Background. Failure to reach 85% of maximal predicted heart rate (MPHR) during exercise may rende... more Background. Failure to reach 85% of maximal predicted heart rate (MPHR) during exercise may render a myocardial perfusion single photon emission computed tomography (MPS) study nondiagnostic for ischemia detection. Although commonly used to increase heart rate (HR) during dobutamine stress, the administration of atropine for patients failing to achieve 85% of MPHR during exercise performed for MPS is still infrequent. Methods and Results. Patients undergoing dual-isotope MPS were considered candidates for the study when, during exercise treadmill testing, they had less than 85% of MPHR and were unable to continue because of fatigue, without an ischemic response. Forty-seven patients (aged 65.3 ؎ 12.5 years, 78.7% men) received atropine (0.6-1.2 mg). Maximal HR achieved before and after atropine was 118.0 ؎ 14.8 beats/min (76.3% ؎ 6.2% of MPHR) and 146.4 ؎ 12.6 beats/min (94.4% ؎ 8.1% of MPHR), respectively (P < .001). Of patients, 44 (93.6%) reached at least 85% of MPHR after atropine and had diagnostic MPS studies. After atropine, arrhythmias occurred in 14 patients (29.8%) and other minor side effects in 1 (2.1%). Conclusions. Atropine allows patients initially failing to achieve 85% of MPHR during exercise to increase HR and have a diagnostic MPS study, without major complications. It may provide an alternative to pharmacologic stress for patients with a blunted HR response to exercise.
A comparison of left ventricular ejection time (LVET) measured directly from the central aortic p... more A comparison of left ventricular ejection time (LVET) measured directly from the central aortic pressure tracing (CAPT) and a densitogram recording was carried out in 39 patients during diagnostic cardiac catheterization. The correlation coefficient between the LVET derived from the CAPT and densitogram of 32 patients while at rest was 0.974 with a standard deviation from regression (SDR) of 6.2 msec. Sequential LVETs were analyzed in two patients during atrial pacing, three patients during exercise and three patients with atrial fibrillation. Correlation coefficients were 0.981, 0.951 and 0.974 with SDRS of 5.3, 6.2 and 6.7 msec respectively. Assuming LVET from the CAPT to be error free, the over-all error of estimating LVET by den-sitogram was less than 5 % for over 95 % of the measurements. The largest mean difference between CAPT and densitogram derived LVETs was present during atrial pacing and corresponds to an error of less than 2 % of the average LVET for the group. We concl...
Morphine (MS) may relieve pulmonary edema by attenuating the central nervous system (CNS) sympath... more Morphine (MS) may relieve pulmonary edema by attenuating the central nervous system (CNS) sympathetic alpha adrenergic transmission resulting in venous pooling from arteriolar dilation. To clarify this mechanism, the effect of MS on the cardiovascular system under CO2 challenge was determined in 10 normal subject*. Forearm blood flow was measured plethysmographically and forearm vascular resistance (FVR) calculated. CO2 challenge was rebreathing 7% CO 30% 02, 63% N for 5 minutes while FVR, PaC02 and PA 02 were measure 6' 2. Intravenous MS (15
International Journal of Biomedical Research, 2015
Background: Though laparoscopic cholecystectomy is a minimal invasive surgery but inadequate pain... more Background: Though laparoscopic cholecystectomy is a minimal invasive surgery but inadequate pain management interferes with early discharge of patient. Administration of opioid for pain relief is a concern because of its side effects. To avoid this problem, we planned our study to find out the best alternative of opioid in patients undergoing laparoscopic cholecystectomy. Methods: 68 patients were enrolled for this study in a stipulated time of 1 year in a tertiary level hospital. A questionnaire was responded by patients and a chart was maintained for pain score in visual analogue scale (VAS) and for side effects. We used paracetamol and diclofenac as post operative analgesic in two different groups and data was recorded in Excel panel and was analyzed by standard statistical test by software MINITAB 1513 with a significant p-value of <0.05. Results: We have found the significant outcome (p-values are 0.0005 at 0 hrs, 0.003 at 2 hrs, 0.001 at 6 hrs, 0.0005 at 12 hrs) in VAS pain score in between the two groups at different intervals. Patients who were administered paracetamol had shown better outcome with less requirement of rescue analgesia and side effects. Conclusion: Administration of intravenous paracetamol in the intra operative period 30 minutes prior to the completion of surgery followed by administration of 1g paracetamol every 8 hourly in the post-operative period gives better quality of analgesia.
The video dilution technique for measuring blood flow consists of electronically and mathematical... more The video dilution technique for measuring blood flow consists of electronically and mathematically processing video-taped selective arteriograms to measure the flow in selectively catheterized arteries and to express this flow as a fraction of the flow in any reference artery. Flows were measured by video dilution and an electromagnetic flowmeter in ten dogs; the correlations were excellent. Video dilution flows were also measured in 105 patients. The technique is accurate, simple, and adds no risk to routine selective arteriography.
Medical Intelligence from The New England Journal of Medicine The Abbreviated Pr Interval of Fa... more Medical Intelligence from The New England Journal of Medicine The Abbreviated Pr Interval of Fabry's Disease.
Video dilution technique is now available for clinical use in evaluating patients with peripheral... more Video dilution technique is now available for clinical use in evaluating patients with peripheral vascular disease. The measurements can easily be performed in any modern angiographic suite. The only additional equipment required is a videodensitometer, video tape recorder, and a strip chart recorded. The new technique has been developed and tested in a hydrodynamic model and compared to volumetric flows. Further, the video dilution technique has been compared to electromagnetic flow readings using a canine model to measure the cerebral, renal, splanchnic, and extremity circulation and has proven to be extremely accurate (n = 389; r = 0.99). By applying the technique to patients with peripheral vascular disease, it is possible to evaluate the hemodynamic significance of stenotic lesions and arteriovenous shunts. Other uses of video dilution technique include evaluating the effects of vasoactive drugs and the adequacy of transluminal angioplasty.
A contrast medium was injected in the aortic arch and selectively in a renal artery to estimate t... more A contrast medium was injected in the aortic arch and selectively in a renal artery to estimate the renal blood flow as a percentage of the cardiac output by the videodensitometric (VD) method. Twenty-six paired VD measurements in four mongrel dogs were obtained and the results compared to electromagnetic (EM) flow readings from the aortic arch and a renal artery. The relative renal blood flow estimated by the VD method averaged 9.1% and correlated with the EM flow average of 9.6% with r = 0.96. Previous in vitro investigations of relative flow in a model have now been validated in vivo. These results suggest that videodensitometry could be a clinical tool for measuring renal blood flow in conjunction with routine arteriography.
Morphine (MS) may relieve pulmonary edema by attenuating the central nervous system (CNS) sympath... more Morphine (MS) may relieve pulmonary edema by attenuating the central nervous system (CNS) sympathetic alpha adrenergic transmission resulting in venous pooling from arteriolar dilation. To clarify this mechanism, the effect of MS on the cardiovascular system under CO2 challenge was determined in 10 normal subject*. Forearm blood flow was measured plethysmographically and forearm vascular resistance (FVR) calculated. CO2 challenge was rebreathing 7% CO 30% 02, 63% N for 5 minutes while FVR, PaC02 and PA 02 were measure 6' 2. Intravenous MS (15
A comparison of left ventricular ejection time (LVET) measured directly from the central aortic p... more A comparison of left ventricular ejection time (LVET) measured directly from the central aortic pressure tracing (CAPT) and a densitogram recording was carried out in 39 patients during diagnostic cardiac catheterization. The correlation coefficient between the LVET derived from the CAPT and densitogram of 32 patients while at rest was 0.974 with a standard deviation from regression (SDR) of 6.2 msec. Sequential LVETs were analyzed in two patients during atrial pacing, three patients during exercise and three patients with atrial fibrillation. Correlation coefficients were 0.981, 0.951 and 0.974 with SDRS of 5.3, 6.2 and 6.7 msec respectively. Assuming LVET from the CAPT to be error free, the overall error of estimating LVET by densitogram was less than 5% for over 95% of the measurements. The largest mean difference between CAPT and densitogram derived LVETs was present during atrial pacing and corresponds to an error of less than 2% of the average LVET for the group. We conclude that densitometry is a practical and reliable noninvasive method for LVET measurements in a variety of physiological and pathological conditions.
BACKGROUND: Failure to reach 85% of maximal predicted heart rate (MPHR) during exercise may rende... more BACKGROUND: Failure to reach 85% of maximal predicted heart rate (MPHR) during exercise may render a myocardial perfusion single photon emission computed tomography (MPS) study nondiagnostic for ischemia detection. Although commonly used to increase heart rate (HR) during dobutamine stress, the administration of atropine for patients failing to achieve 85% of MPHR during exercise performed for MPS is still infrequent. METHODS AND RESULTS: Patients undergoing dual-isotope MPS were considered candidates for the study when, during exercise treadmill testing, they had less than 85% of MPHR and were unable to continue because of fatigue, without an ischemic response. Forty-seven patients (aged 65.3 +/-12.5 years, 78.7% men) received atropine (0.6-1.2 mg). Maximal HR achieved before and after atropine was 118.0 +/-14.8 beats/min (76.3% +/-6.2% of MPHR) and 146.4 +/-12.6 beats/min (94.4% +/-8.1% of MPHR), respectively (P < .001). Of patients, 44 (93.6%) reached at least 85% of MPHR after atropine and had diagnostic MPS studies. After atropine, arrhythmias occurred in 14 patients (29.8%) and other minor side effects in 1 (2.1%). CONCLUSIONS: Atropine allows patients initially failing to achieve 85% of MPHR during exercise to increase HR and have a diagnostic MPS study, without major complications. It may provide an alternative to pharmacologic stress for patients with a blunted HR response to exercise. PMID 12569331 [PubMed-indexed for MEDLINE] De Lorenzo A1, Foerster J, Sciammarella MG, Suey C, Hayes SW, Friedman JD, Berman DS J Nucl Cardiol. 2003 Jan-Feb;10(1):51-5.
Background. Failure to reach 85% of maximal predicted heart rate (MPHR) during exercise may rende... more Background. Failure to reach 85% of maximal predicted heart rate (MPHR) during exercise may render a myocardial perfusion single photon emission computed tomography (MPS) study nondiagnostic for ischemia detection. Although commonly used to increase heart rate (HR) during dobutamine stress, the administration of atropine for patients failing to achieve 85% of MPHR during exercise performed for MPS is still infrequent. Methods and Results. Patients undergoing dual-isotope MPS were considered candidates for the study when, during exercise treadmill testing, they had less than 85% of MPHR and were unable to continue because of fatigue, without an ischemic response. Forty-seven patients (aged 65.3 ؎ 12.5 years, 78.7% men) received atropine (0.6-1.2 mg). Maximal HR achieved before and after atropine was 118.0 ؎ 14.8 beats/min (76.3% ؎ 6.2% of MPHR) and 146.4 ؎ 12.6 beats/min (94.4% ؎ 8.1% of MPHR), respectively (P < .001). Of patients, 44 (93.6%) reached at least 85% of MPHR after atropine and had diagnostic MPS studies. After atropine, arrhythmias occurred in 14 patients (29.8%) and other minor side effects in 1 (2.1%). Conclusions. Atropine allows patients initially failing to achieve 85% of MPHR during exercise to increase HR and have a diagnostic MPS study, without major complications. It may provide an alternative to pharmacologic stress for patients with a blunted HR response to exercise.
A comparison of left ventricular ejection time (LVET) measured directly from the central aortic p... more A comparison of left ventricular ejection time (LVET) measured directly from the central aortic pressure tracing (CAPT) and a densitogram recording was carried out in 39 patients during diagnostic cardiac catheterization. The correlation coefficient between the LVET derived from the CAPT and densitogram of 32 patients while at rest was 0.974 with a standard deviation from regression (SDR) of 6.2 msec. Sequential LVETs were analyzed in two patients during atrial pacing, three patients during exercise and three patients with atrial fibrillation. Correlation coefficients were 0.981, 0.951 and 0.974 with SDRS of 5.3, 6.2 and 6.7 msec respectively. Assuming LVET from the CAPT to be error free, the over-all error of estimating LVET by den-sitogram was less than 5 % for over 95 % of the measurements. The largest mean difference between CAPT and densitogram derived LVETs was present during atrial pacing and corresponds to an error of less than 2 % of the average LVET for the group. We concl...
Morphine (MS) may relieve pulmonary edema by attenuating the central nervous system (CNS) sympath... more Morphine (MS) may relieve pulmonary edema by attenuating the central nervous system (CNS) sympathetic alpha adrenergic transmission resulting in venous pooling from arteriolar dilation. To clarify this mechanism, the effect of MS on the cardiovascular system under CO2 challenge was determined in 10 normal subject*. Forearm blood flow was measured plethysmographically and forearm vascular resistance (FVR) calculated. CO2 challenge was rebreathing 7% CO 30% 02, 63% N for 5 minutes while FVR, PaC02 and PA 02 were measure 6' 2. Intravenous MS (15
International Journal of Biomedical Research, 2015
Background: Though laparoscopic cholecystectomy is a minimal invasive surgery but inadequate pain... more Background: Though laparoscopic cholecystectomy is a minimal invasive surgery but inadequate pain management interferes with early discharge of patient. Administration of opioid for pain relief is a concern because of its side effects. To avoid this problem, we planned our study to find out the best alternative of opioid in patients undergoing laparoscopic cholecystectomy. Methods: 68 patients were enrolled for this study in a stipulated time of 1 year in a tertiary level hospital. A questionnaire was responded by patients and a chart was maintained for pain score in visual analogue scale (VAS) and for side effects. We used paracetamol and diclofenac as post operative analgesic in two different groups and data was recorded in Excel panel and was analyzed by standard statistical test by software MINITAB 1513 with a significant p-value of <0.05. Results: We have found the significant outcome (p-values are 0.0005 at 0 hrs, 0.003 at 2 hrs, 0.001 at 6 hrs, 0.0005 at 12 hrs) in VAS pain score in between the two groups at different intervals. Patients who were administered paracetamol had shown better outcome with less requirement of rescue analgesia and side effects. Conclusion: Administration of intravenous paracetamol in the intra operative period 30 minutes prior to the completion of surgery followed by administration of 1g paracetamol every 8 hourly in the post-operative period gives better quality of analgesia.
The video dilution technique for measuring blood flow consists of electronically and mathematical... more The video dilution technique for measuring blood flow consists of electronically and mathematically processing video-taped selective arteriograms to measure the flow in selectively catheterized arteries and to express this flow as a fraction of the flow in any reference artery. Flows were measured by video dilution and an electromagnetic flowmeter in ten dogs; the correlations were excellent. Video dilution flows were also measured in 105 patients. The technique is accurate, simple, and adds no risk to routine selective arteriography.
Medical Intelligence from The New England Journal of Medicine The Abbreviated Pr Interval of Fa... more Medical Intelligence from The New England Journal of Medicine The Abbreviated Pr Interval of Fabry's Disease.
Video dilution technique is now available for clinical use in evaluating patients with peripheral... more Video dilution technique is now available for clinical use in evaluating patients with peripheral vascular disease. The measurements can easily be performed in any modern angiographic suite. The only additional equipment required is a videodensitometer, video tape recorder, and a strip chart recorded. The new technique has been developed and tested in a hydrodynamic model and compared to volumetric flows. Further, the video dilution technique has been compared to electromagnetic flow readings using a canine model to measure the cerebral, renal, splanchnic, and extremity circulation and has proven to be extremely accurate (n = 389; r = 0.99). By applying the technique to patients with peripheral vascular disease, it is possible to evaluate the hemodynamic significance of stenotic lesions and arteriovenous shunts. Other uses of video dilution technique include evaluating the effects of vasoactive drugs and the adequacy of transluminal angioplasty.
A contrast medium was injected in the aortic arch and selectively in a renal artery to estimate t... more A contrast medium was injected in the aortic arch and selectively in a renal artery to estimate the renal blood flow as a percentage of the cardiac output by the videodensitometric (VD) method. Twenty-six paired VD measurements in four mongrel dogs were obtained and the results compared to electromagnetic (EM) flow readings from the aortic arch and a renal artery. The relative renal blood flow estimated by the VD method averaged 9.1% and correlated with the EM flow average of 9.6% with r = 0.96. Previous in vitro investigations of relative flow in a model have now been validated in vivo. These results suggest that videodensitometry could be a clinical tool for measuring renal blood flow in conjunction with routine arteriography.
Morphine (MS) may relieve pulmonary edema by attenuating the central nervous system (CNS) sympath... more Morphine (MS) may relieve pulmonary edema by attenuating the central nervous system (CNS) sympathetic alpha adrenergic transmission resulting in venous pooling from arteriolar dilation. To clarify this mechanism, the effect of MS on the cardiovascular system under CO2 challenge was determined in 10 normal subject*. Forearm blood flow was measured plethysmographically and forearm vascular resistance (FVR) calculated. CO2 challenge was rebreathing 7% CO 30% 02, 63% N for 5 minutes while FVR, PaC02 and PA 02 were measure 6' 2. Intravenous MS (15
A comparison of left ventricular ejection time (LVET) measured directly from the central aortic p... more A comparison of left ventricular ejection time (LVET) measured directly from the central aortic pressure tracing (CAPT) and a densitogram recording was carried out in 39 patients during diagnostic cardiac catheterization. The correlation coefficient between the LVET derived from the CAPT and densitogram of 32 patients while at rest was 0.974 with a standard deviation from regression (SDR) of 6.2 msec. Sequential LVETs were analyzed in two patients during atrial pacing, three patients during exercise and three patients with atrial fibrillation. Correlation coefficients were 0.981, 0.951 and 0.974 with SDRS of 5.3, 6.2 and 6.7 msec respectively. Assuming LVET from the CAPT to be error free, the overall error of estimating LVET by densitogram was less than 5% for over 95% of the measurements. The largest mean difference between CAPT and densitogram derived LVETs was present during atrial pacing and corresponds to an error of less than 2% of the average LVET for the group. We conclude that densitometry is a practical and reliable noninvasive method for LVET measurements in a variety of physiological and pathological conditions.
BACKGROUND: Failure to reach 85% of maximal predicted heart rate (MPHR) during exercise may rende... more BACKGROUND: Failure to reach 85% of maximal predicted heart rate (MPHR) during exercise may render a myocardial perfusion single photon emission computed tomography (MPS) study nondiagnostic for ischemia detection. Although commonly used to increase heart rate (HR) during dobutamine stress, the administration of atropine for patients failing to achieve 85% of MPHR during exercise performed for MPS is still infrequent. METHODS AND RESULTS: Patients undergoing dual-isotope MPS were considered candidates for the study when, during exercise treadmill testing, they had less than 85% of MPHR and were unable to continue because of fatigue, without an ischemic response. Forty-seven patients (aged 65.3 +/-12.5 years, 78.7% men) received atropine (0.6-1.2 mg). Maximal HR achieved before and after atropine was 118.0 +/-14.8 beats/min (76.3% +/-6.2% of MPHR) and 146.4 +/-12.6 beats/min (94.4% +/-8.1% of MPHR), respectively (P < .001). Of patients, 44 (93.6%) reached at least 85% of MPHR after atropine and had diagnostic MPS studies. After atropine, arrhythmias occurred in 14 patients (29.8%) and other minor side effects in 1 (2.1%). CONCLUSIONS: Atropine allows patients initially failing to achieve 85% of MPHR during exercise to increase HR and have a diagnostic MPS study, without major complications. It may provide an alternative to pharmacologic stress for patients with a blunted HR response to exercise. PMID 12569331 [PubMed-indexed for MEDLINE] De Lorenzo A1, Foerster J, Sciammarella MG, Suey C, Hayes SW, Friedman JD, Berman DS J Nucl Cardiol. 2003 Jan-Feb;10(1):51-5.
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Papers by James Foerster
De Lorenzo A1, Foerster J, Sciammarella MG, Suey C, Hayes SW, Friedman JD, Berman DS
J Nucl Cardiol. 2003 Jan-Feb;10(1):51-5.
De Lorenzo A1, Foerster J, Sciammarella MG, Suey C, Hayes SW, Friedman JD, Berman DS
J Nucl Cardiol. 2003 Jan-Feb;10(1):51-5.