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Biomedical subjects

C Oakley

Publications and source records attributed to C Oakley.

At least 55 records · Page 3Linked to original sources
PubMed1983

The teeth and infective endocarditis.

During 1981 and 1982 544 cases of infective endocarditis were investigated retrospectively by means of a questionnaire. Only 13.7% had undergone any dental procedure within three months of the onset of the illness, and in 42.5% there was no known cardiac abnormality before the onset of the disease. Furthermore, the number of cases occurring annually was about the same as or more than it was before the introduction of penicillin. The mouth and nasopharynx were the most likely sources of the commonest organism, Streptococcus viridans, and it is suggested that it is not dental extractions themselves which are of importance but good dental hygiene. In most patients with infective endocarditis the portal of entry of the organism whatever its nature cannot be identified. If this is so antibiotics are being given to only a small proportion of those at risk, and this would explain why the number of cases is much the same as it was before the introduction of penicillin. Furthermore, the large proportion of patients with no known previous cardiac abnormality adds to the difficulty of providing effective prophylaxis. The evidence suggests that antibiotic prophylaxis should still be given before dental procedures, and a schedule is appended. Much more importance should be given, however, to encouraging people to seek better routine dental care. We also believe that doctors and dentists should appreciate that the pattern of the disease has changed considerably in the past 50 years and that the information given here warrants a revised approach to the problem.

Adolescent↗
PubMed1981

Prognosis in hypertrophic cardiomyopathy: role of age and clinical, electrocardiographic and hemodynamic features.

Retrospective analysis of the clinical course of 254 patients with hypertrophic cardiomyopathy, followed up for 1 to 23 years (mean 6), disclosed that 58 had died, 32 of them suddenly. The 196 survivors were compared with the 32 patients who died suddenly and with the 38 who died suddenly or with heart failure. The combination of young age (14 years or less), syncope at diagnosis, severe dyspnea at last follow-up and a family history of hypertrophic cardiomyopathy and sudden death best predicted sudden death (false negative rate 30 percent, false positive rate 27 percent). A "malignant" family history was associated with poor prognosis, particularly in the younger patients; a family history of hypertrophic cardiomyopathy without sudden death was more frequent in the survivors (12 percent) than in the dead (5 percent). Patients who had a diagnosis in childhood were usually asymptomatic, had an unfavorable family history and a 5.9 percent annual mortality rate. In those aged 15 to 45 years at diagnosis, there was a 2.5 percent annual mortality rate and syncope was the only prognostic feature. Among those diagnosed between age 45 and 60 years, dyspnea and exertional chest pain were more common in the patients who died, and the annual mortality rate was 2.6 percent. Poor prognosis was better predicted by the history at the time of diagnosis and by changes in symptoms during follow-up than by an electrocardiographic or hemodynamic measurement.

Adolescent↗
PubMed1981

Arrhythmia in hypertrophic cardiomyopathy. I: Influence on prognosis.

In order to examine the association between arrhythmia and subsequent prognosis, 72-hour ambulatory electrocardiographic monitoring was performed in 86 unselected patients with hypertrophic cardiomyopathy. During monitoring 23 patients experienced at least one episode of supraventricular tachycardia and 24 had ventricular tachycardia (of whom 10 had more than three episodes). The patients were then followed for a mean of 2.6 years (range one to four). Seven patients died suddenly. Of these, five had exhibited multiform and paired ventricular extrasystoles and ventricular tachycardia. These arrhythmias were significantly associated with sudden death whereas supraventricular arrhythmias were not. The patients who died suddenly were older and had experienced more symptoms than the survivors, and three had a family history of hypertrophic cardiomyopathy and sudden death. This experience provides the basis for the assessment of treatment in patients with hypertrophic cardiomyopathy and serious ventricular arrhythmia.

Adolescent↗
PubMed1979

Pel-Ebstein fever coinciding with cyclical haemolytic anaemia and splenomegaly in a patient with Hodgkin's disease.

A 46-year-old man with an aortic valve replacement was investigated for recurrent episodes of fever associated with splenomegaly and haemolytic anaemia. Initially bacterial endocarditis was suspected. At laparotomy he proved to have mixed cellularity Hodgkin's disease confined to the spleen. The undefined mechanism underlying Pel-Ebstein fever in this patient may also have been the cause of simultaneous haemolysis and splenomegaly.

Anemia, Hemolytic↗
PubMed1978

Diagnosis and natural history of congested (dilated) cardiomyopathies.

The diagnosis of primary dilated cardiomyopathy depends on the recognition of a dilated poorly contracting left ventricle with increased end-diastolic and end-systolic volumes in the absence of a detectable cause. The diagnosis is made only after exclusion both of structural heart disease and of known causes of secondary heart muscle disorder. The natural history is still largely unknown and is probably as variable as the likely causes. The left ventricular disorder does not cause symptoms until heart failure supervenes except for occasional patients who develop an early atrial or ventricular dysrhythmia, conduction defect, chest pain or murmur of mitral regurgitation. This period of latency may be short, prolonged or even permanent since it is unlikely that all cases progess to the point of failure. A few patients recover normal or near-normal cardiac function. The interplay between high blood pressure, hypertensive heart failure and dilated cardiomyopathy is illustrated by patients who recover from heart failure to become hypertensive and vice versa and in current treatment with vasodilators and diuretics for patients at either end of the spectrum.

Alcoholism↗
PubMed1977

Wolff-Parkinson-White syndrome type A obscured by left bundle branch block.

2 patients are presented whom the presence of left bundel branch block obscured the signs of the Wolff--Parkison--White syndrome expected with a bypass on the left side of the heart. While it was possible to infer the presence of both disorders from the surface ECGS, electrophysiological studies proved invaluable in defining the precise situation in both cases. When atypical electrocardiographic appearances are observed in the Wolff-Parkinson-White syndrome, careful investigation may reveal the cause to be bundle branch block on the same side of the hear as the anomalous pathway. In both patients there was in addition evidence of sinoatrial disease, which was associated with the occurrence of arrythmias, and this was also confirmed with intracardiac studies.

Adult↗
PubMed1976

Pregnancy in patients after valve replacement.

This report is based on information obtained from a questionnaire sent to major cardiac centres in the United Kingdom. This produced details of 39 pregnancies in 34 patients after valve replacement. The 39 pregnancies gave rise to 30 healthy babies. The small size of the series probably reflects both the increasing rarity of young women with rheumatic heart disease in this country and the cautious attitude of their cardiologists. This makes it likely that these women represented the best end of the spectrum of cardiac function after valve replacement. Twenty-four pregnancies in 20 women who were not given anticoagulants producted 23 healthy babies and 1 spontaneous abortion. This group comprised 6 patients with free aortic homografts, 1 patient with a fascia lata mitral valve, 1 with a Beall tricuspid prosthesis, 1 with a combined mitral homograft and Starr Edwards aortic prosthesis, and 1 with mitral and aortic frame-mounted fascia lata valves. There were no maternal deaths or thromboembolic complications in this group which included 5 patients who were in atrial fibrillation. Fifteen pregnancies in 14 women who received anticoagulants gave rise to 7 healthy babies. The fetal losses were one stillbirth, one intrauterine death at 34 weeks, and 3 spontaneous abortions; one surviving child has hydrocephalus as a result of blood clot and there were 2 maternal deaths. This group included 13 patients with Starr Edwards valves, 11 mitral and 2 aortic. A patient with a Hammersmith mitral valve was the only one to have been treated with heparin and her valve thrombosed. One patient with a mounted mitral homograft had a cerebral embolus. Nine of these patients were in atrial fibrillation. In 3 additional patients the valve replacement was carried out during pregnancy. Two of the patients survived operation. In one of these who was treated with warfarin the pregnancy well, but there is an increased fetal wastage in patients pregnancy gave rise to a congenitally malformed baby who died in the neonatal period. The baby born to the mother who did not receive anticoagulants has a hare-lip and talipes. Women with artificial valves can tolerate the haemodynamic load of pregnancy well, but there is an increased fetal wastage in patients taking oral anticoagulants. This is probably largely attributable to fetal haemorrhage but there is also a risk of malformation caused by a teratogenic effect of warfarin. Experience gained in non-pregnant patients suggests that withholding anticoagulatns in pregnant patients with prosthetic valves would usually be undersirable but warfarin should be avoided. The advantages of biological valves were apparent in this series.

Abnormalities, Drug-Induced↗