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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the last decade, world literature abounds in reports of harmful side effects which develop with the use of oral contraceptives including visual problems such as partial and total clotting in the retinal veins, infections, blood in the retina, and dilated veins signalling imminent stroke. 2 particular cases treated at the Opthalmological Clinic of the Academy of Medicine in Lodz deserve consideration. M.W., a 19 year old student who had had measles and scarlet fever in childhood, reported increasing visual problems. Due to irregular menstrual periods, she had been taking the contraceptive Angravid, consisting of 1 mg ethynodiol acetate, a synthetic progestogen and .05 mg mestranol, a synthetic estrogen. After a complete examination retrobulbar neuritis with the presence of papilloedema in the eye fundus of local origin was diagnosed. She was treated for general and local infection and for the prevention of clotting. After a month all symptoms regressed. H.U., a 30 year old stomatologist, reported to the clinic, complaining of sudden and periodic visual disturbances occurring in both eyes, accompanied by severe headache pains. In childhood she had had measles and whooping cough, later frequent bouts of flu and angina. She had given birth 3 times, each a natural delivery with healthy children. Recently she had been taking the oral contraceptive femigen, consisting of 2 mg chloromadinon acetate and .05 mg mestranol. After a complete series of skull and brain tests, papilloedema with the pseudotumor syndrome cerebri was diagnosed. Intensive treatment for edema produced visible improvement and the patient was discharged.
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PMID:[Ophthalmological complications after oral contraceptives (author's transl)]. 67 30

Cardiovascular risk factors in 566 patients with peripheral arterial disease undergoing major vascular operations were analyzed by chi-square analysis. There were 37 postoperative deaths, for a mortality rate of 8.5%. Cardiovascular complications were responsible for 23 deaths (62%). Five risk factors--congestive heart failure, prior myocardial infarction, prior stroke, arrhythmia, and abnormal electrocardiogram--showed significant individual associations with postoperative cardiovascular complications. A multivariate analysis of these five risk factors and angina led to the development of an equation which predicts the probability of a postoperative cardiovascular complication. The number of complications observed corresponded closely to that predicted by the equation. There was a significantly higher incidence of complications in patients predicted to be at high risk than in those at low risk.
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PMID:Cardiovascular risk factors in patients with peripheral vascular disease. 69 38

Regional systolic left ventricular performance after myocardial infarct was assessed from 216 radionuclide angiograms performed in 170 patients. Recording of first transit of an intravenously injected bolus of technetium-99m pertechnetate was made by a multicrystal scintillation camera at a framing rate of 20 per second. The RAO view was used and a simultaneous ECG was employed. Statistics adequate for resolving regional events were obtained by a compact bolus input and phasic summation into one representative cycle of data obtained during left ventricular passage. Emphasis was given to imaging of regional systolic left ventricular function: perimeter images of end-systole and end-diastole, regional stroke volume images and ejection fraction images were processed. New trend images were presented that reflect total systolic contraction and improve image quality: regional rate of decrease and increase images, wall motion trend images and regional mean transit time images. In 96% of the cases, correspondence was found between the electrocardiographic location of the infarct and the region of major wall motion and ejection disorder. Akinesia and/or dyskinesia were seen in 77% of the cases; a ventricular aneurysm was found in 11%. Additional areas of wall motion anomalies were shown by 70%. Image analysis, nuclear image signs and their diagnostic meaning, as well as the indications for this nontraumatic examination in coronary heart disease are discussed. Relevant information for medical or surgical therapy can be obtained from early and follow-up studies in patients with unstable, progressive angina, ischemic electrocardiographic signs and those who have had myocardial infarctions.
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PMID:Radionuclide angiography of the heart in coronary heart disease: where do we stand? 74 2

Although hypertension is an acknowledged risk factor in ischaemic heart disease (IHD) the question remains whether antihypertensive therapy is necessarily beneficial. A priori, because coronary atherosclerosis is probably irreversible, the time for effective intervention would seem to be well before the development of clinical manifestations. The Australian National Blood Pressure Study, a long term clinical trial of the treatment of mild hypertension, is in principle better suited than previous trials to answer the question because the trial population selected (4000 subjects aged 30-69) contains substantial proportions of younger age groups (26% below 45) and of females (37%) and none had manifest IHD at entry. Sensitivity to the emergence of IHD in the trial population is increased by including as diagnostic indices angina and ischaemic ECG changes, using suitably objective methods, as well as myocardial infarction and sudden death. Thus morbidity and mortality from IHD which currently accounts for 71% of trial end points (cf 19% for stroke) will effectively determine the outcome of the trial. The occurrence of a substantial proportion of subjects withdrawn from randomised treatment will mean that the question will be answered necessarily in two ways: firstly in respect of those subjects remaining on their assigned treatments and secondly in terms of all subjects initially assigned one treatment or other irrespective of the subsequent need to change treatment on ethical grounds or of the degree of compliance.
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PMID:The Australian National Blood Pressure Study: a test of the effectiveness of antihypertensive therapy on the incidence of ischaemic heart disease. 79 27

The haemodynamic effects of nitroglycerin (0.6 mg sublingual) have been studied in eleven patients with coronary artery disease, by means of the thermodilution method which enables cardiac output to be repeatedly measured at short time intervals (1-2 minutes). The following data have been studied: blood pressure (BP), pulmonary arterial pressure (PA), left ventricular filling pressure (LVFP), cardiac output (CO), stroke volume (SV), heart rate (HR), total systemic resistance (TSR), total pulmonary resistance (TPR), tension-time index (TTI) and left ventricular stroke work index (LVSWI). Within 1 minute following nitroglycerin (NG) administration the patients showed a decrease in TSR, TPR, and an increase in CO, SV, HR and LVCWI. TTI was reduced at the 5th minute. LVFP, PA and BP decreased after 3-5 minutes. CO increase at the 1st minute often compensated the fall in TSR, and blood pressure remained unchanged. The LVSWI/LVFP curve showed a transitory shift to the left at the 1st minute. In eleven normal subjects NG induced a minor increase in CO and SV, and a minor decrease in TSR at the 1st minute. The mechanism of action of NG in angina pectoris is briefly discussed.
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PMID:[Haemodynamic effects of nitroglycerin (author's transl)]. 81 Mar 83

The effects of nitroglycerin ointment (15 mg nitroglycerin) on hemodynamics at rest and during exercise were studied in 12 patients with coronary artery disease and exertional angina (angina group) and in 8 patients with normal coronary arteriograms or with nonsignificant arteriographic abnormalities who did not have exertional chest pain (nonangina group). In both groups at rest nitroglycerin ointment induced within 15 minutes a significant decrease in left ventricular end-diastolic pressure that was sustained for at least 60 minutes; systemic arterial pressure also decreased within 15 minutes and continued to decrease during the 60 minutes of observation. By 30 to 60 minutes there were significant decreases in cardiac index, stroke index, left ventricular stroke work index and tension-time index. During exercise performed 60 minutes after receiving nitroglycerin ointment, 10 of the 12 patients in the angina group had no pain, whereas 2 had delayed and less severe symptoms. Hemodynamic observations during this exercise period revealed significant decreases in left ventricular end-diastolic pressure, systemic pressure and tension-time index from values in the initial exercise period; heart rate remained unchanged. These data document the protective effect of nitroglycerin ointment for a period of at least 60 minutes and also suggest that the beneficial effects are related to a reduction in myocardial oxygen requirements.
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PMID:Effect of nitroglycerin ointment on the clinical and hemodynamic response to exercise. 82 28

Action taken by the Food and Drug Administration (FDA) toward the th erapeutic use of estrogens is reported. The FDA has 1st ordered revision of physician-labeling for estrogens, and 2nd has prepared a brochure explaining the advantages and disadvantages of estrogen therapy to patients. Some of the points made in the new labeling and brochure are: 1) the risk of cancer of the uterus increases with duration of use and dosage; 2) users of estrogens should be examined by their physicians at least every 6 months; 3) estrogens should never be given to pregnant women; 4) estrogens should not be given in cases of breast or uterine cancer, undiagnosed abnormal vaginal bleeding, clotting in the legs and lungs, or previous heart disease, angina, or stroke; and 5) estrogens should not be used to treat menopausal nervousness, as they have proved ineffective, or for improving the complexion. There is also no evidence that estrogens are effective in preventing threatened or habitual abortion. It is recommended that estrogens be administered cyclically (3 of 4 weeks), and that the dosage be reduced or discontinued every 3-6 months to assess the need for their continued use.
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PMID:Informing patients about estrogens. 82 30

The myocardial contractility function was studied with the aid of echocardiography in 42 male patients during dosaged physical exercises. The patients were selected so that at the peak of the exercises they developed an angina pectoris attack documented by ischaemic ECG changes. In some of the patients the changes were also observed during attacks of angina decubitus. Anginal attacks are accompanied by a reduction of the myocardial function. Haemodynamic reactions of two types were noted with myocardial ischaemia: type I reaction was observed in patients with ischaemic heart disease and practically normal values of the initial heart volume, and consisted in an increasing end-systolic and end-diastolic volumes, with the stroke volume remaining unchanged, and the ejection fraction somewhat decreasing; type 2 reaction was observed in patients with initially increased heart volumes, and consisted in a decreasing end-diastolic and stroke volumes, with an insignificant alteration of the end-systolic volume. The ejection fraction, being initially insignificantly decreased, tends to decrease further during the attack.
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PMID:[Myocardial contractility during angina pectoris attack in ischemic heart disease]. 85 2

Ten male anginal patients with angiographically documented coronary artery disease, in a randomized double-blind crossover study, smoked one marijuana cigarette (containing 18 mg of delta-9-THC) on one morning and one placebo marijuana cigarette (containing 0.05 mg of delta-9-THC) on a successive morning. Significant increases occurred in average cognitive and intellectual impairment scores, derived from the objective content analysis of 5 min of speech, 30 mins after smoking the marijuana cigarette as compared to the placebo marijuana cigarette, and these scores decreased to near presmoking levels 60 min after smoking. No significant average changes occurred in anxiety or three hostility scale scores following smoking marijuana. Sizable individual differences were noted in the psychological responses to marijuana smoking due, presumably, to personality differences and/or differences in THC pharmacokinetics. Significant psychocardiovascular hemodynamic correlations, as measured by echocardiography, were observed during placebo-marijuana smoking between hostility inward scores and systolic blood pressure and ejection fraction, overt hostility outward scores and diastolic blood pressure, as well as between anxiety scores and stroke volume and left ventricular end-diastolic dimension and left ventricular diastolic volume. These significant psychophysiologic correlations were all eliminated during marijuana smoking. In view of associated findings that marijuana smoking decreased myocardial oxygen delivery, decreased exercise time until the onset of anginal pain, and increased myocardial oxygen demand in anginal patients, the use of marijuana by such patients is clearly inadvisable.
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PMID:Effect of marijuana and placebo-marijuana smoking on psychological state and on psychophysiological cardiovascular functioning in anginal patients. 87 96

To access left ventricular function and compare pulmonary capillary wedge pressure and left ventricular end-diastolic pressure in the supine and sitting positions, 20 men with angina pectoris secondary to coronary artery disease underwent hemodynamic studies at rest and during exercise in the two positions. At rest the values for cardiac index, stroke index, systolic ejection rate index and left ventricular stroke work index were lower in the sitting position; heart rate, left ventricular end-diastolic pressure and pulmonary capillary wedge pressure were similar in the two positions. All patients experienced angina during both exercise periods. At angina during supine exercise, stroke index, systolic ejection rate index and left ventricular stroke work index did not increase significantly from the resting values. In contrast, during sitting exercise, significant increases in these variables were observed. Comparison of data during exercise revealed higher values for heart rate, mean systemic pressure, cardiac index, systolic ejection rate index, left ventricular stroke work index and rate-pressure product and lower values for mean pulmonary capillary wedge pressure (20 +/- 3 versus 27 +/- 3 [mean +/- standard error of the mean] mm Hg, P is less than 0.001), and left ventricular end-diastolic pressure (24+/- 3 versus 31 +/- 3 mm Hg, P is less than 0.02) in the sitting position; stroke index and S-T segment depression were similar during the two exercise periods. Four patients had insignificant increases in left ventricular filling pressure during both exercise periods. Of the 16 patients with abnormal left ventricular filling pressure during supine exercise, only 10 had a similar response during exercise in the sitting position. There was a good correlation between left ventricular end-diastolic pressure and mean pulmonary capillary wedge pressure at rest and during exercise in the two postures.
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PMID:Hemodynamics at rest and during supine and sitting bicycle exercise in patients with coronary artery disease. 87 Nov 6


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