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Biomedical subjects

S Butman

Publications and source records attributed to S Butman.

18 recordsLinked to original sources
PubMed1993

Dose-related efficacy and bleeding complications of double-chain tissue plasminogen activator in acute myocardial infarction. The Wellcome Tissue Plasminogen Activator Study Group.

Although the efficacy of recombinant tissue-type plasminogen activator (rt-PA) in acute myocardial infarction has been demonstrated, little formal dose-ranging information is available. This study examined the use of duteplase, the double-chain rt-PA subsequently used in the Third International Study of Infarct Survival, in a multicenter trial of 267 patients with evolving acute myocardial infarction assigned to receive 1 of 6 weight-adjusted doses. The primary end point was infarct vessel patency after 90 minutes of drug infusion. Patency was defined as Thrombolysis in Myocardial Infarction trial grade 2 or 3 perfusion, and was determined by an independent core laboratory masked to treatment assignment. Patency was present in 48% of patients receiving the lowest dose range and 78% of those receiving the highest, with an association between thrombolytic dose and patency (p = 0.009). The frequency of serious bleeding complications also correlated with the total dose of rt-PA infused (p = 0.003). Bleeding complications were primarily related to instrumentation; blood loss requiring transfusion or otherwise deemed clinically significant occurred in 12% of patients (central nervous system hemorrhage occurred in 1.1%). Thus, higher doses of rt-PA are associated both with increased efficacy and increased risk of serious bleeding complications. Weight-adjusted dosing may provide an optimal risk-benefit ratio for thrombolysis during acute myocardial infarction.

Adult↗
PubMed1993

Clinical significance of weight difference between donor and recipient in heart transplantation.

A standard and important criterion for donor acceptance is to match the donor's body weight to within 20% of the recipient's body weight. However, to meet the increasing demand of patients who need heart transplantation, frequently a heart that is below the standard criteria for donation is accepted. Of the 200 consecutive patients who underwent heart transplantation at the University of Arizona, 27 patients received a heart from a smaller donor with a weight difference of more than 30% (range 30% to 46%). The early mortality and late survival of these 27 patients were not different when compared with those of the patients who received transplants from donors with a weight difference of less than 30%. The probability of freedom from rejection and infection and postoperative ejection fraction were also similar between the two groups. Therefore, we believe that the widely accepted donor-recipient weight-match criterion of 20% can be safely extended.

Adult↗
PubMed1990

Angioplasty of recent total coronary occlusions: cardiac death can occur in "low-risk" cases.

Revascularization by angioplasty of total coronary artery occlusions is generally thought to be relatively safe in experienced hands. Although success rates are lower than with diseased but patent vessels, reasonable success can be expected. In this report, different events led to a sudden and fatal outcome in two patients with total coronary occlusions subtending recently infarcted, but still viable, areas of myocardium. The cases and procedural details are presented.

Angiography↗
PubMed1987

Relationship between age, body size, gender, and blood pressure and Doppler flow measurements in the aorta and pulmonary artery.

Previous studies have demonstrated a relationship between both age and body surface area (BSA) and M-mode echocardiographic measurements of left ventricular, left atrial, and aortic root dimensions and left ventricular wall thickness. We evaluated the relationships between age, BSA, gender and blood pressure, and Doppler aortic and pulmonary artery (PA) flow velocity measurements in 97 adults, aged 21 to 78 years, without clinical evidence of cardiac disease. No significant relationship was found between gender or blood pressure and aortic or PA flow velocity measurements. Aortic peak flow velocity, flow velocity integral, and average acceleration decreased with increasing age (all p less than 0.001), whereas ejection time (corrected for heart rate) increased, and acceleration time did not change. In contrast, there was no relationship between age and Doppler PA flow velocity measurements. Although there was no relationship between BSA and Doppler aortic flow measurements, PA peak flow velocity and average acceleration increased, while acceleration time decreased with increasing BSA (all p less than 0.02). Decreases in aortic peak flow velocity and flow velocity integral may be partly related to known increases in aortic root diameter with aging. The relationship between PA flow velocity measurements and BSA is not readily explained.

Adult↗
PubMed1985

Echocardiographic and Doppler flow observations in obstructed and nonobstructed hypertrophic cardiomyopathy.

Some investigators have suggested that left ventricular (LV) ejection is completed much earlier than normal in patients with hypertrophic cardiomyopathy (HC), whether or not a LV outflow gradient is present, and they have therefore concluded that LV ejection is not impeded in HC, but merely ends early because of early completion of LV emptying. This possibility was examined using pulsed Doppler echocardiography to record ascending aortic flow velocity patterns in 20 patients with HC, 12 with evidence of LV outflow gradient at rest (obstructed HC) and 8 without evidence of a significant resting gradient (nonobstructed HC). Peak aortic flow velocity was similar in patients with nonobstructed HC (92 +/- 26 cm/s) and those with obstructed HC (94 +/- 26 cm/s) and in 20 normal subjects (92 +/- 11 cm/s). However, mean ejection time measured from the aortic flow velocity tracing or aortic echogram was longer in those with obstructed HC (345 +/- 30 ms) than in those with nonobstructed HC (296 +/- 24 ms, p less than 0.02) and in normal subjects (294 +/- 19 ms, p less than 0.01). Furthermore, a rapid decrease in aortic flow velocity in midsystole was seen in 11 of 12 patients with obstructed HC, but in none of the patients with nonobstructed HC or normal subjects. Doppler left atrial flow velocity recordings, obtained in 11 patients, demonstrated mitral regurgitation in 4 of 5 patients with obstructed HC but in none of 6 patients with nonobstructed HC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Multiple aortic root echoes: clinical, radiographic, and angiographic correlations.

Multiple diastolic echoes in the aortic root on M-mode echocardiography may represent fibrosis or calcification of the aortic wall, aortic leaflets, or proximal portions of the coronary arteries. In this study, 83 patients with multiple diastolic echoes were evaluated by cardiac fluoroscopy and the incidence of valvular, coronary, and aortic wall calcification was determined. In patients with multiple diastolic echoes who have no evidence of significant aortic stenosis (aortic valve opening less than or equal to 1.0 cm) or aortic insufficiency (fine fluttering of the anterior leaflet of the mitral valve), the presence of multiple diastolic echoes was highly associated with significant coronary artery calcification (64%) with over two-thirds having multivessel involvement. Patients referred for echocardiography who are free of significant aortic stenosis or aortic insufficiency by echocardiographic criteria who are found to have multiple diastolic echoes in the aortic root should be evaluated further for the possible presence of significant multivessel coronary artery disease.

Adult↗
PubMed1984

Pre- and postsynaptic localization of 3H-imipramine binding sites in rat cerebral cortex.

The subcellular localization of 3H-imipramine binding sites in brain was investigated with the aim of learning about the possible mechanism of action of this antidepressant. The rat cerebral cortex was submitted to a systematic fractionation and both the nuclear and the synaptosomal fractions were purified by gradient centrifugation. Using a centrifugation assay for the binding, we found that the synaptosomal membranes had the highest specific activity and showed two binding sites, one of high affinity with a KD of 14 nM and a Bmax of 3.1 pmol per mg protein, and another of lower affinity with a KD of 99 nM and a Bmax of 14.2 pmol per mg protein. Purified nuclei have a lower specific activity than the synaptosomal membrane, specially when expressed per g tissue. On the other hand, myelin and capillaries have few binding sites. Synaptosomal membranes were treated with 0.1, 0.2 and 0.5% Triton X-100 to dissolve the pre- and post-synaptic membrane and submitted to 3H-imipramine binding in the presence of the detergent or after washing of the residue. The results obtained suggest that although most 3H-imipramine binding sites are localized pre-synaptically, a certain proportion are post-synaptic. These findings are discussed in relation to previous studies from this laboratory on the localization of central receptors with reference to the synaptic region and to the antidepressant action of imipramine.

Animals↗
PubMed1983

Validation of technetium-99m stannous pyrophosphate myocardial scintigraphy for diagnosing acute myocardial infarction more than 48 hours old when serum creatine kinase-MB has returned to normal.

Determination of lactic dehydrogenase (LDH) isoenzymes is the current method of choice for diagnosing acute myocardial infarction (AMI) greater than 48 hours old. However, other causes of enzyme elevation make the availability of an alternate method of diagnosis worthwhile. Accordingly, serial technetium-99m pyrophosphate scintigrams were obtained in 61 patients with transmural AMI and in 46 patients with subendocardial AMI. Imaging was performed in all 107 patients at the time creatine kinase isoenzyme (CK-MB) was present 37 +/- 18 hours (range 12 to 72) after the onset of AMI, and at the time CK-MB was absent 106 +/- 34 hours (range 48 to 168) after the onset of AMI. At the time CK-MB was absent, the sensitivity using either a regional or a diffuse positive scintigram was 95% (58 of 61 patients) for transmural AMI and 65% (30 of 46 patients) for subendocardial AMI. The sensitivity using a regional positive scintigram was 82% (50 of 61 patients) for transmural AMI and 37% (17 of 46 patients) for subendocardial AMI. The sensitivity using a high-grade regional positive scintigram was 36% (22 of 61 patients) for transmural AMI and 11% (5 of 46 patients) for subendocardial AMI. The specificity was 70% (143 of 204 patients) for either a regional or a diffuse abnormality, 92% (187 of 204 patients) for a regional abnormality, and 100% (204 of 204 patients) for a high-grade regional abnormality. Thus, pyrophosphate scintigraphy is useful in confirming the diagnosis of AMI, particularly transmural, greater than 48 hours old and when CK-MB has returned to normal. A positive scintigram with a high-grade regional abnormality is specific for a recent AMI and may be contributory in establishing the diagnoses when LDH isoenzymes are inconclusive.

Adult↗
PubMed1983

Innominate artery aneurysm with thrombus: detection by two-dimensional echocardiography.

A 51 year old man with an innominate artery aneurysm presented with claudication and ischemia of the right forearm and hand. Two-dimensional echocardiography visualized the saccular aneurysm and a pedunculated mobile thrombus within it that were not seen during aortic arch angiography. Two-dimensional echocardiography, shown to be useful in identifying intracardiac masses and aortic aneurysms, may be important in selecting patients with increased risk of embolization.

Aneurysm↗
PubMed1982

Stress myocardial imaging in patients with mitral valve prolapse: evidence of a perfusion abnormality.

Twenty-four patients with mitral valve prolapse underwent cardiac catheterization, exercise testing, and exercise 201thallium scintigraphy. Of 10 patients with coronary artery disease, six had abnormal scintigrams. Two of these six had exercise-induced reversible defects, two had defects that persisted during redistribution, and two had both reversible and persistent defects. Of 14 patients with normal coronary arteries, five had negative scintigrams. Of the remaining nine patients, two had exercise-induced defects, and seven (50%) had defects involving the inferior or posterior wall that persisted during redistribution. Possible mechanisms for this latter finding are discussed. In contrast to previous reports, exercise 201thallium scintigraphy was not entirely successful in identifying patients with coronary artery disease in our patients with mitral valve prolapse.

Adult↗
PubMed1982

Verapamil versus placebo in relieving stable angina pectoris.

Verapamil and placebo were compared in patients with stable, effort-induced angina. Single-blind dose titration (240, 360 and 480 mg/day) preceded a double-blind crossover. Among the 18 patients who completed graded exercise stress tests with reproducible pretreatment effort-limiting angina, exercise duration increased from 348 +/- 127 seconds (SD) before treatment to 494 +/- 182 seconds after verapamil (p less than 0.001), but did not change after placebo. Compared with placebo, verapamil reduced the weekly number of anginal episodes from 4.54 +/- 5.03 to 2.44 +/- 3.30 (p less than 0.05) and reduced nitroglycerin consumption from 3.46 +/- 5.30 to 1.55 +/- 2.89 tablets per week (p less than 0.05). Of 26 patients who completed the single-blind dose titration, 16 were improved (greater than 1 minute) at a dosage of 240 or 360 mg/day. No patient improved (greater than 1 minute) on 480 mg/day who had not already improved on a lower dose, but side effects requiring reduction in dosage occurred in seven patients receiving 480 mg of verapamil per day. Verapamil is an effective antianginal drug that appears most efficacious at a dose of 360 mg/day, but side effects are common at a dose of 480 mg/day.

Aged↗
PubMed1977

Rheumatoid pericarditis. Rapid deterioration with evidence of local vasculitis.

In a patient with classical rheumatoid arthritis and pericardial involvement, accelerated restriction of cardiac filling resulting from pericardial constriction developed. Pericardiectomy was necessary to relieve this condition. Examination of the synovial and pericardial fluid showed noteworthy decreases in total hemolytic complement (CH50) and C3 levels, while these were normal in the serum. Immunofluorescence staining of the pericardium showed plasma cell infiltration and immune deposit staining of pericardial vessels with IgG, IgM, IgA, or C3. These findings suggest that immune complexes deposition plays an important role in the pathogenesis of this condition.

Adult↗