE chymase pathways.

Adult↗
PubMedDate not supplied

Fatality due to intravenous diltiazem for acute ventricular rate control.

Progressive, sustained bradycardia resulting in asystole and subsequent death is reported in a 70-year-old woman with hyperkalemia and suspected digoxin toxicity following a 0.25 mg/kg intravenous diltiazem dose for treatment of atrial fibrillation with a rapid ventricular response. The possible pharmacodynamic and pharmacokinetic interactions between diltiazem, digoxin, and an elevated plasma potassium concentration are discussed and related to the outcome of the case. The routine practice of concomitant administration of diltiazem for rapid ventricular rate control and digoxin for long-term control may be dangerous in a subset of patients.

Aged↗
PubMedDate not supplied

Comparison of publication rates for basic sciences versus practice from pharmacy-based grant programs.

The future of a profession in an era of scarce resources depends on maintaining a focus on science. The times demand that pharmacy practice examine its commitment to science. To address this concern, pharmacy practice-based research awards from the American College of Clinical Pharmacy Research Institute Award Program, American Society of Health-System Pharmacists Research and Education Foundation Grant Program, and American Association of Colleges of Pharmacy New Investigator Program were compared with basic sciences awards from the American Association Colleges of Pharmacy New Investigator Program from their inception to 1991 to determine the percentage of awarded grants successfully published (publication rate). Pharmacy practice published awarded grants at 46% (70/154) versus 62% (26/42) for basic sciences (p = 0.09). A significant decline of 37% in pharmacy practice publication rate was observed over the study period. Economically, an average of $11,393 was spent to publish one manuscript in pharmacy practice versus $8077 in basic sciences. The results suggest that pharmacy practice should redefine a paradigm of commitment to scholarship to provide firm evidence for supporting science and sustaining professional growth.

Financing, Organized↗
PubMedDate not supplied

High-dose versus standard-dose epinephrine treatment of cardiac arrest after failure of standard therapy.

STUDY OBJECTIVE: To assess the efficacy of high-dose epinephrine (HDE) compared with standard-dose epinephrine (SDE) in emergency department patients in cardiac arrest after SDE failed to improve asystole or ventricular fibrillation. DESIGN: Prospective, multicenter, blinded, controlled trial. SETTING: Eight academic center emergency departments. PATIENTS: One hundred forty patients treated for cardiac arrest. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were either improvement in cardiac rhythm or return of spontaneous circulation (ROSC). Of the 140 patients enrolled, 78 received HDE and 62 received SDE. Of the 34 patients with ventricular fibrillation, 3 were resuscitated with HDE and 2 with SDE (p = 0.60). Of those with asystole, ROSC occurred in 12 of HDE and 5 of SDE recipients (p = 0.11). No patient had return of significant neurologic function and none survived to hospital discharge. Overall, there was no advantage to HDE after failure of SDE. CONCLUSION: Our results are similar to those of controlled clinical trials comparing HDE with SDE in cardiac arrest.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

Carvedilol: therapeutic application and practice guidelines.

Current knowledge of the mechanisms contributing to progression of heart failure suggests that therapies that limit or interfere with the consequences of neurohormonal activation and improve myocardial energetics appear to be most beneficial. Carvedilol, a nonselective beta-adrenergic blocker with peripheral vasodilating properties, reduces mortality, slows progression of disease, and improves quality of life in patients with heart failure when added to standard therapy. When administered according to recommended guidelines, carvedilol is well tolerated. Clinical guidelines on the use of carvedilol in heart failure are provided.

Adrenergic beta-Antagonists↗