摘要:

Myocardial infarction (MI) usually results from thrombotic coronary artery occlusion at the site of a ruptured atherosclerotic plaque. The factors responsible for triggering MI are not known but conditions that increase serum catecholamines may be involved. Accordingly, the authors prospectively evaluated the presence of factors that may increase catecholamines immediately prior to MI in 186 patients. Myocardial infarction was documented by a rise in serum CK-MB. There were 149 men and 37 women, aged 57 ± 12 (mean ± SD) years. All patients were interviewed within 72 hours of admission concerning strenuous physical activity, emotional stress, and assumption of the upright posture immediately prior to the onset of symptoms. Seventy-five (40%) patients had one or more of these factors immediately prior to the onset of MI chest pain. Fourteen (8%) experienced acute emotional upset; 28 (15%) were involved in strenuous physical activity; and 39 (21%) had suddenly changed position. In the latter group, 18 changed from being supine for more than 1 hour to standing; three rose from supine to sitting; and 18 changed from prolonged sitting (> 60 minutes) to standing. The conclusion is that a potential triggering factor is present in many patients immediately prior to the onset of MI. A sudden change in position is the most frequent potential trigger, typically occurring the morning after awakening from sleep.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To maintain reduced body weight by behavioral therapy in moderately obese patients, body weight was measured four times daily and charted in a weekly graph. Seventytwo female patients with simple obesity were divided into two groups: 55 patients with appliance of charting of weight pattern (group-I), and 17 patients without the charting (group-II). The percentage of patients followed for 2 years was different between group-I (87%) and group-II (65%) during 2 years after completion of weight reduction therapy interviews (p<0.05). Fortyeight of group-I patients succeeded in decreasing their weight by 15.2 ± 1.5 (mean ± SEM) kg during the 6.5 ± 0.8 months of the therapy interviews. They were followed up for 3.8 years with no rebound weight gain. Eleven patients in group-II also succeeded in decreasing their weight by 16.8 ± 1.9 kg during 7.8 ±1.3 months but their body weight rebounded by 9.0 kg during the 2-year followup period. Twelve of 15 male patients with weight charting maintained reduced weight during 4.3 years. It was easier and more effective for obese patients to maintain weight graphs for the longer period than to record no weight graphs. Obese patients could themselves monitor irregular weight patterns produced by overeating and correct the irregularities in food intake and daily lifestyles. This seems to explain why the illustration of daily fluctuations of weight measurements was useful for long-term maintenance of weight reduction.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Combined insulin and sulfonylurea therapy for type 2 diabetes may improve the effectiveness of a single injection of insulin, thereby postponing the need for multiple injections. This concept was tested in 21 obese subjects imperfectly controlled by 20 mg of glyburide daily in a double masked, placebo-controlled, parallel design, 16-week protocol. Premixed 70% NPH/30% Regular insulin was taken before supper, and the dosage was adjusted weekly by an algorithm seeking nearly normal fasting glycemia. Eleven subjects using insulin plus 10 mg glyburide before breakfast had lower mean fasting glucose at 10-16 weeks than 10 subjects using insulin with placebo (mean ± SEM; 5.9 ± 0.3 versus 7.5 ± 0.7 mmol/L; p<0.05), and had a greater decrement of glycosylated hemoglobin from baseline values (1.3 ± 0.1 versus 0.8 ± 0.2% Al, p<0.05). After 16 weeks the combined therapy group used half as much insulin as the insulin-only group (50 ± 5 versus 101 ± 13 units/ d; p<0.01). Fasting serum free insulin values increased 58% from baseline after insulin therapy in the insulin-only group (p<0.05) but did not increase with combined therapy. Weight gain was similar in the two groups. These data support this form of combined therapy as one option for treating obese persons with type 2 diabetes no longer responsive to oral therapy alone.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Alpha-fetoprotein (AFP) is a fetal specific glycoprotein normally produced primarily by the fetal liver. Normally, AFP levels decline rapidly after birth, reaching undetectable levels (>10 ng/ml) within several months after birth. The authors have developed a more sensitive radioimmunoassay, which has allowed them to study low levels of AFP in normal adults and to determine factors which may affect its normal level. Two hundred and seventy normal Houston blood donors were screened for the absence of hepatitis B and normal ALT levels. The mean AFP level was 3.04 ng/ml ± 1.9 SD. There was a statistically significant higher level in men compared to women (p<.004). Regression analysis demonstrated a statistically significant increase of AFP levels with age both in men (p<.05) and in women (p<.01). These data delineate the normal level of serum AFP in normal adults in the United States. With the normal level now defined, it becomes possible to compare levels in different populations including those exposed to hepatotoxins or hepatocarcinogens in the environment.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Plasma norepinephrine (NE) and epinephrine (E) increase with exercise but the reproducibility of their response to short-term serial exercise testing has not been established. Therefore, NE and E were measured at rest, 6 minutes, peak exercise, and 5 minutes postexercise in 10 normal subjects undergoing three identical exercise tolerance tests within 4—13 days. Norepinephrine and E were also measured in tests 2 and 3 at the time equivalent to the peak exercise duration in test 1 (peak—equivalent). Exercise duration increased slightly from test 1 (15.6 ± 0.7 min) to test 2 (16.5 ± 0.5 min; p=0.07) but no further on test 3 (16.2 ± 0.9 min). Norepinephrine and E did not differ across the three tests at rest, 6 minutes, peak test or posttest, but a significant decrease in both NE and E was seen at peak-equivalent by test 3 (p<0.05). Heart rate decreased across the three tests at 3, 6, 9, and 12 minutes (p<0.02 for each) and peak equivalent (p<0.005) but was unchanged at rest, peak exercise and postexercise. Thus, plasma catecholamines and heart rate decrease at high levels of exercise with repeated, short-term exercise testing, possibly due to familiarity with the protocol. These results suggest that control groups are important when measuring the effects of short-term pharmacologic intervention by serial exercise tests.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The effect of morphine and naloxone on acute cocaine toxicity was studied. Male Sprague-Dawley rats were pretreated intraperitoneally (ip) with saline, morphine sulfate 25 mg/kg, or naloxone 1.0 mg/kg 15 minutes prior to challenge by cocaine. After pretreatment, each group was challenged with one of three doses of cocaine (35, 50, or 75 mg/kg ip). Each of the nine drug combinations was tested on at least 10 animals. Animals were observed for behavior, seizures, and death. The animals pretreated with saline and challenged with cocaine (35, 50, or 75 mg/kg) had seizure incidences of 0%, 40%, and 100%, respectively, after increasing doses. Pretreatment with morphine resulted in cocaineinduced seizures of 20%, 80% and 100%, respectively (p<0.05 with cocaine 35 and 50 mg/kg). Time to seizures in these groups did not differ significantly compared to the saline groups. Pretreatment with naloxone resulted in cocaineinduced seizures of 0%, 50%, and 60% (p <, 0.05 at the 75 mg/kg dose). The incidence of death was significantly increased by pretreatment with morphine in animals that received cocaine 50 or 75 mg/kg. The time to death was not significantly different compared to saline controls. The death rate in naloxone pretreated animals was not significantly different from the saline groups. In additional studies, high-dose naloxone pretreatment (10 mg/kg) also failed to provide protection from acute cocaine toxicity. In conclusion, cocaine toxicity is potentiated by morphine and does not appear to be altered by naloxone.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Electrocardiographic ST segment changes that mimic myocardial infarction (MI) may occur secondary to metastatic carcinoma. Presented here is a case in which symptomatology suggestive of acute MI occurred with impressive new anterior ST segment elevation in a patient with a history of laryngeal carcinoma. Clinical options in this setting are discussed, including use of thrombolytic agents and acute catheterization.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Pulmonary lymphangitic carcinomatosis is an unusual presentation of diffuse infiltrative lung disease. In this report, we present a case secondary to cervical carcinoma that has been previously reported in only four patients. The diagnosis was made by transbronchial lung biopsy.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A 63-year-old white female who was being treated for hypertension with lisinopril presented with seizures, altered mental status, and a serum sodium of 101 mEq/L. Serum sodium prior to initiation of lisinopril therapy was 137 mEq/L. The hyponatremia was corrected and did not recur after lisinopril was stopped. The hyponatremia may have been a result of polydipsia and inappropriate antidiuresis secondary to ACE-inhibitor therapy.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Rhodococcus equi, a facultative intracellular bacterium, is a common cause of pulmonary infection in farm animals, especially foals. Pulmonary and disseminated infection caused by this organism is occasionally seen in humans, especially in patients whose cell-mediated immunity has been altered by glucocorticoids or cytotoxic chemotherapy. Not surprisingly, the organism may cause serious disease in human immunodeficiency virus (HIV)-infected humans whose T cell-dependent immune system has been profoundly suppressed. This report describes an HIV infected patient with Rhodococcus equi pneumonia and reviews nine additional HIV-infected patients. Treatment in humans is not standardized. Studies in foals indicate that erythromycin and rifampin together are the treatment of choice. The patient in this report responded to this treatment briefly before relapsing and dying of the infection.

ISSN:0002-9629    

出版商:OVID    

年代:1992

数据来源: OVID