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Biomedical subjects

R C Starling

Publications and source records attributed to R C Starling.

At least 73 records · Page 4Linked to original sources
PubMed1993

Timing of recipient atrial contraction: a major determinant of transmitral diastolic flow in orthotopic cardiac transplantation.

The effect of recipient left atrial contraction on diastolic transmitral flow was studied in eight asymptomatic heart transplant patients (seven men and one woman, mean age 51.8 +/- 9.7 years) with normal left ventricular systolic function. The transmitral flow velocity profile was evaluated in 326 beats (mean 40.8 +/- 12 beats, range 20 to 58 beats/patient). Recipient left atrial contraction was classified as early diastolic, late diastolic, and systolic. Results showed: (1) early diastolic transmitral flow velocity integral (in centimeters) was lower (p < 0.05) following late diastolic recipient left atrial contractions (7.5 +/- 2.1) compared with early diastolic (10.1 +/- 2.7) or systolic (8.5 +/- 1.5) recipient left atrial contractions; (2) late diastolic transmitral flow velocity integral was higher following late diastolic (4.7 +/- 1.8) compared with systolic (4.1 +/- 1.9) recipient left atrial contractions and was virtually abolished (0.45 +/- 14) following early diastolic recipient left atrial contractions; and (3) total diastolic transmitral flow velocity integral was significantly higher (p < 0.05) following late diastolic and systolic (12.2 +/- 2.8 and 12.0 +/- 2.5) compared with early diastolic left atrial contractions (10.5 +/- 2.8). Thus recipient left atrial contraction is a significant determinant of the transmitral diastolic flow pattern in heart transplant patients. Variations in the timing of recipient left atrial contraction may lead to fluctuations of diastolic flow and may compromise cardiac output.

Adult↗
PubMed1993

Echocardiographic evaluation of pulmonary artery distensibility.

The aim of this study was to verify the hypothesis that pulmonary artery (PA) distensibility may modify the pattern of right ventricular ejection. Pulmonary artery distensibility was evaluated with M-mode measurements of right pulmonary artery diameter from suprasternal notch simultaneous with pulmonary pressure measurements. Pulmonary artery pressure was measured in 19 subjects, 29 to 75 years old (mean age, 49 years). Pulmonary artery systolic pressure was 22 to 108 mm Hg (mean, 52 mm Hg). Pulmonary artery pressure strain modulus (Ep) was calculated as follows: PADD x (PASP-PADP)/PADD-PADS (PADS-PA diameter in systole, PADD-PA diameter in diastole, PASP-PA systolic pressure, PADP-PA diastolic pressure) was 6 +/- 8 10(5) dynes/cm2. Right ventricular outflow tract velocity was recorded with pulsed Doppler echocardiography and acceleration times (AT) and ejection times (ET) were measured. Log Ep was correlated with pulmonary artery systolic and mean pressure (r = 0.90 and r = 0.87, p < 0.0001) but not with age (r = 0.30, p = NS). Acceleration time and AT/ET ratio were correlated with log Ep (r = 0.73 and r = 0.76, p < 0.001) and with pulmonary artery mean pressure (r = 0.91 and r = 0.89, p < 0.0001). When pulmonary artery pressure was included in multiple analyses, the relationships between Doppler indices and elastic modulus did not prove to be significant. These findings emphasize the independence of Doppler right ventricular outflow tract velocity indexes used for noninvasive evaluation of pulmonary hypertension from pulmonary artery distensibility in a clinical setting.

Adult↗
PubMed1992

Cyclosporin inhibits mitochondrial calcium efflux in isolated adult rat ventricular cardiomyocytes.

Exchangeable intracellular Ca2+ as measured by 45Ca2+ uptake more than doubled when isolated adult rat ventricular cardiomyocytes were incubated 30 min with 8 microM cyclosporin; nevertheless the cells retained a normal rod-shaped morphology. High concentrations of ouabain caused a similar increase in 45Ca2+ uptake, but in this case the Ca2+ overload caused nearly all cells to hypercontract into a round disorganized form. The response to cyclosporin was concentration dependent with an apparent half-maximal effective concentration of 0.5 microM for enhancement of net 45Ca2+ accumulation. Verapamil (1 microM) could not inhibit this cyclosporin effect, but it was abolished by a 5-min preincubation with 12 microM crude ruthenium red. Cyclosporin also decreased the rate of 45Ca2+ efflux from prelabeled myocytes into Ca(2+)-containing and Ca(2+)-free media. These data are consistent with inhibition of mitochondrial 45Ca2+ efflux through the cyclosporin-sensitive mitochondrial inner membrane pore. It would appear that periodic transient increases in mitochondrial inner membrane permeability provide a pathway for mitochondrial Ca2+ extrusion under relatively normal conditions in isolated adult rat heart cells.

Animals↗
PubMed1991

Preserved atrial natriuretic peptide secretory function after cardiac transplantation.

The purpose of this investigation was to determine whether atrial natriuretic peptide (ANP) secretory function is preserved after cardiac transplantation. Thirteen hemodynamically stable outpatients performed supine exercise on a bicycle an average of 7 months after orthotopic cardiac transplantation. Right atrial pressure increased 2.2-fold (6 +/- 1 to 13 +/- 2 mm Hg) and pulmonary artery wedge pressure 2.1-fold (11 +/- 1 to 23 +/- 7 mm Hg) with exercise in the transplant recipients. Resting venous ANP level (114 +/- 19 pg/ml) and peak exercise venous level (373 +/- 61 pg/ml) was elevated in transplant recipients (p less than 0.001) compared with control subjects (21 +/- 1 and 92 +/- 14 pg/ml, respectively. This represents a 3.3-fold (114 +/- 19 to 373 +/- 61 pg/ml) increase in the ANP level from resting to exercise in transplant recipients and a 4.4-fold (21 +/- 1 to 92 +/- 14 pg/ml) increase in control subjects. A correlation between venous ANP levels and hemodynamics (right atrial pressure) was observed r = 0.49 p = 0.01. It is concluded that ANP levels at rest are elevated after cardiac transplant, the levels correlate with the intracardiac hemodynamics, and exercise-induced augmentation of plasma levels occurs.

Adult↗
PubMed1991

Empiric antibiotic selection by physicians: evaluation of reasoning strategies.

The objectives of the study were to evaluate the appropriateness of empiric antibiotic selection by housestaff treating medical patients with bacteremia. The design was a prospective, observational study at a university-affiliated hospital. Seventy-eight patients with bacteremia were evaluated. A clinical grade of acceptable or not acceptable was assigned to each antibiotic prescription by a consensus panel. The consensus panel found that 34.6% of antibiotic prescriptions were unacceptable (clinical grade). At least one flaw in the chain of reasoning was found in 56.4% of the 78 cases evaluated. Assessment of the clinical setting was correct in 94.9% of the cases; the portal of entry was identified in 91%; adequate knowledge of the bacterial flora at the suspected site of infection was found in 69%; the diagnostic workup was appropriate in 81%, and the correct antibiotic susceptibility patterns were given in 72%. A correct chain of reasoning was more likely to result in an acceptable clinical grade than flawed reasoning (p less than 0.005). However, an appropriate antibiotic selection was made by some physicians despite flawed reasoning, and inappropriate antibiotic selection occurred in a few cases despite fautless reasoning. In 3.8% of cases, unexpected organisms appeared in blood culture. Prescription of broad spectrum antibiotics may then be learned response. If so, educational efforts that emphasize narrow, rather than broad spectrum prescribing may be inadequate to change physician prescribing habits.

Anti-Bacterial Agents↗
PubMed1989

Disparity between improvement in left ventricular function and changes in clinical status and exercise capacity during chronic enoximone therapy.

Twenty patients with moderately severe congestive heart failure were randomized to chronic enoximone (n = 10) or placebo (n = 10) therapy in a double-blind manner and serially evaluated over a 16-week-period. The purpose of the study was to determine if the addition of standard doses (1 and 2 mg/kg) of this new phosphodiesterase inhibitor to conventional therapy (digitalis and diuretics) would alter the clinical and laboratory course of this patient population. Except for a transient improvement in the quality of life score, none of the symptomatology indicators were significantly affected by enoximone. Similarly, maximal exercise capacity was not altered. Enoximone did elicit a statistically significant augmentation of echocardiographic, radionuclide angiographic, and systolic time interval parameters of left ventricular function. These enoximone-induced effects were accompanied by a significant increase (7% to 11%) in resting heart rate. Enoximone is capable of improving ventricular function when added to digitalis-diuretic therapy in moderately severe congestive heart failure. While individual patients may benefit from enoximone, the ability of standard doses of this agent to improve symptoms and exercise capacity over a 16-week period appears somewhat limited in a moderately severe heart failure population as a whole. Furthermore, a disparity between improvement in ventricular function parameters and changes in clinical status and exercise performance is apparent in this heart failure population.

Adult↗
PubMed1986

Pneumococcal pericarditis. Diagnostic usefulness of counterimmunoelectrophoresis and computed tomographic scanning.

Although counterimmunoelectrophoresis (CIE) analysis of cerebrospinal fluid has proved useful in the diagnosis of meningitis, there has been little experience with its use in analyzing pericardial fluid. We describe two patients with pneumococcal pneumonia whose hospital course was complicated by purulent pericarditis. In one patient, results of a computed tomographic scan were important in suggesting the diagnosis. Results of a Gram's stain and culture of pericardial fluid failed to yield any organisms, presumably because both patients had received nine days of beta-lactam antibiotic therapy. However, the results from CIE analysis of pericardial fluid in both cases were positive for Streptococcus pneumoniae. In one patient, for whom capsular typing of the organism was performed, the pneumococcus type isolated from pericardial fluid matched the type isolated previously from a blood sample. The results of CIE can allow focused antibiotic therapy by establishing the correct diagnosis.

Antigens, Bacterial↗
PubMedDate not supplied

The heart failure pandemic: changing patterns, costs, and treatment strategies.

Heart failure is the most important public health problem in cardiovascular medicine, and is increasing in both prevalence and expense. Programs that use an interdisciplinary team to improve outpatient treatment and prevent hospitalizations will help improve care and control costs. But the most important long-term strategy for dealing with the heart failure pandemic is more aggressive primary and secondary prevention.

Adult↗