mark milner - Academia.edu (original) (raw)
Papers by mark milner
with Anorexia Nervosa in Adolescent Patients
The intake laboratory data of 46 patients seen between 1970 and 1980 who were 36 International Un... more The intake laboratory data of 46 patients seen between 1970 and 1980 who were 36 International Units/liter (IU/L), and 65% (27/41) had alkaline phosphatase levels < 58 IU/L. We suggest that patients with anorexia nervosa may reflect a state of hepatic dysfunction and/or dehydration before therapy.
Double-blind crossover trial of diltiazem versus propranolol in the management of thyrotoxic symptoms
Pharmacotherapy, 1990
We compared the efficacy of diltiazem and propranolol in a randomized, prospective, double-blind,... more We compared the efficacy of diltiazem and propranolol in a randomized, prospective, double-blind, crossover study in six patients with untreated thyrotoxicosis (mean age 31 yrs). The patients received either diltiazem 60 mg orally four times a day or propranolol 40 mg orally four times a day, each for 1 week, separated by a 3-day drug-free period. Blood pressure, heart rate, thyroid hormone levels (free T4, T3), electrocardiogram, two-dimensional and M-mode echocardiograms, and Doppler studies were performed. In addition, 8 clinical signs and 18 symptoms of thyrotoxicosis were graded. All subjects felt better with drug therapy, with three preferring diltiazem to propranolol. No significant difference in clinical response or in hemodynamic effects was noted between the agents. These data suggest that diltiazem may serve as an alternative therapy for beta blockers in controlling thyrotoxic symptoms in patients in whom beta blockade may be contraindicated.
Transesophageal echocardiographic detection of transseptal catheter-related thrombi in patients with mitral stenosis
The intake laboratory data of 46 patients seen between 1970 and 1980 who were < 19 years of age w... more The intake laboratory data of 46 patients seen between 1970 and 1980 who were < 19 years of age with a discharge diagnosis of anorexia nervosa were retrospectively reviewed to determine their metabolic profile. The major findings for those who had laboratory data were as follows: 45% (19/42) had serum glutamic oxalacetic transaminase (SGOT) values > 36 International Units/liter (IU/L), and 65% (27/41) had alkaline phosphatase levels < 58 IU/L. We suggest that patients with anorexia nervosa may reflect a state of hepatic dysfunction and/or dehydration before therapy.
American Journal of Cardiology, 1990
Catheterization and Cardiovascular Diagnosis, 1993
Limited data are available concerning the long-term survival and quality of life of octogenarians... more Limited data are available concerning the long-term survival and quality of life of octogenarians treated with percutaneous transluminal coronary angioplasty (PTCA). We retrospectively compared the results of PTCA in 118 octogenarians to that of 500 younger subjects. Among the octogenarians, long term follow-up was obtained including survival, relief of angina, assessment of quality of life, and capacity for independent living. These results were compared between men and women. The clinical success rate was 93% for the octogenarians and 88% for the younger patients (p = NS). The lesion success rates were 89% and 88% for these groups, respectively. Results of multilesion PTCA and dilatation of coronary occlusions were similar in both age groups. Major complication rates were 5.9% for the elderly and 3.8% for the younger patients (p < .008). Hospital mortality was higher among the octogenarians (4.6% vs 0.2%, p < .05). Among long-term octogenarian survivors, > 90% indicated a high level of satisfaction with their quality of life and health status. If needed, 88% would undergo the procedure again. Independent living was possible for 66% of these patients and automobile driving for 55%. Octogenarian men and women had similar baseline clinical characteristics, procedural success, complications, relief of angina, and survival. Women indicated a slightly lower level of satisfaction and capacity for independent living. PTCA can achieve a success rate in octogenarians comparable to that of younger patients but with an increased risk of serious complications. Patient satisfaction remains high and a majority of octogenarians remain physically active and capable of independent living.
Myotonic heart disease
Neurology, 1992
To the Editor: Hawley et all stress the importance of cardiac monitoring in patients with myotoni... more To the Editor: Hawley et all stress the importance of cardiac monitoring in patients with myotonic dystrophy (MD). This prompted us to investigate cardiac conduction in patients with MD. We performed invasive cardiac electrophysiologic studies in seven consecutive patients with MD (ages 31 to 49 years; three women, four men), all asymptomatic with regard t o cardiac conduction abnormalities. Since there have been reports about ventricular arrhythmias,2 programmed atrial stimulation was performed in all patients. Compared with those in other studies, all our patients also underwent programmed ventricular stimulation to evaluate ventricular vulnerability. Although all patients had been asymptomatic up to the time of electrophysiologic evaluation, 1 of 7 had signs of sinus node dysfunction (CSNRT maximum, 710 msec), 3 of 7 showed HV prolongation (HV >60 msec), and 3 of 7 had a Wenckebach point <I20 msec. Using a moderate protocol during programmed ventricular stimulation with one and two premature extrastimuli, all but one patient had a maximum of two consecutive ventricular echo beats (VEBs) inducible and one patient had ventricular salvoes (maximum, four consecutive VEBs) inducible. Thus, even asymptomatic patients with myotonic dystrophy have a high incidence of atrioventricular conduction abnormalities, whereas ventricular vulnerability a s assessed by programmed ventricular stimulation was normal in our cohort of patients. Furthermore, there were no arrhythmias in 24-hour ECG monitoring. Since even cardially asymptomatic patients with MD may have significant cardial conduction abnormalities, frequent cardiologic investigation and, specifically, questions about syncope in each patient appear to be advised. Consideration of pacemaker treatment'^^,^ in symptomatic patients, eg, with syncope, seems to be important to avoid sudden unexpected death.
Myotonic heart disease: A clinical follow-up
Neurology, 1991
We followed 37 patients with myotonic dystrophy for a mean of 6 years. Two developed atrial flutt... more We followed 37 patients with myotonic dystrophy for a mean of 6 years. Two developed atrial flutter or fibrillation, 6 developed a new bundle branch block, 1 developed complete heart block requiring a pacemaker, and another with progressive 1st-degree heart block and a widening QRS interval had a sudden death. Most patients had predictable, gradually progressive disease of their cardiac conduction system. We recommend that patients with progressive atrioventricular block or widening QRS interval due to myotonic heart disease have yearly ECGs and be questioned about syncope or presyncope to determine the need for a cardiac pacemaker.
Journal of the American College of Cardiology, 1990
Transesophageal echocardiographic detection of transseptal catheter-related thrombi in patients with mitral stenosis
Journal of the American College of Cardiology, 1991
Cardiovascular Hazards of Air Travel
JAMA: The Journal of the American Medical Association, 1988
To the Editor.— In the April 1 issue of JAMA , Cummins et al 1 address the risk of sudden death d... more To the Editor.— In the April 1 issue of JAMA , Cummins et al 1 address the risk of sudden death during commercial air travel. Yet, the risk of sudden death is slight compared with the in-flight dangers we place on our coronary anatomy. On a recent cross-country flight, I had the displeasure of being seated in the malodorous smoking section. Not only was my circulatory system subjected to five hours of nicotine-containing vasospastic fumes, but in addition my lipoprotein-carrying system was tempted by an "oilaceous" feast of delectable niblets. Breakfast consisted of scrambled eggs, juicy pork sausages, a muffin with butter, and coffee with an artificial creamer containing coconut and palm oil. Not to be outdined, the luncheon chef designed a plaque-forming meal of a ham and cheese sandwich, 196 g (7 oz) of creamy cheddar cheese, and chocolate-covered macadamia nuts. The only safe food was two breadsticks and Dijon
Diltiazem for the Treatment of Thyrotoxicosis
Archives of Internal Medicine, 1989
To the Editor .—We read with interest the article by Roti et al 1 regarding the use of a calcium-... more To the Editor .—We read with interest the article by Roti et al 1 regarding the use of a calcium-channel blocker, diltiazem, for the treatment of tachyarrhythmias in hyperthyroid patients. The authors suggest that calcium channel antagonists may be useful when β-blockers are contraindicated, as in asthmatics, or as a possible adjunct to β-blockers in the treatment of thyrotoxicosis. Unfortunately, as the authors suggest, they did not compare the effect of diltiazem with β-blockers nor take into consideration the possibility of a placebo effect. We completed a randomized, cross-over, double-blind, pilot study 2 comparing the clinical effects of diltiazem (60 mg, orally, four times a day for 1 week) with propranolol (40 mg, orally, four times a day for 1 week) therapy in six newly diagnosed thyrotoxic patients. We found both drugs to be strongly effective in controlling symptoms (18 symptoms were graded) and in improving clinical signs of thyrotoxicosis.
Ventricular Late Potentials in Myotonic Dystrophy
Annals of Internal Medicine, 1991
To determine the prevalence of ventricular late potentials, as determined by signal-averaged elec... more To determine the prevalence of ventricular late potentials, as determined by signal-averaged electrocardiography, in patients with myotonic dystrophy. Cross sectional, with blinded analysis of all electrocardiographic data. Outpatient departments of a Veterans Affairs medical center and a tertiary care private hospital. Twenty-four patients with myotonic dystrophy. Patients were excluded from the study if they had either a history suggestive of significant ventricular arrhythmias or electrocardiographic evidence of a bundle-branch block. Two comparison groups were also formed; one group included 44 healthy employees at the tertiary hospital and the other, 30 cardiac patients with inducible ventricular tachycardia. A time-domain analysis of the signal-averaged electrocardiograms showed that 75% of patients with myotonic dystrophy met one criterion for the presence of late potentials, 67% met two criteria, and 29% met all three criteria. Spectrotemporal mapping in these patients showed markedly abnormal spectral peaks with a mean factor of normality that was significantly lower than that of the normal volunteers; the frequency of electrocardiographic abnormalities approached that seen in patients with known ventricular tachycardia. The presence of late potentials correlated directly with the length of the PR interval and inversely with left ventricular fractional shortening. In our study, the prevalence of late potentials on signal-averaged electrocardiography in patients with myotonic dystrophy approached that seen in cardiac patients with inducible ventricular tachycardia. It is possible that ventricular arrhythmias play a role in the occurrence of sudden death in some patients with myotonic dystrophy.
Catheterization and …, 1993
Key words: ischemic heart disease, mortality, CABG surgery, angina ... Ischemic heart disease aff... more Key words: ischemic heart disease, mortality, CABG surgery, angina ... Ischemic heart disease affects 20% of the 7.4 million octogenarians in the United States [ 1,2]. It remains the number one cause of morbidity and mortality in the eld-erly [3], producing one half of the deaths ...
Journal of the American …, 1987
with Anorexia Nervosa in Adolescent Patients
The intake laboratory data of 46 patients seen between 1970 and 1980 who were 36 International Un... more The intake laboratory data of 46 patients seen between 1970 and 1980 who were 36 International Units/liter (IU/L), and 65% (27/41) had alkaline phosphatase levels < 58 IU/L. We suggest that patients with anorexia nervosa may reflect a state of hepatic dysfunction and/or dehydration before therapy.
Double-blind crossover trial of diltiazem versus propranolol in the management of thyrotoxic symptoms
Pharmacotherapy, 1990
We compared the efficacy of diltiazem and propranolol in a randomized, prospective, double-blind,... more We compared the efficacy of diltiazem and propranolol in a randomized, prospective, double-blind, crossover study in six patients with untreated thyrotoxicosis (mean age 31 yrs). The patients received either diltiazem 60 mg orally four times a day or propranolol 40 mg orally four times a day, each for 1 week, separated by a 3-day drug-free period. Blood pressure, heart rate, thyroid hormone levels (free T4, T3), electrocardiogram, two-dimensional and M-mode echocardiograms, and Doppler studies were performed. In addition, 8 clinical signs and 18 symptoms of thyrotoxicosis were graded. All subjects felt better with drug therapy, with three preferring diltiazem to propranolol. No significant difference in clinical response or in hemodynamic effects was noted between the agents. These data suggest that diltiazem may serve as an alternative therapy for beta blockers in controlling thyrotoxic symptoms in patients in whom beta blockade may be contraindicated.
Transesophageal echocardiographic detection of transseptal catheter-related thrombi in patients with mitral stenosis
The intake laboratory data of 46 patients seen between 1970 and 1980 who were < 19 years of age w... more The intake laboratory data of 46 patients seen between 1970 and 1980 who were < 19 years of age with a discharge diagnosis of anorexia nervosa were retrospectively reviewed to determine their metabolic profile. The major findings for those who had laboratory data were as follows: 45% (19/42) had serum glutamic oxalacetic transaminase (SGOT) values > 36 International Units/liter (IU/L), and 65% (27/41) had alkaline phosphatase levels < 58 IU/L. We suggest that patients with anorexia nervosa may reflect a state of hepatic dysfunction and/or dehydration before therapy.
American Journal of Cardiology, 1990
Catheterization and Cardiovascular Diagnosis, 1993
Limited data are available concerning the long-term survival and quality of life of octogenarians... more Limited data are available concerning the long-term survival and quality of life of octogenarians treated with percutaneous transluminal coronary angioplasty (PTCA). We retrospectively compared the results of PTCA in 118 octogenarians to that of 500 younger subjects. Among the octogenarians, long term follow-up was obtained including survival, relief of angina, assessment of quality of life, and capacity for independent living. These results were compared between men and women. The clinical success rate was 93% for the octogenarians and 88% for the younger patients (p = NS). The lesion success rates were 89% and 88% for these groups, respectively. Results of multilesion PTCA and dilatation of coronary occlusions were similar in both age groups. Major complication rates were 5.9% for the elderly and 3.8% for the younger patients (p < .008). Hospital mortality was higher among the octogenarians (4.6% vs 0.2%, p < .05). Among long-term octogenarian survivors, > 90% indicated a high level of satisfaction with their quality of life and health status. If needed, 88% would undergo the procedure again. Independent living was possible for 66% of these patients and automobile driving for 55%. Octogenarian men and women had similar baseline clinical characteristics, procedural success, complications, relief of angina, and survival. Women indicated a slightly lower level of satisfaction and capacity for independent living. PTCA can achieve a success rate in octogenarians comparable to that of younger patients but with an increased risk of serious complications. Patient satisfaction remains high and a majority of octogenarians remain physically active and capable of independent living.
Myotonic heart disease
Neurology, 1992
To the Editor: Hawley et all stress the importance of cardiac monitoring in patients with myotoni... more To the Editor: Hawley et all stress the importance of cardiac monitoring in patients with myotonic dystrophy (MD). This prompted us to investigate cardiac conduction in patients with MD. We performed invasive cardiac electrophysiologic studies in seven consecutive patients with MD (ages 31 to 49 years; three women, four men), all asymptomatic with regard t o cardiac conduction abnormalities. Since there have been reports about ventricular arrhythmias,2 programmed atrial stimulation was performed in all patients. Compared with those in other studies, all our patients also underwent programmed ventricular stimulation to evaluate ventricular vulnerability. Although all patients had been asymptomatic up to the time of electrophysiologic evaluation, 1 of 7 had signs of sinus node dysfunction (CSNRT maximum, 710 msec), 3 of 7 showed HV prolongation (HV >60 msec), and 3 of 7 had a Wenckebach point <I20 msec. Using a moderate protocol during programmed ventricular stimulation with one and two premature extrastimuli, all but one patient had a maximum of two consecutive ventricular echo beats (VEBs) inducible and one patient had ventricular salvoes (maximum, four consecutive VEBs) inducible. Thus, even asymptomatic patients with myotonic dystrophy have a high incidence of atrioventricular conduction abnormalities, whereas ventricular vulnerability a s assessed by programmed ventricular stimulation was normal in our cohort of patients. Furthermore, there were no arrhythmias in 24-hour ECG monitoring. Since even cardially asymptomatic patients with MD may have significant cardial conduction abnormalities, frequent cardiologic investigation and, specifically, questions about syncope in each patient appear to be advised. Consideration of pacemaker treatment'^^,^ in symptomatic patients, eg, with syncope, seems to be important to avoid sudden unexpected death.
Myotonic heart disease: A clinical follow-up
Neurology, 1991
We followed 37 patients with myotonic dystrophy for a mean of 6 years. Two developed atrial flutt... more We followed 37 patients with myotonic dystrophy for a mean of 6 years. Two developed atrial flutter or fibrillation, 6 developed a new bundle branch block, 1 developed complete heart block requiring a pacemaker, and another with progressive 1st-degree heart block and a widening QRS interval had a sudden death. Most patients had predictable, gradually progressive disease of their cardiac conduction system. We recommend that patients with progressive atrioventricular block or widening QRS interval due to myotonic heart disease have yearly ECGs and be questioned about syncope or presyncope to determine the need for a cardiac pacemaker.
Journal of the American College of Cardiology, 1990
Transesophageal echocardiographic detection of transseptal catheter-related thrombi in patients with mitral stenosis
Journal of the American College of Cardiology, 1991
Cardiovascular Hazards of Air Travel
JAMA: The Journal of the American Medical Association, 1988
To the Editor.— In the April 1 issue of JAMA , Cummins et al 1 address the risk of sudden death d... more To the Editor.— In the April 1 issue of JAMA , Cummins et al 1 address the risk of sudden death during commercial air travel. Yet, the risk of sudden death is slight compared with the in-flight dangers we place on our coronary anatomy. On a recent cross-country flight, I had the displeasure of being seated in the malodorous smoking section. Not only was my circulatory system subjected to five hours of nicotine-containing vasospastic fumes, but in addition my lipoprotein-carrying system was tempted by an "oilaceous" feast of delectable niblets. Breakfast consisted of scrambled eggs, juicy pork sausages, a muffin with butter, and coffee with an artificial creamer containing coconut and palm oil. Not to be outdined, the luncheon chef designed a plaque-forming meal of a ham and cheese sandwich, 196 g (7 oz) of creamy cheddar cheese, and chocolate-covered macadamia nuts. The only safe food was two breadsticks and Dijon
Diltiazem for the Treatment of Thyrotoxicosis
Archives of Internal Medicine, 1989
To the Editor .—We read with interest the article by Roti et al 1 regarding the use of a calcium-... more To the Editor .—We read with interest the article by Roti et al 1 regarding the use of a calcium-channel blocker, diltiazem, for the treatment of tachyarrhythmias in hyperthyroid patients. The authors suggest that calcium channel antagonists may be useful when β-blockers are contraindicated, as in asthmatics, or as a possible adjunct to β-blockers in the treatment of thyrotoxicosis. Unfortunately, as the authors suggest, they did not compare the effect of diltiazem with β-blockers nor take into consideration the possibility of a placebo effect. We completed a randomized, cross-over, double-blind, pilot study 2 comparing the clinical effects of diltiazem (60 mg, orally, four times a day for 1 week) with propranolol (40 mg, orally, four times a day for 1 week) therapy in six newly diagnosed thyrotoxic patients. We found both drugs to be strongly effective in controlling symptoms (18 symptoms were graded) and in improving clinical signs of thyrotoxicosis.
Ventricular Late Potentials in Myotonic Dystrophy
Annals of Internal Medicine, 1991
To determine the prevalence of ventricular late potentials, as determined by signal-averaged elec... more To determine the prevalence of ventricular late potentials, as determined by signal-averaged electrocardiography, in patients with myotonic dystrophy. Cross sectional, with blinded analysis of all electrocardiographic data. Outpatient departments of a Veterans Affairs medical center and a tertiary care private hospital. Twenty-four patients with myotonic dystrophy. Patients were excluded from the study if they had either a history suggestive of significant ventricular arrhythmias or electrocardiographic evidence of a bundle-branch block. Two comparison groups were also formed; one group included 44 healthy employees at the tertiary hospital and the other, 30 cardiac patients with inducible ventricular tachycardia. A time-domain analysis of the signal-averaged electrocardiograms showed that 75% of patients with myotonic dystrophy met one criterion for the presence of late potentials, 67% met two criteria, and 29% met all three criteria. Spectrotemporal mapping in these patients showed markedly abnormal spectral peaks with a mean factor of normality that was significantly lower than that of the normal volunteers; the frequency of electrocardiographic abnormalities approached that seen in patients with known ventricular tachycardia. The presence of late potentials correlated directly with the length of the PR interval and inversely with left ventricular fractional shortening. In our study, the prevalence of late potentials on signal-averaged electrocardiography in patients with myotonic dystrophy approached that seen in cardiac patients with inducible ventricular tachycardia. It is possible that ventricular arrhythmias play a role in the occurrence of sudden death in some patients with myotonic dystrophy.
Catheterization and …, 1993
Key words: ischemic heart disease, mortality, CABG surgery, angina ... Ischemic heart disease aff... more Key words: ischemic heart disease, mortality, CABG surgery, angina ... Ischemic heart disease affects 20% of the 7.4 million octogenarians in the United States [ 1,2]. It remains the number one cause of morbidity and mortality in the eld-erly [3], producing one half of the deaths ...
Journal of the American …, 1987