Edwin L. Bradley

Comparison of primary angioplasty versus thrombolytic therapy for acute myocardial infarction

To determine the relative merits of primary percutaneous transluminal coronary angioplasty (PTCA) and intravenous thrombolytic therapy for acute myocardial infarction, 12 tertiary care hospitals entered patients who had > or = 30 minutes of chest pain and were admitted to a cardiac intensive care unit within 12 hours of symptom onset into a prospective registry. Of 1,170 such patients, 118 (10%) underwent primary PTCA and 230 (19%) received intravenous thrombolytic therapy within 6 hours of registry hospital admission (144 at the registry hospital and 86 prior to arrival at the registry hospital). Baseline demographic characteristics of PTCA and thrombolytic subgroups were remarkably similar. The interval from initial evaluation at the registry hospital to treatment was shorter with intravenous thrombolytic therapy than with primary PTCA (64 vs 104 minutes, p < 0.001), as was the interval from pain onset to treatment (184 vs 252 minutes, p < 0.001). Among the 230 thrombolytic patients, coronary arteriography and PTCA were performed within the first 24 hours in 44% and 18%, respectively, and during the entire hospitalization in 90% and 49%, respectively. During hospitalization, blood was transfused in 16% of the 230 thrombolytic patients versus 5.9% of the 118 PTCA patients (p < 0.001). Otherwise, adverse events during the initial hospitalization were similar in PTCA and thrombolytic groups. Survival at 1-year follow-up was 88% in the PTCA group and 91% in the thrombolytic group (p = NS), and survival free of reinfarction was 85% and 88%, respectively (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Considerations in Selection and Management of Patients Undergoing Valve Replacement with Glutaraldehyde-Fixed Porcine Bioprostheses

From November, 1973, through June, 1978, 428 operations in 425 patients were performed for replacement of aortic, mitral, or aortic plus mitral valves, utilizing 277 Hancock and 180 Carpentier-Edwards bioprostheses. Actuarially determined survival at 36 months was similar for all three groups and compared favorably with our experience with the Björk-Shiley prosthesis. Certain patient-related variables influencing late survival were identified by multivariate analysis and included previous operation for congenital heart disease, coronary artery bypass grafting in nonaortic valve replacement, race (black), age at operation, and New York Heart Association Functional Class. A small but definite incidence of thromboembolism occurred in all three groups, again similar to our experience with the Björk-Shiley prosthesis. Multivariate analysis identified four factors influencing risk of thromboembolism: previous cardiac operation, age, double-valve replacement, and rhythm at discharge. Valve degeneraation occurred, primarily in children and young adults. Over the medium term, the porcine bioprosthesis compared favorably with mechanical prostheses in terms of survival, function, and thromboembolism. Certain patient-related variables affecting survival may be modified by earlier surgical intervention.

Glucose‐6‐phosphate dehydrogenase: A possible clinical indicator for prostatic carcinoma

Any system of biochemical analysis that can be used to detect chemical differences between normal and malignant cells may add potentially valuable information to complement the histologic data which provide the practical definition of human prostatic carcinoma. A difference (P < 0.0001) was observed in the levels of glucose‐6‐phosphate dehydrogenase (G‐6‐PD) activity in prostatic tissue with benign hyperplasia and prostatic carcinoma. Measured as a function of the amount of protein extracted from whole‐tissue homogenates, the values for G‐6‐PD activity in prostatic carcinoma are almost four times those measured for benign prostatic hyperplasia. The degree of elevation of the activity of this enzyme suggests a correlation between enzymatic activity and clinical prognosticators, ie., histotogic differentiation and clinical stage.

Enhanced evaluation of treadmill tests by means of scoring based on multivariate analysis and its clinical application: a study of 608 patients.

Six hundred eight patients being evaluated for chest pain who did not have valvular disease, cardiomyopathy, left ventricular hypertrophy or bundle branch block, and were not receiving digitalis, had treadmill tests and coronary angiograms. In 351, various exercise variables were correlated by multivariate analysis to coronary artery disease (CAD). In men, significant variables were: (1) maximal heart rate achieved less than 80% of maximal predicted heart rate (Mx PHR), (2) ST-T change greater than or equal to 1 mm, (3) age greater than or equal to 55 years and (4) treadmill time (TT) less than 8 minutes. These variables rated diagnostic scores of 9, 6, 5, and 3, respectively. A score of greater than or equal to 7 was considered diagnostic of CAD. In a test group of 192 men in which ST-T change was compared with treadmill score, sensitivity was 65 versus 85%, specificity 79 versus 74% and accuracy 69 versus 83%. In women, maximal heart rate less than 90% of Mx PHR and TT of less than 6 minutes were significant, with an accuracy of 75%. Moreover, 89% of incomplete tests and 70% of tests in patients with previous myocardial infarction were also correctly diagnosed. This method allows convenient use of significant exercise variables for clinical purposes with improved results.

HODGKIN'S CELLS AND ATTACHED LYMPHOCYTES A Possible Prognostic Indicator in Splenic Tumor

After the purification of Hodgkins cells by a previously reported method from splenic tumor of 8 patients with Stages III or IV Hodgkins disease, we have examined the proportions of Hodgkins cells with attached lymphocytes. All patients were studied 3‐5 years after staging laparotomy. Four patients had no recurrent disease; 3 had histologically confirmed recurrent disease; and 1 had clinically suspected recurrent disease (enlarged nodes) but has thus far refused further medical study and care. The proportion of purified Hodgkins cells which had attached lymphocytes was consistently higher in the patients who were clinically free of disease. The possible biological significance of this observation is discussed briefly and would appear to warrant further investigation of this phenomenon in more patients with splenic tumor than are available to us.