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Biomedical subjects

C Layton

Publications and source records attributed to C Layton.

At least 37 records · Page 2Linked to original sources
PubMed1987

Ventricular septal rupture complicating myocardial infarction: is earlier surgery justified?

Fifty-five consecutive cases of ventricular septal rupture following myocardial infarction were reviewed in order to ascertain clinical and haemodynamic determinants of in-hospital mortality. Factors associated with a poor prognosis included clinical evidence of a poor haemodynamic state or biochemical evidence of impaired renal function. Twenty-six patients managed before 1982 (group 1) were then compared with 29 managed subsequently (group 2) when a policy of earlier surgical intervention had been adopted. Patients in group 2 were more haemodynamically compromised and had greater impairment of renal function. The surgical mortality in group 1 was 3 of 18 patients (17%) which was not significantly different from that in group 2 (7 of 22 patients, 32%). Earlier surgical intervention in ventricular septal rupture is frequently undertaken in critically ill patients whose prognosis is poor. However their surgical risk is not significantly increased and such an approach can therefore be justified as it may salvage some patients who otherwise would not survive.

Adult↗
PubMed1987

Intravenous digital subtraction angiography in the diagnosis and management of acute aortic dissection.

Eleven patients presenting with the clinical diagnosis of suspected aortic dissection underwent intravenous digital subtraction aortography. In nine patients digital subtraction angiography (DSA) was performed as the investigation of first choice. In five of these the diagnosis was confirmed with this technique alone and surgical repair was undertaken without further investigation. Direct cine aortography was also undertaken in the other four patients and confirmed the DSA findings, demonstrating aortic dissection in one case and no dissection in three others. In two of the eleven patients, direct cine aortography was performed as the initial investigation. The results of subsequent digital aortography concurred in both cases, aortic dissection being demonstrated in one patient. In two cases, despite normal cine and digital aortography, aortic dissection was confirmed by computed tomography. We have found DSA to be a valuable technique for diagnosing aortic dissection, with no false positive or false negative findings when compared to direct cine aortography. Since it is a less traumatic procedure than direct aortography it should be the investigation of choice if computed tomography is not immediately available.

Aortic Dissection↗
PubMed1987

What proportion of patients with myocardial infarction are suitable for thrombolysis?

Four hundred and three patients were considered for entry into a trial of intravenous streptokinase in suspected myocardial infarction. Three hundred and sixty seven (91%) were excluded. Two hundred and sixty (65%) did not meet the inclusion criteria and 45 of the remaining 143 (35%) patients had contraindications to thrombolysis. This left 98 (24%) patients who were suitable for thrombolysis and 42 of them were over 70 years, the upper age limit. Thus according to this trial protocol 56 (14%) patients were eligible for recruitment; 36 (9%) patients were finally randomised. These data suggest that treatment with intravenous streptokinase may be applicable to only a small proportion of patients with myocardial infarction.

Adult↗
PubMed1986

Outcome of early surgery after coronary angioplasty.

Nineteen of 69 patients undergoing coronary angioplasty required immediate coronary surgery after the procedure. Six of these operations were planned as a result of angioplasty that failed without producing any complication. The remaining 13 cases were operated upon because complications occurred during angioplasty. These were coronary artery dissection in four, occlusion in five, continuing severe spasm in two, tamponade in one, and in one other detachment of a guidewire tip. In these 13 cases the vessel in which angioplasty had been attempted was the left anterior descending coronary artery in eight, the right in four, and the circumflex artery in one. This distribution was no different from that in the 56 patients without complications. There was one early postoperative death due to extensive anterior myocardial infarction, and there was electrocardiographic evidence of new infarction in three other patients. A mean of 16 months postoperatively, 16 of the 18 surviving patients had no cardiac symptoms, while angina had improved in the remaining two. Sixteen of the 18 patients had nuclear left ventricular angiography after a mean of 27 months. When the results of this investigation were compared with the left ventricular cineangiograms performed before angioplasty was attempted only two patients showed evidence of a new left ventricular wall motion abnormality. Prompt operation after complications of angioplasty is usually successful with good symptomatic relief and without left ventricular damage. The incidence of complications requiring operation, however, was high in this group of patients, most of whom had single vessel coronary artery disease.

Aged↗
PubMed1986

Note on test-retest characteristics of the General Health Questionnaire.

The state-type 60-item General Health Questionnaire was administered on two occasions, with intervening periods of 11-12 mo. and 6-7 mo., to 186 male school-leavers and 101 men facing redundancy, respectively. Significant test-retest correlations suggested that the questionnaire is to some considerable extent measuring an underlying tendency for normal subjects to report a general, minor, nonpsychotic psychiatric morbidity, as opposed to purely transitory fluctuations in mental well being.

Adolescent↗
PubMed1985

Randomised placebo controlled trial of aspirin and dipyridamole in the prevention of coronary vein graft occlusion.

Treatment with the combination of aspirin and dipyridamole is believed to reduce the incidence of coronary vein graft occlusion. A double blind randomised controlled trial was carried out in which aspirin 990 mg and dipyridamole 225 mg daily or placebo were added to the routine postoperative management (warfarin for three months) of 320 patients undergoing coronary bypass grafting. The trial treatment was given for 12 months, after which the results were assessed by coronary and graft angiography. The two randomised groups, each of 160 patients, were comparable in age, sex, symptomatic state, angiographic findings, and operative procedure. Repeat coronary arteriography was carried out on 266 patients, 133 in each group. All grafts and distal anastomoses were patent in 68% (91/133) of the placebo patients and in 75% (100/133) of those receiving active treatment. Overall graft patency was 87% (306/352) and 89% (342/385) respectively. Retrospective subgroup analysis showed patency rates of 72% (26/36) and 78% (39/50) of grafts to vessels requiring preliminary endarterectomy, and 80% (36/45) and 91% (40/44) of distal anastomoses to vessels measured at operation to have a diameter of less than or equal to 1 mm. None of these differences was significant at the 5% level. Thus in this group of patients with high graft patency rates, treatment with aspirin and dipyridamole conferred no appreciable advantage.

Adult↗
PubMed1984

Correlation of heart rate/ST slope and coronary angiographic findings.

The heart rate/ST slope was evaluated in 49 patients undergoing routine investigation for possible coronary artery disease. The slope correctly predicted the absence of any 75% stenoses in the seven patients to whom this applied; it was, however, correct for only four of 30 with one stenosis, one of 10 with two, and neither of the patients with three. Distinct slope ranges were not found, and the previously published ranges said to be specific for no significant stenosis and one, two, and three vessel disease were not.

Adult↗
PubMed1982

Isolated disease of left anterior descending coronary artery. Angiocardiographic and clinical study of 218 patients.

The angiocardiographic and clinical findings in 218 patients with significant obstruction confined to the left anterior descending coronary artery were reviewed to study the influence of the site of obstruction and of the collateral circulation on clinical presentation and prognosis. One hundred and fifty-six patients had been managed medically, 51 had had aortocoronary bypass operations, and 11 had had left ventricular aneurysms excised. The artery was divided into three segments: left anterior descending 1 (LAD1) from its origin to the first septal branch, left anterior descending 2 (LAD2) from the first septal to the first diagonal branch, and left anterior descending 3 (LAD3) the remaining distal vessel. Cardiogenic shock occurred only in patients with LAD1 lesions, but apart from this the clinical presentation bore no consistent relation to the site of disease. Patients with proximal lesions were more likely to have a "positive" exercise test, had more severely impaired left ventricular function, and had a worse prognosis than those with more distal disease. Non-visualisation of collateral vessels in patients with left anterior descending occlusion was associated with extensive infarction, and patients who presented with infarction had more severely impaired ventricular function than those who presented with angina and subsequently had an infarction. Left ventricular function was poor at the time of angiography in 11 of 12 of those who subsequently died; it is therefore unlikely that the prognosis of patients with isolated left anterior descending obstruction could be improved by expanding the indication for aortocoronary bypass from that of severe angina.

Adult↗
PubMed1982

Normal coronary arteriogram. An avoidable test?

Between 10 and 20% of coronary arteriograms in patients with chest pain show normal vessels, often in association with a history of "atypical" angina. Conventional non-invasive tests are inaccurate in this group of patients compared with those with classical angina. This study prospectively evaluates combined 12 lead exercise electrocardiography and thallium-201 scintigraphy as a screening test in patients with atypical angina in order to determine whether normal arteriograms are avoidable in this important subgroup of patients presenting with chest pain. Sixty seven consecutive patients with atypical angina underwent both maximal exercise testing and thallium scintigraphy before coronary arteriography. Chest pain during exercise was a poor predictor of coronary disease in this group. Eleven (16%) had abnormal arteriography, with the sensitivity of exercise and thallium tests being 45% and 73%, respectively. When both tests were applied the predictive accuracy for normal coronary arteries was 96% (54/56) and that for the presence of coronary disease was 82% (9/11). If coronary arteriography was withheld in patients in whom both the exercise test and thallium scintigraphy were negative, the number of normal coronary arteriograms could be reduced with only a very small risk of failing to detect individuals with coronary disease.

Adult↗
PubMed1981

Cardiac pain at rest. Management and follow-up of 100 consecutive cases.

One hundred consecutive patients, admitted to the coronary care unit with cardiac pain at rest but no evidence of recent myocardial infarction have been followed up for nine to 26 (mean 14) months. They were treated initially with bed rest, beta-adrenergic blockade, and nitrates. In 54 patients pain subsided within 24 hours. Coronary angiography was carried out in 46. Thirty-five had coronary artery lesions and three had spasm in normal coronary arteries. One had hypertrophic cardiomyopathy and seven had normal findings. Seventeen patients with previous angina and severe coronary disease were operated on, with one death and one perioperative infarction; two died late, 12 were symptom free, and two had angina. Seven of 18 patients treated medically had recurrent angina and underwent operation. Of the 11 unoperated patients, one died, three had angina, and seven were symptom free. Two of the eight patients who were not catheterised developed infarction, four had angina, and three were symptom free. Recurrent pain continued for more than 24 hours in 46 patients, and all underwent angiography. Forty-three had coronary artery disease and 34 underwent early bypass surgery; there were two operative deaths and three perioperative infarctions. Twenty-six symptom free at follow-up. Of the nine unoperated patients with coronary disease, four developed infarction, two were operated on for recurrent angina, two were symptom free, and one had mild angina. Optimal management of patients with pain at rest can be determined only with knowledge of the coronary artery anatomy and of left ventricular function. Many respond initially to intensive medical treatment and coronary angiography can be performed electively. In those with continuing pain, urgent angiography is required and can be done safely.

Adult↗