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Alistar A, Morris B, Luther S, Pardee T, Morganstein N, Alpert J, Burak N. P-222 GA CPI 613: A single-arm, open-label phase I study of CPI-613 in combination with gemcitabine and nab-paclitaxel for patients with locally advanced or metastatic pancreatic cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Papakostas G, Shelton R, Zajecka J, Rickels K, Clain A, Baer L, Schoenfeld D, Nelson E, Barbee J, Lydiard B, Mischoulon D, Alpert J, Zisook S, Fava M. L-methylfolate augmentation of selective serotonin reuptake inhibitors (SSRIS) for major depressive disorder: Results of two randomized, double-blind trials. Eur Psychiatry 2020. [DOI: 10.1016/s0924-9338(11)72299-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionTwo randomized, controlled trials of L-methylfolate augmentation of SSRIs for major depressive disorder (MDD) were conducted using a novel study design (sequential parallel comparison design- SPCD).Objectives/aimsTo evaluate the efficacy of L-methylfolate augmentation using the Hamilton Depression Rating Scale.MethodsIn study one (TRD-1), 148 outpatients with SSRI-resistant MDD were enrolled in a 60-day, SPCD study, divided into two 30-day periods (phases 1 and 2). Patients were randomized 2:3:3 to receive L-methylfolate (7.5mg/d in phase 1, 15mg/d in phase 2), placebo in phase 1 followed by L-methylfolate 7.5mg/d in phase 2, or placebo for both phases. Study two (TRD-2) involved 75 patients and was identical in design to TRD-1 except for the dose of L-methylfolate (15mg only).ResultsIn the TRD-1 Study, L-methylfolate 7.5 mg/d was not found to be more effective than placebo. In phase 1 of the TRD-2 Study, 37% of patients on L-methylfolate 15mg/d responded and 18% of placebo patients responded, while in phase 2 among placebo non-responders, the response rates were 28% on L-methylfolate 15mg/d and 9.5% on placebo. When phases 1 and 2 were pooled according to the SPCD model, the difference in response rates was statistically significant in favor of L-methylfolate (p = 0.0399). The rates of spontaneously reported AEs and rates of study discontinuation appear r comparable between L-methylfolate and placebo in both studies. Rates of study discontinuation were also comparableConclusionsThese studies suggest that L-methylfolate 15 mg/d may be a safe and effective augmentation strategy for inadequate response to SSRIs.
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Brown RF, Davis R, Wilson Genderson M, Grant S, Cadet D, Lessard M, Alpert J, Ward J, Ginder G. African-American patients with cancer Talking About Clinical Trials (TACT) with oncologists during consultations: evaluating the efficacy of tailored health messages in a randomised controlled trial-the TACT study protocol. BMJ Open 2016; 6:e012864. [PMID: 27986738 PMCID: PMC5168644 DOI: 10.1136/bmjopen-2016-012864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Low rates of accrual of African-American (AA) patients with cancer to therapeutic clinical trials (CTs) represent a serious and modifiable racial disparity in healthcare that impedes the development of promising cancer therapies. Suboptimal physician-patient consultation communication is a barrier to the accrual of patients with cancer of any race, but communication difficulties are compounded with AA patients. Providing tailored health messages (THM) to AA patients and their physician about CTs has the potential to improve communication, lower barriers to accrual and ameliorate health disparities. OBJECTIVE (1) Demonstrate the efficacy of THM to increase patient activation as measured by direct observation. (2) Demonstrate the efficacy of THM to improve patient outcomes associated with barriers to AA participation. (3) Explore associations among preconsultation levels of: (A) trust in medical researchers, (B) knowledge and attitudes towards CTs, (C) patient-family member congruence in decision-making, and (D) involvement/information preferences, and group assignment. METHODS AND ANALYSIS First, using established methods, we will develop THM materials. Second, the efficacy of the intervention is determined in a 2 by 2 factorial randomised controlled trial to test the effectiveness of (1) providing 357 AA patients with cancer with THM with 2 different 'depths' of tailoring and (2) either providing feedback to oncologists about the patients' trial THM or not. The primary analysis compares patient engaged communication in 4 groups preconsultation and postconsultation. ETHICS AND DISSEMINATION This study was approved by the Virginia Commonwealth University Institutional Review Board. To facilitate use of the THM intervention in diverse settings, we will convene 'user groups' at 3 major US cancer centres. To facilitate dissemination, we will post all materials and the implementation guide in publicly available locations. TRIAL REGISTRATION NUMBER NCT02356549.
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Affiliation(s)
- R F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - R Davis
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - M Wilson Genderson
- Siminoff Research Group, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - S Grant
- Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - D Cadet
- Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - M Lessard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - J Alpert
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - J Ward
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - G Ginder
- Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Gilmer WS, Trivedi MH, Rush AJ, Wisniewski SR, Luther J, Howland RH, Yohanna D, Khan A, Alpert J. Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatr Scand 2005; 112:425-33. [PMID: 16279871 DOI: 10.1111/j.1600-0447.2005.00633.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify baseline sociodemographic and clinical factors associated with a current chronic major depressive episode (MDE). METHOD Outpatients with major depressive disorder enrolled in 41 US primary or psychiatric care sites were divided into two groups based on self-report of current episode length (<24 or > or =24 months). Logistic regression models were used to identify factors associated with chronicity of current depressive episode. RESULTS About 21.2% of 1380 subjects were in current, chronic MDEs. Older age, less education, lower income, no private insurance, unemployment, greater general medical illness burden, lower physical quality of life, concurrent generalized anxiety disorder, fewer prior episodes, and history of prior suicide attempts were all associated with chronic episodes. Blacks, Hispanics, and patients receiving care in primary as opposed to psychiatric care settings exhibited greater chronicity. CONCLUSION Chronic depressive episodes are common and are associated with greater illness burden, comorbidity, socioeconomic disadvantage, and racial/ethnic minority status.
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Affiliation(s)
- W S Gilmer
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Farabaugh AH, Mischoulon D, Fava M, Green C, Guyker W, Alpert J. The potential relationship between levels of perceived stress and subtypes of major depressive disorder (MDD). Acta Psychiatr Scand 2004; 110:465-70. [PMID: 15521832 DOI: 10.1111/j.1600-0447.2004.00377.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We wanted to explore whether major depressive disorder (MDD) subtypes (melancholic depression, atypical depression, double depression, and MDD with anger attacks) were related to levels of perceived stress, as measured by the Perceived Stress Scale (PSS). METHOD Our sample [n = 298; female = 163 (55%); mean age 40.1 +/- 10.5 years] consisted of out-patients with MDD. The Structured Clinical Interview for DSM-III-R, the 17-item Hamilton Rating Scale for Depression, the Anger Attack Questionnaire, and the PSS were administered prior to initiating treatment. RESULTS Depressed women had significantly higher levels of perceived stress (P = 0.02) than depressed men. Greater severity of depression at baseline was significantly related to higher levels of perceived stress (P < 0.0001). After adjusting for age, gender, and severity of depression at baseline, higher levels of perceived stress were significantly related to the presence of anger attacks (P < 0.0001; t = -4.103) as well as to atypical depression (P = 0.0013; t = 3.26). CONCLUSION Out-patients with MDD who are more irritable and/or present with atypical features have higher levels of perceived stress, indicating a potential reactive component to their depression.
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Affiliation(s)
- A H Farabaugh
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA WAC 812, USA.
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Perlis RH, Alpert J, Nierenberg AA, Mischoulon D, Yeung A, Rosenbaum JF, Fava M. Clinical and sociodemographic predictors of response to augmentation, or dose increase among depressed outpatients resistant to fluoxetine 20 mg/day. Acta Psychiatr Scand 2003; 108:432-8. [PMID: 14616224 DOI: 10.1046/j.0001-690x.2003.00168.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Patients with major depressive disorder often show only partial or no response to antidepressants, necessitating next-step interventions such as dose increase or augmentation. Factors moderating response to these next-step interventions are not well-studied. METHOD In this randomized, double-blind investigation of next-step treatments in 101 outpatients who failed to respond to fluoxetine 20 mg for 8 weeks, the impact of depressive course and sociodemographic factors on likelihood of treatment response following dose increase or lithium or desipramine augmentation was examined. RESULTS After controlling for depression severity at baseline, current marriage and earlier onset of depression were associated with greater likelihood of response in a logistic regression. Intervention strategy was not predictive of response. CONCLUSION Marital status and earlier onset of depression may be clinically useful in predicting outcome following any next-step intervention for treatment resistance, rather than with particular strategies.
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Affiliation(s)
- R H Perlis
- Depression Clinical and Research Program, Massachusetts General Hospital, WACC 812, 15 Parkman Street, Boston, MA 02114, USA.
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Lavori PW, Rush AJ, Wisniewski SR, Alpert J, Fava M, Kupfer DJ, Nierenberg A, Quitkin FM, Sackeim HA, Thase ME, Trivedi M. Strengthening clinical effectiveness trials: equipoise-stratified randomization. Biol Psychiatry 2001; 50:792-801. [PMID: 11720698 DOI: 10.1016/s0006-3223(01)01223-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As psychiatric practice patterns evolve to take advantage of the growing list of treatments with proven efficacy, research studies with broader aims will become increasingly important. Randomized trials may need to accommodate multiple treatment options. In completely randomized designs, patients are assigned at random to one of the options, requiring that patients and clinicians find each of the options acceptable. In "clinician's choice" designs, patients are randomized to a small number of broad strategies and the choice of specific option within the broad strategy is left up to the clinician. The clinician's choice design permits some scope to patient and clinician preferences, but sacrifices the ability to make randomization-based comparisons of specific options. We describe a new approach, which we call the "equipoise stratified" design, that merges the advantages and avoids the disadvantages of the other two designs for clinical trials. The three designs are contrasted, using the National Institute of Mental Health Sequenced Treatment Alternatives to Relieve Depression trial as an example.
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Affiliation(s)
- P W Lavori
- Department of Veterans Affairs Cooperative Studies Program, Palo Alto VA, Palo Alto, California, USA
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Abstract
OBJECTIVE We evaluated whether anger attacks in patients with major depressive disorder (MDD) are associated with higher rates of panic or other Axis I or II comorbid disorders. METHODS 306 out-patients (163 women, mean age 39.5+/-10.5) with MDD were administered the Structured Clinical Interviews for Axis I and II Disorders, and the Anger Attacks Questionnaire. RESULTS Patients with anger attacks showed only a trend toward a significantly higher rate of current panic disorder (P = 0.06) but no other difference in Axis I comorbidity. In addition patients with anger attacks had a slightly but significantly greater degree of depression severity. Consistent with previous studies, we have also found that depressed patients with anger attacks had significantly higher rates of dependent, avoidant, narcissistic, borderline, and antisocial personality disorders than those without anger attacks. CONCLUSION Anger attacks do not appear to be associated with any specific pattern of Axis I comorbidity, but they are certainly linked with certain personality disorders. It is possible that the acute depressive state may have confounded the assessment of personality disorder rates, as well as the presence of anger attacks. On the other hand, both depressed patient groups (with or without anger attacks) were subject to the same confounding effect as their depression severity was rather comparable, thereby limiting the impact of this potential bias.
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Affiliation(s)
- J Tedlow
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston 02114, USA
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Mooney JJ, Samson JA, McHale NL, Colodzin R, Alpert J, Koutsos M, Schildkraut JJ. Signal transduction by platelet adenylate cyclase: alterations in depressed patients may reflect impairment in the coordinated integration of cellular signals (coincidence detection). Biol Psychiatry 1998; 43:574-83. [PMID: 9564442 DOI: 10.1016/s0006-3223(97)00327-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adenylate cyclase (AC) responds to distinct but coincident signals from the agonist-stimulated G-protein Gs and the inhibitory G-protein Gi by generating a greater output signal-to-noise ratio--i.e., agonist-stimulated to basal ratio (fold-stimulation)--through coincidence detection than that generated by a single input (Gs) alone. Such coincidence detection by murine brain AC was found to be enhanced during chronic antidepressant treatment with imipramine. METHODS We examined and compared the basal, agonist-stimulated, and guanosine 5'-3-O-(thio)triphosphate (GTP gamma S) or AlF4 ion postreceptor-stimulated AC activities in mononuclear leukocytes and platelets from the same blood specimens obtained from depressed patients (n = 27) and control subjects (n = 19). RESULTS In all subjects, the differences (delta GTP gamma S or delta AlF4) between postreceptor measures of AC in mononuclear leukocytes (where AC is regulated by Gs but not by Gi) and platelets (where AC is regulated by both Gs and Gi) were highly significant. In controls, the relationships between delta GTP gamma S or delta AlF4 and basal, agonist-stimulated, and the fold-stimulation of agonist-stimulated platelet AC resembled the regulation of AC by Gi in model-membrane systems. Comparable relationships between delta GTP gamma S or delta AlF4 and basal, agonist-stimulated, and the fold-stimulation of agonist-stimulated platelet AC activities were not observed in depressed patients. CONCLUSIONS Our results suggest that in controls, platelet AC enzyme activity is determined (in part) by the coordinated integration of signals from Gs and Gi through coincidence detection, while such coincidence detection by platelet AC may be impaired in patients with depressive disorders.
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Affiliation(s)
- J J Mooney
- Massachusetts Mental Health Center, Boston, USA
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Abstract
PURPOSE To review findings of recent research studies on anger in children and adolescents, the outcomes of mishandled anger and interventions to promote appropriate anger management. SOURCE Published literature. CONCLUSIONS Anger may be a healthy or unhealthy response in children experiencing small frustrations or great injustices. Research findings vary and there is a need to clearly define anger and the correlates of anger in children and adolescents. In addition, there are limited studies on anger management strategies and their effectiveness that would assist healthcare professionals.
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Abstract
OBJECTIVE The rate of adverse events following discontinuation of treatment with extended-release venlafaxine was compared with the rate associated with discontinuation of placebo administration. METHOD The subjects were 20 outpatients with major depressive disorder who had participated in a multicenter, double-blind, placebo-controlled study of the efficacy of the new extended-release formulation of venlafaxine. RESULTS During the 3 days after discontinuation of treatment with the study drug, seven (78%) of the nine venlafaxine-treated subjects and two (22%) of the nine placebo-treated patients reported the emergence of adverse events, a statistically significant difference. CONCLUSIONS These results suggest that clinicians discontinuing venlafaxine treatment should consider tapering the medication dose gradually.
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Affiliation(s)
- M Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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Worthington J, Fava M, Agustin C, Alpert J, Nierenberg AA, Pava JA, Rosenbaum JF. Consumption of alcohol, nicotine, and caffeine among depressed outpatients. Relationship with response to treatment. Psychosomatics 1996; 37:518-22. [PMID: 8942202 DOI: 10.1016/s0033-3182(96)71515-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors present findings from the first investigation of the use of alcohol, nicotine, and caffeine in nonsubstance-abusing outpatients with major depressive disorder. The patients (N = 94) were assessed for their intake of alcohol, nicotine, and caffeine, and then treated openly for 8 weeks with 20 mg/day of fluoxetine. The degree of alcohol consumption at baseline was a significant predictor of poorer response to the antidepressant. This relationship remained significant even after adjusting for severity of depression at baseline. Even moderate levels of alcohol consumption appear to negatively affect pharmacologic treatment in depressed outpatients.
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Affiliation(s)
- J Worthington
- Depression Research Program, Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA
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Abstract
OBJECTIVE The aim of our study was to assess gender differences in Axis I comorbidity in patients with a primary diagnosis of Major Depressive Disorder (MDD), as well as gender differences in age of onset of MDD. METHODS The presence of MDD, including age of onset, and of comorbid Axis I disorders were assessed in 396 depressed outpatients. RESULTS Women were significantly more likely than men to meet criteria for comorbid bulimia nervosa and for simple phobia, while men were significantly more likely than women to meet criteria for lifetime history of alcohol abuse/dependence and other substance abuse/dependence. No other significant gender differences in those comorbid Axis I disorders examined were observed. In addition, the age of onset of the first episode of MDD was significantly lower in women than in men. CONCLUSIONS Our findings are consistent with those of previous studies showing a greater prevalence of alcohol and substance abuse and dependence in men and of eating disorders in women.
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Affiliation(s)
- M Fava
- Department of Psychiatry, Massachusetts General Hospital, Boston 02114, USA
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Abstract
"Anger attacks" are outbursts of anger which are accompanied by intense autonomic arousal and are clearly inappropriate to the situation in which they occur. The Anger Attacks Questionnaire, designed to assess these attacks, was administered to 164 consecutive patients (78 men and 86 women; mean age, 40.5 +/- 11.0 years) diagnosed as having major depression with the Structured Clinical Interview for DSM-III-R. These patients were treated openly with fluoxetine, 20 mg/day for 8 weeks, and the prevalence of anger attacks was assessed before and after treatment. At baseline, 64 (39%) (26 men and 38 women) of these patients reported having anger attacks according to our criteria. Forty-one (64%) of the 64 depressed patients with anger attacks at baseline did not report anger attacks following fluoxetine treatment, while 7 (7%) of the 100 patients who did not have anger attacks at baseline reported these attacks following treatment, with this difference being statistically significant (chi 2 = 22.7, p < .0005).
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Affiliation(s)
- M Fava
- Depression Research Program, Massachusetts General Hospital, Boston 02114, USA
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Abeln SH, Alpert J. Reducing the risk of CTDs. Rehab Manag 1995; 8:131-2. [PMID: 10166388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- S H Abeln
- Strategic Healthcare Alternatives, San Clemente, Calif., USA
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Abstract
We investigated the incidence and mechanism of pulmonary artery hypertension (PAH) in a consecutive series of patients with aortic stenosis who were undergoing diagnostic cardiac catheterization. Forty-five patients with severe aortic stenosis were divided into two groups: group 1 comprised 13 patients (29%) with PAH (pulmonary artery systolic pressure > 50 mm Hg); group 2 comprised 32 patients (71%) without PAH. Group 1 patients had a higher incidence of congestive heart failure, a lower left ventricular ejection fraction and cardiac index, and more mitral regurgitation as compared with group 2 patients. Of the 13 group 1 patients, 8 had a transpulmonary gradient (pulmonary artery mean pressure--pulmonary capillary wedge pressure) > or = 10 mm Hg, consistent with reactive PAH. We conclude that PAH frequently accompanies aortic stenosis and is often reactive.
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Affiliation(s)
- K Silver
- Department of Medicine, University of Massachusetts Medical Center, Worcester 01655
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Hofmann AA, Wyatt RW, Beck SW, Alpert J. Cementless total knee arthroplasty in patients over 65 years old. Clin Orthop Relat Res 1991:28-34. [PMID: 1914307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Many factors influence the decision to implant a knee prosthesis with or without cement. Implant retrieval studies have demonstrated that bone ingrowth into porous-coated devices is possible even in older age groups. Early clinical follow-up observations suggest that cementless total knee arthroplasty can be successful in patients over 65 years of age, and need not be reserved for younger patients.
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Affiliation(s)
- A A Hofmann
- Division of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City 84132
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Abstract
This study investigated the test-retest reliability and validity of the isokinetic and gravity/inertia modes of the Lido Lift (TM) and the Progressive Lifting Capacity II test (PLC II). Maximum lifting capacity tests were performed in the isokinetic and gravity/inertia modes on the Lido Lift and with the PLC II with 29 healthy male subjects. Pearson product-moment correlations were calculated to determine the test-retest reliabilities and to compare PLC II test values with isokinetic and gravity/inertia test values. The correlations for the isokinetic, gravity inertia, and the PLC II werer=.90, .82, and .91, respectively. The correlations between the isokinetic and gravity/inertia tests and the PLC II werer=.64 and .74 during the test andr=.72 and .81 during the retest. The results of this study support the reliability of both Lido Lift (TM) tests and of the PLC II, and the validity of the isokinetic and gravity/inertia tests when compared to the PLC II.
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Affiliation(s)
- J Alpert
- Occucare Industrial Health Clinics, Pomona, California
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Kahle WK, Anderson MB, Alpert J, Stevens PM, Coleman SS. The value of preliminary traction in the treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1990; 72:1043-7. [PMID: 2384503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In forty-one children who had forty-seven congenitally dislocated hips, the results of attempted closed reduction with general anesthesia, but without preliminary traction, were studied. Twenty (43 per cent) of the hips could not be reduced closed, and an open reduction was needed. After the reduction, all of the involved hips were immobilized in the so-called human position (marked flexion and slight abduction). At a minimum follow-up of two years, osteonecrosis of the femoral head had developed in only two hips (4 per cent). Patients who were more than one year old when the hip was reduced had a higher incidence of osteonecrosis of the femoral head and were more likely to need reconstructive procedures later. Patients who were more than eighteen months old at the time of the attempted closed reduction were more likely to need an open reduction of the hip. Treatment of congenital dislocation of the hip in young children remains an extremely complex problem. It has not been clearly established that the use of preliminary traction decreases the incidence of osteonecrosis of the femoral head or improves the outcome of treatment. In our experience, uncomplicated (non-teratological, postnatal) congenital dislocation of the hip has been safely treated with either open or closed reduction without preliminary traction in patients who were younger than two years old, provided that the reduction could be obtained without excessive force.
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Affiliation(s)
- W K Kahle
- University of Utah Medical Center, Salt Lake City 84132
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Eisenbud DE, Brener BJ, Shoenfeld R, Creighton D, Goldenkranz RJ, Brief DK, Alpert J, Huston J, Novick A, Krishnan UR. Treatment of acute vascular occlusions with intra-arterial urokinase. Am J Surg 1990; 160:160-4; discussion 164-5. [PMID: 2382768 DOI: 10.1016/s0002-9610(05)80298-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study reviewed 57 patients with 71 vascular occlusions treated with urokinase from 1985 to 1988. Of these patients, 89% were candidates for urgent surgery. Total clot lysis was achieved in 73% of cases. The success rate rose with increasing experience (p less than 0.05), and recent occlusions had more favorable outcomes than older ones (p less than 0.05). The length and type of occluded conduit (graft or vessel), age, sex, other medical conditions, and concurrent use of heparin had no influence on success. Of 18 cases successfully lysed and not subjected to any adjunctive therapy directed at the cause of occlusion, 9 (50%) reoccluded within 1 to 88 days (mean: 25 days). Cases successfully treated with thrombolysis and surgery or dilation of the causative stenosis had poor 1-year patencies: 17%, 20%, and 55% for vein grafts, prosthetic grafts, and native arteries, respectively. With additional urokinase treatments, surgical operations, and percutaneous procedures, 1-year patencies were 22%, 45%, and 65%, respectively.
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Affiliation(s)
- D E Eisenbud
- Department of Surgery, Newark Beth Israel Medical Center, New Jersey 07112
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Kimmelstiel C, Goldberg R, Decker R, Chen Z, Osganian V, Drady P, Gore J, Alpert J. Impact of female gender on incidence and prognosis of infarction-associated heart failure: The worcester heart attack trial. J Am Coll Cardiol 1990. [DOI: 10.1016/0735-1097(90)92387-h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brener BJ, Brief DK, Alpert J, Goldenkranz RJ, Parsonnet V. The risk of stroke in patients with asymptomatic carotid stenosis undergoing cardiac surgery: a follow-up study. J Vasc Surg 1987; 5:269-79. [PMID: 3820401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
During a 7-year period, 4047 patients underwent a battery of noninvasive carotid tests before cardiac surgery. Two thirds of the patients with abnormal studies underwent carotid angiography. One hundred fifty-three patients (3.8%) had significant carotid disease, narrowing the luminal diameter by greater than 50%. The incidence of transient ischemic attack or cerebrovascular accident following cardiac surgery was 1.9% in those patients with no carotid disease and 9.2% in those patients with carotid lesions. The incidence of transient ischemic attack or cerebrovascular accident in 32 patients with inoperable (occluded) carotid vessels was 15.6% and in 121 patients with operable (stenotic) lesions was 7.4%. In the group of patients with stenosis, 57 patients underwent carotid operation with an 8.8% incidence of neurologic deficit. During the last 1 1/2 years, no patient with asymptomatic carotid stenosis underwent simultaneous carotid and coronary surgery. Four of 64 patients with combined lesions but no carotid surgery (6.3%) had a neurologic deficit, one of which was severe and permanent. The highest incidence of neurologic dysfunction occurred in patients with unilateral occlusions and contralateral stenosis. Four of 12 patients in this group had a deficit (three of seven patients underwent operation; one of five did not), one of which was permanent. The operative mortality rate after cardiac surgery was three times higher in patients with carotid disease than in those patients with normal carotid arteries. Combined carotid and coronary surgery is currently reserved for patients with neurologic symptoms and severe cardiac disease.
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Friedell ML, Alpert J, Parsonnet V, Brief DK, Brener BJ, Goldenkranz RJ, Nozick J. Femorofemoral grafts for lower limb ischemia caused by intra-aortic balloon pump. J Vasc Surg 1987; 5:180-6. [PMID: 3795384 DOI: 10.1067/mva.1987.avs0050180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
From January 1975 to December 1985, 1454 patients had an intra-aortic balloon inserted for cardiac assistance. Eighty balloon-dependent patients had severe limb ischemia and required a femorofemoral graft (FFG) (5% of the total group of patients). Twenty-nine of the 80 patients with grafts (or 36%) left the hospital and 28 were followed up for an average of 40 months to determine late complications associated with the crossover grafts. All grafts remained patent. The 28 patients were classified into five groups according to the degree and type of lower limb ischemia. Group I consisted of 13 asymptomatic patients (46%); group II had four (14%) patients with mild claudication caused by preexisting peripheral arteriosclerosis; group III comprised four patients (14%) without preexisting disease but claudication subsequent to the FFG; group IV had five patients with irreversible ischemic sequelae before grafting ending in amputation, foot drop, or persistent paresthesia; and group V consisted of two patients with graft infection (7%). The perioperative mortality rate of the balloon-dependent patients with an FFG (64%) reflects the gravity of the cardiac condition. Placement of an FFG to relieve limb ischemia in these patients is followed by few immediate or late complications in the survivors and any persistent limb changes were related to the prolonged ischemia present before revascularization. Our data suggest that in balloon-dependent patients with limb-threatening ischemia, aggressive use of the FFG is limb-saving, durable, and allows continuation of balloon support.
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Friedell ML, Goldenkranz RJ, Parsonnet V, Alpert J, Brief DK, Brener BJ, Aueron FM. Migration of a Greenfield filter to the pulmonary artery: a case report. J Vasc Surg 1986; 3:929-31. [PMID: 3520028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A case of Greenfield filter migration to the left pulmonary artery is presented and the pertinent literature reviewed. Technical points are made regarding the prevention and the management of proximal filter migration.
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28
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McBride DC, Burgman-Habermehl C, Alpert J, Chitwood DD. Drugs and homicide. Bull N Y Acad Med 1986; 62:497-508. [PMID: 3488788 PMCID: PMC1629247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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29
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Møller M, Love J, Haffajee C, Sloan K, Alpert J. [Mexiletine treatment of ventricular tachy-arrhythmias endangering life based on programmed ventricular stimulation]. Ugeskr Laeger 1985; 147:1254-7. [PMID: 4002389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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30
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Alpert J, Brener BJ, Parsonnet V, Meisner K, Sadow S, Brief DK, Goldenkranz RJ. Carotid endarterectomy and completion contact arteriography. J Vasc Surg 1984; 1:548-54. [PMID: 6492297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intraoperative angiography in carotid extracranial surgery demonstrates technical defects in 5% to 8% of patients. A simple and safe method of completion contact angiography (CCA) has been perfected by adapting dental x-ray equipment, small dental film cassettes, and a "shoe box" type of developing unit. The method is not technician dependent, requires only 5 ml of contrast medium, has a completion time of less than 5 minutes, and produces no measurable radiation to the operating team. CCA was performed with no complications in 40 patients undergoing carotid endarterectomy. Two unsuspected internal carotid artery defects (5%) were discovered: in one a stenosis was immediately repaired, and in the other small thrombi that were seen but not removed were probably the cause of a postoperative transient ischemic attack. Two complete occlusions and one prominent intimal flap in the external carotid artery were also identified. We believe that CCA after carotid surgery should be used routinely because it is safe and simple and reveals unsuspected operative defects that can be corrected immediately.
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Freedson P, Chang B, Katch F, Kroll W, Rippe J, Alpert J, Byrnes W. INTRA-ARTERIAL BLOOD PRESSURE DURING FREE WEIGHT AND HYDRAULIC RESISTIVE EXERCISE. Med Sci Sports Exerc 1984. [DOI: 10.1249/00005768-198404000-00138] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Freedson P, Chang B, Katch F, Kroll W, Rippe J, Alpert J, Byrnes W. INTRA-ARTERIAL BLOOD PRESSURE DURING FREE WEIGHT AND HYDRAULIC RESISTIVE EXERCISE. Med Sci Sports Exerc 1984. [DOI: 10.1249/00005768-198404000-00133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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33
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Brener BJ, Brief DK, Alpert J, Goldenkranz RJ, Parsonnet V, Feldman S, Gielchinsky I, Abel RM, Hochberg M, Hussain M. A four-year experience with preoperative noninvasive carotid evaluation of two thousand twenty-six patients undergoing cardiac surgery. J Vasc Surg 1984; 1:326-38. [PMID: 6332923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
From January 1979 through December 1982, 2026 patients scheduled to undergo open heart surgery were evaluated by a preoperative battery of noninvasive carotid tests including phonoangiography, oculopneumoplethysmography, pulse-timing oculoplethysmography, periorbital Doppler examination, and during the last 12 months, continuous-wave Doppler ultrasonography with spectral analysis. The incidence of hemispheric neurologic deficit following cardiac surgery in the 47 patients with carotid disease was 14.9%; the incidence in patients with no carotid disease was 1.9% (p less than 0.001). Fourteen of the 47 patients were not candidates for carotid surgery because of unilateral occlusion in 13 and bilateral occlusion in one. Three of the 14 (21.4%) had intraoperative strokes on the appropriate side. Thirty-three of the 47 had operable carotid disease. Four with unilateral stenosis had no carotid surgery; one had a postoperative deficit on the side referable to the nonstenotic artery. Eighteen with unilateral stenosis underwent simultaneous cardiac and carotid surgery; one (5.6%) had a transient deficit. Seven patients with bilateral stenosis underwent cardiac and unilateral carotid surgery; no deficits occurred. Four patients with unilateral stenosis and contralateral occlusion underwent combined surgery; one had a transient ischemic attack and one a fatal stroke, both referable to the hemisphere ipsilateral to the occlusion. It appears that the presence of carotid disease increased the risk of stroke during heart surgery. Proof that carotid endarterectomy lowers this risk awaits a prospective randomized trial.
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DiBianco R, Alpert J, Katz RJ, Spann J, Chesler E, Ferri DP, Larca LJ, Costello RB, Gore JM, Eisenman MJ. Bepridil for chronic stable angina pectoris: results of a prospective multicenter, placebo-controlled, dose-ranging study in 77 patients. Am J Cardiol 1984; 53:35-41. [PMID: 6362386 DOI: 10.1016/0002-9149(84)90680-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bepridil, a new calcium-channel blocking agent with an extended plasma elimination half-life of greater than 50 hours, was compared to placebo in 77 patients with confirmed coronary artery disease and chronic stable angina pectoris. The effects of bepridil were compared with those of placebo on angina frequency, nitroglycerin tablet use, the resting ECG and hemodynamics at rest and maximal exercise using a study design comprising 5 sequential 2-week single-blind treatment phases. After 2 weeks of placebo (phase 1), bepridil was given for 3 phases (2, 3 and 4) at total daily dosages of 200, 300 and 400 mg, respectively; the study was completed after a final reintroduction of placebo (phase 5). Within each phase once- and twice-daily regimens of bepridil were randomly compared. Bepridil (300 mg/day) reduced anginal frequency 68%, from 8.5 +/- 1.1 (standard error of the mean) to 2.7 +/- 0.7 attacks/week and nitroglycerin tablet use 76% (p less than 0.001). Bepridil improved exercise duration 26%, from 6.9 +/- 0.4 to 8.7 +/- 0.5 minutes (p less than 0.001) and exercise work 52%, from 2.7 +/- 0.3 to 4.1 +/- 0.4 kpm X 10(-3) (p less than 0.001) on a standardized treadmill protocol. Resting and peak exercise heart rate and blood pressure were unaffected by bepridil. The antianginal effects were similar with either once- or twice-daily treatment schedules. Minor side effects of nausea, epigastric discomfort and tremor were infrequent and there were no major side effects. The results of this large but preliminary, single-blind and short-term study suggest that bepridil is an effective and well tolerated antianginal agent when administered once daily.
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Franks RD, Adler LE, Waldo MC, Alpert J, Freedman R. Neurophysiological studies of sensory gating in mania: comparison with schizophrenia. Biol Psychiatry 1983; 18:989-1005. [PMID: 6416309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The action of central nervous system mechanisms involved in sensory gating was assessed in acutely psychotic manic patients. An early positive component of the auditory average evoked response, recorded at the vertex 50 msec after a click stimulus, was studied. Stimuli were delivered at 10-sec intervals to establish a base-line response. Sensory gating mechanisms were then tested using a conditioning-testing paradigm to assess the change in response to a second stimulus following the first at either 0.5-, 1.0- or 2.0-sec intervals. A similar paradigm had been used previously to assess deficits in this function in acute and chronic schizophrenics. We found a deficit in sensory gating in acutely manic patients. similar to that found in schizophrenics, although the variability in response was more marked in the manic patients. We followed these patients during their treatment on lithium carbonate and found a return of these neuronal functions towards normal values which corresponded to their clinical improvement. A series of stable euthymic bipolar patients were found to have responses indistinguishable from normal controls. The data suggest that deficits in neuronal gating functions, similar to those found in schizophrenia, can be seen during acute mania but these deficits return to normal as the acute psychosis abates.
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Brief DK, Brener BJ, Goldenkranz R, Alpert J, Yalof I, Parsonnet V. An argument for increased use of subtotal colectomy in the management of carcinoma of the colon. Am Surg 1983; 49:66-72. [PMID: 6824243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Subtotal colectomy (STC) is a safe operation because operative mortality rates are as good as, if not better than, conventional segmental colon resections. It is no more difficult to perform than conventional segmental resections. Suture line complications, such as fecal fistulas and suture line recurrences, are not as common before as they are after colocolic anastomoses. In addition to being used in cases with known synchronous carcinomas, and carcinoma associated with polyps, STC should be considered in selected patients with obstructing or partially obstructing lesions of the sigmoid or left colon when complete evaluation of the proximal colon has not been possible. STC can be combined with a preliminary transverse colostomy for obstructing left colon lesions when appropriate evaluation demonstrates suitable indications for the resection of the colostomy as a one-stage procedure with ileocolic anastomosis. It also should be considered if there is significant distal sigmoidal diverticular disease associated with proximal carcinomas. Statistically, STC does not appear to be indicated as a prophylactic operation to avoid the development of metachronous colon cancer when the entire colon can be surveyed colonoscopically to assure that there is no associated neoplasm.
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Feldman SM, Alpert J, Dick LS, Brief DK, Goldenkranz R, Brener BJ, Parsonnet V. Clinical observations with intravenous prostaglandin E1 in peripheral vascular disease. J Med Soc N J 1982; 79:985-7. [PMID: 6961223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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38
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Alpert J. Grüntzig's plaque pressing: "verbum sapienti". J Med Soc N J 1981; 78:87. [PMID: 6938716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
One hundred thirty-three patients with unilateral iliac artery obstruction were treated with crossover femorofemoral grafts and followed up for one to 12 years. Cumulative patency was 73.3% at five years and 63.6% at ten years. There were 17 early closures with ten unsuccessful revisions and 22 late failures between three and 122 months. Inability to establish adequate runoff was the primary cause of early failure, and the progression of distal disease was the major cause of late failures. In only five cases did progressive disease of the donor artery cause failure of the graft. Operative morbidity and mortality were low (6%), and the results compare favorably with alternative methods of treating unilateral iliac artery occlusions.
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40
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Alpert J, O'Donnell JA, Parsonnet V, Brief DK, Brener BJ, Goldenkranz RJ. Clinically recognized limb ischemia in the neonate after umbilical artery catheterization. Am J Surg 1980; 140:413-8. [PMID: 7425216 DOI: 10.1016/0002-9610(80)90180-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
During a 4 year period, 1,461 critically ill neonates were admitted to the newborn intensive care unit of the Newark Beth Israel Medical Center, and 507 (35 percent) had umbilical artery catheters inserted for physiologic monitoring. In five patients (1 percent) clinically significant limb ischemia developed as a result of catheter complications. Frank gangrene was observed in three patients; two died from the primary illness soon after the onset of gangrene and the third survived after leg amputation. The other two infants had advanced ischemia that responded favorably to catheter removal and heparinization. Irreversible limb ischemia in this setting is infrequent, and milder forms are usually unrecognized or undocumented. High placement of the catheter or the length of time it is in place were not related to complications. Limb ischemia occurred soon after catheter insertion rather than after its protracted use. Major complications may be reduced by placement of the catheter in the lower abdominal aorta or internal iliac artery, clinical awareness and observation and frequent noninvasive monitoring. Immediate catheter removal and intravenous anticoagulation are warranted if ischemia persists. From this study, we believe that the benefits derived from judicious umbilical artery catheterization outweigh any inherent risk.
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Abstract
Infected aneurysms of the abdominal aorta are relatively uncommon, but potentially lethal if improperly managed. Two case reports emphasize the importance of the preoperative aortogram for accurate diagnosis. We stress the principles of total excision of infected tissue and revascularization in uninfected tissue planes. A useful vascular reconstructive technique consisting of unilateral axillofemoral bypass and an ilioiliac anastomosis was used in both patients.
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Alpert J, Parsonnet V, Goldenkranz RJ, Bhaktan EK, Brief DK, Brener BJ, Gielchinsky I, Abel RM. Limb ischemia during intra-aortic balloon pumping: indication for femorofemoral crossover graft. J Thorac Cardiovasc Surg 1980; 79:729-34. [PMID: 7366238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Catheter insertion for intra-aortic balloon pumping (IABP) was successful in 91% of 332 candidates. Fifty-three patients (16.5%) had significant catheter-associated vascular complications, of which lower extremity ischemia with threatened limb loss was the most prevalent (70%). Thirty-six of these patients required an angioplastic repair or vascular grafting. Of the 36, 19 patients with ischemia who needed continued balloon support received femorofemoral (F-F) grafts to restore and maintain adequate limb perfusion. Wound infection occurred in six of the patients but there was no limb loss. F-F grafting is a simple procedure that requires little time and allows one to maintain IABP for prolonged periods without concern for critical obstruction to limb perfusion.
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Abel RM, Alpert J, Fisch D, Gielchinsky I, Parsonnet V. Rupture of thoracic aneurysm into the right pleural space. J Med Soc N J 1980; 77:199-202. [PMID: 6929344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
From 1970 to 1977, 127 patients were operated on for unstable angina. On the basis of response to intensive medical therapy, patients were classified into a medically controlled, semielective surgery group (54 patients) and a medically uncontrolled, emergent/urgent surgical group (73 patients). There were five operative deaths. 1/54 in the medically controlled group (1.8%) and 4/73 (5%) in the medically uncontrolled group; 4/5 operative deaths occured with left main coronary stenosis. There were five late deaths during a follow-up period of 12 to 84 months, 37.5 with an actuarial survival of 83.5%. If patients with unstable angina can be medically controlled, operation can be delayed and the operative long-term survival is similar to that of elective coronary bypass. Patients who cannot be controlled medically, particularly those with left main coronary lesions, should be operated on urgently with selective use of preoperative balloon support.
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O'Donnell JA, Brener BJ, Brief DK, Alpert J, Parsonnet V. Renal artery stenosis and ectopic kidney associated with abdominal aortic aneurysm. J Med Soc N J 1978; 75:479-81. [PMID: 275505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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46
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O'Donnell JA, Brener BJ, Brief DK, Alpert J, Parsonnet V. Realistic expectation for patients having lower extremity bypass surgery for limb salvage. Arch Surg 1977; 112:1356-63. [PMID: 921533 DOI: 10.1001/archsurg.1977.01370110090009] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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47
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Alpert J. Peripheral nerve division for relentless ischemic foot pain. Pain 1977. [DOI: 10.1016/0304-3959(77)90110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Alpert J, Brener BJ, Brief DK, Parikh S, Parsonnet V. Popliteal aneurysms. Am Surg 1977; 43:579-82. [PMID: 900649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A review of 64 popliteal aneurysms in 43 patients treated over a 14-year period revealed that thrombotic occlusion with ischemia and threatened limb loss was the most frequent complication (68%). Ten major amputations (23%) were necessary, four of which were the primary operations soon after admission. No limb loss occurred after operation in 11 patients with asymptomatic aneurysms. Direct revascularization was successful in 29 limbs (83%). Popliteal aneurysms should be resected, preferably in the asymptomatic stage, unless medical contraindications exist. Once thrombosis occurs, limb loss becomes a threatening likelihood.
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49
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Brener BJ, Brief DK, Alpert J, Parsonnet V, Frankel H, Ribot S. External femorosaphenous shunts for chronic hemodialysis: a shunt of last resort. Am Surg 1977; 43:565-72. [PMID: 900647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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50
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Eslami H, Ribot S, Brief DK, Alpert J, Brener B, Frankel HJ, Goldblat M, Parsonnet V. Stenosis of the renal artery in human kidney transplantation. J Med Soc N J 1977; 74:215-20. [PMID: 320342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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