PubMed Health⌕ Search

Biomedical subjects

S Scheidt

Publications and source records attributed to S Scheidt.

At least 19 recordsLinked to original sources
PubMed1990

Angina: evolution of the role of nitrates.

In recent years, concern has been expressed over attenuation of therapeutic effect in patients receiving continuous nitroglycerin therapy for the treatment of angina. Studies have shown that exercise tolerance time does not improve with continuous nitroglycerin regimens, although the frequency of anginal attacks may decrease. Intermittent therapy, which incorporates a nitrate-free interval, improves both exercise time and clinical angina. The optimal duration of the nitrate-free interval has yet to be determined. Future research is likely to focus more on supply-side factors in angina. Of the available antianginal drugs, nitrates have been shown to be highly effective coronary vasodilators, particularly in areas of stenosis.

Angina Pectoris↗
PubMed1988

Therapy for angina pectoris: comparison of nicardipine with other antianginal agents.

Nicardipine is a new dihydropyridine calcium channel blocking drug with actions that suggest considerable usefulness as an agent for chronic stable angina. Hemodynamic studies in patients with coronary artery disease confirm major coronary vasodilator actions, perhaps even exceeding its considerable systemic vasodilator properties with little or no negative inotropic effect. Three recent controlled clinical trials that used nicardipine alone suggest approximately 20% to 30% increase in exercise time, and at least that much decrease in anginal episodes and sublingual nitroglycerin consumption when compared with placebo in doses of 90 to 120 mg daily. Five trials comparing nicardipine with other calcium channel blockers, and three with beta blockers, suggest equivalent efficacy, including decrease in angina and increase in exercise time. Adverse effects of nicardipine generally relate to its potent vasodilatory capability and are usually minor. Side effects are frequent at the beginning of many trials, usually do not cause undue withdrawals, and are quite rare after 6 to 12 months on the drug in most studies.

Angina Pectoris↗
PubMed1987

Ischemic heart disease: a patient-specific therapeutic approach with emphasis on quality of life considerations.

Advantages and disadvantages of the various therapies for stable angina are considered with particular attention to quality of life. Advantages of coronary artery bypass surgery (CABS), apart from the question of survival, include less angina, less activity limitation, and less need for drugs than with medical treatment. However, data from the Coronary Artery Surgery Study (CASS) and others show that there is no difference between medical and surgical therapy in return to work and in need for subsequent hospitalization. In CABS patients, there is also predictable return of angina, substantial late vein graft occlusion, and possibly increased progression of native coronary artery disease in grafted vessels. Percutaneous transluminal coronary angioplasty (PTCA) has advantages similar to those of CABS, with very low initial mortality and major complication rates, minimal discomfort, very short disability period, and moderate cost. Its major disadvantages are a high short-term reocclusion rate and uncertain long-term outcome. Beta blockers provide good control of angina, have additional antihypertensive and antiarrhythmic effects, and may be beneficial in preventing sudden cardiac (arrhythmic) death and limiting myocardial infarct size, should these events supervene in the patient with angina. Disadvantages of beta blockers involve the occasional major side effects, including potential exacerbation of bronchospasm, peripheral vascular disease (PVD), diabetes, congestive heart failure and bradyarrhythmia, and frequent "nuisance" side effects. Calcium blockers control both exercise and rest angina and pose no problem in patients with bronchoconstriction, PVD, or diabetes. Disadvantages include need for frequent dosage, cost, and side effects. Long-acting nitrates have few major side effects and usually transient minor side effects, with little effect on quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1986

Efficacy and safety of nicardipine for chronic, stable angina pectoris: a multicenter randomized trial.

Nicardipine, a new calcium channel blocking drug of the dihydropyridine family, was administered to 63 patients at a dose of 30 or 40 mg 3 times daily in a multicenter, randomized, double-blind, placebo-controlled, crossover trial. Nicardipine midly increased heart rate (HR) at rest and midly decreased the blood pressure (BP) at rest. When generally similar responses to the 30- and 40-mg doses were averaged, nicardipine produced a 7% increase in peak exercise HR, which was balanced by a 6% decrease in peak exercise BP. Thus, no change occurred in the exercise HR-BP product. With nicardipine, treadmill exercise duration increased 9%, time to angina increased 15%, time to 1-mm ST-segment depression increased 16%, and oxygen consumption at peak exercise increased 13%. Mean anginal frequency declined, as did mean weekly sublingual nitroglycerin consumption, but not significantly. There were more cardiovascular side effects with nicardipine than with placebo, with at least 3 patients having increased angina judged by investigators as probably related to the drug. Vasodilatory side effects were also more frequent with nicardipine, but were generally mild and well tolerated; the drug had to be discontinued in only 1 patient, because of vasodilatory effects. Nicardipine is effective and generally well tolerated in patients with chronic stable angina.

Adult↗
PubMed1986

Lipid regulation: a clinician's view of patient management.

Practicing physicians now have the capability as well as the responsibility to treat hyperlipidemia. Recent conclusive trials have demonstrated the link between lipid elevations and coronary heart disease, as well as the likelihood of reducing coronary heart disease risk by lowering blood lipids via diet and/or drug intervention. Screening criteria for hyperlipidemia in normal patients and in special patient subgroups are described, and recommendations for treatment are proposed. The diet recommended by the American Heart Association--which limits fat intake to 25% to 30% of all calories in a 1:1:1 ratio of saturated, monounsaturated and polyunsaturated fats, and limits cholesterol to less than 300 mg/day--is discussed. Guidelines are suggested for drug therapy with lipid-lowering agents to reduce abnormal lipid levels when diet alone proves insufficient after 2- to 3-month trial.

Adult↗
PubMed1986

Enlisting family support in drug treatment.

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.

Family↗
PubMed1985

Data quality and DRGs: an assessment of the reliability of federal beneficiary discharge data in selected Manhattan hospitals.

New York County Health Services Review Organization (NYCHSRO), the physicians' professional standards review organization of Manhattan, examined whether diagnostic coding errors identified in Manhattan hospitals would affect reimbursement under a diagnostic-related group (DRG) method of financing inpatient services. A sampling of 1,027 Medicare and Medicaid cases representing discharges from 18 Manhattan hospitals during 1982 and 1983 revealed incorrect DRG assignment for 17.5% of patient record abstracts, but these appear to have been unsystematic rather than deliberate errors. The difference between estimated reimbursement based on original and reabstracted records was not statistically significant either in the aggregate or for specific hospitals. It is emphasized that while New York State's Prospective Hospital Reimbursement Methodology (in effect during the study period) is not solely dependent upon DRG's case-mix is one of several factors used to make adjustments to existing per diem rates. A key recommendation is that hospitals conduct internal monitorings with all involved departments to improve the quality of the data abstracting process.

Diagnosis-Related Groups↗
PubMed1985

Nicardipine for stable angina pectoris.

Nicardipine, 30 and 40 mg thrice daily, was administered to 66 patients with stable angina pectoris in a multicentre, randomised, double-blind, cross-over trial. With nicardipine therapy, duration of exercise and cumulative oxygen consumption increased, while times to onset of angina and 1 mm ST segment depression were prolonged. Anginal frequency and nitroglycerin consumption declined with use of nicardipine, but this did not reach statistical significance. Resting heart rate increased slightly and resting blood pressure decreased. Two patients on nicardipine and one on placebo sustained acute infarction. Otherwise, side effects were generally mild and transient.

Adult↗
PubMed1977

Serum myoglobin in myocardial infarction: the "staccato phenomenon." Is acute myocardial infarction in man an intermittent event?

When serum was sampled frequently and soon after acute myocardial infarction, myoglobinemia was extremely common, occurring in 12 of 13 selected patients. Myoglobin first appeared in the serum within a few hours after infarction, but not consistently earlier than creatine phosphokinase. The peak level of serum myoglobin was reached appreciably earlier than the peak values of serum creatine phosphokinase activity. Time of earliest myoglobin appearance in the serum, peak level of myoglobin measured, and duration of detectable myoglobin release all correlated poorly with clinical and biochemical estimates of severity of myocardial infarction. There was no correlation between myoglobin levels and infarct size as estimated from creatine phosphokinase kinetics. Myoglobin appeared in the serum in multiple short "staccato" bursts, or episodes, often lasting only one to two hours. The hypothesis is suggested that the pattern of myoglobin appearance is a reflection of the episodic nature of acute myocardial infarction. Although isolated myoglobin determination may not be useful at present, for quantification of total myocardial damage, its pattern of release may be a sensitive marker for studying the time course of infarction, and may be useful to evaluate therapeutic interventions designed to interrupt an ongoing syndrome of myocardial necrosis.

Acute Disease↗