Biomedical subjects
Publications and source records attributed to C W Pattison.
A case of splenic herniation complicated by spurious hypertension is described. A misleading provisional diagnosis was made despite computerised tomography (CT Scan). Diaphragmatic herniation is discussed and the use of computerised tomography in the diagnosis of masses arising from the posterior aspect of the diaphragm is emphasized.
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A patient presented with pain in the wrist and neck and X-rays showed destructive lesions of several carpal bones and cervical vertebrae. The carpal lesion was explored surgically and found to be tuberculous. Chemotherapy resulted in healing at both sites of disease.
The second reported case and first successful treatment of oesophageal obstruction due to a saccular aneurysm of the distal thoracic aorta is described. The patient, a 69-year-old male, presented with severe dysphagia which was thought to be due either to achalasia or a tumour. Operation, however, revealed a large aneurysm at the level of the diaphragmatic hiatus which was compressing the oesophagus against the right crus. As the anatomy of the aneurysm was unknown and there was a significant risk of damage to the spinal arteries the oesophageal obstruction was treated by transposition of the oesophagus combined with an anti-reflux repair. This has given an excellent clinical result and the aneurysm has remained unchanged over a period of eighteen months.
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Acute hydrothorax is a well recognized complication of continuous ambulatory peritoneal dialysis (CAPD) and is usually regarded as a contra-indication to the further use of this form of dialysis. We report the first case of treatment by surgical closure of a communication between the peritoneal and the right pleural cavity enabling CAPD to continue successfully. The development of an acute hydrothorax on CAPD is therefore not a reason to abandon this form of dialysis and can be treated by a simple thoracic surgical procedure.
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Skeletal muscle has an inherent plasticity which allows it to undergo fibre type transformation when induced by a specific stimulus. Electrical stimulation has been used here to induce transformation of a predominantly fast type skeletal muscle towards a slow, more fatigue-resistant phenotype, which is more suitable for use in long-term cardiac assistance. Muscle samples from animals electrically stimulated for periods up to 6 months have been analysed by electrophoresis for myosin heavy chain (MHC) and myosin light chain (MLC) fast and slow isoforms. Densitometry and computer analysis have been used to determine the pattern of transformation of the different myosin subunits over this time period. MHC and MLC 2 fast to slow isoform switching preceded that of the alkali light chains (MLC1 and MLC3). After 3 months of stimulation the MHC slow isoform was found to have doubled in concentration relative to the unstimulated control muscle and by 4 months accounted for almost 50% of the total MHC content. The slow isoform accounted for 75% of the MLC2 after 4 months of stimulation. The protein products of mRNA isolated from stimulated muscle samples, translated in vitro and separated by electrophoresis, showed that transformation at the mRNA level preceded that at the protein level. By 2-4 weeks of stimulation MLC2 slow isoform mRNA represented over 60% of the total MLC2 mRNA population. An understanding of the molecular structure of muscle during transformation provides insight into its haemodynamic performance in cardiac assistance.
We have developed and evaluated a prototype external pulse train stimulator for use with a new technique of circulatory assistance. This involves the use of skeletal muscle (latissimus dorsi) wrapped around the thoracic aorta as an entirely autologous extra-aortic counterpulsation system. The stimulator has been successful in initiating both muscle contraction at the desired part of the cardiac cycle (diastole) and the necessary fibre-type transformation required for long-term work (fatigue resistance). The background to the development of the stimulator and the early haemodynamic results are described in this paper. The evaluation of the prototype design and the areas for future development are discussed.
Dysrhythmias, particularly of supraventricular origin, are an important cause of morbidity following coronary artery bypass grafting (CABG). This study compared the incidence of dysrhythmias in patients undergoing CABG using either cold crystalloid cardioplegia or intermittent ischaemic arrest (32 C). We conclude that the incidence correlated well with right coronary endarterectomy irrespective of the technique of myocardial preservation employed and to the exclusion of other variables.
Congestive heart failure is a growing problem in the Western world, which modern therapeutic options are doing little to ameliorate. Dynamic cardiomyoplasty may be one option which has great potential. This article reviews the use of skeletal muscle for circulatory assist and suggests that, with further work, it should take a significant place in the treatment armamentarium.
Advances in the technology of gas exchange analysers have made cardiopulmonary exercise testing a relatively simple, cheap and reliable diagnostic tool. Its practice and uses include grading the severity of heart failure, evaluation of the cause of exertional dyspnoea and monitoring a patient's response to therapy. Areas of debate and future development are highlighted.
Massive haemoptysis is rare but associated with a high mortality. Even in a major regional cardiothoracic centre only one or two cases will be seen annually. As a consequence, no consensus about its investigation and management has emerged, with the result that much time may be lost on inappropriate investigation and treatment may be misdirected.