Managing innovation to overhaul a patient-care environment.

Innovation in public service organizations must be managed, just as it must be in any business. However, in older, large public organizations, specific strategies are needed. One such strategy is described in development and impact.

Good prognosis for dilated cardiomyopathy without severe heart failure or arrhythmia.

In 124 patients with dilated cardiomyopathy, symptoms of heart failure and ventricular arrhythmia at initial assessment were related to outcome a mean of 43 months later. Using life table analysis, the two-year mortality from progressive heart failure was 59 per cent (90 per cent symptoms, six per cent (1-11 per cent) for patients with class 2 symptoms and zero for patients with class 1 symptoms. The two-year mortality from sudden death was 18 per cent (5-32 per cent) for patients with class 3 symptoms, eight per cent (3-14 per cent) for patients with class 2 symptoms and seven per cent (0-17 per cent) for patients with class 1 symptoms.

Prognostic significance of radionuclide-assessed diastolic function in hypertrophic cardiomyopathy.

To evaluate the prognostic significance of diastolic function in hypertrophic cardiomyopathy (HC), technetium-99m gated equilibrium radionuclide angiography, acquired in list mode, was performed in 161 patients. Five diastolic indexes were calculated. During 3.

Assessment of diastolic filling indexes obtained by radionuclide ventriculography.

This study assesses how differences in residual volume and heart rate influence the measurement and interpretation of commonly used indexes of left ventricular filling obtained by radionuclide ventriculography. Thirty patients with hypertrophic cardiomyopathy (HC) and 26 normal subjects were studied. The time to peak filling rate (168 +/- 42 vs 139 +/- 35 ms; p = 0.

Synergistic effect of the v-myc oncogene with H-ras on radioresistance.

Resistance of tumors to irradiation or chemotherapeutic agents is thought to be one of the reasons why patients who present with early malignancies may not be cured. Much is now known about the molecular mechanisms that underlie drug resistance, but until recently little was known about genetic contributions to radiation resistance. Some evidence now links oncogenes, particularly the ras family of oncogenes, to radiation resistance but heterogeneity between tumors and cell lines has complicated this analysis.

[Prognosis of elderly patients with mitral valve prolapse: the difference between Japanese and English patients].

Clinical pictures and prognosis in 24 patients (nine males, 15 females) with mitral valve prolapse (MVP) aged 60 years and older were examined at our institution. Valvular redundancy was noted in seven (29%) of the 24 patients. During a follow-up period of 38 +/- 18 months, four patients had mitral valve replacement and one died of congestive heart failure due to severe mitral regurgitation (MR).

Left lower lobe ventilation is reduced in patients with cardiomegaly in the supine but not the prone position.

To determine the effect of the heart on regional ventilation, Krypton-81m (81mKr) tomographic (SPECT) ventilation scans were recorded in seven patients with cardiomegaly and four normal subjects in the supine and prone positions. All patients had a cardiothoracic ratio of greater than 0.50 and clear lung fields radiographically.

Mapping a gene for familial hypertrophic cardiomyopathy to chromosome 14q1.

To identify the chromosomal location of a gene responsible for familial hypertrophic cardiomyopathy, we used clinical and molecular genetic techniques to evaluate the members of a large kindred. Twenty surviving and 24 deceased family members had hypertrophic cardiomyopathy; 58 surviving members were unaffected. Genetic-linkage analyses were performed with polymorphic DNA loci dispersed throughout the entire genome, to identify a locus that was inherited with hypertrophic cardiomyopathy in family members.

The use of magnetic resonance imaging and spectroscopy in the assessment of patients with head and neck and other superficial human malignancies.

The proper demarcation of diseased tissue is important for radiation therapy planning and treatment. The volume to be irradiated is usually identified on radiographs or on x-ray computed tomography (CT) sections. Magnetic resonance (MR)-derived images of the proton T2 relaxation times in small pixel elements, typically 0.

Oncogenes and tumor progression.

Although tumors are often characterized as being the result of uncontrolled proliferation, clinically the morbidity from cancer results from its ability to invade and metastasize and to become resistance to our current therapeutic modalities such as chemotherapy and radiation. The study of oncogenes has largely stressed their ability to alter cell growth, but in fact they also influence these crucial features of tumor progression. In this review, we will summarize the data from our laboratory that indicated that the ras oncogene can induce metastasis as well as tumorigenicity and that the ras oncogene can also influence the development of radiation resistance.

Significance of signal-averaged electrocardiography in relation to endomyocardial biopsy and ventricular stimulation studies in patients with ventricular tachycardia without clinically apparent heart disease.

Signal-averaged electrocardiography (ECG) was performed in 38 patients (mean age 38 years, range 15 to 70) with ventricular tachycardia who had no clinical evidence of structural heart disease. Spontaneous ventricular tachycardia was nonsustained in 23 patients and sustained in 15. None of the patients had symptoms of heart failure or ischemic heart disease, and at cardiac catheterization none had significant coronary artery disease or left ventricular wall motion abnormalities.

Determinants of exercise capacity in hypertrophic cardiomyopathy.

Exercise capacity in hypertrophic cardiomyopathy is thought to relate to elevated left atrial pressure as a consequence of impaired diastolic function, but this assumption has not previously been evaluated. Twenty-three patients with hypertrophic cardiomyopathy underwent hemodynamic assessment during symptom-limited maximal exercise with objective measurement of exercise capacity by respiratory gas analysis. Maximal oxygen consumption and anaerobic threshold were 28.

Echocardiographic and histologic evaluation of the right ventricle in ventricular tachycardias of left bundle branch block morphology without overt cardiac abnormality.

The right ventricle was investigated by multiple biopsies and detailed echocardiographic evaluation, including measurement of cavity dimensions at the level of the inflow, body and outflow tract, in 27 patients with right ventricular tachycardia who had no clinical evidence of an underlying morphologic abnormality. Nine (33%) patients had abnormal biopsy results, with a quantifiable increase in interstitial fibrosis. Abnormal echocardiograms, defined as an increase in greater than or equal to 2 dimensions of the right ventricular cavity or wall motion abnormalities or both, were seen in 9 patients.

The digoxin-amiodarone interaction.

To assess the cause of the digoxin-amiodarone interaction, the systemic availability and renal excretion of digoxin were examined in 10 patients. Patients were studied before and after 1 week and 6 weeks of concurrent amiodarone therapy, and four were also studied after 4-8 months. Mean (+/- SD) peak plasma digoxin concentration rose from 1.

Clinical sustained uniform ventricular tachycardia in hypertrophic cardiomyopathy: association with left ventricular apical aneurysm.

Of 51 patients with hypertrophic cardiomyopathy who had episodes of ventricular tachycardia detected during ambulatory electrocardiographic monitoring only two had clinical sustained uniform ventricular tachycardia that required medical treatment because of worsening symptoms. In both patients the arrhythmia was associated with the uncommon finding of an apical aneurysm with angiographically normal coronary arteries.

Site-specific integration of H-ras in transformed rat embryo cells.

A karyotypic analysis was performed on seven independently derived clones of primary rat embryo cells transformed by the ras oncogene plus the cooperating oncogene myc. The transfected oncogenes were sometimes present in amplified copy number, with heterogeneity in the levels of amplification. Some chromosomal features, such as aberrantly banding regions and double-minute chromosomes, typical of cells carrying amplified genes, were also seen in three of the seven cell lines.