The Experts below are selected from a list of 123 Experts worldwide ranked by ideXlab platform
Thomas W Smith - One of the best experts on this subject based on the ideXlab platform.
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treatment of 150 cases of life threatening Digitalis intoxication with digoxin specific fab antibody fragments final report of a multicenter study
Circulation, 1990Co-Authors: Elliott M Antman, T Wenger, V P Butler, Edgar Haber, Thomas W SmithAbstract:One hundred fifty patients with potentially life-threatening Digitalis toxicity were treated with digoxin-specific antibody fragments (Fab) purified from immunoglobulin G produced in sheep. The dose of Fab fragments was equal to the amount of digoxin or digitoxin in the patient's body as estimated from medical histories or determinations of serum digoxin or digitoxin concentrations. The youngest patient received Fab fragments within several hours of birth, and the oldest patient was 94 years old. Seventy-five patients (50%) were receiving long-term Digitalis therapy, 15 (10%) had taken a large overdose of Digitalis accidentally, and 59 (39%) had ingested an overdose of Digitalis with suicidal intent. The clinical response to Fab was unspecified in two cases, leaving 148 patients who could be evaluated. One hundred nineteen patients (80%) had resolution of all signs and symptoms of Digitalis toxicity, 14 (10%) improved, and 15 (10%) showed no response. After termination of the Fab infusion, the median time...
Steven W. Graves - One of the best experts on this subject based on the ideXlab platform.
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sodium pump isoform specificity for the Digitalis like factor isolated from human peritoneal dialysate
Hypertension, 1997Co-Authors: Norman K. Hollenberg, Deborah A Price, Steven W. GravesAbstract:We have isolated a labile, specific sodium pump inhibitor or Digitalis-like factor from the peritoneal dialysate of volume-expanded renal failure patients whose levels correlated closely with volume status and blood pressure. This study characterizes the inhibitory profile of this agent compared with that of ouabain against the three α-isoforms of the sodium pump. We prepared microsomal Na,K-ATPase from rat tissues representing the highest proportion of one of the α-isoforms. Both Northern and Western blot analyses confirmed that kidney had predominantly the α1-isoform, skeletal muscle the α2-isoform, and fetal brain the α3-isoform. Ouabain (5×10−6 mol/L) produced little inhibition of kidney Na,K-ATPase (3.4±2.0%) but significant inhibition of skeletal muscle (37.2±3.7%, P <.001) and fetal brain (38.8±3.5%, P <.001) activity. In contrast, the labile Digitalis-like factor, causing comparable inhibition of fetal brain Na,K-ATPase activity (33.3±4.7%), produced markedly greater inhibition of kidney (42.5±5.6%, P <.001) and moderately greater inhibition of skeletal muscle pump activity (57.7±6.3%, P <.05). In addition, the labile Digitalis-like factor produced a marked concentration-dependent inhibition of the α2- and α3-isoforms ( r =.79, P =.00005). Experiments combining the labile Digitalis-like factor and ouabain confirmed that Digitalis-like factor, unlike ouabain, was an effective inhibitor of all three isoforms in rat, in particular α2. The different pattern of isoform sensitivity displayed by the labile Digitalis-like factor and ouabain further differentiates the two agents and raises some interesting possibilities about the functional implications of the endogenous factor.
Elliott M Antman - One of the best experts on this subject based on the ideXlab platform.
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treatment of 150 cases of life threatening Digitalis intoxication with digoxin specific fab antibody fragments final report of a multicenter study
Circulation, 1990Co-Authors: Elliott M Antman, T Wenger, V P Butler, Edgar Haber, Thomas W SmithAbstract:One hundred fifty patients with potentially life-threatening Digitalis toxicity were treated with digoxin-specific antibody fragments (Fab) purified from immunoglobulin G produced in sheep. The dose of Fab fragments was equal to the amount of digoxin or digitoxin in the patient's body as estimated from medical histories or determinations of serum digoxin or digitoxin concentrations. The youngest patient received Fab fragments within several hours of birth, and the oldest patient was 94 years old. Seventy-five patients (50%) were receiving long-term Digitalis therapy, 15 (10%) had taken a large overdose of Digitalis accidentally, and 59 (39%) had ingested an overdose of Digitalis with suicidal intent. The clinical response to Fab was unspecified in two cases, leaving 148 patients who could be evaluated. One hundred nineteen patients (80%) had resolution of all signs and symptoms of Digitalis toxicity, 14 (10%) improved, and 15 (10%) showed no response. After termination of the Fab infusion, the median time...
S B Olsson - One of the best experts on this subject based on the ideXlab platform.
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Digitalis a dangerous drug in atrial fibrillation an analysis of the sportif iii and v data
Heart, 2008Co-Authors: Knut Gjesdal, J Feyzi, S B OlssonAbstract:OBJECTIVE: In heart failure, Digitalis increases exercise capacity and reduces morbidity, but has no effect on survival. This raises the suspicion that the inotropic benefits of Digitalis may be counteracted by serious adverse effects. Patients with atrial fibrillation (AF) were studied to clarify this. DESIGN: In the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation (SPORTIF) III and V studies, 7329 patients with AF at moderate-to-high risk were randomised to preventive treatment of thromboembolism, either with warfarin or the oral direct thrombin inhibitor ximelagatran. The survival of users and non-users of Digitalis was investigated. RESULTS: At baseline, 53.4% of the study population used Digitalis, and these patients had a higher mortality than non-users (255/3911 (6.5%) vs 141/3418 (4.1%), p<0.001; hazard ratio (HR) = 1.58 (95% CI 1.29 to 1.94)). Digitalis users also had more baseline risk factors. After multivariate risk factor adjustment, the increased mortality persisted (p<0.001; HR = 1.53 (95% CI 1.22 to 1.92 vs 1.23 to 1.92)). CONCLUSIONS: The results suggest that Digitalis, like other inotropic drugs, may increase mortality. This may be concealed in heart failure, but be revealed in patients with AF, who need the rate-reducing effect of Digitalis, but do not benefit much from an increased inotropy. Cautious interpretation of the data is mandatory since the patients were not randomised with respect to Digitalis use.
S Knox - One of the best experts on this subject based on the ideXlab platform.
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the effect of gender on outcome in Digitalis treated heart failure patients
Journal of Cardiac Failure, 2005Co-Authors: Michael J Domanski, Jerome L Fleg, Michael R Bristow, S KnoxAbstract:Abstract Background The use of Digitalis is recommended for the treatment of heart failure to reduce hospitalization. Recent data suggest that Digitalis treatment may adversely affect survival in women but not in men. We studied patients with left ventricular dysfunction enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) to determine whether there was a gender-based survival difference in patients treated with Digitalis. Methods and Results Symptomatic (n = 2569) and asymptomatic (n = 4228) patients with left ventricular ejection fraction ≤0.35 were studied. Digitalis use was assessed at baseline and baseline demographic variables were catalogued and compared. A multivariate analysis, incorporating known covariates of risk for adverse cardiovascular events, was used to examine the association of Digitalis with all-cause mortality, cardiovascular death, death from heart failure, and arrhythmic death, with, or without, worsening heart failure in women compared with men. Analysis for an interaction between Digitalis and gender on mortality was also performed. No interaction between gender and Digitalis treatment on survival was found, and there was no significant difference in the hazard ratios for men and women on Digitalis either with respect to all-cause mortality, cardiovascular mortality, heart failure mortality, or arrhythmic death with worsening heart failure. When mortality for arrhythmic death without worsening heart failure was adjusted for the probability of being treated with Digitalis (propensity analysis), women fared better than men. Conclusion Data from the SOLVD trials suggest that Digitalis treatment of heart failure does not result in a difference in survival between men and women. Because a randomized trial to definitively answer the question is unlikely, and perhaps inappropriate, examination of other heart failure populations for a gender-Digitalis interaction is indicated.
