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Biomedical subjects

R F Zelis

Publications and source records attributed to R F Zelis.

At least 19 recordsLinked to original sources
PubMed1983

What is the appropriate "dress code" for the cardiac catheterization laboratory?

In order to determine the effect of the manner of dress by personnel and observers on cardiac catheterization-related infections, a retrospective survey was undertaken of 107,203 catheterization procedures done during the calendar year prior to this survey. An analysis of 55,976 cutdowns and 53,578 percutaneous procedures was performed (some subjects had both procedures performed). A total of 379 infections in 109,554 entrance sites were reported for an overall incidence of infection of 0.35%. There were 33 infections at the percutaneous site (incidence = 0.06%) and 346 at the cutdown site (incidence = 0.62%). The manner of dress of personnel not involved with catheter manipulation and of the observers had no relationship to the incidence of infection when the percutaneous technique was used. When cutdowns were performed, there was a lower incidence of infection in those laboratories where all personnel and observers were required to wear a mask, cap, and gown (17,311 cutdowns, 83 infections, 0.48% infection rate) than in those laboratories where none of these was required (15,170 cutdowns, 109 infections, 0.72% infection rate) (P less than 0.025). Laboratories which did 150 or less cutdowns/year had more infections than those laboratories performing more than 150/year (P less than 0.0001). Our data suggest that the risk of infection from cardiac catheterization is more closely correlated with the volume of studies done in the laboratory than in the manner of dress of the laboratory personnel and visitors in the laboratory. However, the wearing of full "sanitary clothing" will help decrease the infection rate in cutdowns.

Cardiac Catheterization↗
PubMed1982

The pharmacokinetics of diltiazem in healthy American men.

Plasma diltiazem concentration was determined for 24 hours after oral administration of 30, 60, 90 and 120 mg (sustained release tablets) in healthy adult white men. The plasma concentration was too low after the 30 mg dose to calculate pharmacokinetic variables. After administration of 60 mg (n = 12), 90 mg (n = 10), and 120 mg (n = 4), peak plasma concentrations were 72, 117, and 152 ng/cm3 and time to peak concentrations were 3.9, 3.3, and 4.0 hours, respectively. Half-lives for clearance from the plasma were 4.1, 5.1, and 5.6 hours and areas under the concentration-time curve were 514, 984, and 1258 ng/hour per cc, respectively. There was wide variability among patients after the administration of a single dose. The area under the curve also tended to increase more than the multiple of the dose administered. If the plasma diltiazem concentration is quantitatively related to efficacy and toxicity, then these data suggest that dosage requirements may vary considerably from patient to patient. Therefore, if a patient fails to respond sufficiently, the plasma drug concentration should be determined to see if adequate concentration has been attained. Alternatively, if the drug should prove to have a high therapeutic index, one might simply administer more than the usually required dose of diltiazem.

Administration, Oral↗
PubMed1980

Regional distribution of cardiac output in conscious rats at rest and during exercise. Effects of diltiazem.

The effects of intravenous infusion of the calcium antagonist, diltiazem (6, 30, and 150 mg/kg/hr) on cardiac and circulatory hemodynamics and on regional blood flow and cardiac output distribution to the major peripheral circulations were studied in conscious, normal Sprague-Dawley rats in the resting state. Therapy with diltiazem consistently increased cardiac output levels, as well as stroke volume, and decreased mean arterial pressure and systemic vascular resistance in a dose-related fashion. Diltiazem had a substantial effect on increasing coronary blood flow and reducing coronary vascular resistance. Effects of similar direction and magnitude were observed in the cerebral and hepatic arterial circulations. In a second study, rats were subjected to a submaximal treadmill exercise protocol during continuous intravenous infusion of either saline solution or diltiazem (DZ) in order to determine the effects of this agent on cardiac output distribution during exercise. The results indicate that the positive effects of diltiazem on cardiac output are maintained during exercise. The increase in cardiac output with diltiazem appears to be distributed throughout the major regional circulations in proportion to regional demand.

Animals↗
PubMed1979

Recurrent pulmonary emboli secondary to right atrial thrombus around a permanent pacing catheter: a case report and review of the literature.

This report describes the management of a woman with multiple pulmonary emboli secondary to a large right atrial clot which had formed around her permanent transvenous pacemaker. She continued to have pulmonary emboli despite adequate anticoagulation. Removal of the catheter and pacing required right atriotomy under cover of cardiopulmonary bypass. Additionally, eight English language case reports of symptomatic pericatheter thromboses are reviewed. In these cases, pericatheter clot resulted either in right-sided inlet obstruction or pulmonary emboli. The mortality rate was 75%. Although the cause for our patent's thromboembolic events is uncertain, congestive heart failure was a predisposing factor in 75% of the other reported cases. We suggest that pacemaker patients in congestive heart failure might benefit greatly from chronic anticoagulation.

Aged↗
PubMed1977

The changing status of ejection fraction as a predictor of early mortality following surgery for acquired heart disease.

Several reports in the literature and our experience prior to 1974 support the thesis that operative risk in patients with acquired heart disease and poor ventricular function (as assessed by a biplane ejection fraction [EF] less than or equal to 0.40) was very significantly increased over the risk in patients with normal ventricular function. These results led to disagreement in the literature regarding the advisability of surgery in patients with poor ventricular function. Various EFs from less than 0.31 to less than 0.50 were suggested as contradicting elective surgery, while more aggressive groups recommended surgery in all patients with angina. Precise comparison of the results reported by different groups was not always possible because of the common reliance on single-plane right anterior oblique ventriculograms, which tend to underestimate EF and overestimate operative risk. Using biplane ventribulograms for accurate estimation of EF, we have demonstrated a significant reduction in 30-day operative risk to a clinically acceptable 3 percent (1/32) for single valve replacement and aortocoronary surgery patients with poor ventricular function (EF less than or equal to 0.40) during 1974. Considering the high risk of medically treated patients with reduced ventricular function, these results support further evaluation of surgical palliation for patients with valvular or coronary heart disease and reduced ventricular function.

Cardiac Volume↗
PubMed1977

Echocardiographic diagnosis of intraventricular clot.

The literature contains many reports of the echocardiographic findings in left atrial myxoma and clot; however, descriptions of left ventricular thrombus or tumor are rare. We discuss here the echocardiographic findings in a patient with a large apical left ventricular thrombus which was confirmed both angiographically and pathologically. The importance of echocardiographically examining the area below the mitral valve near the apex of the left ventricle, where most of the thrombi are located, is stressed.

Diagnosis, Differential↗
PubMed1976

Myocardial performance and N2O analgesia in coronary-artery disease.

Inhalation of 40 per cent N2O by nine patients who had occlusive disease in two or more coronary arteries with elevation of left ventricular end-diastolic pressures (LVEDP) significantly decreased arterial pressure (average 5 per cent) and myocardial contractility as measured by dP/dt/CPIP (average 14 per cent), and increased LVEDP (average 21 per cent). N2O had no significant effect in four patients who had angina without angiographically demonstrable coronary arterial disease. It is concluded that N2O depresses myocardial function in patients who have occlusion of the coronary arteries and impaired left ventricular function.

Adult↗