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Biomedical subjects

A G Rose

Publications and source records attributed to A G Rose.

At least 91 records · Page 5Linked to original sources
PubMed1984

Absence of evidence of myocarditis in endomyocardial biopsy specimens from patients with dilated (congestive) cardiomyopathy.

This study aimed: to assess the clinical value of endomyocardial biopsy (EMB) in 76 patients with dilated cardiomyopathy (DCM); to look for residual evidence of myocarditis, especially in patients in whom EMB was undertaken shortly after the onset of cardiac symptoms; to identify ultrastructural changes which may indicate the cause of DCM; and to see if the observed ultrastructural alterations correlated with duration of symptoms, left ventricular ejection fraction and the ratio of left ventricular wall thickness to chamber diameter. Biopsy diagnosis of DCM was possible with adequate exclusive clinical data combined with evidence of myofibre hypertrophy and exclusion of other morphologically detectable causes of cardiac hypertrophy and dilatation, e.g. myocarditis. The ultrastructural features did not correlate with duration of symptoms, ejection fractions or ratio of left ventricular wall thickness to chamber diameter. The lack of evidence of myocarditis in EMB specimens from our DCM patients, including those with a short history, suggests that myocarditis is an uncommon cause of DCM. Only a quarter of the biopsy specimens showed fibrosis and the ultrastructural features were those of hypertrophy. Degenerative changes were present in varying percentages of the specimens examined (e.g. myofilament loss in 64%). This study suggests that conditions other than myocarditis should be considered as causes of DCM--such causes (e.g. metabolic dysfunction) may be potentially reversible if recognized and treated.

Adolescent↗
PubMed1984

Sudden death of a champion athlete. Autopsy findings.

We report the autopsy findings after the sudden death of a champion swimmer. The athlete was asymptomatic and had only recently retired from a sport in which he had been the South African captain for 4 years and the national record holder in the 400 m medley event. He died suddenly shortly after returning from a 5 km run. At autopsy there was histological evidence of hypertrophic cardiomyopathy.

Adult↗
PubMed1984

Primary cardiac haemangiomas. A report of 2 cases.

Primary heart tumours are extremely rare. Over a period of 25 years 22 primary cardiac tumours were diagnosed clinically or at autopsy at Groote Schuur Hospital. Fourteen patients with myxomas, 1 with lymphocytic lymphoma and 2 with haemangiomas underwent surgery. A further 4 myxomas and 1 histiocytoma were found at autopsy. In both the cases of haemangioma the diagnosis of a vascular tumour was made before surgery. One tumour had infiltrated the lateral wall of the left ventricle and was unresectable; only a biopsy specimen was taken. The patient, however, remains well some 6 years later. In the second patient the haemangioma was situated in the outflow tract of the right ventricle and was successfully excised. The clinical history, pathological features and management of both cases are presented.

Child, Preschool↗
PubMed1984

Exercise-related death in subjects with coexistent hypertrophic cardiomyopathy and coronary artery disease. Case reports.

Autopsy findings in 3 White men who died suddenly during or after exercise are described. Two were well conditioned marathon runners who had recently completed a 90 km ultramarathon, while the third was active in sports other than running. At autopsy all had significant coronary artery disease (CAD) involving the left anterior descending and right coronary arteries and macroscopic or histological features diagnostic of hypertrophic cardiomyopathy (HCM). Although CAD and HCM are well-established causes of sudden death in athletes, the combination is uncommon. The absence of symptoms prior to death in 2 of the subjects indicates that the possibility of antemortem diagnosis (particularly of HCM) was unlikely.

Adult↗
PubMed1984

Prediction of acute cardiac rejection using radionuclide techniques.

Radionuclide scanning of the donor left ventricle using technetium-99m-labelled red cells was used to monitor acute rejection after heterotopic heart transplantation and compared with histopathological evidence of rejection obtained at examination of an endomyocardial biopsy specimen. The ejection fraction and end-diastolic, end-systolic and stroke volumes were calculated at each examination; an equation was derived from these data to predict the degree of acute rejection, using histopathological examination of endomyocardial biopsy specimens as criteria of the presence and severity of rejection. A highly significant multiple correlation between radionuclide scanning parameters and endomyocardial biopsy was found. The advantages of non-invasive radionuclide scanning over the invasive procedure of endomyocardial biopsy are discussed.

Adolescent↗
PubMed1984

Evaluation of pathological criteria for diagnosis of hypertrophic cardiomyopathy.

This study aims to evaluate and compare the current pathological criteria for the diagnosis of hypertrophic cardiomyopathy (HOCM). The following criteria were applied to 39 autopsy patients whose hearts showed myofibre disarray: (i) disarray involving more than 5% of ventricular septal myofibres, (ii) asymmetrical septal hypertrophy (ASH), (iii) mirror-image subaortic plaque, and (iv) a positive histologic HOCM index (HHI). Group 1 (27 patients) with greater than 5% ventricular septal myofibre disarray were diagnosed as HCM, whereas group 2 (12 patients) had less than 5% disarray. The mean disarray value in group 1 was 52% compared to 1.2% in group 2. The two groups showed significant differences regarding ASH and in the amounts of myofibre disarray in the free walls of both ventricles. A new finding was that the histologic HOCM index was significantly higher in patients who died suddenly. The HHI was the commonest positive criterion in group 1, followed by ASH and a mirror-image endocardial plaque. None of the current imperfect pathological criteria for the diagnosis of HCM can be used as the 'gold standard'.

Adolescent↗
PubMed1984

Primary arteriopathy in Takayasu's disease.

Three patients with classic Takayasu's arteritis affecting the aorta and its major branches were found to have a unique small pulmonary arteriopathy characterized by deficiency of the outer media, with capillary ingrowth both here and in the thickened fibrosed intima. In one patient there was also evidence of a mononuclear cellular arteritis of the affected arteries and widespread focal angiomatoid like lesions. Another patient had similar, but less well-defined dilatation lesions. This patient's major coronary arteries showed an active arteritis with ingrowth of reparative granulation tissue capillaries into both media and intima, yielding an appearance not dissimilar to that seen in the small pulmonary arteries. The outer pulmonary artery medial defects observed in our patients bear some similarity to experimental acute immune-complex arteritis and may thus provide tenuous evidence for an autoimmune basis for Takayasu's disease.

Adult↗
PubMed1984

Pathologic findings in long-term cardiac transplants.

Since the introduction of cardiac transplantation at our institution 15 years ago, major advances have occurred in the monitoring and treatment of these patients, resulting in many long-term survivors. We defined the pathologic features in 14 cardiac transplants with survival times longer than one year. Only one heart showed no evidence of rejection, while the remaining 13 hearts showed advanced chronic rejection, which was the main cause of death or of graft failure in 11 patients. One patient died of gastric carcinoma, one of Kaposi's sarcoma, and one of cerebral embolus. The most obtrusive change in the donor hearts was an obliterative arteritis, which in the epicardial coronary arteries mimicked atherosclerosis. Superadded thrombosis often resulted in myocardial infarction. These severe vascular lesions bore no constant relationship to survival time and took from 1.1 to 12.5 years to evolve.

Adult↗
PubMed1984

Marathon running and immunity to coronary heart disease: fact versus fiction.

Marathon runners should not consider themselves immune to either sudden death or coronary heart disease. Further, physicians should not assume that marathon runners cannot have serious cardiac disease. All symptomatic marathon runners should undergo exhaustive cardiovascular evaluation. However, since some runners do not have any premorbid warning symptoms, not even these measures will prevent all cases of sudden death during marathon running.

Angiocardiography↗
PubMed1984

Endoscopic laser endarterectomy.

The effects of the Neodymium YAG laser on atheroma have been examined in human cadaver aortoiliac arteries and in normal porcine vessels. YAG laser is effective when used to ablate atheroma in an air environment and can be used successfully through the vascular endoscope. When atheroma were treated in the saline solution environment necessary for vascular endoscopy, the laser was less effective. Laser-treated areas of porcine arteries were not thrombogenic. Severe laser damage was easily recognized by blanching and marked elevation of the initma and consistently resulted in late aneurysm formation. ELE is feasible and further investigation is warranted.

Air↗
PubMed1983

Pulmonary veno-occlusive disease due to bleomycin therapy for lymphoma. Case reports.

Two patients with lymphocytic lymphoma and bleomycin-induced pulmonary toxicity were shown at autopsy to have pulmonary venular alterations identical to pulmonary veno-occlusive disease (PVOD). While hepatic veno-occlusive disease due to alkylating agents has been reported, I am unaware of any report of PVOD related to bleomycin therapy.

Adult↗
PubMed1983

Orthotopic allotransplantation and autotransplantation of the baboon heart following 24-hr storage by a portable hypothermic perfusion system.

A nonpulsatile perfusion apparatus, based on the air-lift pump principle, has been developed. Circulation of the perfusate, as well as oxygenation and maintenance of acid-base balance, is provided by the flow of a mixture of 97% oxygen and 3% carbon dioxide. The system is easily and entirely portable. Eleven baboons underwent orthotopic allotransplantation with donor hearts stored by continuous hypothermic (4-10 degrees C) perfusion for periods of up to 24 hr. Three were electively killed after 2 to 3 days; the remaining eight, immunosuppressed with methylprednisolone and either azathioprine or cyclosporin A, survived to rejection at between 10 and 49 days. Cardiac catheterization performed in six animals 7-14 days after allotransplantation showed virtually normal hemodynamic data. Three more baboons underwent heart excision and storage by hypothermic perfusion for 24 hr, and subsequent othotopic autotransplantation, the circulation of the baboon being maintained in the interim by an allograft. One animal survives 8 months later with hemodynamic data at cardiac catheterization differing little from that obtained before autotransplantation. This perfusion system has subsequently been used to store four human donor hearts prior to heterotopic transplantation.

Animals↗
PubMed1983

Infectious complications after heart transplantation.

Infection has been the major cause of death and morbidity in patients undergoing cardiac transplantation at Groote Schuur Hospital. Twenty-two (55%) patients suffered at least one major episode of infection, which accounted for 10 (59%) of the deaths in the first year. The major site of origin of infection was the lung, though dissemination was not infrequent. Bacteria accounted for 22 (59%) infections; but viral, fungal and protozoal infections were not uncommon and in fact accounted for seven (64%) of the fatal infections. Several unusual causative microorganisms have been isolated in this group of immunocompromised subjects. There is a higher incidence of infection in patients over the age of 35 years and in patients who did not comply with instructions and advice.

Adult↗
PubMed1983

Toxoplasmosis of donor and recipient hearts after heterotopic cardiac transplantation.

Toxoplasmosis of both donor and recipient hearts was diagnosed by means of endomyocardial biopsy specimens after heterotopic cardiac transplantation for dilated cardiomyopathy. Before transplantation, the donor had raised antibody titers to Toxoplasma, and the recipient was negative. When toxoplasmosis was diagnosed on the basis of endomyocardial biopsy specimen, the recipient had a greatly elevated antibody titer of 1:1,027. This suggests that the infection could have been transferred with the donor heart. The mononuclear cell response elicited by disrupted toxoplasmic cysts interferes with the diagnosis of rejection in graft biopsy specimens. Electron microscopy is valuable in confirming a light microscopic diagnosis of toxoplasmosis. Drug therapy eradicated the toxoplasmosis, but the patient died later of tuberculous meningitis.

Diagnosis, Differential↗