Showing papers by "Lenox Hill Hospital published in 1981"

The effect of slow releasing oral magnesium chloride on the qtc interval of the electrocardiogram during open heart surgery

Abstract: Recent work in both animal and human studies emphasizes the value of magnesium in the maintenance of the functional and structural integrity of cardiac muscle. Both intracellular and extracellular magnesium concentrations can vary independently and the serum and red cell magnesium levels may not give an accurate account of intracellular cardiac magnesium deficiency. However, electrocardiographic studies of magnesium levels could provide an accurate index of intracellular cardiac magnesium levels. Twenty-four patients scheduled electively for mitral valve replacement were studied to evaluate the effect of slow releasing oral magnesium chloride on the QTc interval of the electrocardiogram. Although pretreatment QTc values in all patients were not significantly different, there was a highly significant difference between the control group and the treatment group after four days of preoperative treatment with oral magnesium chloride. During the postoperative phase of the trial, all patients developed a similar pattern of increase in QTc interval, reaching a peak at the end of the second day and followed by a decrease over the final two days. All patients who developed arrhythmias postoperatively had not been pretreated (primed) with oral magnesium chloride and had abnormal QTc intervals both before and after operation. The results of this study demonstrate the usefulness of oral magnesium chloride in reducing the QTc interval of the electrocardiogram and so protecting the myocardium against possible arrhythmias.

Indirect assessment of cardiovascular "demands" using telemetry on professional football players

Abstract: Aerobic training is not a major component of the conditioning programs of professional football play ers We used telemetric ECG monitoring to examine the cardiovascular "demands" of practice and game situations in six athletes who were selected to affect a variety of positions and aerobic capacities Heart rates commonly considered high enough for an aero bic conditioning effect were rarely attained during practice sessions Maximum oxygen consumption testing confirmed that professional football players do not receive a sufficient amount of aerobic conditioning during practice Telemetrically monitored heart rate response is much greater in a game situation than that experienced during practice Telemetry results sup port injury statistics by indicating that aerobic condi tioning should have a significant role in the training program of the professional football player

Intraarticular iliotibial band reconstruction for anterior cruciate ligament insufficiency

Abstract: Intraarticular reconstruction of the anterior cruciate ligament by transferring the distal aspect and insertion of the iliotibial band has been clinically successful Our surgical technique theoretically retains normal neurovascular supply, and thus, the potential for dynamic repair exists Thirty-five patients, 28 men and 7 women, underwent this reconstruction The average age was 24 years, with a range from 18 to 46 There were 27 chronic and 8 acute injuries Pathological findings included an absent anterior cruciate (14 knees), severe stretching (13), failed reconstruction or repair (4), midportion tears (3), and avulsion (1) Postoperative patients were evaluated according to the Kennedy criteria An anterior drawer of 2+ was not observed in any patient There were no cases of 2+ rotary instability, and no pivot shifts The possibility of a dynamic or proprioceptive repair was assessed by electromyography While no evidence of electrical activity was recorded on the gluteus maximus on 60 normal knee examinations, all 10 tested postoperative iliotibial band patients had electrical activity The failed results of the series showed no evidence of activity

Uterine cancer (prevention).

Abstract: Cancer prevention as related to the problem of cervical and endometrial cancer involves a great number of factors that are considered contributory to the development of neoplasms in the uterus Lifestyles encouraging the development of cervical cancer are different from those encouraging endometrial cancer Cancer of the cervix is a disease of the inner city It is seen in those staring intercourse in their teens, having multiple partners, having many children, and coming from the low socioeconomic groups Semen and herpes virus II may have an adverse effect on immature cells, but there are no hard data to confirm these roles Cancer of the endometrium is a disease of suburbia The American Cancer Society estimates that there will be 38,000 new cases of endometrial carcinoma in 1980, making it the most common female genital cancer Women at highest risk for later carcinoma of the endometrium are those who have obesity, diabetes, infertility, irregular menses and failure of ovulation, adenomatous hyperplasia, and/or prolonged estrogen administration For both cervical and endometrial cancers, it is possible to identify the high-risk patient, to detect changes at an early stage, and, by instituting appropriate therapy, to prevent a more serious problem It is obvious that prevention, detection, and treatment are all closely intertwined This paper identifies the patient at high risk and makes suggestions for correcting any imbalance that may predipose to the development of invasive cancer

Immunologic aspects of gynecologic cancer.

Abstract: All vertebrates have a defense mechanism, the immune defense system, that protects them from disease-causing microorganisms. Its deliberate exploitation has conquered many infectious diseases and has been a major achievement of medical science in preventing suffering and saving lives. At the beginning of this century, hope was held that dissimilarities between normal and neoplastic cells could be demonstrated by immunologic methods and that vaccination against cancer might become possible. When it was recognized that the many claims of tumor=specific antigenicity were based on experiments in which an immunity to normal alloantigens, rather than tumor-specific antigens, had been demonstrated, the field of tumor immunology came into disrepute. The work of Gross in 1943 and Prehn and Main in 1957 rekindled interest in tumor immunology. Many contributions have advanced the concept of tumor immunology. They are the following: (1) an abundant supply of highly inbred (syngeneic) animals; (2) extensive work on experimental transplantable tumors; (3) an understanding of the mechanism causing rejection of grafted normal and cancerous tissues in animals; (4) identification of the function of the humoral and cell-mediated mechanisms following organ transplantation; (5) the observation that cancers do arouse a specific immune response in the organisms in which they appear; (6) antigenic differences represent the first known qualitative distinction between cancer cells and their normal counterparts; (7) the application of improved technology--columns, use of fluorescein-tagged antibodies, urea as a chaotropic agent, nephelometer; (8) hybridoma to produce a supply of monoclonal antibodies; (9) new vaccines directed against invasive tumors, and (10) the exploration of the role of immune complexes in oncology. The areas of promise and the future of cancer immunology have once again challenged the minds of scientists.

Comment on Effect of Cimetidine on Theophylline Clearance

Abstract: TO THE EDITOR: We read Drs. Ambrose and Harralson's interesting report describing the lack of effect of cimetidine on theophylline clearance (DICP 1981; J5: 389-90). This report is in contrast to two others that demonstrate an inhibitory effect by cimetidine on theophylline elimination.!·~ Jackson and associates observed a decrease in theophylline clearance in five healthy subjects.! Weinberger and co-workers reported a 15-year-old asthmatic female whose theophylline elimination half-life increased after concurrent cimetidine usage.~ We have recently encountered two elderly female patients who experienced this same phenomenon (data as yet unpublished). In addition, we have provided consultations on four other elderly female patients who exhibited decreases in theophylline clearance with concomitant cimetidine usage. However, follow-up levels to confirm the presence of this drug interaction could not be obtained in these patients after cimetidine was discontinued. It is interesting to note that the patients we have encountered were all elderly females. Inasmuch as cimetidine has been shown to interact with other drugs metabolized in the liver,:\\-ii this appears to present a plausible explanation of the mechanism for this interaction. We wish to warn clinicians of the potential effects of cimetidine on theophylline elimination. More studies are needed to further elaborate on this drug interaction so that appropriate dosage recommendations can be made.

Diagnosis of transanal prolapse and bleeding with an inspection mirror

Abstract: t:.XA~,IINArION o f the pat ient in the lateral Sims or inver ted posit ion, with the r e c t u m d i s t ended by atm o s p h e r i c pressure , d,>es not readi ly permi t c temons t ra t ion o f ,real mucosal or h e m o r r h o i d a l p ro lapse even d m i n g straining. D e m o n s t r a t i o n o f p ro lapse is best aecomplislaed b}\" e x a m i n i n g the pal ient d u r i n g o r just a f te r a Valsalva m a n e u v e r while the pa t ien t is seated on the toilel. ~ This can be a most i nconven ien t and u n d i g n i f i e d e x p e r i e n c e fo r both pa t i en t and physician, necessi tat ing the use t)f a Hashlight and ret ract ion o f tb.e buttocks. T h e use o f an adjustable m i r r o r great ly simplifies the ex, tminat ion. From tke D@arttn.crlt ~!f Surgery at Le~wx Hill Ho.~p/ta/, New York, New York; am/tlw Departmeut cf (;olm~ atzd Rectal Surgery at The (,'a~l~ (Tlim,, Url.lmi, llh'nr