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Biomedical subjects

A Rickards

Publications and source records attributed to A Rickards.

At least 19 recordsLinked to original sources
PubMed2001

Children followed with difficulty: how do they differ?

OBJECTIVE: To determine if very low birthweight children followed with ease differ in any perinatal or sociodemographic characteristics, or outcomes, compared with children followed with more difficulty. METHODOLOGY: Consecutive children of birthweight < 1000 g or with gestational ages < 28 weeks born in 1991 (n = 51) or of birthweight < 1500 g born in 1992 (n = 166) at the Royal Women's Hospital, Melbourne, surviving to 5 years of age, were assessed at 5 years of age, corrected for prematurity. Those who attended on the first mutually agreed appointment without substantial reluctance were considered to have been followed with ease. The remainder were considered to have been followed with difficulty. Outcomes included impairments such as cerebral palsy, blindness, deafness, and low IQ. Children had a disability if they had any of cerebral palsy, blindness, deafness requiring amplification, or an IQ more than 1 SD below the mean. RESULTS: Of the 217 survivors, 204 (94%) were assessed fully at 5 years of age. Of the 204 children assessed, 153 (75%) were followed with ease, and 51 (25%) with difficulty. Of data available in the perinatal period, significantly fewer children followed with more difficulty came from intact families, and more of their mothers had fewer than 12 years of schooling. More children followed with difficulty had a disability (41% compared with 19%), as they predominantly had lower IQ scores (mean difference in IQ - 12.7, 95% confidence interval - 18.0, - 7.4). The association between difficulty of assessment and both higher rates of disability and lower IQ scores remained after adjustment for significant perinatal and sociodemographic variables. CONCLUSIONS: Children followed with difficulty can partly be recognized on several sociodemographic characteristics in the perinatal period, and have substantially worse sensorineural outcomes than those followed with ease. In any longitudinal study, the more incomplete the follow up, the lower will be the rate of adverse sensorineural outcome.

Child Development↗
PubMed2001

Two episodes of life-threatening anaphylaxis in the same patient to a chlorhexidine-sulphadiazine-coated central venous catheter.

Chlorhexidine allergy has been described in the literature, mainly in Japanese individuals. Most reactions have been limited to the skin, mild in severity and a result of chlorhexidine containing solutions such as 'Savlon' (Novartis Consumer Health, Horesham, UK). We describe what we believe is the first reported case of anaphylaxis in a European patient to a chlorhexidine- sulphadiazine-coated central venous catheter.

Anaphylaxis↗
PubMed1997

X-linked recessive panhypopituitarism associated with a regional duplication in Xq25-q26.

We present a linkage analysis and a clinical update on a previously reported family with X-linked recessive panhypopituitarism, now in its fourth generation. Affected members exhibit variable degrees of hypopituitarism and mental retardation. The markers DXS737 and DXS1187 in the q25-q26 region of the X chromosome showed evidence for linkage with a peak LOD score (Zmax) of 4.12 at zero recombination fraction (theta(max) = 0). An apparent extra copy of the marker DXS102, observed in the region of the disease gene in affected males and heterozygous carrier females, suggests that a segment including this marker is duplicated. The gene causing this disorder appears to code for a dosage-sensitive protein central to development of the pituitary.

Alleles↗
PubMed1995

Protocol-directed shared care in cardiology.

In the new market-oriented UK National Health Service, hospitals succeed or fail on the quality of service they provide to their customers. It is therefore important that institutions like the Royal Brompton Hospital can meet the information and communication needs of General Practitioners and hospitals who use their services so that co-ordination between healthcare professionals involved in the co-operative care of individual patients can be ensured. One method of improving the relationship between healthcare professionals is by the use of consensus-based clinical protocols which define "best practice' co-operative care for a particular condition. The Royal Brompton Hospital has been a clinical partner in the AIM project DILEMMA which has been examining technology and methodologies for applying clinical protocols supported by telematics to general practice and shared care. A detailed requirements analysis has been carried out to look at the problems of shared care in cardiology and this has resulted in a demonstration system being developed to show how protocol-directed shared care and its supporting technology could be implemented to solve real clinical problems. Conclusions have been drawn that concern the use of protocols and information technology generally in routine clinical care.

Cardiology↗
PubMed1992

Angiographic restenosis after successful Wallstent stent implantation: an analysis of risk predictors.

Follow-up angiographic study was performed in 86 patients after initially successful Wallstent stent (Medinvent, Lausanne, Switzerland) implantation between April 1986 and October 1990. The stent angiographic restenosis rate was 16% at a mean of 8 months after stenting despite the inclusion of a substantial number of patients at high risk of restenosis after percutaneous transluminal coronary angioplasty (PTCA). Of a total 15 variables analyzed, only suboptimal stent placement was found to be a significant predictor of stent restenosis. Age; gender; baseline New York Heart Association functional class; previous PTCA; indication for stenting; left ventricular ejection fraction; preangioplasty and immediate postangioplasty diameter stenosis severity; stented vessel site, lesional morphology; number, diameter, and length of stents implanted; and the interval between stenting and follow-up angiographic restudy were not significant risk factors of stent restenosis. Our study suggests that intracoronary stent implantation with the Wallstent may be a useful and promising adjunctive option after PTCA, particularly in patients at high risk of restenosis after PTCA. However, because of the significantly enhanced risk of restenosis after suboptimal stent implantation, we strongly recommend the selection and placement of Wallstent stents that adequately cover the entire length of the dilated coronary segment.

Adult↗
PubMed1989

Transvenous ablation of atrioventricular conduction with a low energy power source.

A power source modified to increase voltage delivery and minimise arcing (for a given energy) was used for transvenous ablation of atrioventricular conduction to control refractory supraventricular arrhythmias in 14 patients. Twelve had atrial fibrillation or flutter, one had atrioventricular nodal reentry tachycardia, and the other had permanent junctional reentry tachycardia. Despite treatment with 5-7 (median 6) antiarrhythmic drugs symptoms had persisted in all the patients. Cathodal discharges of 0.5-39.5 J were delivered to the distal electrode (in one case in parallel with the middle electrode). In all patients shocks produced complete atrioventricular block; this was permanent in eleven (79%). Four patients required a second procedure. In one patient, only a transient atrioventricular block could be produced and catheter ablation with a conventional power source also failed. In the other two atrioventricular conduction was modified such that previously ineffective treatment produced satisfactory control of heart rate. The cumulative energy delivered to those in whom permanent complete heart block resulted ranged from 3.6 to 97.8 (mean 38.3) J with a mean of three shocks (range 1-7) delivered per patient. During follow up of 1-28 (mean 14) months 11 patients remained in complete heart block and free of arrhythmia.

Aged↗
PubMed1988

Lack of effect of warfarin on the restenosis rate or on clinical outcome after balloon coronary angioplasty.

Between September 1985 and April 1987, 110 consecutive patients who had successful coronary angioplasty were included in a randomised prospective controlled evaluation of the effects of warfarin on restenosis. The warfarin (n = 56) and the control (n = 54) groups were not different in terms of age, sex, previous coronary bypass surgery or coronary balloon angioplasty, severity of symptoms, and frequency of multivessel disease or of total coronary occlusions. Warfarin was started on the day of the procedure and the dosage was adjusted to maintain the thromboplastin international normalised ratio greater than or equal to 2.5. One hundred and five (96%) of the patients were given verapamil and other antianginal drugs were prescribed as needed. Low molecular weight dextran and heparin were given during the procedure and heparin was continued for 24 hours in all patients. One hundred and eight (98%) of patients were followed up clinically after a median of five months (range 1-20). Eighty five (77%) had follow up angiography at five months. In the warfarin group symptoms improved in 46 (85%) patients by at least 1 angina class and 31 (57%) were symptom free; the exercise test remained positive in 20 (36%) patients and the angiographic restenosis rate was 25% per lesion and 29% per patient. There were no major bleeding complications. In the control group 46 (85%) patients were improved by at least 1 angina class and 31 (57%) were symptom free; the exercise test was positive in 11 (21%) patients and the angiographic restenosis rate was 33% per lesion and 37% per patient. Although the incidence of angiographic restenosis tended to be lower with warfarin, none of these differences was significant. These data suggest that the combination of verapamil and warfarin, in the absence of aspirin, is not significantly better than verapamil alone in preventing symptom recurrence or angiographic restenosis after coronary angioplasty.

Adult↗
PubMed1987

Outcome in infants of birth weight 500 to 999 g: a continuing regional study of 5-year-old survivors.

During 1979 and 1980, 351 infants of birth weight 500 to 999 g were born in the State of Victoria: 89 (25.4%) survived to the age of 2 years corrected for prematurity, and 83 were fully assessed by a multidisciplinary team; partial data were obtained on the remainder. At the age of 5 years, corrected for prematurity, 85/89 (96%) were evaluated by a multidisciplinary team, although not all children could be fully evaluated by the psychologists. Reports were available for another three children; one child was untraced. Of the survivors able to be classified at 5 years, 59/82 (72%) had no functional handicap. Functional handicaps was severe in 16 (19%), moderate in four (5%), and mild in three (4%). Functional handicaps were present in 50% (8/16) of outborn survivors compared with the 23% (15/66) for the inborn survivors (P = 0.02). Cerebral palsy was diagnosed in eight children at 5 years and in 12 children at 2 years. The diagnosis was stable for the children not ambulant at 2 years; five of seven 2-year-old children with mild cerebral palsy had "outgrown" the diagnosis by 5 years, but ataxic cerebral palsy was not identified in one child until 5 years. Six children were blind; four had severe sensorineural or mixed deafness, one more than at 2 years. Of 82 children assessed according to identical criteria for functional handicap at both 2 and 5 years, 52 (63%) remained in the same category at 5 years, three (4%) were judged to be more severely handicapped, and 27 (33%) were less severely handicapped. The 2-year evaluation of extremely low birth weight children often proved to be unduly pessimistic, for many showed improvement or recovery from functional handicaps and impairments by 5 years of age.

Australia↗
PubMed1987

Coronary balloon angioplasty for elderly patients with severe angina.

From February 1983 to December 1986, 65 angioplasty procedures were attempted in 51 patients aged 65 or more. All had angina refractory to medical treatment and 89% of procedures were performed in patients in Canadian Cardiovascular Society angina class III or IV. Sixty eight per cent of patients had multivessel disease. Angioplasty was attempted on a single vessel in 52 instances (80%) and on multiple vessels in 13 (20%). The initial success rate was 75% for stenosis and 44% for occlusion. No attempt was made to treat all visible lesions in every case. At least one major complication occurred in 6.2% of the procedures: Q wave infarction in 4.6%, emergency surgery in 4.6%, and death in 4.6%. After a median follow up of four months (range 1-31) 37% of the patients in whom the procedure was initially successful were asymptomatic and 76% were improved by at least one Canadian Cardiovascular Society angina class. Angiographic restenosis occurred in 28% of treated lesions and 39% of patients had at least one recurrent stenosis. Among the patients with an initially successful procedure, 11% needed surgical revascularisation during the follow up period compared with 50% of those with a failed angioplasty. Balloon coronary angioplasty can be an effective form of treatment for the relief of severe angina in elderly patients.

Aged↗
PubMed1986

Relationship of growth and psychoneurologic status of 2-year-old children of birthweight 500-999 g.

There were 257 liveborn infants of birthweight 500-999 g born in one tertiary centre in the 5 1/4 years commencing January 1977; 86 (33.5%) survived to 2 years of age, corrected for prematurity and 83/86 (96.5%) were fully assessed. The prevalence of cerebral palsy was 10/83 (12%) and 17/83 (20%) had a major impairment. The distribution of weights and heights for 2-year-old boys and girls was significantly lower than for the standard population, as was the head circumference distribution for boys; the distribution of the Mental Developmental Index (Bayley Scales) was not related to the head circumference or body weight at two years or to head-circumference/bodyweight or height ratios. At birth measurements of weight, length and head circumference were under the 3rd percentile for 13/86 (15%), 9/86 (10.5%) and 9/86 (10.5%) respectively. By 2 years of age, weight, length and head circumference were under the 3rd percentile in 23/83 (27.7%), 26/83 (31.3%) and 4/83 (4.8%) respectively. 12 children who were SGA at birth were fully assessed at 2 years; the group of 6, who continued with poor postnatal weight gains (under the 3rd percentile) had the highest rate of major impairment but included were the only extremely SGA twins and the only two major malformations in the study. We found no association of other health problems or unfavourable social factors with poor postnatal growth or impaired outcome.

Blindness↗
PubMed1984

Outcome in infants with birth weight 500 to 999 gm: a regional study of 1979 and 1980 births.

During 1979 and 1980, 351 infants weighing 500 to 999 gm were born in the State of Victoria, Australia; 89 (25.4%) survived to 2 years of age. Survival was better for tertiary center births (29%) than for those born elsewhere (17%). Multidisciplinary teams reviewed 83 of the survivors at 2 years of age postterm; some data were available for the other six children. Overall, 22.5% of infants had severe functional handicap, 29.2% had either moderate or mild handicap, and 48.3% had no handicap. Severe functional handicap was present in 50% of outborn infants; this was significantly more common than in those born in tertiary centers (15.5%), and the Bayley Mental Developmental Index was also significantly lower in outborn infants. The prevalence of cerebral palsy (13.5%), bilateral blindness (3.4%), and severe sensorineural deafness (3.4%) did not differ significantly in the inborn and outborn infants. Singleton inborn infants of appropriate weight for gestational age had significantly less severe functional handicap (9.1%), compared with 37.5% for the group of infants who were either small for gestational age or one of multiple births. Six of the 18 outborn infants could have been transferred in utero, and improvements in immediate neonatal care were possible in seven other infants.

Age Factors↗
PubMed1984

Outcome of extremely low birth-weight infants in relation to the hospital of birth.

There were 351 liveborn infants of birth-weight 500-999 g born in the State of Victoria in the years 1979 and 1980; 89/351 (25.4%) survived to the age of 2 years: 42 (47.2%) survivors were of gestational ages of 24 to 26 weeks and 47 (52.8%) were born at 27 to 32 weeks' gestation. Survival of these extremely low birth-weight infants was significantly better (71/245, 29%) for births in tertiary centres compared with those born elsewhere (18/106, 17%). Of the 351 livebirths, 69.8% occurred in 1 of the 3 tertiary centres. All 89 survivors were traced; 84 (94.4%) were assessed at the age of at least 2 years by a multidisciplinary team. Three children had been fully assessed at 1 year of age and paediatric reports were available for 2 children. The quality of survival of children born in tertiary centres was significantly better than those transferred to a tertiary centre after birth; the prevalence of serious functional handicap was 72.2% (13/18) for outborn children compared with 22.5% (16/71) for those born in tertiary centres. The prevalence of serious functional handicap in the inborn survivors was lowest (9/55, 16.4%) in singleton births who had been of appropriate birth-weight for gestation. A review of the 18 surviving outborn infants' records indicated that 6 (33.3%) could have been transferred to a tertiary centre in utero and for the 12 infants where birth in a tertiary centre was not feasible, improvements in the early neonatal care were possible in another 7 infants.

Australia↗
PubMed1983

Collaborative study of very-low-birth-weight infants. Correlation of handicap with risk factors.

Two large maternity services studied consecutive inborn infants (birth weight range, 500 to 1,500 g) born between 1977 and 1978. The multidisciplinary team members used identical assessment methods and documentation. Of 259 long-term survivors, 252 (97.3%) were seen at 2 years of age. Survival rates for hospitals 1 and 2 were 68.5% and 69.0%, respectively. Cerebral palsy rates for hospitals 1 and 2 were 11.8% and 11.2%, respectively. Major handicaps (cerebral palsy, mental developmental index [MDI] on the Bayley scales less than 69, epilepsy, deafness, or blindness) occurred in 30 (18.6%) and 17 (17.3%) of hospitals 1 and 2 survivors, respectively. Both cerebral palsy and developmental delay (MDI below 75 without severe or moderate cerebral palsy) were significantly correlated with a number of perinatal variables, but none were common to the two hospitals. Of the 30 children with cerebral palsy, 15 (50%) were not ventilated, and 28 (93%) had a five-minute Apgar score greater than 4; there was no indication that selective treatment to prevent cerebral palsy was possible.

Blindness↗
PubMed1983

The mechanism of mitral regurgitation in dilated left ventricle.

To assess the mechanism of mitral regurgitation in ventricular dilatation, 24 patients with dilated cardiomyopathy (13 with and 11 without mitral regurgitation) and 10 normal individuals were studied by two-dimensional echocardiography. Left ventricular dimensions and mitral ring diameters in systole and diastole were measured in the long-axis section, and systolic interpapillary muscle distance in the short-axis section. The results showed: Mitral ring diameter is increased in most patients with dilated cardiomyopathy. Neither increased ring diameter, reduced ring contraction, nor decreased interpapillary muscle distance determine the presence of mitral regurgitation. The only difference between those patients with and without mitral regurgitation was the degree of left ventricular dilatation (p less than 0.05).

Adult↗
PubMed1983

Cross-sectional echocardiographic features of ruptured chordae tendineae.

Thirty-two patients with mitral regurgitation secondary to ruptured chordae tendineae were studied by cross-sectional echocardiography. Twenty of them subsequently underwent operation. Three signs are described. (1) Non-coaptation of the leaflets (55%). (2) Systolic fluttering echo in the left atrium originating from the mitral valve (20%). (3) A previously not described small diastolic chaotically moving echo in the short axis section of the left ventricle at the level of the papillary muscles (65%). The combined sensitivity of these three signs was 85%. The specificity of the three signs when compared with those of 107 patients with mitral regurgitation of different aetiologies studied by cross-sectional echocardiography was 99%, 100% and 99%, respectively. Six patients were studied after mitral valve repair; restriction of the surgical treated leaflet and reduction of its valve area was seen in all of them, and the disappearance of the valvar signs of ruptured chordae noted. The persistence of the small echo sign in the short axis of the left ventricle indicated its chordal origin.

Chordae Tendineae↗
PubMed1983

Systolic anterior motion of the mitral valve in hypertrophic cardiomyopathy. A cross-sectional echocardiographic study.

UNLABELLED: Different cross-sectional echocardiographic patterns of systolic anterior motion of the mitral valve (SAM) have been observed in patients with hypertrophic cardiomyopathy. chordae tendineae and/or the free edge of the mitral valve were seen to be involved in some: SAM(c). The body of the mitral valve encroached upon the left ventricular outflow tract in this movement in a second group: SAM(v). Other patients did not show SAM. A study of 27 patients was performed to investigate the relationship of these patterns of SAM to the subaortic gradient as well as the prevalence and degree of mitral regurgitation. The absence of SAM correlated with no obstruction and 29% prevalence of mitral regurgitation. In SAM(c), the mean gradient was 10 +/- 10 mmHg. (0-35 mmHg), and mitral regurgitation involved 36% of the patients. In SAM(v) the mean gradient found was 81 +/- 37 mmHg (20-150), and 67% had mitral regurgitation. In situations where mitral regurgitation was most prevalent its degree was greatest. IN CONCLUSION: (1) chordal or leaflet participation in SAM is relevant to the presence and degree of obstruction; (2) leaflet involvement usually implies severe obstruction; (3) distortion of the mitral valve apparatus may contribute to the genesis of mitral regurgitation.

Adolescent↗
PubMed1983

Anomalous systemic venous return: recognition by two-dimensional echocardiography.

The two-dimensional echocardiographic features of anomalies of systemic and coronary venous return are described as they were seen in 23 patients with this diagnosis proven at angiography. A left-sided superior vena cava draining to the right atrium via an enlarged coronary sinus was correctly identified in all 17 patients with this condition by observing a characteristically moving ovoid structure in the region of the posterior atrioventricular groove. This structure opacified before the right side of the heart following bolus injections of contrast material from a left arm vein. Injection from the right arm in 12 patients or femoral vein in four patients of this group produced contrast echoes within the right heart only. A left-sided superior vena cava draining directly to a left atrium in three patients, or left side of a common atrium in two patients with atrial situs inversus, was identified by the immediate opacification of the left-sided chamber following injection from the left arm. Two patients with hemiazygos inferior vena caval return to the left superior vena cava or left atrium were studied using injections of contrast from the femoral vein which successfully identified the venous abnormality. Two-dimensional echocardiography, when combined with peripheral venous injections of contrast will reliably demonstrate anomalies of systemic venous return, and thus provides important information before more invasive procedures.

Adolescent↗