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Biomedical subjects

Y Friedman

Publications and source records attributed to Y Friedman.

At least 37 records · Page 2Linked to original sources
PubMed1993

Bedside percutaneous tracheostomy in critically ill patients.

Bedside percutaneous dilational tracheostomy was performed by critical care attending physicians or supervised pulmonary and critical care fellows on 100 patients in the ICU at Cook County Hospital, Chicago, over a 3-year period. A needle is inserted in the first or second tracheal interspace followed by a guidewire. The tract is enlarged with a series of dilators to allow placement of a standard tracheostomy tube. Average procedure duration for 46 patients was 6.7 +/- 2.9 min. The intraoperative complication rate was 8 percent: transient oxygen desaturation (4 percent), transient hypotension (3 percent), and paratracheal insertion (1 percent). The postoperative complication rate was 10 percent: bleeding (5 percent), stomal infection (3 percent), and subcutaneous emphysema (2 percent). One patient died of presumed innominate artery rupture. Fifteen of 37 patients who survived hospitalization were decannulated. Stomal closure occurred in 13 of these 15 patients within 3 days with a minimal residual scar. Comparison of percutaneous dilational tracheostomy with two other techniques of percutaneous tracheostomy reveals a similar success rate with a lower incidence of serious complications. Bedside percutaneous dilational tracheostomy can be performed in the ICU by trained physicians with a low complication rate. We believe it to be the procedure of choice for many critically ill patients who require tracheostomies.

Critical Illness↗
PubMed1993

The technique of percutaneous tracheostomy. Using serial dilation to secure an airway with minimal risk.

Percutaneous tracheostomy is the procedure of choice for most patients who require prolonged use of an artificial airway; it can be performed rapidly at the bedside and is associated with fewer complications than is the standard procedure. The serial dilational technique involves the insertion of prelubricated dilators that gradually enlarge the diameter of a tract made by a guidewire and guiding catheter, facilitating placement of a standard double-cannula tracheostomy tube. The most dangerous complication, paratracheal insertion, occurs only rarely. The small skin incision and resulting tight fit of the tracheostomy tube in the stoma help prevent bleeding and infection.

Contraindications↗
PubMed1993

Mask continuous positive airway pressure in AIDS.

FMCPAP and NCPAP therapy is an effective modality for treating patients with PCP, hypoxia, and respiratory insufficiency. The therapy decreases intrapulmonary shunting and improves oxygenation. It is safe and, in some cases, can be provided outside of an intensive care unit. The major benefit of MCPAP is that it postpones (and sometimes obviates) the need for intubation and mechanical ventilation. This may provide adequate time for a trial of therapy, education, ethical discussions, and completion of personal matters by patients. It is conceivable that failure to respond to MCPAP may provide prognostic information to help guide further therapy. Further outcome studies are needed to clarify this issue. Adding MCPAP to mechanical ventilation and conventional mask oxygen therapy increases the options that practitioners can use to provide the best titrated care for their patients.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Long-term prognosis after acute myocardial infarction in patients with left ventricular hypertrophy on the electrocardiogram. SPRINT Study Group.

Among 4,720 consecutive hospital survivors from acute myocardial infarction (AMI) treated in 13 coronary care units between July 1981 and August 1983, the estimated prevalence of electrocardiographic left ventricular (LV) hypertrophy was 6.1%. The prevalence of electrocardiographic LV hypertrophy increased with age and was higher in patients with previous myocardial infarction, angina and systemic hypertension. Mean age of patients with electrocardiographic LV hypertrophy was 67.2 vs 61.4 years in counterparts free of electrocardiographic LV hypertrophy. Patients with electrocardiographic LV hypertrophy had a higher rate of congestive heart failure on admission, or developing during their stay in coronary care units. The 1- and 5-year mortality rates were 19.7 and 46.6% among patients with electrocardiographic LV hypertrophy versus 8.7 and 26.2%, respectively (p less than 0.001) in patients without this finding. The covariate-adjusted odds ratio of 1-year mortality was 1.88 for the presence of electrocardiographic LV hypertrophy when age alone was adjusted for, and 1.51 (90% confidence interval, 1.09 to 2.10) when multiple covariate adjustment was undertaken. After multiple covariate adjustment for 5-year mortality after discharge, the relative risk associated with electrocardiographic LV hypertrophy was 1.51 (90% confidence interval, 1.26 to 1.80). The results of the present study showed that the presence of electrocardiographic LV hypertrophy on the discharge electrocardiogram of survivors from AMI is associated with a 1.5-fold increase of short- and long-term mortality. Patients with electrocardiographic LV hypertrophy, potentially at an increased post-discharge risk, may be candidates for early noninvasive testing and more intensive follow-up after recovering from AMI.

Aged↗
PubMed1992

The prognostic significance of angina pectoris preceding the occurrence of a first acute myocardial infarction in 4166 consecutive hospitalized patients.

We examined the role of chronic (greater than 1 month) angina pectoris (AP) before acute myocardial infarction (AMI) in predicting hospital and long-term mortality rates among 4166 patients with first AMIs. The prevalence of AP in these patients was 43%. Chronic AP was more common in women (49%), patients with hypertension (49%), and diabetic patients (49%) than in men and counterparts free of the former conditions (p less than 0.005). In patients with AP the hospital course was more complicated and non-Q-wave AMI was more common than in counterparts without AP. In-hospital (16%), as well as 1 (8%)- and 5-year postdischarge (26%), mortality rates in hospital survivors were higher among patients with previous AP than in patients without previous AP (12%, 6%, and 19%, respectively) (p less than 0.01). After adjustment for age and all other predictors of increased hospital mortality rates in this cohort of patients, AP preceding AMI emerged as an independent predictor of increased hospital mortality rates (odds ratio 1.30; 90% confidence interval 1.10 to 1.53). For postdischarge mortality rates (mean follow-up 5 1/2 years), the covariate-adjusted relative risk of death in patients with AP was similar at 1.29 (p less than 0.0001; 90% confidence interval 1.16 to 1.44), according to estimation by Cox proportional hazards model. These data support the notion that preexisting AP identifies a group of patients at increased risk of death.

Angina Pectoris↗
PubMed1991

Frequency of use of thrombolytic therapy in acute myocardial infarction in Israel.

Thrombolysis is now generally accepted as the initial treatment for patients with acute myocardial infarction (AMI). The extent to which this therapy is implemented in daily practice and the reasons for exclusion from thrombolytic therapy among 413 consecutive patients with AMI hospitalized in 18 coronary care units in Israel during a 1-month survey were prospectively investigated. Thrombolytic therapy administered to 145 patients (35%) was given to 38% of men versus 29% of women (p = not significant), to 38% of patients less than 75 years old compared with 18% of the very elderly (p less than 0.005), and more often to patients with a first or anterior AMI (40 and 48%) than to counterparts with recurrent or inferior AMI (23 and 31%, respectively, p less than 0.005 for both). The 2 most frequent reasons for excluding patients from thrombolysis were late arrivals to coronary care units (33%) and lack of ST elevation on the admission electrocardiogram (28%). Hospital mortality was 6% in the thrombolytic group versus 20% in patients found ineligible for thrombolysis. The significance of this difference is not clear as treatment was not randomized.

Aged↗
PubMed1991

Long-term survival of patients with AIDS, Pneumocystis carinii pneumonia, and respiratory failure.

OBJECTIVE: --To evaluate the long-term survival of patients admitted to the medical intensive care unit, Cook County Hospital, Chicago, Ill, with Pneumocystis carinii pneumonia and acute respiratory failure. DESIGN: --Cohort study over a 4-year period. SETTING: --Municipal teaching hospital. PATIENTS: --Seventy-three consecutive patients who had 75 episodes of P carinii pneumonia and acute respiratory failure were followed up from the time of hospital admission until their deaths or the termination of the study. OUTCOME MEASURES: --Duration of survival from the time of initial hospital admission with diagnoses of P carinii pneumonia and acute respiratory failure. RESULTS: --Consistent with recent reports of improved short-term outcome, the immediate hospital survival was 47% (35/75). The 1-year survival was 37% (95% confidence interval, 26% to 49%). Two patients have survived for 40 months. Almost three quarters of the patients who survived hospitalization lived for at least 1 year. CONCLUSIONS: --The long-term prognosis for patients with the acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure is now substantially better than anticipated. Respiratory failure due to P carinii pneumonia does not necessarily signify the terminal phase of human immunodeficiency virus infection. Accordingly, patients with the acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure can be appropriate candidates for life support in medical intensive care units.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Cerebrovascular accident complicating acute myocardial infarction: incidence, clinical significance and short- and long-term mortality rates. The SPRINT Study Group.

PURPOSE: The purpose of this study was to report the incidence, the antecedents, and the clinical significance of clinically recognized cerebrovascular accidents or transient ischemic attacks (CVA-TIA) complicating acute myocardial infarction. PATIENTS AND METHODS: During 1981 to 1983, a secondary prevention study with nifedipine (SPRINT) was conducted in 14 hospitals in Israel among 2,276 survivors of acute myocardial infarction. During the study, demographic, historical, and medical data were collected on special forms for all patients with diagnosed acute myocardial infarction in 13 of these 14 hospitals (the SPRINT registry, n = 5,839). Mortality follow-up was completed for 99% of hospital survivors for a mean follow-up of 5.5 years (range: 4.5 to 7 years). RESULTS: The incidence of CVA-TIA was 0.9% (54 of 5,839). The latter rate increased significantly only with age, from 0.4% among patients up to 59 years old to 1.6% among those aged greater than or equal to 70 years. Multivariate analysis identified age, congestive heart failure, and history of stroke as predictors of CVA-TIA during the acute phase of myocardial infarction. Patients with CVA-TIA exhibited a complicated hospital course, with a 15-day mortality rate of 41%. Subsequent mortality rates in survivors at 1 and 5 years were 34% and 59%, respectively. Rates at the same time points in patients without CVA-TIA were 16%, 11%, and 29% (p less than 0.01). In a multivariate analysis that included age, gender, congestive heart failure, history of previous myocardial infarction, and hypertension, CVA-TIA was independently associated with increased 15-day mortality (covariate-adjusted odds ratio [OR] = 2.62; 90% confidence interval [CI], 1.59 to 4.32), as well as subsequent 1-year (OR = 3.29; 90% CI, 1.70 to 6.36) and long-term (mean follow-up = 5.5 years) mortality (OR = 2.46; 90% CI, 1.30 to 4.69). CONCLUSION: In this large cohort of consecutive patients with myocardial infarction, CVA-TIA was a relatively infrequent complication of acute myocardial infarction. Factors independently favoring the occurrence of CVA-TIA were old age, previous CVA, and congestive heart failure. CVA-TIA occurring during acute myocardial infarction independently increased the risk of early death threefold as well as the risk of long-term mortality in early-phase survivors. (2.5-fold).

Aged↗
PubMed1991

Prolonged reversible quadriparesis in mechanically ventilated patients who received long-term infusions of vecuronium.

The use of neuromuscular blocking agents, particularly pancuronium, in patients receiving mechanical ventilation has been reported to cause prolonged paralysis and atrophy. We describe two mechanically ventilated patients with asthma who developed prolonged muscular weakness and atrophy after receiving the shorter-acting agent vecuronium. These cases illustrate the potential of any neuromuscular blocking agent to cause these complications, especially in patients who are immobile, have decreased renal or liver function, or receive concomitant myotoxic agents.

Adult↗
PubMed1990

Non-histone chromatin proteins in beef thyroid: distinct phosphorylation patterns of several protein kinases.

Non-histone chromatin protein (NHCP) fractions were extracted from purified beef thyroid nuclear preparations and tested for the presence of protein kinase activities using several known mediators of thyroid regulation, as well as potential phosphotransferase substrates using purified or partially purified protein kinase activities. The addition of cAMP/3-isobutyl-1-methylxanthine had no effect on NHCP histone kinase activity; the addition of 10 micrograms of the heat-stable cAMP-dependent protein kinase A inhibitor, however, resulted in a 47% reduction in histone H1 kinase activity. Nuclear casein kinase II activity was present in the NHCP fractions as evidenced by the capacity of spermine to stimulate (ED50 = 0.19 mM) and heparin to inhibit (ID50 = 0.09 microgram/ml) the phosphorylation of casein; further, the phosphotransferase activity could be purified by sequential casein-agarose and spermine-agarose affinity chromatography. Neither calcium-calmodulin nor calcium/phosphatidylserine/diolein had an effect on NHCP casein kinase or histone kinase activities, respectively. The addition of cAMP-dependent protein kinase A catalytic subunit, nuclear casein kinase II, calcium-activated calmodulin-dependent protein kinase and diacylglycerol-activated calcium/phospholipid-dependent protein kinase C activities exhibited distinct phosphorylation patterns when NHCP were used as substrates and analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis and autoradiography. We conclude that NHCP fraction from beef thyroid: 1) contains both cAMP-dependent protein kinase A catalytic subunit and nuclear casein kinase II and 2) substrates for cAMP-dependent protein kinase A, calcium-activated calmodulin-dependent protein kinase, protein kinase C, and nuclear casein kinase II.

Animals↗
PubMed1989

Improved survival in patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure.

Pneumocystis carinii pneumonia (PCP) causing acute respiratory failure (ARF) in patients with acquired immunodeficiency syndrome (AIDS) has been reported in several studies to have a mortality of 84 to 100 percent. A recent report found a 42 percent survival rate. We followed 58 patients with AIDS who required positive pressure ventilation and identified 33 patients with PCP and ARF who had a PaO2/FIo2 level less than 150 mmHg. We report the survival of 12 of these 33 (36 percent). The mean duration of survival after discharge from the hospital was 7.9 +/- 1.8 months, which is an improvement over previous reports. These data suggest that we should reevaluate the reported recommendations that patients with AIDS, PCP and ARF should not receive intensive care or mechanical ventilation.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Purification of a 107 kilodalton (kDa) casein kinase G substrate from thyroid cytosol.

A 107 kDa (pp107) casein kinase G (ck-G) substrate has been purified from mouse and beef thyroid cytosol; ck-G was purified from beef thyroid cytosol. Ck-G and pp107 were found to co-elute on DEAE cellulose chromatography at approximately 300 mM NaCl. Ck-G and pp107 were separated by spermine-agarose affinity chromatography; pp107 is eluted with a stepped gradient at 250 mM NaCl and ck-G is eluted at 500 mM NaCl. Ck-G was subsequently purified by casein-agarose and GTP-agarose affinity chromatography. The 107 kDa protein was purified using heparin-agarose affinity chromatography. Phosphorylation of purified pp107 by ck-G was stimulated by spermine (ED50 = 0.2 mM) and inhibited by low concentrations of heparin (0.1-5 micrograms/ml). The Km and Vmax for the reaction were 1.46 microM and 32.2 nmoles P transferred/20 min/mg protein, respectively; 1 mole pp107 incorporated 0.81 mole phosphorus. pp107 was found to be an acidic substrate with a pI of 3.87 and was absorbed to wheat-germ agglutinin-agarose. The specificity of pp107 phosphorylation was studied using diacylglycerol-activated calcium/phospholipid-dependent protein kinase C, calcium-activated calmodulin-dependent protein kinase, and the catalytic subunit of cAMP-dependent protein kinase A. Phosphorylation of pp107 by the other protein kinases tested never exceeded 4% of that of ck-G. Our data show that pp107 is an acidic glycoprotein which may serve as a high-affinity and specific substrate for ck-G.

Animals↗
PubMed1986

Calcium-activated, calmodulin-dependent protein kinase activity in bovine thyroid cytosol.

Bovine thyroid 100,000 X g supernatant contained calcium-activated, calmodulin-dependent protein kinase (PK-CaM) activity. The PK-CaM was partially purified using ion-exchange chromatography and characterized. PK-CaM, using casein as exogenous substrate, was not stimulated by Ca2+(0-500 microM) or calmodulin (1-10 micrograms) by themselves, but was stimulated by the combination of the two by 100%. The activation of the enzyme by Ca2+ and calmodulin was dose-dependent with maximal stimulation evident at 1 microM free-Ca2+ and 3 micrograms calmodulin. Both chlorpromazine and trifluoperazine inhibited the thyroid enzyme in a dose-related manner. The molecular weight (MW) of the PK-CaM, based on gel filtration, was approximately 500,000. PK-CaM could also be demonstrated using endogenous thyroid cytosol proteins as substrate. Separation of these 32P-labelled proteins by SDS-PAGE and subsequent autoradiography revealed that one major protein of approximately 56,000 MW was phosphorylated by PK-CaM. In some experiments, a second, less-intense protein band of approximately 64,000 MW was also phosphorylated. Evidence is presented, suggesting that these two protein bands may result from the autophosphorylation of the PK-CaM holoenzyme. These results offer a molecular mechanism, in addition to protein kinase C, by which Ca2+ effects may be mediated in thyroid.

Animals↗