Search PubMed⌕ Search

Biomedical subjects

J B Atkinson

Publications and source records attributed to J B Atkinson.

At least 145 records · Page 8Linked to original sources
PubMed1986

Acquired coronary arterial aneurysms: an autopsy study of 52 patients.

In the past decade most studies of coronary arterial aneurysms have been clinical; few have focused on morphology and etiopathogenesis. The subjects of the present autopsy study were 52 patients, 5 months to 80 years of age, with coronary arterial aneurysms. Patients were divided into two groups: 38 with atherosclerotic coronary aneurysms and 14 with aneurysms secondary to inflammation. Of the 38 patients with atherosclerotic aneurysms, 20 (53 per cent) had histories of ischemic heart disease; the aneurysms were in the right coronary artery in 18 (47 per cent), the left coronary artery in 13 (35 per cent), and in the right and left coronary arteries in seven (18 per cent). Of the four major coronary arteries, the average number of severely narrowed arteries (reduction of more than 75 per cent) in cross-sectional luminal area) was 1.8/patient; aortic aneurysms were present in eight of these patients (24 per cent). Of the 14 patients with coronary aneurysms secondary to inflammation, four had histories of ischemic heart disease; 10 had histories of an influenza-like syndrome. Isolated left coronary arterial aneurysms were seen in six of these patients (43 per cent), while eight (51 per cent) had multiple right and left coronary arterial aneurysms. The average number of severely narrowed coronary arteries in this group was 1.5/patient, and only one patient had an aortic aneurysm. Therefore, patients with atherosclerotic aneurysms are more often symptomatic; they have increased heart weights and equal numbers of coronary arterial aneurysms in the right and left vessels, and the majority (89 per cent) have single aneurysms with thrombi in the lumen. Patients with coronary arterial aneurysms secondary to inflammation are younger; the majority of these patients have a prodromal influenza-like syndrome, a low incidence of ischemic heart disease, and multiple coronary arterial aneurysms.

Adolescent↗
PubMed1986

Isolated right ventricular infarction: a rare complication of coronary artery dissection.

Infarction of the right ventricle generally occurs in association with posterior left ventricular infarction, and isolated right ventricular infarction is unusual. We have reported a case of acute infarction of the right ventricle unassociated with infarction of the left ventricle in a patient with type I aortic dissection that extended into the right coronary artery, resulting in near-complete occlusion of its lumen. We believe that poor collateral circulation of the myocardium played a major role in the pathogenesis of isolated right ventricular infarction after sudden occlusion of the right coronary artery.

Aortic Dissection↗
PubMed1985

Correlation of saphenous vein bypass graft angiograms with histologic changes at necropsy.

Previous studies of saphenous vein (SV) bypass grafts have been either angiographic or morphologic, and few have correlated angiograms with histology. Nine necropsy patients who had received 21 SV implants 12 to 120 months (mean 67 +/- 42) before death were studied. All patients had severe coronary artery disease. Three types of histologic changes were found: atherosclerosis in 9 grafts, fibrointimal proliferation in 8 and total occlusion with fibrosis in 4. All patients had premortem angiograms 0 to 3 months (mean 0.7 +/- 1.1) before death. In 14 of 21 grafts, premortem angiograms accurately reflected the postmortem findings. In 7 grafts, the premortem angiograms either overestimated (4 grafts) or underestimated (3 grafts) the extent of luminal narrowing. Six of the 7 SV implants incorrectly assessed by angiography had fibrointimal proliferation and 1 had atherosclerosis. The presence of smooth muscle in SV implants with fibrointimal proliferation may be a mechanism of spasm or relaxation during angiography, which could cause errors in estimating the degree of stenosis. Nitrates or calcium antagonists may be useful in both assessing the degree of underlying vasomotion in SV grafts and as a therapeutic modality.

Aged↗
PubMed1985

Association of eosinophils with cardiac rupture.

Cardiac rupture occurs in 10 per cent of patients who die with acute myocardial infarction, but the pathogenesis remains unclear. Twenty randomly selected patients with cardiac rupture were reviewed retrospectively at autopsy, and the findings were compared with those of 20 age- and sex-matched control subjects who had died of acute transmural myocardial infarction without rupture. The times from the onset of chest pain to death were similar in the two groups (5.7 +/- 5.8 days for patients with rupture versus 4.2 +/- 4.9 days for control subjects), and there were no differences in the incidences of systemic hypertension, diabetes mellitus, hypercholesterolemia, history of myocardial infarction, or angina pectoris. The severity of coronary atherosclerosis was different in the two groups, with 55 per cent of the patients with cardiac rupture having single-vessel disease and 70 per cent of the patients without cardiac rupture having disease in three vessels. Additionally, the incidence of thrombosis was greater in patients with cardiac rupture than in those without. The inflammatory cell response in each patient was quantitated microscopically (number and type of leukocytes) in ten high-power fields. The inflammatory response was greater in patients with cardiac rupture. The number of eosinophils in the inflammatory response was significantly (P less than 0.01) greater in hearts associated with cardiac rupture (29.5 +/- 4 per cent) than in control hearts (11.7 +/- 3.1 per cent). It is postulated that eosinophils rich in arylsulfatase B, peroxidase, glucuronidase, beta-glycerophosphatase, major basic protein, and eosinophilic cationic protein may further weaken the necrotic myocardium and, in part, determine whether acute myocardial infarction will eventually result in cardiac rupture.

Coronary Disease↗
PubMed1985

Morphologic changes in long-term saphenous vein bypass grafts.

A retrospective autopsy study was performed in 56 patients who had undergone saphenous vein bypass graft (SVBG) surgery 12 to 168 months prior to death. Twenty-five grafts had atherosclerosis, 66 grafts had fibrointimal proliferation, and 26 grafts were fibrotic with total occlusion. No significant differences were noted among the three morphologic groups with regard to age of the patient or number of native coronary arteries severely narrowed. Vein grafts with fibrointimal proliferation occurred with greater frequency in patients with systemic hypertension (p less than 0.001), and atherosclerotic grafts were more prevalent in patients with hypercholesterolemia (p less than 0.02). Therefore, the presence of risk factors may determine the type of change that occurs in saphenous vein bypass grafts: systemic hypertension leads to fibrointimal proliferation, whereas hypercholesterolemia leads to atherosclerotic change.

Adult↗
PubMed1985

Contrast enhanced MRI. Evaluation of a canine model of osmotic blood-brain barrier disruption.

An osmotic model of blood-brain barrier (BBB) disruption was studied by magnetic resonance (MR) imaging (0.5 T) in 17 canines. The animals were killed after imaging and the lesions confirmed on gross pathology by the presence of Evans blue dye. No accompanying cerebral edema was demonstrated on histologic examination. The disrupted BBB could be identified in only one of five control animals on unenhanced MRI, despite the use of calculated T1 and T2 images. In a second group of five animals, the area of abnormal vascular permeability was consistently demonstrated after IV injection of 0.25 mmol/kg Gd DTPA. The time course of enhancement was evaluated in four additional animals. The brain tissue concentration of the gadolinium ion responsible for the observed enhancement was determined by ion coupled plasma analysis in the last three canines. In a study of pulse techniques, spin echo sequences with both short TRs and TEs (ie, SE 500/30) and inversion recovery techniques proved to be most efficacious for the detection of contrast enhancement. However, contrast could be demonstrated on more T2 weighted sequences.

Animals↗
PubMed1984

Hemangiopericytoma in infants and children. A report of six patients.

The case histories of six infants and children (five male and two female) with hemangiopericytoma have been reviewed (two patients were born with the tumor). The tumor originated on an extremity in three patients, in the intranasal fossa in one, in the neck and upper mediastinum in one, and in the abdomen in another. In the patients with the tumor on the extremity, the lesion was removed with a margin of normal tissue. These patients remained well for 2,8, and 1.5 years after diagnosis. In the patient with an intranasal mass, the tumor was removed, but local recurrence developed 3 months later. The recurrent tumor was removed, and the patient remained well for 10 years. The patient with the neck and upper mediastinal tumor was born with the lesion and presented with airway obstruction at 2 months of age. This patient received radiotherapy and cyclophosphamide with no apparent response. He underwent partial excision of the lesion 1 month after diagnosis but died 1 month later from massive hemorrhage into the airway. The patient with the abdominal mass had extensive retroperitoneal tumor, and excision was not possible. He received chemotherapy and radiotherapy, and although the tumor decreased in size, osseous metastases developed 4 months after diagnosis. The metastatic lesions in this child disappeared with further chemotherapy, and at second-look operation 9 months after diagnosis, the tumor was removed. Postoperatively, new bone metastasis developed but again responded to chemotherapy with complete disappearance of the metastatic lesion. The patient had no evidence of disease 16 years after diagnosis.

Adolescent↗
PubMed1984

Cardiac fungal infections: review of autopsy findings in 60 patients.

An autopsy study of 60 patients with fungal infections of the heart was undertaken. The patients ranged in age from 2 months to 79 years. Fifteen of the patients had undergone cardiac surgery; neoplasms were found in 13, renal failure in eight, bacterial infections in five, liver disease in five, gastrointestinal disorders in five, and immune disease in four; two had been intravenous drug abusers; other miscellaneous disorders were observed in three. The fungal infection was limited to the myocardium in 27 patients and to the endocardium in 17 patients. Myocardium and endocardium were involved in nine patients and pericardium and myocardium in five; two patients had pericarditis alone. The most frequent organism was Candida (62 per cent). Aspergillus (12 per cent) and Phycomycetes (12 per cent) were also found frequently. In 51 patients (85 per cent) other deep organs, usually lung, kidney, brain, or spleen were involved. Cultures for fungus had been positive in 26 patients prior to death, and postmortem cultures were positive in 29 patients. Patients who had undergone cardiac surgery had a higher incidence of endocarditis (93 per cent), with Candida (53 per cent) being the most frequent cause. Patients who had received antineoplastic drugs, antibiotics, or corticosteroids had a higher incidence of myocarditis (79 per cent), again most often due to Candida (60 per cent).

Adolescent↗
PubMed1984

Necrotizing fasciitis. A serious sequela of omphalitis in the newborn.

We reviewed all cases of omphalitis seen at Childrens Hospital of Los Angeles from 1961 to 1981. One hundred and forty patients were seen and, of these, eight had necrotizing fasciitis. All patients with necrotizing fasciitis acquired omphalitis at home, making the incidence of necrotizing fasciitis over 10% in patients with community acquired omphalitis. Most of the infants appeared relatively well on admission with no fever but had a marked leukocytosis. The disease rapidly spread to involve most of the abdominal wall over a period of several hours to days. Seven of the eight patients died (87.5%). Five patients were operated upon but despite extensive resection of involved tissue, four died within 24 hours of surgery. A polymicrobial flora of both gram positive and gram negative bacteria was recovered in all patients cultured. The high incidence of necrotizing fasciitis following omphalitis in the newborn with its attendant morbidity and mortality mandates close observation of these infants with early surgical intervention if there is any question of the diagnosis.

Bacterial Infections↗
PubMed1984

Percutaneous drainage of abdominal fluid collections in children.

Percutaneous drainage of intraabdominal fluid collections was performed in 13 children. After initial diagnosis with either sonography or computed tomography, a smallbore aspiration needle (22 gauge) was guided into the collection, usually by sonography. In five patients, complete evacuation was possible using the aspirating needle alone. In seven others, the fluid was successfully drained via a catheter introduced percutaneously. In one patient, surgery was required for complete evacuation of a hematoma containing large blood clots. There were no complications.

Adolescent↗
PubMed1984

Cardiac infections in the immunocompromised host.

Bacterial infections of the heart in compromised patients are uncommon but may be increasing in relative frequency. They are associated with near-equal frequencies in patients who have pre-existing or simultaneous infections at other sites, patients with neoplasms (usually solid tumors), those who have undergone cardiac surgery, and intravenous drug or ethanol abusers. Staphylococcus aureus is the bacteria most often identified, in contrast to a preponderance of Streptococcus isolated in the pre- and early antibiotic era. Gram-negative bacilli are the causative organisms in a significant number of cases. The endocardium remains the most common site of infection, and left-sided valves are most commonly involved, especially the mitral valve, often in the absence of pre-existing valvular damage. The majority of cases are associated with involvement at other sites, and premortem blood cultures are positive in approximately two thirds of patients who undergo autopsy. Fungal infections involving the heart do not occur as often as bacterial infections. The frequency, however, is increasing. Fungal infections usually occur in patients who have received treatment with antineoplastic agents, antibiotics, or corticosteroids, alone or in combination, or who have had abdominal or cardiac surgery. Candida is the organism found most frequently and usually causes myocarditis or endocarditis, whereas Aspergillus involves the myocardium but may be invasive to the endocardium or pericardium. Other fungi that occasionally infect the heart include Phycomycetes and Cryptococcus. Dissemination is usually present and involves the lungs, kidneys, brain, or gastrointestinal tract. The diagnosis may be difficult prior to death, because blood cultures are positive in only one third of patients who come to autopsy. Precipitin tests and antibody titers for specific organisms may be helpful in providing early diagnosis. Survival rates can be improved by early diagnosis and the institution of aggressive antifungal treatment.

Adolescent↗
PubMed1984

Ischemia of the brain stem as a cause of sudden infant death syndrome.

Recent evidence indicates that the sudden infant death syndrome (SIDS) is related to abnormal control of respiration. Focal morphologic changes have not been noted. In a case of SIDS, ischemic degeneration was noted bilaterally in the medulla, particularly in the dorsal motor nucleus of the vagus nerve. Pathologic changes were not found elsewhere in the CNS. To our knowledge, this is the first description of a focal brain-stem lesion in SIDS that had enough of a role in altered respiratory control to cause death.

Brain Ischemia↗
PubMed1983

Treatment of esophageal varices by sclerotherapy in children.

Bleeding from esophageal varices may be a serious or lethal complication of portal hypertension in children. The standard therapy over the past 30 years has been to create a portosystemic shunt. In children physiologic complications leading to high rates of perioperative morbidity and early and late thrombosis with recurrence and encephalopathy have been common. Over a 42 month period, we treated six patients aged 5 to 18 years, with endoscopic injection of 3 percent sodium tetradecyl sulfate into the varix. Five patients required only injection, whereas one underwent direct oversewing of gastric varices followed by endoscopic sclerosis of the esophageal varices which remained. A total of 38 endoscopic procedures were performed. There has been complete cessation of bleeding in two patients, minimal subsequent bleeding in two others, and anemia requiring transfusion in the last two treated. These last two patients, although still requiring occasional transfusions, have been free from hypotensive or exsanguinating hemorrhage since beginning sclerotherapy. No deaths or serious complications were encountered in this series. Follow-up has ranged from 18 to 42 months (mean 26 months). The results of this trial suggest that repeated endoscopic sclerotherapy of varices, combined with operative oversewing of gastric varices when necessary, offered a viable alternative therapy for patients with esophageal varices.

Adolescent↗
PubMed1983

The surgeon's role in chronic peritoneal dialysis.

Hemodialysis has been the mainstay for children with end-stage renal disease until a successful renal transplant is accomplished. Chronic peritoneal dialysis has been a second choice and, in special circumstances such as for small infants, children without vascular access, or patients unstable on hemodialysis, it is the only alternative. Recent refinements in peritoneal catheters and dialysis have added to the many medical, psychological, and economic advantages, resulting in the displacement of hemodialysis by peritoneal dialysis as the most frequently used modality. Forty-six patients were followed for 593 catheter months on peritoneal dialysis. A total of 74 procedures were performed, and 56 catheters were implanted. Complications included infection and mechanical occlusion of the catheter. Peritonitis occurred in 13 of the 46 patients on 56 separate occasions. There were 5 episodes of subcutaneous catheter infection. The peritonitis was treated with medical therapy alone in 50 of the 56 episodes of peritonitis. Mechanical occlusion in 10 patients and remedial surgery was required in 9. Of the total series, 4 patients were returned to hemodialysis and 5 patients died. Based on this experience we have developed guidelines to assist the surgeon in preventing and treating the various complications associated with chronic peritoneal dialysis.

Adolescent↗
PubMed1983

Pulmonary blastomycosis: filamentous forms in an immunocompromised patient with fulminating respiratory failure.

A 72-year-old woman with Sjögren's syndrome manifested acute fulminating respiratory failure and was treated with high-dose corticosteroids. Autopsy revealed overwhelming pulmonary infection by Blastomyces dermatitidis with no evidence of extrapulmonary dissemination. Hyphal forms, usually not observed in vivo, were noted in premortem sputum samples as well as in sections of lung obtained at autopsy. It is proposed that the immunocompromised state of the patient played a pathogenetic role in the fulminating clinical course as well as in the production of filamentous forms of B. dermatitidis.

Aged↗
PubMed1982

Morphologic abnormalities of erythrocytes from patients with homozygous familial hypercholesterolemia.

Erythrocytes from patients with various disorders of lipoprotein metabolism have been found to have abnormal morphology. We report morphologic abnormalities of erythrocytes from two patients with homozygous familial hypercholesterolemia (HFH), in which knisocytes, stomatocytes and crenated cells were observed. The membrane lipid and phospholipid fatty acid composition of HFH erythrocytes was not significantly different from controls. HFH erythrocytes incubated in HFH patient plasma and a lipoprotein-rich fraction of HFH plasma appeared morphologically similar to erythrocytes from HFH patients. These studies support the concept that serum lipids exert an important role in the regulation of erythrocyte morphology in the normal state, as well as in patients with disorders of lipoprotein metabolism.

Cholesterol↗
PubMed1982

Blastomyces dermatitidis and the adult respiratory distress syndrome. Case reports and review of the literature.

The adult respiratory distress syndrome (ARDS) developed in 2 patients with blastomycosis. In one, ARDS apparently followed the rupture of an infected subcarinal lymph node into a bronchus. Extensive involvement of alveoli with Blastomyces dermatitidis was noted at autopsy in both patients. Four additional cases of blastomycosis with definite or presumed ARDS are reviewed. The clinical course of these 6 patients was characterized by a prolonged prodrome (median, 36 days), consistent with pulmonary blastomycosis, and a rapid demise (median, 5 days) associated with ARDS.

Aged↗