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Biomedical subjects

D J Radford

Publications and source records attributed to D J Radford.

At least 37 records · Page 2Linked to original sources
PubMed1986

Naturally occurring cardiac glycosides.

Cardiac glycoside poisoning from the ingestion of plants, particularly of oleanders, occurs with reasonable frequency in tropical and subtropical areas. We have assessed a variety of plant specimens for their cardiac glycoside content by means of radioimmunoassays with antibodies that differ in their specificity for cardiac glycosides. Significant amounts of immunoreactive cardiac glycoside were found to be present in the ornamental shrubs: yellow oleander (Thevetia peruviana); oleander (Nerium oleander); wintersweet (Carissa spectabilis); bushman's poison (Carissa acokanthera); sea-mango (Cerbera manghas); and frangipani (Plumeria rubra); and in the milkweeds: redheaded cotton-bush (Asclepias curassavica); balloon cotton (Asclepias fruiticosa); king's crown (Calotropis procera); and rubber vine (Cryptostegia grandifolia). The venom gland of the cane toad (Bufo marinus) also contained large quantities of cardiac glycosides. The competitive immunoassay method permits the rapid screening of specimens that are suspected to contain cardiac glycosides. Awareness of the existence of these plant and animal toxins and their dangers allows them to be avoided and poisoning prevented. The method is also useful for the confirmation of the presence of cardiac glycosides in serum in cases of poisoning.

Amphibian Venoms↗
PubMed1986

The immunocompetence of children with congenital heart disease.

We studied the immunocompetence of 18 children with conotruncal malformations (13 with tetralogy of Fallot, 5 with truncus arteriosus) and 22 children with cardiac shunt lesions. There were reduced total T cell percentages and T helper cells in the conotruncal group but no T cell abnormality in the shunt group. Also, 7 of the 18 cases in the conotruncal group had facial dysmorphism reminiscent of the Di George syndrome. These results suggest that patients with conotruncal malformations fall into the wide spectrum of the Di George syndrome. There was some humoral deficiency in both groups with reduced levels of immunoglobulins IgG and IgA and low levels of complement C3 and C4. The clinical records showed a high frequency of infections. Hospital admissions for these episodes had occurred in 61% of the conotruncal group and 32% of the shunt group. Thus, there is an increased susceptibility to infection in children with congenital heart disease, and the predilection to infection has an immunological basis.

B-Lymphocytes↗
PubMed1985

Hypereosinophilic heart disease.

A 45-year-old patient with cardiac involvement from the idiopathic hypereosinophilic syndrome suffered from severe congestive cardiac failure with progressive deterioration despite intensive medical therapy. Investigations indicated bilateral ventricular infiltration with endomyocardial fibrosis which had caused severe haemodynamic restriction and bilateral atrioventricular valvular incompetence. Extensive surgery, which included bilateral ventricular endomyomectomy and mitral and tricuspid valve replacements, resulted in a significant improvement for six months.

Endomyocardial Fibrosis↗
PubMed1985

Truncus arteriosus and facial dysmorphism.

Facial features of infants with truncus arteriosus were photographed and reviewed. Anomalies included hypertelorism, low set ears, micrognathia, down-slanting palpebral fissures, short philtrum and small mouths. Associated cardiovascular defects were interrupted aortic arch, double aortic arch, right aortic arch and aberrant brachiocephalic vessels. Potential teratogenic factors included maternal diabetes, syphilis, alcohol ingestion, carbimazole therapy and infant chromosomal anomalies. The facial features, together with the rare cardiac abnormalities of truncus arteriosus and aortic arch defects are similar to those described in Di George syndrome (defect of fourth branchial arch and derivatives of third and fourth pharyngeal pouches). However none of these patients had symptomatic hypocalcaemia or absence of the thymus. It is concluded that this association of truncus arteriosus, aortic arch abnormalities and facial anomalies involves first and fourth branchial arch maldevelopment, and indicates embryological insult between the fourth and seventh weeks of gestation.

Abnormalities, Multiple↗
PubMed1985

Endocardial fibroelastosis and infantile polycystic disease.

A child with infantile polycystic disease who developed cardiac failure from endocardial fibroelastosis is described. Endocardial fibroelastosis has been reported in adult type polycystic disease in childhood. Endocardial fibroelastosis should be suspected in a child with polycystic disease who develops unexplained cardiac failure.

Endocardial Fibroelastosis↗
PubMed1985

Vegetations in infective endocarditis. Clinical relevance and diagnosis by cross sectional echocardiography.

Cross sectional echocardiography identified vegetations in 45 of 62 (73%) patients who had clinical evidence of active infective endocarditis. The sensitivity of this technique in diagnosing vegetations in infective endocarditis was 93% and the specificity 89%. The predictive value of a positive test was 96% and that of a negative test 80%. Vegetations were detected with a similar frequency on the aortic and mitral valves. The incidence of valvar incompetence, congestive heart failure, and the need for surgical intervention was similar in the patients with and without vegetations. Embolism occurred in 47% of those patients with vegetations and in 12% of those without. The mortality rate was 27% in those with vegetations, and no patient without vegetations died. Thus cross sectional echocardiography is accurate in diagnosing vegetations in patients with infective endocarditis, and this finding identifies patients at high risk of embolic complications and death.

Adolescent↗
PubMed1985

Diagnosis and natural history of Ebstein's anomaly.

Thirty five cases of Ebstein's anomaly were diagnosed by cardiac catheter study or echocardiography between 1962 and 1984. The anomaly was an isolated abnormality in 27 patients; the remainder had additional heart lesions. Six patients have died and four of these had other cardiac lesions. Thirteen are currently symptom free. Twelve cases presented with cyanosis and heart murmur on the first day of life. Eight of these had associated thrill which is a rare finding in neonates. As pulmonary vascular resistance fell there was clinical improvement. This was assisted by oxygen treatment. Another two cases presented in the first week of life and 10 in the first decade with a murmur or supraventricular tachycardia. Eleven cases presented as adolescents or adults with a murmur, cardiomegaly, or cardiac symptoms. Three patients were seen initially in the sixth decade. Clinical diagnosis was correct in only one adult. Twenty five patients had cardiac catheterisation. Important arrhythmias occurred in 10 cases, and two required cardioversion. Difficulty was experienced in entering the pulmonary artery in 11 infants and children. Diagnosis at initial catheter study was incorrect in four patients. Echocardiograms were recorded in 29 cases. Earlier M mode measurements of time delay of tricuspid closure compared with mitral closure did not always lead to the correct diagnosis. Cross sectional studies gave good images of tricuspid leaflet displacement, its tethering, and the atrialised portion of the right ventricle and have facilitated the diagnosis of more cases in recent years. Echocardiography is the procedure of choice for diagnosis of Ebstein's anomaly.

Adolescent↗
PubMed1979

Persistent fetal circulation. Two cases with myocardial dysfunction and severe acidosis.

Two neonates with the most severe form of persistent fetal circulation are described. Their presentation mimicked severe congenital heart disease. As well as persistent pulmonary hypertension and right-to-left shunting through the ductus arteriosus, they had poor myocardial contractility and atrioventricular valve regurgitation. Associated acidaemia was extreme. They survived with medical management, and the functional abnormalities resolved.

Acidosis↗
PubMed1979

Conduction disturbances after surgical correction of ventricular septal defect by the atrial approach.

Conduction disturbances have been documented after correction of ventricular septal defects by the ventricular route. Recently, repair of the ventricular septal defect has been through the right atrium to overcome damage to the conduction system and a right ventriculotomy. Thirty-nine children with ventricular septal defects under the age of 5 years were operated upon by the atrial route (group 1). The incidence of conduction disturbances in this group was compared with that occurring in 19 children of comparable age with a ventricular septal defect repaired via a right ventriculotomy (group 2). Complete right bundle-branch block developed in 13 of 39 children (33.3%) in group 1, compared with 15 of 19 children (78.9%) in group 2. This was a statistically significant reduction in complete right bundle-branch block in group 1. The incidence of left axis deviation occurring with complete right bundle-branch block was similarly statistically reduced. Transient complete heart block and arrhythmias were not statistically different in the two groups. The atrial approach to the repair of the ventricular septal defect significantly reduced the incidence of complete right bundle-branch block alone and occurring with left axis deviation.

Aortic Coarctation↗
PubMed1978

Torsade de pointes ventricular tachycardia in a newborn infant.

A case of paroxysmal ventricular tachycardia of torsade de pointes variety occurring in a newborn infant is described. A rare problem in the newborn, ventricular tachycardia has been associated with congenital heart disease, electrolyte abnormality, and cardiac tumour. In this case, the association was with myocarditis. The arrhythmia was refractory to treatment, and the infant died.

Electrocardiography↗
PubMed1977

Evaluation of children with ventricular arrhythmias.

Ventricular arrhythmias are rare in childhood but may be associated with syncope and sudden death. This report describes 8 children with ventricular arrhythmias, 6 of whom suffered syncopal episodes. Ventricular tachycardia was documented in 5. One boy died suddenly. Complete cardiac investigation was carried out with exercise testing, Holter monitoring, echocardiography, cardiac catheterization, angiography, and electrophysiological studies. The spectrum of abnormalities related to the arrhythmias included prolapsing mitral valve, prolonged QT syndrome, sick sinus syndrome, congenital heart disease, cardiomyopathy, and idiopathic ventricular tachycardia. Exercise testing and Holter monitoring were particularly useful in documenting the arrhythmias and monitoring response to therapy.

Adolescent↗
PubMed1977

Atrial fibrillation in children.

Atrial fibrillation is rare in children. Previous reports associated it with severe rheumatic heart disease and a poor prognosis. This review is of the unique experience of 35 cases of atrial fibrillation in children in the past 22 years; 23 patients were boys. The age of onset ranged from 1 day to 19 years (average, 8 years). Associated cardiac conditions were severe rheumatic mitral regurgitation (3 cases), cardiomyopathy (5), atrial tumors (2), infective endocarditis (1), paroxysmal atrial tachycardia of infants (4), idiopathic paroxysmal atrial fibrillation (1), Marfan's syndrome with mitral regurgitation (1), endocardial fibroelastosis (1), and structural congenital heart malformations (17). Surgical correction of congenital heart lesions was directly related to the development of atrial fibrillation in 14. Varying arrhythmias of the sick-sinus syndrome were observed in five children. The atrial fibrillation was paroxysmal or transient in 21 patients and persistent in 14. Treatment depended on the underlying condition. Digoxin was used in all cases and cardioversion attempted in ten; no patient was given anticoagulants. Three children had cerebral emboli, with residual defects. Eighteen patients are known to be alive, 13 are dead, and 4 are lost to follow-up. Atrial fibrillation in childhood is an indication for complete investigation of the patient and for the institution of treatment appropriate to the underlying disease.

Adolescent↗
PubMed1976

Mucocutaneous lymph node syndrome with coronary artery aneurysm.

A white North American girl with clinical features of the mucocutaneous lymph node syndrome had a myocardial infarct and angiographic evidence of a coronary artery aneurysm and mitral regurgitation. The mucocutaneous lymph node syndrome has been extensively diagnosed in Japan in recent years. It appears to be a distinct entity, although not precisely separated from polyarteritis nodosa in childhood. The condition may be more common than previously realized.

Aneurysm↗
PubMed1976

Congenital paroxysmal atrial tachycardia.

Ten infants who had paroxysmal atrial tachycardia in utero or at birth are reported. Because of apparent fetal distress, caesarean section was performed in 4 cases and labour was induced in 1. Birthweight was generally large for gestational age. Severe ascites and hydrops at birth were manifestations of cardiac failure. Atrial flutter was recorded in 4 infants and supraventricular tachycardia in 5. The WoLff-Parkinson-White syndrome became evident later in 2. Digoxin was given to all 10 infants, and cardioversion was required and was effective in 4. Known recurrences in childhood have occurred in only 1 patient. Congenital atrial tachyarrhythmias may be commoner than generally believed, and fetal electrocardiography may help to avoid unnecessary termination of pregnancy. Blood sugar determinations are important, since neonatal hypoglycaemia was found. Cardioversion should be performed promptly in severely ill infants or if there is no response to digoxin. Care is required to avoid digoxin toxicity.

Birth Weight↗