Treatment of acute motion sickness induced by parabolic flight with a preparation of scopolamine ... more Treatment of acute motion sickness induced by parabolic flight with a preparation of scopolamine placed in the buccal pouch was investigated. Twenty-one subjects flew aboard a KC-135 aircraft operated by the National Aeronautics and Space Administration (NASA) which performed parabolic maneuvers resulting in periods of 0-g, 1-g, and 1.8-g. Each subject flew once with a tablet containing scopolamine and once with a placebo in a random order, crossover design. Signs and symptoms of motion sickness were systematically recorded during each parabola by an investigator who was blind to the content of the tablet. Compared with flights using placebo, flights with buccal scopolamine resulted in significantly lower scores for nausea (31%-35% reduction) and vomiting (50% reduction in number of parabolas with vomiting). Side effects of the drug during flight were negligible. We conclude that buccal scopolamine is more effective than a placebo in treating ongoing motion sickness.
Treatment of acute motion sickness induced by parabolic flight with a preparation of scopolamine ... more Treatment of acute motion sickness induced by parabolic flight with a preparation of scopolamine placed in the buccal pouch was investigated. Twenty-one subjects flew aboard a KC-135 aircraft operated by the National Aeronautics and Space Administration (NASA) which performed parabolic maneuvers resulting in periods of 0-g, 1-g, and 1.8-g. Each subject flew once with a tablet containing scopolamine and once with a placebo in a random order, crossover design. Signs and symptoms of motion sickness were systematically recorded during each parabola by an investigator who was blind to the content of the tablet. Compared with flights using placebo, flights with buccal scopolamine resulted in significantly lower scores for nausea (31%-35% reduction) and vomiting (50% reduction in number of parabolas with vomiting). Side effects of the drug during flight were negligible. We conclude that buccal scopolamine is more effective than a placebo in treating ongoing motion sickness.
Pneumocystis carinii characteristically causes pneumonia in patients with immunodeficiency disord... more Pneumocystis carinii characteristically causes pneumonia in patients with immunodeficiency disorders. It occurs most often in patients with malignancy or renal transplants whose immune response has been suppressed by corticosteroids or cytotoxic agents. Individuals with connective tissue disease who receive immunosuppressive drugs become susceptible to Pneumocystis. The incidence of Pneumocystis infection in connective tissue disease is low but may increase if immunosuppressive drugs are used more often. Our patient acquired Pneumocystis pneumonia after immunosuppressive therapy for polyarteritis nodosa. Prompt recognition of this condition is essential now that specific therapy is available. Untreated Pneumocystis infection is usually fatal.
Compression of the left main coronary artery by a dilated pulmonary artery can be a life-threaten... more Compression of the left main coronary artery by a dilated pulmonary artery can be a life-threatening condition. It can present with angina, symptoms of left ventricular dysfunction, and sudden death. Diagnosis and treatment of this condition is very important. We demonstrate significant compression of the left main coronary artery on coronary angiography and thorax CT examinations.
Compared to other non-invasive methods, the conventional 12-lead electrocardiogram (ECG) has low ... more Compared to other non-invasive methods, the conventional 12-lead electrocardiogram (ECG) has low sensitivity and specificity for identifying coronary artery disease (CAD). We compared the newly developed high-frequency QRS electrocardiogram (HFQRS ECG, 150-250 Hz) with adenosine sestamibi myocardial perfusion study (MPI)-the most sensitive non-invasive study in cardiology practice. Using advanced 12-lead computer-based ECG software recently developed at NASA, criteria for a positive 12-lead HFQRS-ECG test for obstructive CAD were developed using 300 signal-averaged beats from patients undergoing elective coronary angiograms for evaluation of chest pain. These criteria, which rely strictly upon the presence or the absence of morphologic 'reduced amplitude zones' (RAZs) and not upon the 'root mean squared' (RMS) voltage amplitudes of the HFQRS complexes, were then applied prospectively to 18 patients undergoing MPI. Active CAD was considered present when reversible isc...
Journal of cardiovascular diagnosis and procedures, 1997
This article presents selected findings obtained with Holter monitoring from two crew members of ... more This article presents selected findings obtained with Holter monitoring from two crew members of the expedition, performed during a 175-day space mission on board orbital space station "MIR." Using mathematical processing of daily cardiointervals files, 5-minute sections of records were analyzed consecutively. Then, the average daily values of indices, the average-per-every-eight-hours values (morning, evening, night) and mean values per hour were computed. The results of analysis showed that prolonged exposure of man to microgravity conditions leads to important functional alteration in human neuroautonomic regulatory mechanisms. Both crew members had significant increase of heart rate, the rise of stress index, the decrease in power of the spectrum in the range of respiratory sinus arrhythmia. These marked signs of activation of the sympathetic section of the vegetative nervous system showed individual variations. The analysis of the daily collection of cardiointervals w...
Subjects were exposed to an 8-h mild hypoxia exposure (8000 ft. equivalent, 2438 m) with and with... more Subjects were exposed to an 8-h mild hypoxia exposure (8000 ft. equivalent, 2438 m) with and without a 28-h period of 6 degrees headdown bedrest. Anticipated responses to the bedrest and the hypoxia were observed. There was no indication that bedrest affected the arterial oxygenation or the oxygen gradient across the lungs of the subjects undergoing mild hypoxia. It is concluded that there is no evidence that would preclude an alveolar O2 pressure as low as 69 torr during contingency spacecraft operation.
Each of 20 subjects was given two Bruce Protocol symptom-limited maximum treadmill stress tests b... more Each of 20 subjects was given two Bruce Protocol symptom-limited maximum treadmill stress tests breathing sea-level compressed air (20.9% 02) for one test and a 2440-m equivalent (15.5% 02) for the other. Subjects ranged from 18-38 years of age; 15 were male and 5 female. Half of the population was tested first on the sea-level air, the other half on the altitude mixture. Real time measurements included heart rate, blood pressure, exercise time, oxygen consumption, carbon dioxide production, respiratory rate and volume, CO2 production, and several other derived parameters. A significant difference existed between measured VO2 max (p less than 0.002) and exercise time (p less than 0.004) for the two conditions. Mean differences were 8.3% and 6.7%, respectively. No significant differences were observed in heart rate or the recovery time to a respiratory quotient of less than 1. Hemoglobin saturation, as measured by an ear oximeter, averaged 95% for sea-level and 91% for the 2440-m equ...
During the first four flights of the space shuttle, cardiovascular data were obtained on each cre... more During the first four flights of the space shuttle, cardiovascular data were obtained on each crewmember as part of the operational medicine requirements for crew health and safety. From monitoring blood pressure and electrocardiographic data, it was possible to estimate the degree of deconditioning imposed by exposure to the microgravity environment. For this purpose, a quantitative cardiovascular index of deconditioning (CID) was derived to aid the clinician in his assessment. Isotonic saline was then investigated as a countermeasure against orthostatic intolerance and found to be effective in partially reversing the hemodynamic consequences. It was observed that the space flight environment of reentry might potentially be arrhythmogenic in at least one individual.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1984
A multiwire proportional counter gamma camera, specifically designed for nuclear medicine applica... more A multiwire proportional counter gamma camera, specifically designed for nuclear medicine applications, is portable and weighs less than 50 lb including shielding and collimator. The basic operating characteristics have been investigated with various radioactive sealed sources. The camera demonstrates a peak count rate of 850,000 cps, an intrinsic spatial resolution of 2.5 mm, and excellent image uniformity when used with x-ray sources in the range of 22-81 keV. Tests of the device with Ta-178--a very promising, short half-life (9.3 min), low-energy radionuclide--using 20 mCi injections provided images of quality comparable to those obtained from 15 mCi Tc-99m studies with conventional imaging devices. The camera used with Ta-178 offers particular promise in first-pass nuclear cardiology studies. Considerably improved study quality will likely result in this area because of the increased injectable dose levels offered by Ta-178 combined with the high-count rate capability and improv...
The cardiovascular "stress test," and particularly the graded treadmill exercise test, ... more The cardiovascular "stress test," and particularly the graded treadmill exercise test, has gained wide acceptance as a diagnostic aid in searching for ischemic heart disease and as a prognostic indicator for those with known coronary artery disease. Controversies still exist, however, in its use in mass screening and in interpreting equivocal tests. A review of the use and value of electrocardiographic exercise testing is presented. Topics such as its use in asymptomatic individuals, the adjuvant use of clinical examination, and the examination of ancillary treadmill parameters are presented. No attempt is made to detail the very significant contributions of radionuclide scanning. The positive exercise electrocardiogram in the asymptomatic subject is discussed and guidelines for clinical management are offered.
Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components pres... more Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components present within the central portion of the QRS complex of an electrocardiogram (ECG) is a more sensitive indicator for the presence of myocardial ischemia than are changes in the ST segments of the conventional low-frequency ECG. However, until now, no device has been capable of displaying, in real time on a beat-to-beat basis, changes in these HF QRS ECG components in a continuously monitored patient. Although several software programs have been designed to acquire the HF components over the entire QRS interval, such programs have involved laborious off-line calculations and postprocessing, limiting their clinical utility. We describe a personal computer-based ECG software program developed recently at the National Aeronautics and Space Administration (NASA) that acquires, analyzes, and displays HF QRS components in each of the 12 conventional ECG leads in real time. The system also updates ...
The topic of pharmacology in space, i.e. the administration of drugs during space flight and the ... more The topic of pharmacology in space, i.e. the administration of drugs during space flight and the subsequent pharmacokinetic handling of the pharmaceuticals, is a new field about which little is known. In a two-part series, Claire Lathers and colleagues highlight some of the current questions in this field. In this first article the physiological and biochemical changes associated with weightlessness in space are discussed. These changes induce adaptive alterations which may influence the pharmacokinetic properties of drugs. The cardiovascular system is of particular relevance here. Also discussed are the classes of pharmacological agent that are most likely to be used during space flight for medical problems and thus, by necessity, will become drugs to be examined in space to determine whether their pharmacokinetic and pharmacodynamic properties are altered. Therapy of the most common spaceflight ailment-motion sickness-will be considered next month in Part 2.
Compared to other non-invasive methods, the conventional 12-lead electrocardiogram (ECG) has low ... more Compared to other non-invasive methods, the conventional 12-lead electrocardiogram (ECG) has low sensitivity and specificity for identifying coronary artery disease (CAD). We compared the newly developed high-frequency QRS electrocardiogram (HFQRS ECG, 150-250 Hz) with adenosine sestamibi myocardial perfusion study (MPI)-the most sensitive non-invasive study in cardiology practice. Using advanced 12-lead computer-based ECG software recently developed at NASA, criteria for a positive 12-lead HFQRS-ECG test for obstructive CAD were developed using 300 signal-averaged beats from patients undergoing elective coronary angiograms for evaluation of chest pain. These criteria, which rely strictly upon the presence or the absence of morphologic 'reduced amplitude zones' (RAZs) and not upon the 'root mean squared' (RMS) voltage amplitudes of the HFQRS complexes, were then applied prospectively to 18 patients undergoing MPI. Active CAD was considered present when reversible isc...
This paper reports on a theoretical investigation into the effects of vasomotion on blood through... more This paper reports on a theoretical investigation into the effects of vasomotion on blood through the human cardiovascular system. The finite element method has been used to analyse the model. Vasoconstriction and vasodilation may be effected either through the action of the central nervous system or autoregulation. One of the conditions responsible for vasomotion is exercise. The proposed model has been solved and quantitative results of flows and pressures due to changing the conductances of specific networks of arterioles, capillaries and venules comprising the arms, legs, stomach and their combinations have been obtained.
This paper reports a theoretical study on the distribution of blood flow in the human cardiovascu... more This paper reports a theoretical study on the distribution of blood flow in the human cardiovascular system when one or more blood vessels are affected by stenosis. The analysis employs a mathematical model of the entire system based on the finite element method. The arterial-venous network is represented by a large number of interconnected segments in the model. Values for the model parameters are based upon the published data on the physiological and rheological properties of blood. Computational results show how blood flow through various parts of the cardiovascular system is affected by stenosis in different blood vessels. No significant changes in the flow parameters of the cardiovascular system were found to occur when the reduction in the lumen diameter of the stenosed vessels was less than 65%.
Treatment of acute motion sickness induced by parabolic flight with a preparation of scopolamine ... more Treatment of acute motion sickness induced by parabolic flight with a preparation of scopolamine placed in the buccal pouch was investigated. Twenty-one subjects flew aboard a KC-135 aircraft operated by the National Aeronautics and Space Administration (NASA) which performed parabolic maneuvers resulting in periods of 0-g, 1-g, and 1.8-g. Each subject flew once with a tablet containing scopolamine and once with a placebo in a random order, crossover design. Signs and symptoms of motion sickness were systematically recorded during each parabola by an investigator who was blind to the content of the tablet. Compared with flights using placebo, flights with buccal scopolamine resulted in significantly lower scores for nausea (31%-35% reduction) and vomiting (50% reduction in number of parabolas with vomiting). Side effects of the drug during flight were negligible. We conclude that buccal scopolamine is more effective than a placebo in treating ongoing motion sickness.
Treatment of acute motion sickness induced by parabolic flight with a preparation of scopolamine ... more Treatment of acute motion sickness induced by parabolic flight with a preparation of scopolamine placed in the buccal pouch was investigated. Twenty-one subjects flew aboard a KC-135 aircraft operated by the National Aeronautics and Space Administration (NASA) which performed parabolic maneuvers resulting in periods of 0-g, 1-g, and 1.8-g. Each subject flew once with a tablet containing scopolamine and once with a placebo in a random order, crossover design. Signs and symptoms of motion sickness were systematically recorded during each parabola by an investigator who was blind to the content of the tablet. Compared with flights using placebo, flights with buccal scopolamine resulted in significantly lower scores for nausea (31%-35% reduction) and vomiting (50% reduction in number of parabolas with vomiting). Side effects of the drug during flight were negligible. We conclude that buccal scopolamine is more effective than a placebo in treating ongoing motion sickness.
Pneumocystis carinii characteristically causes pneumonia in patients with immunodeficiency disord... more Pneumocystis carinii characteristically causes pneumonia in patients with immunodeficiency disorders. It occurs most often in patients with malignancy or renal transplants whose immune response has been suppressed by corticosteroids or cytotoxic agents. Individuals with connective tissue disease who receive immunosuppressive drugs become susceptible to Pneumocystis. The incidence of Pneumocystis infection in connective tissue disease is low but may increase if immunosuppressive drugs are used more often. Our patient acquired Pneumocystis pneumonia after immunosuppressive therapy for polyarteritis nodosa. Prompt recognition of this condition is essential now that specific therapy is available. Untreated Pneumocystis infection is usually fatal.
Compression of the left main coronary artery by a dilated pulmonary artery can be a life-threaten... more Compression of the left main coronary artery by a dilated pulmonary artery can be a life-threatening condition. It can present with angina, symptoms of left ventricular dysfunction, and sudden death. Diagnosis and treatment of this condition is very important. We demonstrate significant compression of the left main coronary artery on coronary angiography and thorax CT examinations.
Compared to other non-invasive methods, the conventional 12-lead electrocardiogram (ECG) has low ... more Compared to other non-invasive methods, the conventional 12-lead electrocardiogram (ECG) has low sensitivity and specificity for identifying coronary artery disease (CAD). We compared the newly developed high-frequency QRS electrocardiogram (HFQRS ECG, 150-250 Hz) with adenosine sestamibi myocardial perfusion study (MPI)-the most sensitive non-invasive study in cardiology practice. Using advanced 12-lead computer-based ECG software recently developed at NASA, criteria for a positive 12-lead HFQRS-ECG test for obstructive CAD were developed using 300 signal-averaged beats from patients undergoing elective coronary angiograms for evaluation of chest pain. These criteria, which rely strictly upon the presence or the absence of morphologic 'reduced amplitude zones' (RAZs) and not upon the 'root mean squared' (RMS) voltage amplitudes of the HFQRS complexes, were then applied prospectively to 18 patients undergoing MPI. Active CAD was considered present when reversible isc...
Journal of cardiovascular diagnosis and procedures, 1997
This article presents selected findings obtained with Holter monitoring from two crew members of ... more This article presents selected findings obtained with Holter monitoring from two crew members of the expedition, performed during a 175-day space mission on board orbital space station "MIR." Using mathematical processing of daily cardiointervals files, 5-minute sections of records were analyzed consecutively. Then, the average daily values of indices, the average-per-every-eight-hours values (morning, evening, night) and mean values per hour were computed. The results of analysis showed that prolonged exposure of man to microgravity conditions leads to important functional alteration in human neuroautonomic regulatory mechanisms. Both crew members had significant increase of heart rate, the rise of stress index, the decrease in power of the spectrum in the range of respiratory sinus arrhythmia. These marked signs of activation of the sympathetic section of the vegetative nervous system showed individual variations. The analysis of the daily collection of cardiointervals w...
Subjects were exposed to an 8-h mild hypoxia exposure (8000 ft. equivalent, 2438 m) with and with... more Subjects were exposed to an 8-h mild hypoxia exposure (8000 ft. equivalent, 2438 m) with and without a 28-h period of 6 degrees headdown bedrest. Anticipated responses to the bedrest and the hypoxia were observed. There was no indication that bedrest affected the arterial oxygenation or the oxygen gradient across the lungs of the subjects undergoing mild hypoxia. It is concluded that there is no evidence that would preclude an alveolar O2 pressure as low as 69 torr during contingency spacecraft operation.
Each of 20 subjects was given two Bruce Protocol symptom-limited maximum treadmill stress tests b... more Each of 20 subjects was given two Bruce Protocol symptom-limited maximum treadmill stress tests breathing sea-level compressed air (20.9% 02) for one test and a 2440-m equivalent (15.5% 02) for the other. Subjects ranged from 18-38 years of age; 15 were male and 5 female. Half of the population was tested first on the sea-level air, the other half on the altitude mixture. Real time measurements included heart rate, blood pressure, exercise time, oxygen consumption, carbon dioxide production, respiratory rate and volume, CO2 production, and several other derived parameters. A significant difference existed between measured VO2 max (p less than 0.002) and exercise time (p less than 0.004) for the two conditions. Mean differences were 8.3% and 6.7%, respectively. No significant differences were observed in heart rate or the recovery time to a respiratory quotient of less than 1. Hemoglobin saturation, as measured by an ear oximeter, averaged 95% for sea-level and 91% for the 2440-m equ...
During the first four flights of the space shuttle, cardiovascular data were obtained on each cre... more During the first four flights of the space shuttle, cardiovascular data were obtained on each crewmember as part of the operational medicine requirements for crew health and safety. From monitoring blood pressure and electrocardiographic data, it was possible to estimate the degree of deconditioning imposed by exposure to the microgravity environment. For this purpose, a quantitative cardiovascular index of deconditioning (CID) was derived to aid the clinician in his assessment. Isotonic saline was then investigated as a countermeasure against orthostatic intolerance and found to be effective in partially reversing the hemodynamic consequences. It was observed that the space flight environment of reentry might potentially be arrhythmogenic in at least one individual.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1984
A multiwire proportional counter gamma camera, specifically designed for nuclear medicine applica... more A multiwire proportional counter gamma camera, specifically designed for nuclear medicine applications, is portable and weighs less than 50 lb including shielding and collimator. The basic operating characteristics have been investigated with various radioactive sealed sources. The camera demonstrates a peak count rate of 850,000 cps, an intrinsic spatial resolution of 2.5 mm, and excellent image uniformity when used with x-ray sources in the range of 22-81 keV. Tests of the device with Ta-178--a very promising, short half-life (9.3 min), low-energy radionuclide--using 20 mCi injections provided images of quality comparable to those obtained from 15 mCi Tc-99m studies with conventional imaging devices. The camera used with Ta-178 offers particular promise in first-pass nuclear cardiology studies. Considerably improved study quality will likely result in this area because of the increased injectable dose levels offered by Ta-178 combined with the high-count rate capability and improv...
The cardiovascular "stress test," and particularly the graded treadmill exercise test, ... more The cardiovascular "stress test," and particularly the graded treadmill exercise test, has gained wide acceptance as a diagnostic aid in searching for ischemic heart disease and as a prognostic indicator for those with known coronary artery disease. Controversies still exist, however, in its use in mass screening and in interpreting equivocal tests. A review of the use and value of electrocardiographic exercise testing is presented. Topics such as its use in asymptomatic individuals, the adjuvant use of clinical examination, and the examination of ancillary treadmill parameters are presented. No attempt is made to detail the very significant contributions of radionuclide scanning. The positive exercise electrocardiogram in the asymptomatic subject is discussed and guidelines for clinical management are offered.
Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components pres... more Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components present within the central portion of the QRS complex of an electrocardiogram (ECG) is a more sensitive indicator for the presence of myocardial ischemia than are changes in the ST segments of the conventional low-frequency ECG. However, until now, no device has been capable of displaying, in real time on a beat-to-beat basis, changes in these HF QRS ECG components in a continuously monitored patient. Although several software programs have been designed to acquire the HF components over the entire QRS interval, such programs have involved laborious off-line calculations and postprocessing, limiting their clinical utility. We describe a personal computer-based ECG software program developed recently at the National Aeronautics and Space Administration (NASA) that acquires, analyzes, and displays HF QRS components in each of the 12 conventional ECG leads in real time. The system also updates ...
The topic of pharmacology in space, i.e. the administration of drugs during space flight and the ... more The topic of pharmacology in space, i.e. the administration of drugs during space flight and the subsequent pharmacokinetic handling of the pharmaceuticals, is a new field about which little is known. In a two-part series, Claire Lathers and colleagues highlight some of the current questions in this field. In this first article the physiological and biochemical changes associated with weightlessness in space are discussed. These changes induce adaptive alterations which may influence the pharmacokinetic properties of drugs. The cardiovascular system is of particular relevance here. Also discussed are the classes of pharmacological agent that are most likely to be used during space flight for medical problems and thus, by necessity, will become drugs to be examined in space to determine whether their pharmacokinetic and pharmacodynamic properties are altered. Therapy of the most common spaceflight ailment-motion sickness-will be considered next month in Part 2.
Compared to other non-invasive methods, the conventional 12-lead electrocardiogram (ECG) has low ... more Compared to other non-invasive methods, the conventional 12-lead electrocardiogram (ECG) has low sensitivity and specificity for identifying coronary artery disease (CAD). We compared the newly developed high-frequency QRS electrocardiogram (HFQRS ECG, 150-250 Hz) with adenosine sestamibi myocardial perfusion study (MPI)-the most sensitive non-invasive study in cardiology practice. Using advanced 12-lead computer-based ECG software recently developed at NASA, criteria for a positive 12-lead HFQRS-ECG test for obstructive CAD were developed using 300 signal-averaged beats from patients undergoing elective coronary angiograms for evaluation of chest pain. These criteria, which rely strictly upon the presence or the absence of morphologic 'reduced amplitude zones' (RAZs) and not upon the 'root mean squared' (RMS) voltage amplitudes of the HFQRS complexes, were then applied prospectively to 18 patients undergoing MPI. Active CAD was considered present when reversible isc...
This paper reports on a theoretical investigation into the effects of vasomotion on blood through... more This paper reports on a theoretical investigation into the effects of vasomotion on blood through the human cardiovascular system. The finite element method has been used to analyse the model. Vasoconstriction and vasodilation may be effected either through the action of the central nervous system or autoregulation. One of the conditions responsible for vasomotion is exercise. The proposed model has been solved and quantitative results of flows and pressures due to changing the conductances of specific networks of arterioles, capillaries and venules comprising the arms, legs, stomach and their combinations have been obtained.
This paper reports a theoretical study on the distribution of blood flow in the human cardiovascu... more This paper reports a theoretical study on the distribution of blood flow in the human cardiovascular system when one or more blood vessels are affected by stenosis. The analysis employs a mathematical model of the entire system based on the finite element method. The arterial-venous network is represented by a large number of interconnected segments in the model. Values for the model parameters are based upon the published data on the physiological and rheological properties of blood. Computational results show how blood flow through various parts of the cardiovascular system is affected by stenosis in different blood vessels. No significant changes in the flow parameters of the cardiovascular system were found to occur when the reduction in the lumen diameter of the stenosed vessels was less than 65%.
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Papers by Michael Bungo