24 results on '"Wildermann, N."'
Search Results
2. Corrigendum to “Effectiveness and design of marine protected areas for migratory species of conservation concern: A case study of post-nesting hawksbill turtles in Brazil” [Biol. Conserv. 261 (2021) 109229]
- Author
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Santos, Armando J.B., Bellini, C., Santos, E.A.P., Sales, G., Ramos, R., Vieira, D.H.G., Marcovaldi, M.A., Gillis, Anthony, Wildermann, N., Mills, M., Gandra, T., and Fuentes, M.M.P.B.
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- 2024
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3. Conflicts and solutions related to marine turtle conservation initiatives in the Caribbean basin: Identifying new challenges
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Barrios-Garrido, H., Wildermann, N., Diedrich, A., and Hamann, M.
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- 2019
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4. Intraspecific variability in flatback turtle habitat use - δ15N as indicator of foraging locations
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Abrantes, K, primary, Wildermann, N, additional, Miller, IB, additional, Hamann, M, additional, Limpus, CJ, additional, Madden Hof, CA, additional, Bell, I, additional, Sheaves, M, additional, and Barnett, A, additional
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- 2023
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5. Effectiveness and design of marine protected areas for migratory species of conservation concern: A case study of post-nesting hawksbill turtles in Brazil
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Santos, Armando J.B., primary, Bellini, C., additional, Santos, E.A.P., additional, Sales, G., additional, Ramos, R., additional, Vieira, D.H.G., additional, Marcovaldi, M.A., additional, Gillis, Anthony, additional, Wildermann, N., additional, Mills, M., additional, Gandra, T., additional, and Fuentes, M.M.P.B., additional
- Published
- 2021
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6. Trade of marine turtles along the Southwestern Coast of the Gulf of Venezuela
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Barrios-Garrido, H., primary, Espinoza-Rodríguez, N., additional, Rojas-Cañizales, D., additional, Palmar, J., additional, Wildermann, N., additional, Montiel-Villalobos, M. G., additional, and Hamann, M., additional
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- 2017
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7. Plasma Renin Activity in Healthy Subjects and Patients With Hypertension: Preliminary Experience With a Rapid and Quantitative Bio-assay
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Gunnells, J. Caulie, Grim, C. E., Robinson, R. R., and Wildermann, N. M.
- Abstract
RECENT observations have demonstrated that measurements of plasma renin activity (PRA) can contribute importantly to the evaluation of patients with hypertension.1-9 This procedure appears particularly useful to the evaluation of patients whose hypertension is secondary to either renovascular disease or primary aldosteronism. Plasma renin activity has been said to be elevated in patients with renovascular hypertension,2-6,9 and "suppressed" or low in patients with hypertension due to primary aldosteronism.7,8,10 In fact, Conn and his colleagues have suggested that the finding of reduced or "suppressed" PRA provides strong evidence for underlying primary aldosteronism even in the presence of normokalemia8,10 and that the incidence of primary aldosteronism may be as high as 20% among patients with "benign essential" hypertension.7Despite its apparent usefulness and potential importance, the bio-assay of PRA has not yet enjoyed widespread use because of the complexity or qualitative nature of most existing methods.191115 There is a real need for
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- 1967
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8. Androgens and estrogens affect hepatic bile acid sulfotransferase in male rats
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Kirkpatrick, R. B., primary, Wildermann, N. M., additional, and Killenberg, P. G., additional
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- 1985
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9. Electrocardiographic differentiation of the ST-segment depression of acute myocardial injury due to the left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies.
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Shah A, Wagner GS, Green CL, Crater SW, Sawchak ST, Wildermann NM, Mark DB, Waugh RA, Krucoff MW, Shah, A, Wagner, G S, Green, C L, Crater, S W, Sawchak, S T, Wildermann, N M, Mark, D B, Waugh, R A, and Krucoff, M W
- Abstract
Lead distributions of peak ST-segment depression were compared between patients undergoing left circumflex artery percutaneous transluminal coronary angioplasty and exercise tolerance test. Localization of peak ST-segment depression to leads V2 or V3 was 96% specific and 70% sensitive for differentiating ischemia due to occlusion of left circumflex artery occlusion from nonocclusive ischemia. [ABSTRACT FROM AUTHOR]
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- 1997
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10. Mapping spatial and temporal variation of seafloor organic matter Δ 14 C and δ 13 C in the Northern Gulf of Mexico following the Deepwater Horizon Oil Spill.
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Rogers KL, Bosman SH, Wildermann N, Rosenheim BE, Montoya JP, Hollander D, Zhao T, and Chanton JP
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- Environmental Monitoring, Geologic Sediments, Gulf of Mexico, Hydrocarbons analysis, Petroleum Pollution analysis, Water Pollutants, Chemical analysis
- Abstract
Following the Deepwater Horizon oil spill of 2010, large amounts of biodegraded oil (petrocarbon) sank to the seafloor. Our objectives were to 1) determine post-spill isotopic values as the sediments approached a new baseline and 2) track the recovery of affected sediments. Sediment organic carbon δ
13 C and Δ14 C reached a post-spill baseline averaging -21.2 ± 0.9‰ (n = 129) and -220 ± 66‰ (n = 95). Spatial variations in seafloor organic carbon baseline isotopic values,13 C and14 C, were influenced by river discharge and hydrocarbon seepage, respectively. Inverse Distance Weighting of surface sediment Δ14 C values away from seep sites showed a 50% decrease in the total mass of petrocarbon, from 2010 to 2014. We estimated a rate of loss of -2 × 109 g of petrocarbon-C/year, 2-11% of the degradation rates in surface slicks. Despite the observed recovery in sediments, lingering residual material in the surface sediments was evident seven years following the blowout., (Copyright © 2021 Elsevier Ltd. All rights reserved.)- Published
- 2021
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11. Predicting the exposure of coastal species to plastic pollution in a complex island archipelago.
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Critchell K, Hamann M, Wildermann N, and Grech A
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- Animals, Coral Reefs, Islands, Queensland, Seasons, Turtles, Wetlands, Wind, Aquatic Organisms growth & development, Environmental Monitoring methods, Models, Theoretical, Plastics analysis, Water Pollutants, Chemical analysis
- Abstract
Plastic pollution in the marine environment is a pervasive and increasing threat to global biodiversity. Prioritising management actions that target marine plastic pollution require spatial information on the dispersal and settlement of plastics from both local and external sources. However, there is a mismatch between the scale of most plastic dispersal studies (regional, national and global) and the scale relevant to management action (local). We use a fine-resolution hydrodynamic model to predict the potential exposure of coastal habitats and species (mangroves, coral reefs and marine turtles) to plastic pollution at the local scale of a management region (the 1,700 km
2 Whitsunday Islands, Queensland, Australia). We assessed the potential exposure of mangroves, coral reefs and marine turtles to plastics during the two dominant wind conditions of the region; the trade wind and monsoon wind seasons. We found that in the trade wind season (April to September) all habitats and species had lower exposure than during the monsoon wind season (October to March). In both wind seasons we found a small proportion of coral reef habitat and large area of turtle habitat were in high potential exposure categories. Unlike coral reefs or marine turtles, mangroves had consistent hotspots of high exposure across wind seasons. Local scale management requires data at fine resolution to capture the variability that occurs at this scale. The outputs of our study can inform the development of conservation resources and local scale management action., (Copyright © 2019 Elsevier Ltd. All rights reserved.)- Published
- 2019
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12. Does behaviour affect the dispersal of flatback post-hatchlings in the Great Barrier Reef?
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Wildermann N, Critchell K, Fuentes MMPB, Limpus CJ, Wolanski E, and Hamann M
- Abstract
The ability of individuals to actively control their movements, especially during the early life stages, can significantly influence the distribution of their population. Most marine turtle species develop oceanic foraging habitats during different life stages. However, flatback turtles ( Natator depressus ) are endemic to Australia and are the only marine turtle species with an exclusive neritic development. To explain the lack of oceanic dispersal of this species, we predicted the dispersal of post-hatchlings in the Great Barrier Reef (GBR), Australia, using oceanographic advection-dispersal models. We included directional swimming in our models and calibrated them against the observed distribution of post-hatchling and adult turtles. We simulated the dispersal of green and loggerhead turtles since they also breed in the same region. Our study suggests that the neritic distribution of flatback post-hatchlings is favoured by the inshore distribution of nesting beaches, the local water circulation and directional swimming during their early dispersal. This combination of factors is important because, under the conditions tested, if flatback post-hatchlings were entirely passively transported, they would be advected into oceanic habitats after 40 days. Our results reinforce the importance of oceanography and directional swimming in the early life stages and their influence on the distribution of a marine turtle species., Competing Interests: The authors have no competing interests.
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- 2017
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13. Reduced thrombus burden with abciximab delivered locally before percutaneous intervention in saphenous vein grafts.
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Barsness GW, Buller C, Ohman EM, Schechter E, Pucillo A, Taylor MA, Miller MJ, Reiner JS, Churchill D, Chandler AB, Gonzalez M, Smith J, Tommaso C, Berdan LG, Wildermann NM, Hasdai D, and Holmes DR Jr
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- Abciximab, Aged, Antibodies, Monoclonal adverse effects, Coronary Angiography drug effects, Coronary Thrombosis diagnostic imaging, Female, Graft Occlusion, Vascular diagnostic imaging, Humans, Immunoglobulin Fab Fragments adverse effects, Infusion Pumps, Male, Middle Aged, Pilot Projects, Platelet Aggregation Inhibitors adverse effects, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Stents, Treatment Outcome, Angioplasty, Balloon, Coronary, Antibodies, Monoclonal administration & dosage, Coronary Artery Bypass, Coronary Thrombosis drug therapy, Graft Occlusion, Vascular drug therapy, Immunoglobulin Fab Fragments administration & dosage, Platelet Aggregation Inhibitors administration & dosage, Premedication, Veins transplantation
- Abstract
Background: Existing thrombus can complicate percutaneous saphenous vein graft (SVG) intervention. Local delivery of thrombolytics has been used to reduce the thrombus burden often associated with these interventions. We sought to determine whether local delivery of a platelet glycoprotein IIb/IIIa inhibitor is feasible and can reduce thrombus burden before percutaneous SVG intervention., Methods: We performed a multicenter pilot study of abciximab (0.25 mg/kg) given by local delivery catheter before percutaneous intervention for de novo SVG stenoses followed by intravenous infusion. All patients (n = 58) had >/=60% stenosis and Thrombolysis In Myocardial Infarction (TIMI) grade >0 flow in an SVG of 3 to 4 mm in diameter. Percent diameter stenosis, TIMI thrombus grade, and TIMI flow grade were measured before and after delivery of abciximab and after intervention., Results: Median percent diameter stenosis improved from 69% to 45% (P =.0001) after local delivery, and TIMI thrombus grade >/=1 incidence reduced from 68% to 34% (P =.0001). TIMI flow grade was not significantly affected (P =.12). All patients had a successful intervention (=50% residual stenosis)., Conclusions: Local abciximab delivery before percutaneous SVG intervention is associated with significantly reduced thrombus burden, significantly improved percent diameter stenosis, and excellent acute procedural results. Further studies of this approach are warranted to define its clinical utility.
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- 2000
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14. Prognostic value of congestive heart failure history in patients undergoing percutaneous coronary interventions.
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Anderson RD, Ohman EM, Holmes DR Jr, Harrington RA, Barsness GW, Wildermann NM, Phillips HR, Topol EJ, and Califf RM
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- Aged, Coronary Disease complications, Coronary Disease physiopathology, Coronary Disease therapy, Female, Follow-Up Studies, Heart Failure physiopathology, Humans, Male, Middle Aged, Odds Ratio, Prognosis, Randomized Controlled Trials as Topic, Risk Factors, Stroke Volume, Survival Rate, Angioplasty, Balloon, Coronary, Atherectomy, Coronary, Coronary Disease mortality, Heart Failure complications
- Abstract
Objectives: We sought to determine the prognostic significance of a history of congestive heart failure above that provided by baseline ejection fraction in patients undergoing percutaneous coronary interventions., Background: Left ventricular function is a known predictor of survival in patients with coronary artery disease, as is a history of congestive heart failure. The contribution of heart failure history independent of left ventricular function is unknown., Methods: Data were pooled from four interventional trials and the Duke University database. The combined dataset included 5,260 patients undergoing percutaneous interventions, 334 with and 4,926 without a history of heart failure. Patients were defined by the treating physician as having a clinical history of heart failure at the time of enrollment., Results: The 30-day and 6-month mortality were higher in patients with a clinical history of congestive heart failure than in those without such a history (2% vs. <1%, p=0.002 at 30 days, 5% vs. 1%, p=0.001 at 6 months). Heart failure history did not influence the incidence of myocardial infarction, use of angioplasty or the use of bypass surgery during follow-up. Multivariable analysis revealed that heart failure history added significantly to ejection fraction in predicting intermediate-term (6-month) mortality (p=0.01). Stepwise logistic regression also revealed heart failure history to be an independent predictor of 6-month mortality (odds risk 1.9, 95% confidence interval 1.1 to 3.5)., Conclusions: A clinical history of congestive heart failure is associated with increased early and intermediate-term mortality in patients undergoing percutaneous revascularization. Congestive heart failure history appears to provide prognostic information independent of that available from a patient's left ventricular function. These findings suggest that patients with a clinical history of congestive heart failure who undergo a percutaneous intervention should be closely monitored, especially those with the lowest ejection fractions.
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- 1998
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15. Non-Q-wave versus Q-wave myocardial infarction after thrombolytic therapy: angiographic and prognostic insights from the global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries-I angiographic substudy. GUSTO-I Angiographic Investigators.
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Goodman SG, Langer A, Ross AM, Wildermann NM, Barbagelata A, Sgarbossa EB, Wagner GS, Granger CB, Califf RM, Topol EJ, Simoons ML, and Armstrong PW
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- Aged, Cardiac Catheterization, Coronary Angiography, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction physiopathology, Prognosis, Treatment Outcome, Ventricular Function, Left drug effects, Fibrinolytic Agents therapeutic use, Myocardial Infarction drug therapy, Streptokinase therapeutic use, Thrombolytic Therapy, Tissue Plasminogen Activator therapeutic use
- Abstract
Background: Although the stratification of patients with myocardial infarction into ECG subsets based on the presence or absence of new Q waves has important clinical and prognostic utility, systematic evaluation of the impact of thrombolytic therapy on the subsequent development and prognosis of non-Q-wave infarction has been limited to date., Methods and Results: We examined 12-lead ECG, coronary anatomy, left ventricular function, and mortality among 2046 patients with ST-segment elevation infarction from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries angiographic subset to gain further insight into the pathophysiology and prognosis of Q- versus non-Q-wave infarction in the thrombolytic era. Non-Q-wave infarction developed in 409 patients (20%) after thrombolytic therapy. Compared with Q-wave patients, non-Q-wave patients were more likely to present with lesser ST-segment elevation in a nonanterior location. The infarct-related artery in non-Q-wave patients was more likely to be nonanterior (67% versus 58%, P=.012) and distally located (33% versus 39%, P=.021). Early (90-minute, 77% versus 65%, P=.001) and complete (54% versus 44%, P<.001) infarct-related artery patency was greater among the non-Q-wave group. Non-Q-wave patients had better global (ejection fraction, 66% versus 57%; P<.0001) and regional left ventricular function (10 versus 24 abnormal chords, P=.0001). In-hospital, 30-day, 1-year, and 2-year (6.3% versus 10.1%, P=.02) mortality rates were lower among non-Q-wave patients., Conclusions: The excellent prognosis among the subgroup of patients who develop non-Q-wave infarction after thrombolysis is related to early, complete, and sustained infarct-related artery patency with resultant limitation of left ventricular infarction and dysfunction.
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- 1998
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16. Does intracoronary thrombus influence the outcome of high risk percutaneous transluminal coronary angioplasty? Clinical and angiographic outcomes in a large multicenter trial. EPIC Investigators. Evaluation of IIb/IIIa Platelet Receptor Antagonist 7E3 in Preventing Ischemic Complications.
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Khan MM, Ellis SG, Aguirre FV, Weisman HF, Wildermann NM, Califf RM, Topol EJ, and Kleiman NS
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- Abciximab, Aged, Antibodies, Monoclonal therapeutic use, Coronary Angiography, Coronary Thrombosis drug therapy, Double-Blind Method, Female, Humans, Immunoglobulin Fab Fragments therapeutic use, Male, Middle Aged, Platelet Aggregation Inhibitors therapeutic use, Prospective Studies, Treatment Outcome, Angioplasty, Balloon, Coronary, Coronary Thrombosis complications, Myocardial Infarction complications, Myocardial Infarction therapy
- Abstract
Objectives: We sought to evaluate the impact of angiographically visible thrombus on short- and long-term clinical outcomes after percutaneous transluminal coronary angioplasty (PTCA)., Background: Intracoronary thrombus is frequently seen on angiography in patients with acute ischemic coronary syndromes or complex lesion morphology, or both, and is often considered to predict a higher rate of complications in patients undergoing PTCA., Methods: Prospectively collected data from 2,099 patients undergoing high risk PTCA in the Evaluation of IIb/IIIa Platelet Receptor Antagonist 7E3 in Preventing Ischemic Complications (EPIC) trial were analyzed. In addition to aspirin and heparin, patients were randomized to receive either abciximab bolus and infusion, abciximab bolus alone or placebo. Based on an angiographic core laboratory interpretation, patients were classified into three groups: thrombus absent, thrombus possible or thrombus present. The primary end point at 30 days was the composite of death, myocardial infarction or urgent revascularization. The 6-month end point was the composite of death, myocardial infarction or any revascularization., Results: Although abrupt closure was most common in patients with thrombus present compared with thrombus absent or possible (13%, 10.0% and 7.4%, respectively), neither the 30-day nor the 6-month clinical end points were different among the three groups (9%, 11% and 11.7%, respectively, and 30%, 34% and 31%, respectively). Most notably, the benefit of treatment with abciximab was present in all three thrombus groups, and the magnitude of benefit was not different among the thrombus groups., Conclusions: In high risk patients undergoing percutaneous coronary revascularization, features of thrombus on the preprocedure angiogram do not indicate an augmented risk of adverse clinical outcomes. Abciximab therapy reduces the rate of adverse outcomes regardless of the presence of thrombus and should therefore not necessarily be reserved for patients whose angiograms have features of intraluminal thrombus.
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- 1998
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17. Device implementation, validation, and application assessment of two continuous 12-lead ECG monitors during percutaneous transluminal coronary angioplasty: description of the validation method and implications for clinical trials.
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Fisher SD, Loeffler AK, Green CL, Wildermann NM, Pope JE, and Krucoff MW
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- Humans, Angioplasty, Balloon, Coronary, Electrocardiography instrumentation, Signal Processing, Computer-Assisted
- Abstract
Comparability of clinical and research data sets may be undermined if the instruments used to acquire them vary. Even when standard 12-lead electrocardiographic formats are used for monitoring, proprietary signal processing techniques and sampling intervals may differ among devices. In order to directly compare the two commercially available standard 12-lead devices with monitoring capabilities, bifurcated wires from a single standard lead set were attached to each device in elective angioplasty patients. Neither device was used as a standard; rather, a method was designed to analyze the output from each device independently, and then, if results differed, data from both monitors were reviewed by consensus to determine the source of the differences. Analysis endpoints for each study included study quality, baseline ST-segment levels, the presence of ischemia, number of ischemic episodes, peak lead location, and peak lead amplitude. Sources of differences in these endpoints visible to consensus review included variations between devices in baseline stability, noise/artifact levels, stability of the QRS complex onset, and temporal sampling intervals.
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- 1998
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18. Comparative prognostic significance of simultaneous versus independent resolution of ST segment depression relative to ST segment elevation during acute myocardial infarction.
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Shah A, Wagner GS, Califf RM, Boineau RE, Green CL, Wildermann NM, Trollinger KM, Pope JE, and Krucoff MW
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- Aged, Angina Pectoris etiology, Female, Heart Failure etiology, Humans, Male, Middle Aged, Myocardial Infarction complications, Myocardial Infarction diagnosis, Myocardial Infarction mortality, Prognosis, Electrocardiography, Myocardial Infarction physiopathology
- Abstract
Objectives: We sought to determine the prognostic significance of simultaneous versus independent resolution of ST segment depression that occurs concomitant with ST segment elevation during acute myocardial infarction (AMI)., Background: ST segment depression in leads other than those showing ST segment elevation during AMI is a common phenomenon. Whether this indicates adverse outcomes remains controversial. We hypothesized that the timing of ST segment depression resolution relative to ST segment elevation resolution might differentiate between a high risk group and a low risk group of patients., Methods: Continuous 12-lead ST segment monitoring was performed after thrombolytic therapy for AMI in 413 patients, 261 of whom met technical criteria for analysis. Blinded analysis of ST segment depression resolution patterns was used to group patients as follows: 1) no ST segment depression at any time (control group); 2) ST segment depression resolving simultaneously with ST segment elevation (simultaneous group); and 3) ST segment depression persisting after ST segment elevation resolution (independent group). These patterns were correlated with the outcomes-recurrent angina, reinfarction, heart failure and death-using chi-square analysis and the Fisher exact test for categoric variables and the Wilcoxon rank-sum test for continuous variables., Results: The incidence of recurrent angina, reinfarction and heart failure was similar among the three groups. In-hospital mortality, however, was significantly higher in the independent group (13%) than either the simultaneous group (1%, p < 0.001) or the control group (0%, p = 0.002)., Conclusions: Continuous analysis of ST segment resolution identifies, among patients with AMI with concomitantly occurring ST segment elevation and depression, a subgroup with increased in-hospital mortality. The pathogenic mechanism of increased mortality is not currently known.
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- 1997
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19. Does hypotension during dobutamine stress echocardiography correlate with anatomic or functional cardiac impairment?
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Lieberman EB, Heinle SK, Wildermann N, Waugh RA, Kisslo JA, and Bashore TM
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- Age Factors, Aged, Angioplasty, Balloon, Atherectomy, Coronary, Blood Pressure drug effects, Cardiac Catheterization, Coronary Angiography, Coronary Disease therapy, Female, Follow-Up Studies, Forecasting, Humans, Hypotension pathology, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Recurrence, Signal Processing, Computer-Assisted, Stroke Volume, Ventricular Function, Left, Coronary Disease pathology, Coronary Disease physiopathology, Dobutamine administration & dosage, Echocardiography, Hypotension physiopathology
- Abstract
The development of hypotension during various exercise stress tests has been correlated with the presence of multivessel coronary artery disease and impaired left ventricular contractility. Hypotension may also occur during dobutamine stress echocardiography; however, its anatomic and functional significance remains unknown. As part of an ongoing study of restenosis, dobutamine stress echocardiography and diagnostic cardiac catheterization were performed on the same day in 105 outpatients approximately 6 months after percutaneous coronary revascularization (balloon angioplasty or directional coronary atherectomy) to determine the anatomic and functional significance of dobutamine-induced hypotension. Dobutamine was infused in stepwise increments to a maximum rate of 30 micrograms/kg/min. Hypotension was defined as a reduction in systolic blood pressure of > or = 15 mm Hg. Anatomic abnormalities were defined by quantitative coronary angiography and functional abnormalities by digitized two-dimensional stress echocardiography. Clinical, angiographic, hemodynamic, and electrocardiographic data underwent multivariable regression analysis to determine their ability to predict independently the development of dobutamine-induced hypotension. Dobutamine-induced hypotension was not associated with the presence of severity of coronary artery disease or with echocardiographic wall motion abnormalities. Univariable predictors of stress-induced hypotension included high baseline systolic blood pressure, advanced age, and high left ventricular ejection fraction. Only a high baseline systolic blood pressure contributed independent predictive information in multivariable stepwise logistic regression analysis. Therefore, the development of hypotension during dobutamine stress echocardiography, unlike that during traditional exercise stress tests, is not associated with the presence of significant coronary artery disease or left ventricular dysfunction.
- Published
- 1995
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20. The impact of autoperfusion on quantitative electrocardiographic parameters of ischemia severity, extent, and "burden" during salvage of elective coronary angioplasty.
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Krucoff MW, Veldkamp RF, Kanani PM, Crater S, Sawchak SR, Wildermann NM, Bengtson JR, Pope JE, Sketch MH Jr, and Phillips HR
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- Female, Humans, Male, Middle Aged, Myocardial Ischemia physiopathology, Perfusion, Angioplasty, Balloon, Coronary, Electrocardiography, Myocardial Ischemia therapy
- Abstract
Long angioplasty inflations have been reported using an autoperfusion system that delivers oxygenated blood distal to the balloon segment. The safety and efficacy of this system has been demonstrated in anatomically selected patients. The clinical use, however, is frequently to stabilize intimal dissection in unselected patients. We reviewed 12-lead continuous electrocardiographic (ECG) recordings in 40 patients in whom prolonged salvage with autoperfusion was attempted. Sub-optimal results were stabilized in 36 of 40, while 4 patients had urgent bypass. The presence of ischemia, as > or = 100 uV ST elevation over the 12 lead ECG, and the total ST deviation over all leads over the entire inflation period (total ischemic "burden") were compared within each patient between the longest standard balloon and autoperfusion inflations. Median duration of inflation was 3.03 min. with balloon vs. 15.6 min. with autoperfusion (p < 0.00002). Of the 40 patients, 35 (87%) had ECG ischemia with balloon vs. 18 (45%) with autoperfusion (p < .00002). Median severity of peak ST deviation was 321 uV with balloon vs. 132 uV with autoperfusion (p = 0.0001). Median extent of ST elevation was 3 leads with balloon vs. 0 leads with autoperfusion (p = 0.0001). Median total ischemic burden was similar with balloon (1173 uVmin) and autoperfusion (1083 uVmin, NS) despite the fivefold longer inflation duration with autoperfusion. Thus, in patients selected by clinical necessity rather than optimal anatomy, severity and extent of ST elevation were significantly reduced, although not entirely eliminated, by autoperfusion.
- Published
- 1994
21. Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era.
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Bengtson JR, Kaplan AJ, Pieper KS, Wildermann NM, Mark DB, Pryor DB, Phillips HR 3rd, and Califf RM
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- Academic Medical Centers, Age Factors, Aged, Angioplasty, Balloon, Coronary standards, Cardiac Catheterization, Cardiac Output, Cardiotonic Agents therapeutic use, Combined Modality Therapy, Coronary Angiography, Creatine Kinase blood, Decision Trees, Female, Follow-Up Studies, Hospital Mortality, Humans, Intra-Aortic Balloon Pumping standards, Isoenzymes, Logistic Models, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Reperfusion methods, North Carolina epidemiology, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Prospective Studies, Shock, Cardiogenic etiology, Shock, Cardiogenic mortality, Stroke Volume, Survival Analysis, Thrombolytic Therapy standards, Treatment Outcome, Vasoconstrictor Agents therapeutic use, Myocardial Infarction complications, Myocardial Reperfusion standards, Shock, Cardiogenic therapy
- Abstract
Objectives: The purpose of this study is to describe the outcome in cardiogenic shock treated with aggressive reperfusion therapy and to identify factors predictive of in-hospital and long-term mortality., Background: Cardiogenic shock is the most common cause of death in patients admitted to the coronary care unit. Although studies have reported lower mortality rates in shock treated with angioplasty, few studies have described a cohort of patients with shock who were not selected because they were most likely to benefit from reperfusion therapy., Methods: A consecutive series of 200 patients admitted with acute myocardial infarction complicated by cardiogenic shock were studied., Results: The in-hospital mortality rate was 53%. Variables with significant univariable association with in-hospital death included patency of the infarct-related artery, patient age, lowest cardiac index, highest arteriovenous oxygen difference and left main coronary artery disease. The most important independent predictors of in-hospital death were patency of the infarct-related artery, cardiac index and peak creatine kinase, MB fraction. The mortality rate in patients with patent infarct-related arteries was 33% versus 75% in those with closed arteries and 84% in those in whom arterial patency was unknown. Patients who survived to hospital discharge were followed up for a median of 2 years, with a mortality rate of 18% after 1 year. The best descriptors of the relation between these variables and postdischarge mortality included age, peak creatine kinase, ejection fraction and patency of the infarct-related artery., Conclusions: In a large consecutive series of patients with cardiogenic shock with complete follow-up, patency of the infarct-related artery was most strongly associated with in-hospital and long-term mortality. This finding supports an aggressive interventional strategy in patients with cardiogenic shock.
- Published
- 1992
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22. Studies of gastric ulcer disease by community-based gastroenterologists.
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Brazer SR, Tyor MP, Pancotto FS, Nickl NJ, Wildermann NM, Harrell FE Jr, and Pryor DB
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- Abdominal Pain etiology, Alcohol Drinking, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Aspirin adverse effects, Female, Gastrointestinal Hemorrhage etiology, Humans, Male, Middle Aged, North Carolina epidemiology, Peptic Ulcer chemically induced, Peptic Ulcer complications, Prospective Studies, Retrospective Studies, Smoking adverse effects, Peptic Ulcer epidemiology
- Abstract
A community-based group of gastroenterologists examined 623 patients (541 prospectively and 82 retrospectively) with endoscopically diagnosed gastric ulcer disease during a 12-month period. Patients averaged 60 years of age; the majority were women (62%). Women were less likely to smoke, abuse alcohol, and were more likely to present with abdominal pain (p less than 0.05). Whereas patients presenting with bleeding or requiring transfusion were less likely to complain of pain (p less than 0.05), they were more likely to be taking aspirin or nonsteroidal anti-inflammatory drugs and have prior history of bleeding (p less than 0.05). Patients with a prior history of ulcer disease were more likely to smoke, present with pain and use acetaminophen (p less than 0.05). Patients with large ulcers were more likely to bleed, present with pain, and obstruct (p less than 0.05). Multiple gastric ulcers were seen in patients taking aspirin or nonsteroidal anti-inflammatory drugs (p less than 0.05).
- Published
- 1990
23. The laboratory method as a variable in the interpretation of serum bilirubin fractionation.
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Killenberg PG, Stevens RD, Wildermann RF, and Wildermann NM
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- Adult, Cholelithiasis blood, Diagnosis, Differential, Gilbert Disease blood, Humans, Male, Bilirubin blood, Hyperbilirubinemia blood, Spectrum Analysis methods
- Abstract
Fractionation of the serum bilirubin into direct and indirect-reacting components has been used in the differentiation of patients with hepatobiliary disease from those with unconjugated hyperbilirubinemia. Previous studies have shown that patients with indirect hyperbilirubinemia usually have total serum bilirubin concentrations less than 5 mg/dl. Therefore, clinically useful methods of fractionating bilirubin must yield reliable results in patients with mild hyperbilirubinemia. Experience with 4 patients with mild hyperbilirubinemia indicated that conflicting results could be obtained from two different laboratories. Therefore, a panel of hyperbilirubinemic sera were submitted to four different laboratories. While there was general agreement in sera containing high concentrations of bilirubin, marked variations were observed in the results reported on sera with less than 5 mg/dl total bilirubin. Finally, clinical and other laboratory parameters were reviewed in patients who had had bilirubin fractionation performed by one or the other of two routine laboratories. In one laboratory, bilirubin fractionation correctly distinguished patients with hepatobiliary disease, while the other laboratory was not able to differentiate patients on the basis of this test. These data suggest that despite the general reported agreement in standard methods for bilirubin fractionation there may be marked differences among methods in ability to reliably fractionate sera with total bilirubin concentrations less than 5 mg/dl.
- Published
- 1980
24. Randomized, double-blind comparison of famotidine with ranitidine in treatment of acute, benign gastric ulcer disease. Community-based study coupled with a patient registry.
- Author
-
Brazer SR, Tyor MP, Pancotto FS, Brice RS, Garbutt JT Jr, Wildermann NM, Harrell FE, Pryor DB, Liss CL, and Root JK
- Subjects
- Clinical Trials as Topic, Double-Blind Method, Famotidine, Female, Histamine H2 Antagonists adverse effects, Humans, Male, Middle Aged, Random Allocation, Ranitidine adverse effects, Registries, Thiazoles adverse effects, Histamine H2 Antagonists therapeutic use, Ranitidine therapeutic use, Stomach Ulcer drug therapy, Thiazoles therapeutic use
- Abstract
A multicenter, double-blind, randomized controlled trial comparing the efficacy and safety of famotidine with ranitidine in the treatment of acute, benign gastric ulcer disease was coupled with a community-based gastric ulcer disease registry. One hundred ninety-five patients with endoscopically documented gastric ulcer disease were enrolled in the trial and randomly allocated to treatment with either famotidine 40 mg at bedtime or ranitidine 150 mg twice a day. Healing rates were similar in both groups: at four weeks 49% vs 48%, at six weeks 71% vs 69%, and at eight weeks 83% vs 81% for famotidine and for ranitidine, respectively. Pain relief, antacid tablet use, and adverse experiences were also similar in the two groups. Only 25% of patients entered in the gastric ulcer registry were enrolled in the trial. Given that patients with more severe or complicated gastric ulcer disease should be excluded from controlled trials of new drugs, the screening criteria used in the present study be excluded from findings being representative of a quarter of the patients seen in these practices. Therefore, coupling a patient registry with a clinical trial helps determine the applicability of its results. Famotidine 40 mg at bedtime is an effective and well-tolerated treatment of acute, benign gastric ulcer disease and is comparable in efficacy and safety to ranitidine 150 mg twice a day.
- Published
- 1989
- Full Text
- View/download PDF
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