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Biomedical subjects

S Gottlieb

Publications and source records attributed to S Gottlieb.

At least 19 recordsLinked to original sources
PubMed1992

Interrelation of left ventricular ejection fraction, pulmonary congestion and outcome in acute myocardial infarction.

The interrelation of different grades of pulmonary congestion evaluated by chest roentgenogram in the coronary care unit, predischarge left ventricular (LV) ejection fraction (EF) and long-term prognosis was studied in 1,850 surviving patients of acute myocardial infarction (AMI). Pulmonary congestion was categorized as: none, mild or moderate, or severe; LVEF was classified as: greater than or equal to 40%, 25 to 39%, or less than 25%. The majority of patients (1,060; 57%) had an LVEF greater than or equal to 40% and no signs of pulmonary congestion. Severe pulmonary congestion was noted in 63 patients (3.4%), 17 with LVEF less than 25% and 16 with LVEF greater than or equal to 40%. One hundred twenty-five patients (6.8%) had an LVEF less than 25%, 49 of whom had no signs of pulmonary congestion. During a mean 2-year follow-up, cardiac mortality occurred in 212 patients (11.5%). The cardiac mortality rate was related to both predischarge LVEF impairment and severity of pulmonary congestion. Cardiac mortality hazard ratios (95% confidence intervals [CI]) for LVEF less than 25%, and 25 to 39% were 5.32 (CI 3.49, 8.13; p less than 0.0001) and 2.91 (CI 2.10, 4.02; p less than 0.0001), respectively, where a referent hazard ratio of 1 was assigned to patients with LVEF greater than or equal to 40% and to those with no pulmonary congestion. Development of pulmonary congestion during AMI significantly increased the cardiac mortality risk derived from LVEF, with a marked mortality effect in patients with severe pulmonary congestion; (hazard ratio 4.20; 95% CI 2.67, 6.62; p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital.

OBJECTIVES: To determine the predisposing factors, attack rate by underlying disease, and outcome of Pneumocystis carinii pneumonia among patients without the acquired immunodeficiency syndrome (AIDS) at a cancer center. DATA SOURCE: Twelve-year retrospective review from a tertiary-care cancer center. STUDY SELECTION: One hundred forty patients, constituting 142 cases, with morphologically proved P carinii pneumonia. DATA SYNTHESIS: Hematologic malignancy (47%) (including lymphoma [27%] and leukemia [18%]), solid tumor (31%), or bone marrow transplantation (18%) was the underlying condition in the majority of cases. Twenty-five cases (18%) were diagnosed at autopsy. All but seven patients had previously established predisposing factors for P carinii pneumonia, including corticosteroid use in 87%. The attack rate for hospitalized patients with primary or metastatic brain tumor increased during the 12-year interval. The attack rates for hospitalized patients with hematologic neoplasm or bone marrow transplantation were stable. The overall mortality rate did not change during the period reviewed. CONCLUSIONS: Despite the availability of effective prophylaxis, P carinii pneumonia continues to occur among patients with neoplastic disease. In addition to patients with certain hematologic neoplasms, those with primary or metastatic brain neoplasm who receive corticosteroids are at risk for the development of P carinii pneumonia and should receive P carinii pneumonia prophylaxis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Myocardial contrast echocardiography: influence of ischaemia and hyperaemia in an animal model.

To evaluate changes in myocardial contrast echocardiography during ischaemia and hyperaemia, contrast studies were performed in 16 open chest dogs. Time-intensity curves were generated using videodensitometry after contrast injections to demonstrate ischaemic and non-ischaemic areas of interest during a wide range of coronary blood flow levels. For each time-intensity curve, the peak contrast intensity (PCI), washout halftime (T1/2) and area under the curve (AUC) were calculated. PCI and AUC decreased significantly only with severe ischaemia (90% or more reduction in flow), and increased significantly with hyperaemia of more than 2.5 times baseline flow. Both ischaemia and hyperaemia were found to prolong the T1/2. There was only a moderate linear correlation between the magnitude of hyperaemia and myocardial contrast echocardiographic parameters. There was significantly less increase in myocardial contrast echocardiographic parameters during hyperaemia in segments supplied by a stenosed coronary artery.

Albumins↗
PubMed1992

Effect of benazepril on myocardial ischaemia in patients with chronic stable angina pectoris.

The anti-ischaemic properties of benazepril, a non-sulfhydryl inhibitor of angiotensin-converting enzyme, were assessed in 20 patients with chronic stable angina pectoris, by repeated exercise tests and repeated 72-h ambulatory electrocardiographic monitoring. The study was a double-blind, placebo-controlled cross-over; 11 patients received benazepril 10 mg b.i.d. and nine received 20 mg b.i.d. All patients had a positive treadmill stress test and at least three ischaemic episodes during 24 h of ambulatory electrocardiographic monitoring. Benazepril at a dose of 10 mg b.i.d. did not improve the exercise duration, the time taken to reach 1 mm ST depression. Similar findings were observed during treatment with 20 mg b.i.d. Benazepril at a dose of 10 mg b.i.d. was ineffective in improving ischaemic parameters during daily activities. However, among the nine patients who received 20 mg b.i.d. the number of ischaemic episodes was reduced from 142 to 103, and the total duration of ischaemic was reduced from 1099 to 531 min. The number of weekly anginal attacks was reduced from 58 to 33, and the weekly sublingual nitroglycerin tablets consumption was reduced from 31 to 14. When the two doses (10 mg and 20 mg) were combined (N = 20), the number of ischaemic episodes was reduced from 314 to 260 (P = 0.074), and the duration of ischaemic was reduced from 3453 to 2514 min (P = 0.072).

Aged↗
PubMed1991

Adhesion of Candida albicans to epithelial cells effect of polyoxin D.

Data from our previous studies suggested that the fungal cell wall component, chitin, is involved in the adhesion of Candida albicans to mucosal surfaces. In the present study, we investigated the effect of polyoxin D, an inhibitor of chitin synthase, on the interaction of the fungus with epithelial cells. The effect of polyoxin D on Candida was evaluated in in vitro assays for its capacity to adhere to buccal epithelial cells (BEC), and by fluorescent-microscopy photometry and flow cytometry using cells stained with cellufluor (CF), a fluorochrome with affinity for chitin. C. albicans grown with and without polyoxin D was stained with CF and examined in a fluorescent microscope equipped with a photometer. Measurements of fluorescence revealed a wide range of intensity among C. albicans cells and a decreased intensity in polyoxin D treated cultures. Flow cytometry analyses of yeasts revealed 2 peaks of fluorescence intensity, and pointed to differences between polyoxin D treated and non-treated microorganisms. C. albicans stained with CF were separated into 2 subpopulations by flow cytometry according to fluorescence intensity. In vitro adhesion of each subpopulation to BEC was similar. Polyoxin D treated fungi showed significantly reduced adherence to BEC, as evaluated by a radioactivity assay with radiolabelled yeasts and by microscopic readings. The reduction in adhesion was Polyoxin D concentration dependent. These observations support our previous findings suggesting involvement of chitin in the attachment process of C. albicans (CBS562) to epithelial cells.

Antifungal Agents↗
PubMed1979

Effect of a physical conditioning program upon left ventricular ejection fractions determined serially by a noninvasive technique.

6 clinically normal subjects underwent a 3-month physical conditioning program with the ejection fractions determined before and after physical conditioning using a scintillation probe. All subjects achieved a conditioning effect as evidenced by increased treadmill test duration after conditioning (mean duration before conditioning: 658 vs. 715 sec after conditioning; p less than 0.02). All 6 subjects increased resting ejection fractions after conditioning (mean ejection fraction before conditioning: 54.5 +/- 5.4%; mean ejection fraction after conditioning: 67.0 +/- 9.0%; p less than 0.01). Thus, an aerobic physical conditioning program appears to increase resting ejection fractions in normal subjects.

Adult↗
PubMed1978

Presymptomatic diagnosis of adult onset polycystic kidney disease by ultrasonography.

Results of an ongoing prospective study of progeny of patients with adult-onset polycystic kidney disease using grey-scale ultrasound and high-dose nephrotomography are reported. Six asymptomatic subjects out of 17 at risk for polycystic kidney disease were found by ultrasonography to have multiple renal cysts; this included two unrelated children aged 18 months and 6 y who had normal high-dose nephrotomography. We suggest that ultrasonography may be the method of choice for presymptomatic detection of polycystic kidney disease. Serial studies of at-risk individuals by sonography will be useful in determining the earliest age of detection, the latest age of ultrasonography presentation, and in following the natural history of polycystic kidney disease.

Adolescent↗
PubMed1977

Computerized tomography, diagnostic ultrasound, and radionuclide scanning. Comparison of efficacy in diagnosis of pancreatic carcinoma.

Forty-six patients, including 33 with proved pancreatic carcinoma, were studied with computerized tomography (CT), ultrasound (US), and radionuclide (RN) scanning. The results of each scanning procedure were compared with the surgical and clinical findings. The detection rate was 82% for CT, and 92% with US. A mass is the most important finding in the diagnosis of pancreatic carcinoma. Measurements of the pancreas with CT and US were similar, with visualization of all parts of the pancreas routinely better with CT scans. Radionuclide scans were abnormal in 96% of the patients with pancreatic carcinoma as well as in 75% of patients without pancreatic disease. A rational approach to examination of a patient with suspected pancreatic carcinoma should begin with US scan with available, because the detection rate with this method is equal to that with CT and its cost per procedure and for equipment is substantially less.

Humans↗
PubMed1977

Aortic aneurysm detected by 99mTc-pyrophosphate imaging: case report.

An example of aneurysmal concentration of 99mTc-pyrophosphate (Tc-PPi) is described. An abdominal aortic aneurysm was suspected when a rectilinear bone scan showed an abnormal paraspinal area of activity. The aneurysm was confirmed by ultrasonic examination. Conventional radiographic examination failed to reveal calcification within the aneurysm. Aneurysmal concentration of Tc-PPi should be considered in patients showing abnormal radioactivity in the region of vascular structures on radionuclide bone images.

Aged↗
PubMed1976

Echocardiographic diagnosis of left atrial myxoma. Usefulness of suprasternal approach.

Three cases of left atrial myxoma were studied by echocardiography. In one case the atrial tumour was prolapsing through the mitral orifice into the left ventricular cavity; in the other two cases it was not. The angiocardiographic and operative findings correlated well with those from echocardiography. A systematic echocardiographic study is important; the suprasternal approach is useful in the echocardiographic exploration of the left atriu, especially for nonprolapsing tumours.

Adult↗
PubMed1976

A new dual-probe system for the rapid bedside assessment of left ventricular function.

A mobile dual-probe system has been developed for the rapid bedside measurement of left ventricular ejection fraction (LVEF) from the beat-to-beat count rate variations that occur during the transit of a single radionuclide bolus through the left ventricle (LV). Cardiac output, pulmonary blood volume, and left ventricular end-diastolic volume can also be calculated. The dual-probe system incorporates a central collimated probe for monitoring activity in the LV surrounded by an annular detector collimated in such a manner as to provide simultaneous real-time monitoring of the LV background activity. The LVEFs obtained from this system correlated well with LVEFs derived from conventional single-plane contrast angiography (r=0.90) in a series of 33 patients with coronary artery disease. Positioning the dual probe over the midpoint of the LV is accomplished with standard M-mode ultrasound. Since the method is noninvasive and sensitive to volume changes in the LV, the dual probe is particularly useful for monitoring seriously ill patients as well as those with segmental wall-motion abnormalities.

Coronary Disease↗
PubMed1975

Applications of diagnostic ultrasound and radionuclides to cardiovascular diagnosis. Part I. Acquired cardiovascular disease in the adult.

Noninvasive methods have become an important part of the diagnostic process for evaluation of cardiovascular anatomy and function in adults and in the young. Because there is a multiplicity of noninvasive methods presently available, in some cases with overlapping capabilities, there has been some confusion as to which constitutes the method of choice in a given clinical circumstance. The reviews that follow outline some of the practical strengths and limitations of two methods (echocardiography and radionuclide cardiography), hopefully thereby providing some rationale for choosing the more appropriate technique in the approach to specific clinical problems. We have found that the information available from radionuclide and from ultrasound studies frequently is complementary and that the most optimal diagnostic results often are obtained when they are combined. Since advances in technique and improvements in instrumentation are occurring continually in both of these areas, we have tried to provide only an overview. Further investigations and clinical experience will help to define the specificity, sensitivity, and capabilities of these methods in terms of present and future applications.

Aortic Valve Insufficiency↗
PubMed1975

Applications of diagnostic ultrasound and radionuclides to cardiovascular diagnosis. Part II. Cardiovascular disease in the young.

Echocardiography (ECHO) and radionuclide cardiography have had a significant impact on pediatric cardiology because they have proved to be sensitive enough to permit early diagnosis of many forms of heart disease and in some cases to estimate its severity and to provide information concerning ventricular performance. An overview of the anatomic and functional information that can be obtained from these two methods will be presented first, followed by details concerning the indications for their use and their relative clinical value in various acquired and congenital heart diseases. We have stressed particularly those facets of pediatric cardiac disease that differ most from those in the adult.

Aortic Coarctation↗
PubMed1975

Hemodynamic features of prolapsing and nonprolapsing left atrial myxoma.

In the course of the evaluation of five patients with left atrial myxoma, it was noted that the movement of the myxoma was related to specific changes in left atrial hemodynamics. Prolapsing tumors, Type I, move from the left ventricle to the left atrium in early systole and from the left atrium to the left ventricle in early diastole, thereby causing prominent c and v waves accompanied by a rapid y descent. Nonprolapsing tumors, Type II, remain in the left atrium during the entire cardiac cycle, impeding flow across the mitral valve. In these latter cases, the y descent is slow and indistinguishable from that caused by mitral valvular stenosis. The cineangiocardiograms and echocardiograms corroborate these two types of hemodynamic observations. The particular value of direct echocardiographic examination of the left atrium prior to cardiac catheterization was evident in two of the three patients with nonprolapsing tumors. Since the hemodynamic pattern of nonprolapsing left atrial myxoma resembles that of mitral valvular stenosis, it is stressed that echocardiography should have an important place in precatheterization assessment of patients with mitral valve disease. If left atrial myxoma is suspected clinically or on the basis of echocardiographic findings, regardless of the pressure curve contours, transseptal cardiac catheterization should be avoided and the left atrium visualized by pulmonary angiography levophase.

Adult↗
PubMed1975

Rapidly progressive obstructive cardiomyopathy in infants with Noonan's syndrome. Report of two cases.

Two patients with hypertrophic obstructive cardiomyopathy and Noonan's syndrome are presented. Both patients were found at postmortem examination to have gross malformation of the mitral valve and obliteration of the left ventricle due to muscle hypertrophy. Each case demonstrated similar clinical, echocardiographic, and angiographic findings. The poor response to medical and surgical therapy are noted.

Cardiomegaly↗