Faculty Bibliography

We used Infra Red (IR) thermography to evaluate gender differences in local thermal regulation, assessing the response of 18 men and 16 women to a 30-second immersion of the dominant hand and digits in water maintained at 3-5degreesC. IR images-taken prior to immersion, immediately after withdrawal, at 15 second intervals for 5 minutes and 30-second intervals for the final 5 minutes -were analyzed to obtain surface temperature of the index finger and dorsum of the hand. Men had higher baseline temperatures than women in both hand and finger (P<0.01). Within sex, there were no hand-finger temperature differences. Immediately after withdrawal, temperatures showed that the finger had cooled more than the hand. The contralateral hand and finger showed a modest drop in temperature. After 10 minutes, men's and women's hands had rewarmed to 91.5 +/- 1% and 86.5 +/- 0.9% (m +/- SE) of baseline, respectively (p<0.001). Men's fingers rewarmed to 89.5 +/- 3.1%, while women's rewarmed to 77.0 +/- 3% (p<0.008). Although our data showed a broad spectrum of rewarming patterns, particularly in fingers, we were able to divide them into slow rewarmers (<90% return to baseline: 12 women, 5 men) and fast rewarmers (>90% of baseline: 13 men, 4 women). Fast rewarmers demonstrated a vasodilation absent in slow rewarmers. As the contralateral side showed a similar pattern, our data suggest that local rewarming is partly mediated by a reflex mechanism that is more prevalent and/or effective in men than women, possibly helping explain the higher incidence of cold-induced vasospastic disorder in women

Differential efficacy of immediate-release metoprolol tartrate and carvedilol in the treatment of congestive heart failure remains a subject of ongoing debate. The degree of beta1-blockade can be assessed by percentage reduction of exercise heart rate. Twelve healthy subjects underwent symptom-limited cardiopulmonary exercise testing repeated weekly and 2 hours after randomized, double-blind administration of 50 mg metoprolol tartrate vs 25 mg carvedilol. Baseline heart rate, heart rate at 40% and 70% peak O2 consumption, and maximal exercise were significantly blunted more by metoprolol tartrate than by carvedilol (P<.05 for all). Peak O2 consumption was significantly reduced by metoprolol tartrate (P<.03) but not by carvedilol (P=.054). The change in O2 consumption was significantly correlated with the degree of beta1-blockade (r =0.45; P<.05). In healthy subjects, a higher degree of beta1-blockade is achieved with 50 mg metoprolol tartrate compared with 25 mg carvedilol

PURPOSE: To assess the effects of horticultural therapy (HT) on mood state and heart rate (HR) in patients participating in an inpatient cardiac rehabilitation program. METHODS: Cardiac rehabilitation inpatients (n = 107) participated in the study. The HT group consisted of 59 subjects (34 males, 25 females). The control group, which participated in patient education classes (PECs), consisted of 48 subjects (31 males, 17 females). Both HT sessions and PEC are components of the inpatient rehabilitation program. Each group was evaluated before and after a class in their respective modality. Evaluation consisted of the completion of a Profile of Mood States (POMS) inventory, and an HR obtained by pulse oximetry. RESULTS: Changes in the POMS total mood disturbance (TMD) score and HR between preintervention and postintervention were compared between groups. There was no presession difference in either TMD score (16 +/- 3.6 and 19.0 +/- 3.2, PEC and HT, respectively) or HR (73.5 +/- 2.5 and 79 +/- 1.8, PEC and HT, respectively). Immediately following the intervention, the HT TMD was significantly reduced (post-TMD = 1.6 +/- 3.2, P < .001), while PEC TMD was not significantly changed (TMD = 17.0 +/- 28.5). After intervention, HR fell in HT by 4 +/- 9.6 bpm (P < .001) but was unchanged in PEC. CONCLUSION: These findings indicate that HT improves mood state, suggesting that it may be a useful tool in reducing stress. Therefore, to the extent that stress contributes to coronary heart disease, these findings support the role of HT as an effective component of cardiac rehabilitation

We assessed the effects of naloxone, an opioid antagonist, on exercise capacity in 13 men and 5 women (mean age = 30.1 yr, range = 21-35 yr) during a 25 W/min incremental cycle ergometer test to exhaustion on different days during familiarization trial and then after 30 mg (iv bolus) of naloxone or placebo (Pl) in a double-blind, crossover design. Minute ventilation (Ve), O(2) consumption (Vo(2)), CO(2) production, and heart rate (HR) were monitored. Perceived exertion rating (0-10 scale) and venous samples for lactate were obtained each minute. Lactate and ventilatory thresholds were derived from lactate and gas-exchange data. Blood pressure was obtained before exercise, 5 min postinfusion, at maximum exercise, and 5 min postexercise. There were no control-Pl differences. The naloxone trial demonstrated decreased exercise time (96% Pl; P < 0.01), total cumulative work (96% Pl; P < 0.002), peak Vo(2) (94% Pl; P < 0.02), and HR (96% Pl; P < 0.01). Other variables were unchanged. HR and Ve were the same at the final common workload, but perceived exertion was higher (8.1 +/- 0.5 vs. 7.1 +/- 0.5) after naloxone than Pl (P < 0.01). The threshold for effort perception amplification occurred at approximately 60 +/- 4% of Pl peak Vo(2). Thus we conclude that peak work capacity was limited by perceived exertion, which can be attenuated by endogenous opioids rather than by physiological limits

OBJECTIVE: Previous reports have suggested that prematurity and low birth weight are risk factors for definitive surgical intervention in congenital cardiac malformations. The following data review our experience with primary repair of the complex malformation of aortic arch obstruction with ventricular septal defect (VSD) in this patient population. METHODS: Since 1988, 21 consecutive preterm (</=36 weeks) and/or low birth weight (<3000 g) infants with interrupted aortic arch (IAA; n=10), or aortic coarctation (n=11) with VSD, underwent primary arch repair and VSD closure. The mean weight at operation was 2310 g (range, 1200-2900 g), including 12 patients at </=2500 g. The gestational age ranged from 30 to 41 weeks (mean, 36.4 weeks). Five patients with interrupted arch and two patients with coarctation also had severe subaortic stenosis, which was relieved by transatrial incision of the infundibular septum. RESULTS: The overall hospital mortality was 14% (3/21). Death was related to low cardiac output in association with severe subaortic stenosis (n=2) and sepsis (n=1). Late mortality occurred in three patients, two of which were non-cardiac. The mean follow-up was 33 months. Two patients had significant recurrent arch obstruction, which was successfully relieved by balloon angioplasty and surgical correction in one each. The survival at 30 days, and at 1 and 3 years was 86, 76 and 70%, respectively. CONCLUSIONS: Complete primary repair of aortic arch obstruction with VSD can be achieved with good results, even in the preterm and low birth weight infant. Therefore, early surgical repair of this congenital malformation is recommended

BACKGROUND AND PURPOSE. People with osteoarthritis (OA) of the knee who have pain generally exhibit decreased activity and physical deconditioning. This study investigated the effects of mechanical unweighting on knee pain and exercise responses in people with OA of the knee who have pain. SUBJECTS. Four men and 23 women, with a mean age of 67.9 years (SD = 11.3, range = 50-88) and having a 12-year average duration of knee OA, participated. METHODS. A mechanical unloading device enabled subjects to perform a modified Naughton treadmill exercise test at 0%, 20%, and 40% of body weight support (BWS). Oxygen consumption (VO2), heart rate (HR), and perceived pain were measured during the last minute of each exercise stage. RESULTS. Mechanical unweighting at 20% and 40% BWS decreased the Vo2 and HR responses to treadmill exercise but did not decrease knee pain during walking in this sample. CONCLUSION AND DISCUSSION. These findings indicate that treadmill exercise accompanied by BWS permits recommended training intensities to be obtained in elderly people with OA, but may not provide pain relief in this group