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Biomedical subjects

D Hunt

Publications and source records attributed to D Hunt.

At least 163 records · Page 9Linked to original sources
PubMed1980

Clofibrate raises plasma apoprotein A-I and HDL-cholesterol concentrations.

In 10 hyperlipidaemic subjects who had been satisfactorily treated with clofibrate, stopping treatment led to significant reductions in plasma apoprotein A-I and high density lipoprotein cholesterol concentrations; resumption of treatment significantly raised both. The changes were therefore inversely related to those in the plasma cholesterol and triglyceride levels and were most prominent in hypertriglyceridaemic subjects.

Aged↗
PubMed1980

An assessment of the clinical use of glyceryl trinitrate in a hospital outpatient population.

Despite the availability of information on the use of glyceryl trinitrate (GTN) in standard texts, in practice many patients fail to obtain maximum benefit from GTN. This study of an Outpatient population, documents the patients' knowledge of the use and precautions which should apply to GTN and records the ways in which these patients took the drug. Fifty patients who regularly took GTN (greater than 5 tablets per week) were asked a series of questions by the same interviewer. Forty-nine of the 50 patients took GTN for the relief of chest pain, but only 34 patients knew that the drug could be used to prevent chest pain. Although 48 patients kept their bulk supply of GTN in the original container, over 40% transferred some or all of the tablets to other containers and locations. Seventy per cent of patients knew that GTN tablets deteriorate with time. However, knowledge of the factors which influence the rate of deterioration was lacking. Less than half the patients knew that the prompt relief of pain or the local effects on the buccal mucosa could be used as simple tests of the activity of tablets. It is recommended that all physicians should take more time to explain to their patients how to use glyceryl trinitrate correctly.

Aged↗
PubMed1980

Prospective angiographic assessment of factors affecting early patency of saphenous vein-coronary artery bypass grafts.

Between November 1977 and September 1978, early post-operative angiography was performed in 50 of 53 consecutive patients undergoing coronary artery bypass surgery. An average of 2.4 grafts per patient were applied. The overall patency rate was 82% and was not affected by the degree of proximal native vessel stenosis. Grafts to circumflex marginal vessels had a significantly lower (P < 0.05) patency rate (72%) than grafts to the left anterior descending (84%) and its diagonal branches (85%), or to the right coronary artery (90%). Ten single grafts were applied and all were patent. Forty-nine of the 50 patients had at least one patent graft. Fifty-three per cent of the grafts were considered of excellent quality and 25% patent but of fair quality only. There was a 100% patency rate for vessels of 2 mm diameter or more, which is significantly better (P < 0.01) than for vessels of 1-2 mm diameter (78%) or for vessels of less than 1 mm diameter (50%). There was a suggestion of a lower patency rate (74%) for vessels with evidence of distal disease, compared with vessels without such disease (85%). An assessment of the overall quality of the recipient vessel was made, taking both diameter and disease into account. This showed improved results for better quality vessels in terms of graft patency (P < 0.1) and graft quality (P < 0.05).

Coronary Angiography↗
PubMed1980

Effects of quinidine and disopyramide on serum digoxin concentrations.

Although quinidine and digoxin are frequently given together, it has only recently become apparent that serum digoxin concentration may rise during quinidine treatment. A prospective study was performed to compare the effects of quinidine and disopyramide in patients receiving maintenance digoxin therapy. During quinidine administration serum digoxin concentration rose by more than 50% in seven of nine patients (the mean concentration rising from 1.43 +/- 0.20 to 2.61 +/- 0.43 nmol/l, P < 0.005). During the disopyramide treatment a small rise in serum digoxin was noted (mean 1.3 +/- 0.16 to 1.5 +/- 0.19 nmol/l, P < 0.05). We suggest that digoxin doses should be reduced immediately prior to commencing quinidine therapy in patients already receiving adequate maintenance digoxin, and patients should be followed carefully for evidence of digoxin toxicity. Disopyramide appears a suitable alternative anti-arrhythmic drug to quinidine in patients on maintenance digoxin.

Adult↗
PubMed1980

Multiform ventricular tachycardia.

Electrophysiological studies were performed in three patients with chronic recurrent ventricular tachycardia (VT) associated with coronary artery disease. In each case the ventricular origin of the tachycardia was confirmed and induction of tachycardia by programmed stimulation suggested a re-entry mechanism. Multiple types of ventricular tachycardia were observed which differed in cycle length, QRS morphology, timing of local epicardial and endocardial ventricular electrograms and the use of the specialized conduction system for propagation. There was evidence of one or more re-entry circuits arising in or near previously infarcted areas, with features of cycle length alternation, change in exit points and variations in subsequent conduction through the myocardium and specialized conduction tissues. These findings suggest multiform VT can be due to a number of factors. A modified surgical approach is recommended for management of medically refractory VT when there is evidence of multiple types.

Adult↗
PubMed1979

Guidelines for the management of oral anticoagulant therapy in patients undergoing surgery.

The management of patients who require surgery while being treated with oral anticoagulants is a difficult balance between the risks of bleeding and those of recurrent thromboembolism. The urgency and the extent and site of surgery are important considerations, as are the strength of the indication for anticoagulants and the degree of anticoagulation. A practical approach is outlined for various situations that may be encountered.

Administration, Oral↗
PubMed1979

Predictors of reinfarction and sudden death in a high-risk group of acute myocardial infarction survivors.

75 patients aged under 70 years who had survived acute myocardial infarction complicated by both significant arrhythmias and cardiac failure were followed-up for 1 year in an attempt to identify features which suggest the likelihood of late death or reinfarction. Patients were carefully instructed in the identification and importance of possible prodromal symptoms and the availability of a mobile intensivecare ambulance service and a 24 h hospital control centre. Horizontal ST-segment depression or anginal pain on an exercise test done within 6 weeks of infarction was a useful predictor of late death. Routine twice weekly E.C.G. recordings taken by telephone transmitter at rest and after mild exertion resulted in the identification of significant arrhythmias in only 7 patients. 13 patients (17%) died, 5 of them instantaneously. 4 of the 13 patients and 22 of the 62 survivors reported "prodromal symptoms". Unreported prodromal symptoms were elicited retrospectively in 14 of the 62 survivors and from the relatives of 4 of the 13 patients who died. Thus, 35% of prodromal symptoms were not reported despite intensive patient education and counselling. The incidence of "prodromal symptoms" was no higher in patients who died than in those who did not die.

Acute Disease↗
PubMed1979

Mitral valve prolapse.

Mitral valve prolapse is a relatively common condition in the general population. The syndrome appears more common in females, and is often associated with a family history. Patients may be asymptomatic or may present with a variety of symptoms ranging from mild chest aches and anxiety to severe angina-like chest pain, palpitations and dizziness. The common auscultatory features include mid-systolic clicks and a late systolic murmur, either alone or in combination. The wide spectrum of symptoms and signs may be explained by ventriculovalvular disproportion, where either the ventricle is too small for the valve, or the valve is too large for the ventricle. The long-term prognosis is very good; severe mitral regurgitation can occasionally develop, but both sudden death and bacterial endocarditis are rare. No treatment is required for asymptomatic patients, beyond antibiotic cover for dental procedures and surgery.

Adolescent↗
PubMed1979

On-line computer management of cardiac surgical data.

The surgeon (or one of his assistants) enters, in a computer file, information on open-heart surgical procedures though a remote terminal located in the recovery room. Clinical and historical findings, complications occurring during the immediate postoperative period, and postmortem data when applicable are entered in the course of the hospital stay or after discharge. Relevant information entering the computer system in other hospital departments is automatically incorporated in the open-heart surgery file. A final multicopy operative report is printed in the recovery room shortly after the surgical procedure is completed. All information on patients in the file constitutes a permanent and dynamic data base that is accessible at any time from any remote terminal in the hospital computer system. This data base contains an average of 500 items of information per surgical procedure and is available via an on-line retrieval program for both quality control purposes and extrapolation of prognostic data on new patients.

Cardiac Care Facilities↗
PubMed1979

Chronic recurrent ventricular tachycardia--an electrophysiological study.

Electrophysiological techniques were used to study 17 patients with chronic recurrent ventricular tachycardia. Twelve of the patients had coronary disease, while eight had pre-existing intraventricular conduction defects. The site of origin of the tachycardia as deduced by analysis of the QRS morphology correlated well with the electrocardiographic evidence of the site of the old infarction. Ventricular tachycardia was induced by pacing techniques in eight patients while it occurred spontaneously during the study in two others. In only four of the eight patients in whom tachycardia was induced, could the arrhythmia be reinduced; the arrhythmia could not be reproduced in one, while reproducibility was not assessed in the remaining three. Tachycardia was terminated by pacing techniques in six patients and by DC cardioversion in four. Ventricular tachycardia was initiated with a run of "torsade de pointes" in four patients. Ventricular tachycardias with varying morphology were observed in three patients. Electrophysiological study was of significant benefit in patient management in 14 of the 17 patients, particularly those with pre-existing intraventricular conduction defects, undocumented tachycardia or undocumented syncope.

Adult↗
PubMed1978

Sinus arrhythmia in acute myocardial infarction.

Sinus arrhythmia, defined by means of a calculation of variance of the R-R interval on admission to hospital, was present in 73 of 176 patients admitted to a coronary care unit with acute myocardial infarction. These patients had a lower hospital mortality. They tended to have a higher incidence of inferior infarction, and a lower incidence of anterior infarction, and to have smaller infarcts as measured by the Norris index. The main difference between patients with sinus arrhythmia and without sinus arrhythmia related to heart rates on admission to hospital, the patients with the former having slower heart rates at that time.

Acute Disease↗
PubMed1978

On-line storage, retrieval, and evaluation of long-term electrocardiographic monitoring data.

A set of on-line computer programs has been designed and implemented for the acquisition and long-term storage, retrieval, and evaluation of Holter monitoring data. The physician interpreting Holter tapes enters his findings in the computer system using an on-line remote terminal located in the heart station. The programs are available practically around the clock and allow reviewing of individual cases, preparation of printed reports, and fast evaluation of the presence or absence of a number of common findings in the entire data base. Approximately 800 cases have been entered since the initiation of this project in early 1977.

Electrocardiography↗
PubMed1978

The Miami Heart Institute information system.

The Miami Heart Institute automation project, conceived as a comprehensive unified hospital information system, has been in continuous development since 1969. As of February 1978, the system supports medical services and laboratories as well as teaching, financial, administrative, and research applications through approximately 100 remote terminals. It is controlled by a single operating system serving interrelated data bases and is available to its users practically 24 hours a day, 7 days a week. The information system transfers data to and from dedicated mini- and microcomputer systems and incorporates digital and analog instrumentation interfaces that include physiologic signal-processing capabilities. Acceptance by user departments ranges from good to excellent, whereas acceptance by the private attending staff at large has been only fair. This report represents a general overview of several major subsystems and discusses advantages and shortcomings of the project.

Attitude of Health Personnel↗