PubMed Health⌕ Search

Biomedical subjects

R J Adolph

Publications and source records attributed to R J Adolph.

At least 19 recordsLinked to original sources
PubMed1990

Myocarditis: unresolved issues in diagnosis and treatment.

Myocarditis is an enigmatic disease. Lymphocytic myocarditis is most commonly viral in origin. Considerable evidence suggests that myocardial damage is due to an immune-mediated mechanism rather than to direct effects of the virus itself. The presentation is variable, ranging from a clinically inapparent or relatively benign illness to acute progressive heart failure and death. Although examination of the endomyocardial biopsy specimen is the "gold standard" for the diagnosis of myocarditis there are problems with this technique, relating particularly to sampling error and histologic interpretation. Considerable evidence, both animal and human, suggests that a link between viral myocarditis and dilated cardiomyopathy does exist. There is a rational basis for the use of immunosuppressive therapy in myocarditis. Although many favorable responses have been reported with the use of these agents, the results of more definitive studies are awaited to determine the role of immunosuppressive therapy in myocarditis more clearly. Recommendations for the practical management of patients with myocarditis are made. Whenever possible, patients with this diagnosis should be entered into the ongoing NIH trial.

Animals↗
PubMed1987

Cost-effectiveness analysis of patient management alternatives after uncomplicated myocardial infarction: a model.

Quantitative decision analyses provide a means whereby the effectiveness, in terms of patient outcome, and costs of diverse clinical approaches to the care of patients with cardiovascular disease can be made explicit and understandable. Increasingly, the profession is being required to justify the costs of clinical care to society, government and third party payers. Such justifications can be effectively presented when structured in decision analytic format. To demonstrate the utility of decision analysis and its extension--cost-effectiveness analysis--as a technique for presenting the rationale for clinical practices and technology utilization, the Cardiovascular Norms Committee of the American College of Cardiology sponsored a model cost-effectiveness analysis. Alternative management options, 6 month mortality and costs for the post-myocardial infarction patient were compared. The options included exercise electrocardiography, exercise thallium scintigraphy and coronary angiography, followed by coronary artery bypass surgery for patients with left main coronary disease only or patients with left main disease, three vessel disease or single or double vessel disease and a significant amount of myocardium in jeopardy. Within the constraints of the model, proceeding directly to angiography for risk stratification was the most effective approach, lowering expected mortality from 8% to approximately 3%. The marginal costs for this strategy, however, were high. The most cost-effective approach was to screen patients initially with exercise electrocardiography.

Angiography↗
PubMed1985

Cardiac prognosis in noncardiac geriatric surgery.

Predictors of perioperative complications, including cardiac death, ventricular tachycardia or fibrillation, and heart failure or myocardial infarction, were assessed in an initial study of 100 patients aged 65 years or older scheduled for elective abdominal or noncardiac thoracic surgery. Preoperative history, results of physical examination, chest roentgenogram, electrocardiogram, laboratory data, Dripps (American Society of Anesthesiologists) class, and Goldman cardiac risk index were compared with rest and exercise radionuclide ventriculograms. Thirteen patients had perioperative cardiac complications, and 6 died. Multivariate analysis showed that an inability to do 2 minutes of bicycle exercise in the supine position to raise the heart rate above 99 beats/min (sensitivity 85%, specificity 64%) gave predictive information not available from clinical or radionuclide data. On prospective testing involving 55 additional geriatric patients, inability to exercise was the only independent predictor of perioperative complications (p less than 0.05). Data from rest and exercise radionuclide ventriculography added little information for predicting perioperative cardiac risk.

Abdomen↗
PubMed1984

Myocardial scintigraphy with 99mTc-tris-DMPE in man.

Cardiac scintigraphy was performed in six patients with a documented previous myocardial infarction, in one patient with mitral regurgitation, and in four healthy volunteers following administration of 99mTc-tris-DMPE. An intense early blood pool phase permitted gated blood pool scintigraphy and left ventricular ejection fraction calculation. A myocardial phase 12-14 h later permitted myocardial perfusion imaging. The rest myocardial perfusion image quality with 99mTc-tris-DMPE appeared to be superior to the resting image quality obtained with 99mTc-dichloro-DMPE but was inferior to the resting image quality obtained with 201Tl.

Aged↗
PubMed1984

Effects of dynamic and isometric exercise on the radionuclide-determined regurgitant fraction in aortic insufficiency.

Twenty-five patients with aortic insufficiency and eight asymptomatic control subjects underwent radionuclide ventriculography at rest and during dynamic and isometric exercise to clarify the mechanisms for preservation of exercise capacity in aortic insufficiency. Regardless of symptomatic state or severity of regurgitation, patients with aortic insufficiency had no significant increase in left ventricular ejection fraction or relative left ventricular end-diastolic volume during dynamic or isometric exercise. The radionuclide stroke count ratio (ratio of left ventricular to right ventricular stroke counts) progressively decreased in patients with aortic insufficiency from 2.98 +/- 1.14 (mean +/- 1 standard deviation) at a mean heart rate at rest of 69.6 beats/min to 2.48 +/- 0.59 (p = not significant [NS]) at a mean submaximal bicycle exercise heart rate of 129 beats/min and to 1.97 +/- 0.57 (p less than 0.005) at a mean maximal bicycle exercise heart rate of 145 beats/min. The decrease in stroke count ratio with bicycle exercise was significantly related to the severity of valvular regurgitation at rest (p less than 0.005). Although achieving lower bicycle exercise heart rates and comparable diastolic blood pressures, symptomatic patients had a lower mean stroke count ratio compared with asymptomatic patients with aortic insufficiency, suggesting that an elevation left ventricular diastolic pressure significantly decreased the regurgitant fraction in symptomatic patients during bicycle exercise. In patients with aortic insufficiency, the mean heart rate (92 beats/min) was significantly lower with isometric exercise than during the submaximal stage of bicycle exercise (129 beats/min). However, diastolic blood pressures, left ventricular diastolic counts and ejection fractions were comparable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Myocardial perfusion imaging with 99mTc-DMPE in man.

Technetium-99m DMPE (99mTc-DMPE) is a newly synthesized myocardial perfusion imaging agent that shows intense myocardial accumulation in the dog. In the present study, dosimetry and potential clinical usefulness of this agent were assessed in four human subjects. Absorbed radiation doses were low, with the highest doses consisting of 200 mrad/mCi (54 microGy/MBq) to the gallbladder and 160 mrad/mCi (43 microGy/MBq) to the liver. No evidence of clinical toxicity was found. Technetium-99m DMPE did image the myocardium, but the ratio of target to nontarget activity was less favorable than that observed in the dog. Intense hepatic 99mTc-DMPE activity interfered with clinical imaging of the cardiac apex in two of the four subjects. We conclude that the prototype radiopharmaceutical, 99mTc-DMPE, is capable of myocardial perfusion imaging in man but the planar myocardial images produced are of inferior quality compared with 201Tl myocardial images. Further work is justified to develop related compounds to overcome the clinical limitations described.

Adult↗