Search PubMed⌕ Search

Biomedical subjects

I R Starkey

Publications and source records attributed to I R Starkey.

48 records · Page 3Linked to original sources
PubMed1986

Staphylococcal infection of a left ventricular aneurysm.

Left ventricular aneurysm formation is a common complication of myocardial infarction. Depending on the definition used, the incidence in survivors of acute myocardial infarction is between 4% and 40%, with mural thrombi present in about half of all aneurysms. Infection of these thrombi at times of bacteraemia might be expected to occur quite commonly but has been described only occasionally. We present such a case and review previously reported cases.

Heart Aneurysm↗
PubMed1982

Alpha 2-macroglobulin and proliferative retinopathy in type 1 diabetes.

Serum alpha 2-macroglobulin (alpha 2m) and total glycosylated haemoglobin (HbA1) concentrations were measured in 110 insulin dependent Type 1 diabetics with minimal or no fundoscopic retinopathy, referred to as non-retinopaths, and in 52 proliferative retinopaths. Proteinuria was recorded in 8 (7%) non-retinopaths and 29 (56%) retinopaths and was accompanied by elevated alpha 2m concentrations in both groups of diabetics but only significantly so in the non-retinopaths. Diabetics without proteinuria showed a significant correlation between alpha 2m concentration and duration of diabetes, HbA1 and age (being higher at extremes of age). Alpha 2m concentrations were significantly higher in retinopaths than in non-retinopaths without proteinuria when allowance was made for the influence of age and duration of diabetes on alpha 2m. This difference may be attributed to the higher HbA, levels found in retinopaths than in non-retinopaths and was no longer evident when account was taken of the prevailing HbA1 concentration in individual patients.

Adult↗
PubMed1982

HLA antigens and other risk factors in the development of retinopathy in type 1 diabetes.

Factors possibly influencing the development of diabetic retinopathy were studied in 112 randomly selected type 1 diabetics having no or minimal retinopathy (group A) and in 82 type 1 diabetics with known severe diabetic retinopathy. The latter comprised those with severe background retinopathy (group B, n = 17) and those having proliferative retinopathy without (group C, n = 38) and with group D, n = 27) diabetic nephropathy. Nonretinopaths (group A) were of similar sex ratio, body weight, and age at diagnosis of diabetes but had been diabetic longer (p less than 0.001) and were thus older (p less than 0.001) than retinopaths (groups B-D). The distribution of HLA antigens of the A, B, and C loci was similar in nonretinopaths and retinopaths with the exception that HLA B7 showed a reduced (p less than 0.05) prevalence in the retinopaths (6% versus 17%) and was singularly underrepresented in group D, where no patients had this antigen. Mean postprandial plasma glucose and HbA1 concentrations were higher (p less than 0.01 and p less than 0.001) and cigarette smoking was more prevalent (p less than 0.01) in the retinopathy groups B-D than in group A. Systolic and diastolic blood pressures were similar in groups A-C, with higher (p less than 0.001) values only in group D. There was no association between insulin antibody binding in the serum or measurable plasma C-peptide immunoreactivity and retinopathy status. The risk of development of diabetic retinopathy in type 1 diabetes may be related to HLA-associated genetic factors and to cigarette smoking.

Adult↗
PubMed1982

Echocardiographic identification of right-sided cardiac intracavitary thromboembolus in massive pulmonary embolism.

In a patient with clinical features of massive pulmonary embolism, two-dimensional echocardiography demonstrated an echo-dense mass moving freely across the tricuspid valve between the right atrium and right ventricle. This mass was also visualized at angiography, which in addition confirmed extensive pulmonary embolism. At autopsy, the mass was found to be a coiled thrombus, one end of which had become wedged in a probe-patent foramen ovale. In another patient, bedside echocardiographic demonstration of thrombus in the right ventricular outflow tract was followed by immediate and successful embolectomy.

Aged↗
PubMed1980

Psychiatric aspects of acute poisoning with tricyclic and related antidepressants--a ten-year review.

The incidence of acute self-poisoning with tricyclic and related antidepressant drugs has increased in recent years so that now approximately 20 per cent of all acute overdoses in patients above the age of 12 are due to this cause. We report the results of a ten-year review of the psychiatric aspects associated with this poisoning in 316 consecutive patients admitted to a District General Hospital. Fifty-four per cent of these patients had sought medical advice in the period immediately prior to the overdosage. The final psychiatric diagnosis following the poisoning is related to the events previously and an attempt is made to judge how appropriate was the original treatment with antidepressant drugs. The important opportunities for prevention of this poisoning are discussed and suggestions made.

Adolescent↗
PubMed1980

Poisoning with tricyclic and related antidepressants--a ten-year review.

Self-poisoning with tricyclic and related anti-depressant drugs has increased in frequency over the last few years so that, at present, some 20 per cent of patients admitted to hospital following self-poisoning have ingested a drug of this group, either alone or, more commonly, in association with alcohol, a benzodiazepine and/or other drugs. We present the results of a retrospective analysis of 316 admissions to a general medical hospital dealing with patients over 12 years, following self-poisoning with tricylic or related drugs. Although serious toxic effects may sometimes occur, their frequency has probably been over-estimated, at least in older children and adults; in this series the incidence of significant hypotension was 13 per cent, grand mal convulsions 4 per cent, respiratory depression to the degree of requiring mechanical ventilation 2 per cent and severe cardiac arrhythmias or conduction disturbances 1.5 per cent. It is suggested that routine 'prophylactic' treatment against convulsions and cardiac arrhythmias, advocated by some previous authors, is unnecessary and potentially dangerous; indeed, even the establishment of an intravenous infusion may put an extra strain on a depressed myocardium. In this series, supportive treatment alone was sufficient for the majority of patients (81.6 per cent) and additional treatment was given only in the presence of some specific indication. Using such conservative measures, the mortality rate in the 10-year study was only 0.6 per cent. Medical efforts in the future, it is suggested, would be more appropriately directed towards preventing unnecessary prescribing of these drugs for trivial mental upset, rather than the development of new drugs of this type or other 'prophylactic' measures, designed to prevent relatively rare toxic effects.

Adult↗
PubMedDate not supplied

A prospective study of left atrial spontaneous echo contrast and thrombus in 100 consecutive patients referred for balloon dilation of the mitral valve.

The aim of this study was to determine the clinical, echocardiographic, and hemodynamic predictors of left atrial spontaneous echo contrast (SEC) and thrombus, respectively, in patients referred for balloon dilation of the mitral valve and to establish the relationship between the two phenomena in this group of patients. One hundred consecutive patients (mean age 57 +/- 14 years) referred for mitral balloon (Inoue) dilation were studied prospectively with transthoracic and transesophageal (83 biplane and 17 single plane) echocardiography (TEE) combined with spectral and color Doppler modalities, immediately before the procedure. TEE was repeated within 24 hours of valvotomy in the first 55 patients. All patients also underwent comprehensive left- and right-sided heart catheterization. TEE was performed successfully in 96 patients. SEC was detected in all 65 patients in atrial fibrillation and in 14 (45%) of 31 patients in sinus rhythm. Patients with SEC were significantly older (61 +/- 13 vs 45 +/- 12 years; p < 0.001) and had larger left atrial volume (98 +/- 48 vs 64 +/- 24 ml; p < 0.001), higher mitral valve echocardiographic scores (7.4 +/- 3.2 vs 5.3 +/- 2.6; p = 0.016), lower cardiac output (3.5 +/- 1.1 versus 4.6 +/- 0.9 L/min; p < 0.001), lower peak systolic pulmonary vein flow velocity (SVm) (24 +/- 12 versus 45 +/- 11 cm/sec; p < 0.001), and correspondingly lower systolic velocity-time integral (4.0 +/- 2.6 vs 7.9 +/- 2.9 cm; p < 0.001) than had patients without SEC. There were no significant associations between SEC and either mitral valve area or anticoagulant therapy. SVm and atrial fibrillation were found to be independent predictors of SEC. In patients in sinus rhythm, SVm was the only independent predictor of SEC. After mitral balloon dilation, SEC disappeared in only two of 35 patients in atrial fibrillation and in five of eight patients in sinus rhythm. Significant mitral regurgitation occurred in the two patients in atrial fibrillation. TEE detected left atrial thrombus in 14 patients. Thrombus was significantly associated with age, mitral valve area, and the severity of SEC. The latter was found to be an independent predictor of thrombus. Two patients in sinus rhythm had evidence of left atrial mechanical dysfunction. Both patients had left atrial SEC and one had thrombus in the appendage. It is concluded that SEC in patients with severe mitral stenosis is dependent on left atrial systolic function and peak systolic pulmonary vein velocity. It is not related to mitral valve area or anticoagulant therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗