Biomedical subjects

R Serokman

Publications and source records attributed to R Serokman.

8 recordsLinked to original sources

PubMed1988

Mechanism of death and prevalence of myocardial ischemic symptoms in the terminal event after acute myocardial infarction.

A prospective study to determine prognostic factors for risk stratification in 867 patients surviving the coronary care unit phase of acute myocardial infarction (AMI) is reported. During a 48-month follow-up, 144 patients (17%) died. The deaths were examined for the chronology, cause, mechanism, location and presence of myocardial ischemia in the terminal event. A classification previously proposed by Hinkle and Thaler was used to define the mechanism of cardiac death and the presence of ischemia. There were 113 deaths due to coronary atherosclerotic coronary artery disease, including 5 due to complications of coronary artery bypass graft surgery. Of the remaining 108 of these deaths, 74% were classified as due to an arrhythmic mechanism and 26% as myocardial failure. Of the deaths due to an arrhythmia or to myocardial failure, 56 (52%) occurred out of hospital. The ratio of arrhythmic: myocardial failure deaths was not different for the patients who died within 3 months after the index AMI compared with later deaths. Sudden death (less than or equal to 1 hour of new symptoms) was strongly associated with arrhythmic death but 32 (54%) of patients who died greater than 1 hour after the onset of symptoms were also classified as having an arrhythmic cause of death. Previously described risk factors, including an ejection fraction less than 0.40 and greater than or equal to 10 ventricular premature complexes/hour, were independent predictors of mortality but did not differentially predict the mechanism of cardiac death. Evidence of myocardial ischemia before the terminal event was found in about 50 (60%) patients whose deaths were witnessed and who died from an arrhythmia or myocardial failure.

Coronary Disease↗

PubMed1987

Atenolol for ventricular ectopy: a dose-response study.

The antiarrhythmic efficacy, safety, and tolerance of atenolol was evaluated in 32 patients with an average of at least 60 ventricular ectopic depolarizations/hr. Patients received, single-blind, the following treatments for 2 weeks each: placebo and atenolol, 50, 100, and 200 mg daily. A 24-hour ambulatory ECG recording was obtained each week. Reduction in ventricular ectopic frequency by at least 75% occurred in six of 32 patients receiving 50 mg daily, five of 30 patients receiving 100 mg daily, and three of 21 patients receiving 200 mg daily (P = not significant for any paired dose comparison). No patient who failed to respond to a lower dose responded to 200 mg daily. The frequency of ventricular tachycardia was reduced by at least 75% in eight of 17 patients receiving 50 mg daily, seven of 16 patients receiving 100 mg daily, and eight of 11 receiving 200 mg daily (P = not significant for any paired dose comparison). Atenolol was discontinued because of adverse effects in 12 patients. The results indicate that atenolol is more effective in suppressing ventricular tachycardia than in suppressing overall ventricular ectopy.

Adult↗

PubMed1986

Ethmozine for ventricular premature complexes.

Twenty patients with an average of more than 30 ventricular premature complexes (VPCs) per hour were treated with ethmozine. Eighteen had either not responded or had adverse reactions to at least 1 other antiarrhythmic drug. Patients were treated with 200 to 300 mg 3 times daily (8.25 to 11.7 mg/kg) and were followed for up to 6 months. Three patients were withdrawn from ethmozine therapy because of unwanted effects before evaluation of efficacy. One of these patients had sustained ventricular tachycardia (VT) after a loading dose of ethmozine. Eleven of the remaining 17 patients (65%) experienced more than a 75% reduction in ventricular ectopic activity. Six patients had a smaller or no decrease in VPC frequency. Eleven of 16 patients (68%) with paired VPCs had a more than 90% reduction in paired VPC frequency. Eleven of 13 patients (84%) with VT events of 3 beats or more had more than a 90% reduction in VT events. Of the 11 patients in whom a more than 75% reduction in VPC frequency occurred, 1 patient died suddenly after 133 days of effective drug therapy. Three patients discontinued ethmozine therapy for reasons not related to the drug. Of the 6 patients in whom there was less than a 75% reduction in VPC frequency, 2 patients discontinued treatment, 1 patient because of hyperanxiety and 1 because of drug-related left anterior hemiblock. Ethmozine lengthened PR and QRS intervals but not the JT interval. Thus, ethmozine is effective and clinically useful for suppression of frequency VPCs in 50% (10 of 20 patients) of a selected population.

Aged↗

PubMed1984

Prognosis of patients with diabetes mellitus after acute myocardial infarction.

Sixty patients with diabetes mellitus who survived the coronary care unit phase of acute myocardial infarction (AMI) were followed an average of 19 months and the prognosis of diabetic patients was compared with that of 719 nondiabetic patients. The mortality rate was 25% in diabetic patients and 8% in nondiabetic patients. These patients had been entered in a Multicenter Postinfarction Program, where analysis of the total data base showed 4 significant prognostic factors: cardiac symptoms before AMI, pulmonary rales when the patient was in the coronary care unit, more than 10 ventricular premature complexes per hour recorded on Holter monitor just before discharge, and a radionuclide ejection fraction of less than 40%. Of these 4 factors, only cardiac symptoms before AMI was significantly more common in diabetic patients (57% in diabetic vs 36% in nondiabetic patients). When each of these 4 factors was stratified for severity, the mortality rate was always higher in diabetic patients. The data were examined to determine other factors in diabetic patients who died. Pulmonary rales was significantly more common in diabetic patients who died (6% in survivors vs 42% in patients who died). In a multivariate analysis of both diabetic and nondiabetic patients, 5 factors were significant determinants of prognosis. They are, in order of entry into the model, rales (p less than 0.001), ejection fraction less than 40% (p less than 0.001), diabetes (p less than 0.001), symptoms before AMI (p = 0.009), and more than 10 ventricular premature complexes per hour (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Complications↗

PubMed1984

Comparison of a QRS scoring system for estimating acute infarct size with radionuclide left ventriculography.

A QRS scoring system was compared with left ventricular ejection fraction (LVEF) in 40 patients enrolled in the Multicenter Post Infarction Program. A poor correlation was found between these two parameters. Possible reasons for these findings include the fact that the radionuclide studies were performed at several institutions or that there was a mean interval of 6 days between the time of the ECG and the radionuclide studies. It was determined that the ECGs could be scored by inexperienced scorers. The utility and limitation of the QRS scoring system for prediction of LVEF need further evaluation, particularly if it is to be applied to a multicenter study.

Cardiac Output↗

PubMed1984

Serum beta 2-microglobulin in the initial staging and subsequent monitoring of monoclonal plasma cell disorders.

Serum beta 2-microglobulin (beta 2-M) measurements were carried out in 97 patients with monoclonal plasma cell disorders. Twenty-six (87%) of 30 patients with monoclonal gammopathy of undetermined significance (MGUS) had increased beta 2-M levels and serial follow-up in seven patients showed a progressive increase with time. Of the 63 patients with active myeloma, pretreatment serum beta 2-M values were available in 25 for correlation with pretreatment stage. Stage III beta 2-M levels were significantly higher than stages I and II (p less than 0.001). Four patients with smoldering myeloma had beta 2-M values similar to stage I disease. There was, therefore, excellent correlation between beta 2-M and myeloma tumor burden. Levels of beta 2-M decreased with response to chemotherapy induction and low levels in stable remission (plateau phase) were associated with unusually good prognosis. Median survival for stage III patients in stable remission with low serum beta 2-M was greater than 48 months. Conversely, at relapse very high beta 2-M levels were associated with a very fulminant and refractory course. Serum beta 2-M, therefore, appears to be an extremely useful marker in initial stratification and follow-up of myeloma patients.

Adult↗

PubMed1983

Lack of dexamethasone effect on the antitumor activity of cisplatin.

High-dose glucocorticosteroids have proven to be effective antiemetic agents when used before and after cisplatin chemotherapy. To rule out a possible decrease in cisplatin antitumor activity by a direct effect of short-term glucocorticosteroid treatment, survival was studied in mice inoculated with P388 leukemia and then treated with cisplatin preceded by a single high dose (1.5 mg/kg) of dexamethasone (Dex). The median survival of animals treated with cisplatin-Dex was 19 days, and that of animals treated with cisplatin alone was 18 days. These survival durations were significantly longer (P less than 0.01) than the survival time of the controls (median, 12 days). A double-layer soft agar clonogenic assay was used to study the possible effect of Dex on cisplatin inhibition of tumor colony-forming units from two human tumor cell lines (HEC-1A, endometrial; and WiDr, colon). In this model, the addition of Dex to cisplatin showed no statistically significant effect. These data suggest that Dex has no inhibitory effect on the antitumor activity of cisplatin.

Animals↗

PubMed1981

Characteristics of the resuscitated out-of-hospital cardiac arrest victim with coronary heart disease.

The clinical entry characteristics and medical history of 142 resuscitated out-of-hospital cardiac arrest victims with coronary heart disease were studied in order to identify factors that affect their long-term survival. The cardiac arrest event was classified as being secondary to an acute myocardial infarction (AMI) in 44% (62 of 142), an ischemic event (IE) in 34% (49 of 142) and a primary arrhythmic event (PAE) in 22% (31 of 142). The majority of patients in all groups had a history of angina pectoris. Twenty-seven percent of the AMI, 55% of the IE, and 71% of the PAE patients had a history of infarction. Ten percent of the AMI, 31% of the IE, and 55% of the PAE had used digitalis before their cardiac arrest. Cardiac arrest was the first cardiac event in 35% of the AMI, 16% of the IE and 6% of the PAE patients. One year after arrest, 89% of the AMI, 80% of the IE and 71% of the PAE were alive (p less than 0.01). Covariate analysis for more than 40 variables indicates that a high-risk group included 22% (31 of 142) of the cardiac arrest victims had 1- and 2-year survival rates of 71% and 55%, respectively, and was characterized as having used digitalis before arrest, experiencing blood urea nitrogen elevation and pulmonary congestion during the hospitalization for the event, and classification of the cardiac arrest event as a PAE. A low-risk group comprised 78% (111 of 142) of the survivors and had 1- and 2-year survival rates of 85% and 69%, respectively. These data indicate that cardiac arrest due to coronary heart disease is secondary to several mechanisms related to subsequent survival.

Acute Disease↗