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Biomedical subjects

R J Kahn

Publications and source records attributed to R J Kahn.

At least 73 records · Page 4Linked to original sources
PubMed1986

Imipramine and chlordiazepoxide in depressive and anxiety disorders. I. Efficacy in depressed outpatients.

We randomly assigned 425 outpatients, independently classified as primarily depressed by two trained psychiatrists, to double-blind treatment with Imipramine hydrochloride, chlordiazepoxide hydrochloride, or placebo. Those patients who remained at least moderately depressed (following a two-week placebo washout period) were treated for an additional eight weeks. An endpoint analysis of 387 patients who completed two or more weeks of medication disclosed early therapeutic advantages of chlordiazepoxide. By week 4 of treatment, however, imipramine produced more improvement than did placebo and chlordiazepoxide. By six and eight weeks a general, marked therapeutic advantage was found for imipramine relative to placebo and to chlordiazepoxide on measures of depression, anxiety, anger-hostility, interpersonal sensitivity, and global improvement. Chlordiazepoxide-treated patients generally did significantly better on sleep difficulty but significantly worse on anger-hostility and interpersonal sensitivity than did imipramine- or placebo-treated patients.

Adult↗
PubMed1986

Imipramine and chlordiazepoxide in depressive and anxiety disorders. II. Efficacy in anxious outpatients.

A double-blind, placebo-controlled comparison at three collaborating university sites included 242 patients diagnosed as having anxiety disorders. A two-week placebo washout period preceded random assignment to eight weeks of imipramine hydrochloride, chlordiazepoxide hydrochloride, or placebo treatment. Antianxiety effects of imipramine were superior to those of the other two agents by the second treatment week; these effects became more clearly significant thereafter and were independent of degree of both baseline depression and anxiety. Excluding patients with possible panic-phobic syndromes from the analyses removed most significant antiphobic and antidepressant effects of imipramine but left intact imipramine's significantly superior antianxiety effects.

Adult↗
PubMed1986

Thermodilution measurement of right ventricular ejection fraction with a modified pulmonary artery catheter.

In 14 critically ill patients in stable cardiopulmonary status, right ventricular ejection fraction (RVEF) was measured by thermodilution technique and by radionuclear (gated first pass) technique. The pulmonary artery catheter was equipped with a fast-response thermistor and an intracardiac ECG monitor. In addition, the proximal lumen ended in a 3-hole port 21 cm from the tip of the catheter to facilitate mixing of the cold bolus above the tricuspid valve. The use of a new algorithm based on an exponential curve analysis of the thermodilution curve limited the variability of RVEF determinations to 7.6%. The correlation between RVEF measured by thermodilution and radionuclear techniques was significant (y = 12.7 +/- 0.49x, r = 0.67, p less than 0.01). However, the values obtained by thermodilution were usually lower, especially for high RVEF. Nevertheless, although some discrepancy was found, thermodilution techniques allow simple, accurate and repetitive bedside measurements of right ventricular volumes in the critically ill.

Cardiac Catheterization↗
PubMed1986

Refractory hyperdynamic shock associated with alcohol and disulfiram.

After massive alcohol intake, a patient under disulfiram therapy developed a severe cardiovascular collapse unresponsive to dopamine but successfully reversed with norepinephrine. Resistance to dopamine could be related to norepinephrine depletion caused by disulfiram. Norepinephrine could, therefore, represent the treatment of choice of these life-threatening conditions.

Disulfiram↗
PubMed1985

Hypophosphatemia after cardiothoracic surgery.

The incidence of hypophosphatemia during the first 48 h following cardiothoracic surgery was prospectively studied in 74 patients. Hypophosphatemia, defined by a serum phosphate below 2.50 mg/dl, was observed in 19 of 34 (56%) patients after thoracic surgery and in 20 of 40 (50%) patients after cardiac surgery. As a whole, hypophosphatemia occurred earlier after thoracic than after cardiac surgery. After thoracic surgery, hypophosphatemia was milder for patients in whom bleeding was more severe. The anticoagulant solution CPD used in stored blood was identified as an important source of phosphate. These results indicate hypophosphatemia is a common finding after cardiothoracic surgery. Since severe hypophosphatemia can be related to phosphate depletion, phosphate supplements could be warranted especially during thoracic surgery when blood transfusions are less than 1000 ml.

Adult↗
PubMed1985

Synergistic necrotizing cellulitis after pneumonectomy.

Synergistic necrotizing cellulitis is a rapidly progressive infection of subcutaneous tissues and muscles. We report a rare case of synergistic necrotizing cellulitis of the chest wall occurring after a pneumonectomy in a patient without any predisposing factors. Despite rapid and aggressive treatment, the patient died in acute respiratory failure 28 h after the first signs of sepsis.

Cellulitis↗
PubMed1985

Hydrochloric acid infusion for treatment of metabolic alkalosis: effects on acid-base balance and oxygenation.

The effects of hydrochloric acid (HCl) administration were studied in 15 critically ill patients whose metabolic alkalosis caused a significant alkalemia (pH 7.50 to 7.58) unresponsive to sodium and potassium chloride administration. Arterial pH and bicarbonate and chloride concentrations normalized after a 6- to 12-h mean infusion of 200 +/- 54 mmol of .25 N HCl. There were no deleterious vascular, hematologic, or metabolic side-effects. HCl administration was associated with an increase in mean PaO2 from 94 +/- 21 to 121 +/- 31 torr (p less than .001). This increase was comparable in patients breathing spontaneously and those treated with controlled mechanical ventilation, and was attributed at least in part to a decrease in pulmonary shunt. These results indicate that .25 N HCl, infused at the rate of 100 ml/h into the superior vena cava, can correct metabolic alkalosis safely and rapidly. The persistence of the beneficial effects of this treatment on arterial oxygenation remains to be confirmed.

Acid-Base Equilibrium↗
PubMed1985

Prevention of the adult respiratory distress syndrome with dipyridamole.

Because the formation of platelet thrombi has been incriminated in the development of the adult respiratory distress syndrome (ARDS), we tested the hypothesis that early administration of antiplatelet agents might protect the lungs in patients at risk to develop ARDS after circulatory shock. This double-blinded study included 40 patients treated with either 3 mg/kg . 24 h of dipyridamole or a corresponding dose of placebo after an episode of hemorrhagic, traumatic, or septic shock. Each patient also received 100 mg of aspirin daily. Arterial blood gases and chest x-rays were not significantly different between dipyridamole and placebo groups. Moreover, two patients receiving dipyridamole but none receiving placebo developed ARDS. This pilot study does not support a beneficial effect of dipyridamole in the prevention of ARDS after circulatory shock.

Adult↗
PubMed1985

Administration of dazoxiben, a selective thromboxane synthetase inhibitor, in the adult respiratory distress syndrome.

Experimental studies suggest that thromboxane A2 could play a role in the pulmonary hypertension of the adult respiratory distress syndrome (ARDS). We therefore investigated the hemodynamic and gasometric effects of dazoxiben, a selective thromboxane synthetase inhibitor, in seven patients who had developed ARDS. The patients were studied for 120 minutes after a single intravenous bolus of 1.5 mg of dazoxiben per kilogram of body weight. During this period, there was no change in pulmonary hemodynamics, a moderate increase in arterial oxygen pressure, and a slight decrease in venous admixture. Therefore, administration of dazoxiben in patients with ARDS does not decrease pulmonary hypertension. This study does not support the role of thromboxane A2 as an important mediator in pulmonary hypertension in human ARDS, at least once the syndrome has been recognized.

Adult↗
PubMed1984

Amoxapine and amitriptyline. I. Relative speed of antidepressant action.

Speed of onset of antidepressant effect was studied in 20 depressed outpatients assigned double-blind to equipotent doses of amoxapine or amitriptyline. In counter-balanced order, each patient had 2 periods of 3 weeks on active agent interspersed with 2 similar periods of placebo control. On daily and weekly self-ratings, amoxapine was found to reduce symptoms significantly more rapidly than amitriptyline. Psychiatrist-ratings were consonant with self-reports.

Adult↗
PubMed1984

Amoxapine and amitriptyline. II. Specificity of cognitive effects during brief treatment of depression.

Cognitive effects of brief antidepressant treatments were studied in depressed outpatients assigned double-blind to equipotent doses of amoxapine or amitriptyline in a 12-week double-crossover of 3-week periods of active agent and placebo. The two drugs had different profiles of effects: amitriptyline was associated with faster reaction time on tests of attention and immediate memory, reduced accuracy on an attention task, and impaired long-term memory (after 1 but not 3 weeks); amoxapine slowed performance and increased intraperson variability on a psychomotor coordination task. Amitriptyline facilitated performance in the more depressed patients, and amoxapine in the older patients. Both agents also increased pulse rate and reduced palmar sweating.

Amitriptyline↗
PubMed1984

Bretylium in severe ventricular arrhythmias associated with digitalis intoxication.

Bretylium has been well-recognized as an effective antiarrhythmic agent for acute ventricular arrhythmias, but its use is believed to be contraindicated in digitalis intoxication. We report of two patients in whom digitalis-induced malignant ventricular arrhythmias were refractory to lidocaine. One patient had had repeated episodes of ventricular fibrillation associated with digitoxin and quinidine intoxication, and one patient had had malignant premature ventricular beats associated with digoxin intoxication. Cardiac electrical activity was paced in both instances. In the two patients, ventricular arrhythmias rapidly resolved, and no side effect was encountered. These observations support the administration of bretylium for severe digitalis-induced ventricular arrhythmias.

Aged↗
PubMed1984

Administration of sulmazol in low-output states following cardiac surgery.

Sulmazol (AR-L 115BS), a phenylimidazopyridine derivative, which combines positive inotropic and vasodilating properties, was administered to nine patients who had a low cardiac output state (cardiac index below 2.0 L/min/m2) within 24 hours after cardiac surgery for valvular replacement (eight patients) or septal repair after myocardial infarction (one patient). Sulmazol, administered as a 60-minute infusion of 1.8 mg/min, resulted in significant increases in cardiac output and cardiac work, associated with significant decreases in cardiac filling pressures. Arterial pressure did not change notably, and systemic vascular resistance decreased significantly. A small but significant increase in heart rate was also observed. By its combined inotropic and vasodilating properties, sulmazol can be helpful in the management of low-output states after cardiac surgery.

Aged↗