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Biomedical subjects

W Shapiro

Publications and source records attributed to W Shapiro.

At least 19 recordsLinked to original sources
PubMed1992

Comparative efficacy of bepridil versus placebo in angina pectoris: treatment and withdrawal studies.

The efficacy and safety of once-daily doses of 200, 300, and 400 mg of bepridil hydrochloride were compared with placebo in a 14-week multi-center, double-blind parallel study. All doses of bepridil significantly reduced weekly anginal attacks and nitroglycerin consumption from baseline levels. Bepridil also significantly improved total exercise time, time to angina, time to 1 mm ST-segment depression, and total work. Reduction in heart rate (maximum mean decreases of 7-8 beats/min) and prolongation of QT and corrected QT (QTc) intervals were associated with bepridil therapy. Bepridil was well tolerated; most adverse reactions reported were mild and tolerable even at the 400-mg dose. This study provides strong support for the use of bepridil in patients with chronic stable angina pectoris that is not optimally controlled by other available antianginal therapies. A double-blind withdrawal study is also reported, in which patients stabilized on bepridil were randomized to either continue on bepridil therapy or receive placebo. Patients who were withdrawn from bepridil therapy showed significant increases in the number of weekly anginal attacks and nitroglycerin consumption compared with levels seen during long-term treatment. Patients withdrawn from bepridil therapy showed significant deterioration in exercise tolerance compared with baseline and with those maintained on bepridil.

Adult↗
PubMed1992

Treatment of malignant gliomas with interstitial irradiation and hyperthermia.

A Phase I study of interstitial thermoradiotherapy for high-grade supratentorial gliomas has been completed. The objective of this trial was to test the feasibility and toxicity of hyperthermia induced by ferromagnetic implants in the treatment of intracranial tumors. The patient population consisted of 16 males and 12 females, with a median age of 44 years and a median Karnofsky score of 90. Nine patients had anaplastic astrocytoma while 19 had glioblastoma multiforme. Twenty two patients were treated at the time of their initial diagnosis with a course of external beam radiotherapy (median dose 48.4 Gy) followed by an interstitial implant with Ir-192 (median dose 32.7 Gy). Six patients with recurrent tumors received only an interstitial implant (median dose 40 Gy). Median implant volume for all patients was 55.8 cc and median number of treatment catheters implanted per tumor was eighteen. A 60-minute hyperthermia treatment was given through these catheters just before and right after completion of brachytherapy. Time-averaged temperatures of all treatments were computed for sensors located within the core of (> 5 mm from edge of implant), and at the periphery of the implant (outer 5 mm). The percentage of sensors achieving an average temperature > 42 degrees C was 61% and 35%, respectively. Hyperthermia was generally well tolerated; however, there have been 11 minor toxicities, which resolved with conservative management, and one episode of massive edema resulting in the death of a patient. In addition, there were three major complications associated with the surgical implantation of the catheters. Preliminary survival analysis shows that 16 of the 28 patients have died, with a median survival of 20.6 months from diagnosis. We conclude that interstitial hyperthermia of brain tumors with ferromagnetic implants is feasible and carries significant but acceptable morbidity given the extremely poor prognosis of this patient population.

Adult↗
PubMed1990

Decompression of epidural metastases from germ cell tumors with chemotherapy.

Epidural cord compression from germ cell tumor metastases is not common. Treatment usually requires high dose corticosteroids with radiation therapy and/or surgical decompression. Three patients with epidural germ cell tumor metastases were treated with cisplatin-based chemotherapy and all three had complete neurologic recovery. Systemic chemotherapy should be considered as initial therapy with corticosteroids for epidural cord compression from metastatic germ cell tumor.

Adult↗
PubMed1990

Improvement in speech perception and production abilities in children using a multichannel cochlear implant.

Nine children received the Nucleus multichannel cochlear prosthesis. The preoperative evaluation consisted of assessments of auditory function, speech recognition, linguistic skills, and speech production. There were no surgical complications, and recovery in all patients was uneventful. The device was programmed 4 to 5 weeks following surgery, and all children were conditioned to the task. Postoperative training began immediately following device stimulation and is ongoing. Auditory skills and speech production scales were devised to monitor each child's progress. All children have shown varying degrees of improvement in auditory skills and speech production using the implant alone.

Auditory Perception↗
PubMed1989

Comparison of atenolol and nifedipine in chronic stable angina pectoris.

The antiangina effects of atenolol, 50 to 200 mg once daily, or nifedipine, 10 to 30 mg 3 times daily, were evaluated in a multicenter, randomized, double-blind, parallel study of 39 patients with known symptomatic coronary artery disease. Treatment was titrated to produce at least a 30% increase in treadmill exercise duration over placebo baseline and then maintained at that dosage for an additional 3 weeks. Both treatments produced significant (p less than 0.001) increases in duration of exercise, total work and exercise capacity when compared with placebo baseline. These improvements in exercise performance were obtained with significant (p less than 0.001) reductions in both ST-segment depression and rate-pressure product for atenolol compared with nifedipine. Furthermore, the total angina attack rate and rate at rest were significantly (p less than 0.01) less frequent with atenolol than with nifedipine. Hence, the antiischemic effects of atenolol exceeded those of nifedipine, based on ST-segment depression and rate-pressure product at comparable workloads.

Aged↗
PubMed1989

Labetalol compared with propranolol in patients with both angina pectoris and systemic hypertension: a double-blind study.

Labetalol is a non-selective beta-adrenoceptor antagonist agent with added alpha 1-adrenergic blocking properties, beta 2-stimulating action, and direct vasodilatory activity. A multi-center, double-blind, parallel group study compared the safety and efficacy of labetalol to propranolol in the treatment of patients with both exertional angina and mild to moderate systemic hypertension. An initial 4 to 5 week placebo washout phase was followed by a five week titration phase and a four month maintenance phase. Labetalol and propranolol had similar effects in reducing supine and standing blood pressures, except for a greater reduction in standing systolic blood pressure seen in the labetalol group. There were comparable effects by both treatments on angina attacks, nitroglycerin use, and exercise tolerance. Adverse effects were frequent with both drugs, but were generally minor. Thus, labetalol appears to be an effective alternative to propranolol in the treatment of patients with coexisting angina pectoris and hypertension, with the choice of agent dependent on the clinical situation.

Adult↗
PubMed1988

Cisplatin for treatment of transitional cell and squamous cell carcinomas in dogs.

Thirteen dogs with tumors were treated with monthly infusions of cisplatin. Complete responses were not observed. Of 8 dogs with urinary tract transitional cell carcinomas, 1 (12.5%) had a partial response of 31 weeks' duration, and 4 (50%) had stable disease for 12, 30, 32, and 34 weeks. Three (60%) of 5 dogs with head and neck squamous cell carcinomas had partial responses for 2, 10, and 15 weeks. All 13 dogs were evaluated for signs of toxicosis. Transient episodes of vomiting were recorded for 7 dogs (54%), and 2 dogs (15%) had mild thrombocytopenia. Although renal function gradually decreased in 2 dogs (15%), none of the dogs had an episode of acute renal failure attributable to cisplatin. These findings suggest that cisplatin may be a safe and potentially effective agent for treatment of transitional cell and squamous cell carcinomas in dogs.

Animals↗
PubMed1988

Use of cisplatin for treatment of appendicular osteosarcoma in dogs.

Nineteen dogs were treated for osteosarcoma of the appendicular skeleton. Eleven dogs treated by amputation and adjunctive cisplatin chemotherapy had a significantly longer (P less than 0.003) median survival time of 43 weeks (range, 20 to 108 weeks) than did 8 dogs whose median survival time was 14.5 weeks (range, 8 to 46 weeks) after amputation alone. All 11 dogs given cisplatin were evaluated for signs of drug toxicosis. Transient episodes of vomiting were recorded in 9 of 11 dogs. Additional toxic effects included gradual decreases in endogenous creatinine clearance in 3 dogs and thrombocytopenia in 1 dog. On the basis of prolonged survival times and minimal adverse effects, we concluded that cisplatin has promise as an effective and relatively nontoxic agent, when combined with amputation, for treatment of dogs with osteosarcoma of the appendicular skeleton.

Amputation, Surgical↗
PubMed1988

Management of pleural effusion secondary to metastatic adenocarcinoma in a dog.

A 4-year-old spayed Collie-type dog was evaluated for pleural effusion secondary to metastatic adenocarcinoma with no identifiable primary tumor. For 48 weeks, chemotherapy and thoracentesis palliated clinical signs associated with pleural effusion. At week 49, 5 mCi of chronic phosphate P32 (32P) suspension was injected into the right pleural space. Pleural effusion was not detected for 14 weeks after 32P administration (week 63). In week 64, 32P suspension was readministered by injecting 7.5 mCi into the right hemithorax and 2.5 mCi into the left. Pleural effusion was again detected 3 weeks later (week 67), and the dog was treated with additional chemotherapy. Death, at week 72, was caused by disseminated intravascular coagulopathy.

Adenocarcinoma↗
PubMed1985

Comparative efficacy of 200, 300 and 400 mg of bepridil for chronic stable angina pectoris.

A total of 178 patients participated in a 14-week, multicenter, double-blind, parallel study to evaluate the comparative efficacy and safety of single daily doses of 200, 300 and 400 mg of bepridil hydrochloride and placebo in the treatment of patients with chronic stable angina pectoris. The results showed that weekly angina attacks and nitroglycerin consumption were significantly reduced from baseline levels with all doses of bepridil (p less than 0.01), and the reductions were consistently greater than those in the placebo group. For the 400-mg dose the reductions in angina attacks and nitroglycerin consumption were significantly greater (p less than or equal to 0.05) than those in the placebo group at all but 1 evaluation point. Exercise tolerance improved significantly during bepridil administration (p less than or equal to 0.05), and a significant linear dose response was noted for total exercise time, total work and time to onset of angina. In addition, bepridil was significantly superior to placebo for these parameters at doses of 300 (p less than or equal to 0.05) and 400 mg (p less than or equal to 0.01). There were small reductions in heart rate (mean 3.7 beats/min) and prolongation of QT and QTc intervals (approximately 30 to 40 milliseconds) associated with bepridil treatment. Bepridil was well tolerated by patients in this study. When adverse effects occurred, they most frequently involved the gastrointestinal and central nervous systems. Of the patients receiving bepridil, 6% discontinued therapy because of adverse effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Hemodynamic actions of bepridil during treatment of stable angina pectoris.

Bepridil, a new calcium-entry blocker, was evaluated in 13 patients with chronic stable angina in a single-blind trial that was placebo controlled within patients. Its antianginal effects were recorded and left ventricular (LV) function was assessed at rest and during exercise by gated blood pool scintigraphy. Mean anginal frequency was significantly reduced from 7.3 to 3.4 episodes/week (p less than 0.01). Total work performed increased from 336 to 625 kpm (p less than 0.01). Supine resting LV end-diastolic volume index, end-systolic volume index, stroke volume index, cardiac index and ejection fraction (EF) were not altered by bepridil. During supine exercise, the EF decreased from 60 to 55 during placebo therapy. Despite an increase in total work, the mean EF increased from 60 to 62 (p less than 0.05 versus exercise on placebo) during exercise with bepridil therapy. Maximal exercise stroke volume index and cardiac index were significantly greater during bepridil therapy. Exercise resulted in new or increased LV wall motion abnormalities in 7 of 13 patients during placebo therapy. During bepridil therapy, only 4 new or increased wall motion abnormalities were noted despite the increase in total work performed. Therefore, bepridil is an effective antianginal agent, allowing an increase in exercise workload while preserving LV performance.

Adult↗
PubMed1984

Evaluation of bepridil, a new antianginal agent: clinical and hemodynamic alterations during the treatment of stable angina pectoris.

The antianginal effects of bepridil, a new calcium entry blocker, were evaluated in 20 patients with chronic stable angina in a single-blind trial that was placebo-controlled within patients. Of the 20 patients, 13 also underwent rest and exercise gated blood pool scintigraphy to assess the effects of the agent on left ventricular (LV) performance. Mean anginal frequency was significantly reduced, from 7.3 to 3.1 episodes/week (p less than 0.01). Total work performed increased from 410 to 581 kpm (p less than 0.005), and exercise time increased from 5.3 to 6.6 minutes (p less than 0.005). Supine resting LV end-diastolic volume index, end-systolic volume index, stroke volume index, cardiac index and ejection fraction (EF) were not altered by bepridil. During supine exercise, EF decreased from 60 to 55% during placebo therapy. Despite an increase in total work, the mean EF increased from 60 to 62% (p less than 0.05 vs exercise placebo) during exercise with bepridil therapy. Maximal exercise stroke volume index and cardiac index were significantly greater during bepridil therapy. Exercise resulted in new or increased LV wall motion abnormalities in 7 of 13 patients during placebo therapy. During bepridil therapy, only 4 new or increased wall motion abnormalities were noted despite the increase in total work performed. Thus, bepridil is an effective antianginal agent. The drug allows an increase in exercise work load and preserves LV performance.

Adult↗
PubMed1984

Programmed ventricular stimulation in patients without spontaneous ventricular tachycardia.

Programmed ventricular stimulation was performed in 52 patients who had not had a documented or suspected episode of spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF). Programmed stimulation with up to three extrastimuli was performed from the right ventricular (RV) apex in all patients and from the left ventricular (LV) apex in 14 patients. A maximum response of one to five intraventricular reentry beats was induced in 52% of patients. Nonsustained VT (six or more repetitive beats terminating spontaneously within 30 seconds) was never induced in the 16 patients without structural heart disease but was induced (usually with triple extrastimuli) in 45% of nine patients with mitral valve prolapse and in 37% of 27 patients with other types of heart disease. Sustained VT was never induced; however, sustained VF was induced in two patients. During programmed RV and LV stimulation with up to three extrastimuli (with 2 msec pulses, 5 mA in intensity), (1) a maximum response of one to five repetitive beats is a nonspecific finding of no predictive value; (2) nonsustained VT was not induced in patients without structural heart disease who had not had spontaneous VT; (3) nonsustained VT was frequently induced in patients with structural heart disease who had not previously been known to have had VT; (4) the induction of sustained VT appears to be a response specific to patients who have had spontaneous VT or VF; and (5) sustained VF can be induced infrequently in patients who have never had spontaneous VT or VF.

Aged↗
PubMed1984

Electrophysiologic and hemodynamic effects of intravenous propafenone in patients with recurrent ventricular tachycardia.

Electrophysiologic and hemodynamic studies were performed before and after intravenous infusion of a new antiarrhythmic agent, propafenone, in 28 patients with recurrent ventricular tachycardia. Propafenone was given at a loading dose of 2 mg/kg in all patients. Subsequently, group A, the first 14 patients, received 1 mg/min and group B, the second 14 patients, received 2 mg/min continuous infusion. Propafenone exerted no effect on sinus nodal recovery time and sinoatrial conduction time, but significantly prolonged atrioventricular (AV) nodal and His-Purkinje conduction time and the QRS duration (respectively, 95 +/- 19, 48 +/- 10 and 120 +/- 23 ms before, and 110 +/- 28, 53 +/- 10 and 135 +/- 27 ms after; p less than 0.001). Propafenone did not change the mean arterial blood pressure but slightly increased right atrial, pulmonary artery and capillary wedge pressures resulting in mild depression of the cardiac index (2.6 +/- 0.8 liters/min per m2 before and 2.3 +/- 0.7 liters/min per m2 after; p less than 0.001). None of the patients were symptomatic from these changes. In group A, propafenone did not affect the inducibility of ventricular tachycardia except for one patient whose arrhythmia was sustained before and become nonsustained after propafenone. In group B, sustained ventricular tachycardia became noninducible in three patients and nonsustained in two patients, and nonsustained ventricular tachycardia became noninducible in one patient after propafenone. Therefore, an appropriate loading dose of intravenous propafenone such as 2 mg/kg followed by 2 mg/min infusion may be given safely and may suppress ventricular tachycardia. Propafenone may be a useful addition to currently available antiarrhythmic agents.

Adolescent↗