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Biomedical subjects

J C Forfar

Publications and source records attributed to J C Forfar.

64 records · Page 4Linked to original sources
PubMed1980

The management of ventricular septal rupture following myocardial infarction.

Twenty-six patients were treated for ventricular septal rupture following myocardial infarction over a five year period. Twenty-three patients underwent full haemodynamic investigation with a view to surgery and nineteen underwent operative closure of the defect. Overall hospital mortality was 47 per cent in the surgical group. Eleven patients had surgery within two weeks of infarction because of marked haemodynamic deterioration soon after septal rupture but only two survived to leave hospital. Eight patients underwent operation two weeks or longer after infaction, all were alive and well at discharge from hospital, six were well at one year and four at three years. Seven patients did not undergo surgery and the maximum survival for these was eight months. No patient in cardiogenic shock before septal rupture benefited from repair. Rapid clinical deterioration following rupture carried a poor prognosis. In all the shunt was large and medical treatment was ineffective. It is concluded that early surgical repair should be considered except when cardiogenic shock antedates the septal rupture.

Aged↗
PubMed1979

Occult thyrotoxicosis: a correctable cause of "idiopathic" atrial fibrillation.

Serum total thyroxine, triiodothyronine and thyrotropin response to thyrotropin-releasing hormone were measured in 75 consecutive patients presenting to a cardiology clinic with atrial fibrillation with no obvious cardiovascular cause. A lack of response of serum thyrotropin to thyrotropin-releasing hormone, indicative of thyrotoxicosis, was found in 10 patients (13 percent), not all whom had raised serum thyroid hormone levels. These 10 patients were predominantly male, had no clinical signs of thyrotoxicosis and a relative excess of nonpalpable autonomous thyroid nodules demonstrated with scintigraphy. Eight of the 10 patients had reversion to stable sinus rhythm after treatment with iodine-131 or carbimazole, either spontaneously or after direct current cardioversion. It would appear that clinically occult thyrotoxicosis can be identified consistently only with the thyrotropin-releasing hormone test and is the cause of "idiopathic" atrial fibrillation in a significant proportion of patients.

Aged↗
PubMed1979

Ectopic ACTH syndrome from bronchogenic carcinoma in association with chronic lymphocytic leukaemia.

A patient under treatment for chronic lymphocytic leukaemia developed lobar pneumonia after 8 months. When antileukaemic therapy was discontinued, features of an ectopic ACTH syndrome developed, secondary to bronchogenic carcinoma. Exogenous steroid therapy for leukaemia seemed to suppress the clinical manifestations of the ectopic ACTH syndrome while subsequent endogenous steroid production controlled the peripheral lymphocyte count.

ACTH Syndrome, Ectopic↗
PubMed1979

Superior vena caval stenosis: a complication of transvenous endocardial pacing.

Superior vena caval obstruction is a rare complication of transvenous endocardial pacing and is usually the result of thrombus formation round the pacing electrode (Kosowsky and Barr, 1972). We report a case of superior vena caval obstruction without thrombus formation secondary to localised stenosis at the site of the proximal cut end of a retracted endocardial electrode. This complication of transvenous pacing electrodes has not been described previously.

Constriction, Pathologic↗
PubMed1978

Severe and early stenosis of porcine heterograft mitral valve.

A patient who had aortic and mitral valves replaced by Carpentier porcine heterografts for bacterial endocarditis developed severe heart failure 18 days after operation. A second emergency operation revealed that the mitral prosthesis had become severely stenosed and calcified. A loud Graham Steell murmur had developed during the 12 hours before reoperation but no distinct murmurs of mitral stenosis had been detected.

Adult↗
PubMedDate not supplied

Alpha-adrenoceptor control of norepinephrine release from acutely ischaemic myocardium: effects of blood flow, arrhythmias, and regional conduction delay.

We studied the effects of yohimbine, and alpha-adrenoceptor blocker with selectivity for the alpha 2-subtype, on myocardial norepinephrine (NE) overflow, regional myocardial blood flow (RMBF), and patterns of epicardial conduction abnormalities during occlusion of the proximal left anterior coronary artery in an open-chest anaesthetised dog model. With a 12-min period of coronary occlusion (n = 9), spontaneous overflow of NE into ischaemic venous effluent was not observed either before or after yohimbine (1 mg/kg i.v.), but the drug significantly potentiated the enhanced NE overflow during supramaximal stimulation of the left stellate ganglion at low (1 Hz) and high (10 Hz) frequency [peak NE 4.3 +/- 0.4 pmol/ml control; 11.8 +/- 5.4 pmol/ml yohimbine (p less than 0.005)] with a delayed return towards prestimulation levels. Myocardial NE overflow on coronary reperfusion was also enhanced. Yohimbine increased arterial epinephrine two- to threefold but did not substantially alter myocardial lactate overflow during coronary occlusion. RMBF was reduced 24 and 36% to ischaemic endocardium and epicardium, respectively (p less than 0.01, compared with control occlusion). This contrasted with a 9 and 6% decrease in flow to the respective nonischaemic areas (p = NS, compared with control occlusion. Spontaneous ventricular fibrillation and the area and magnitude of epicardial conduction abnormalities in the ischaemic myocardium were both increased compared with the control occlusion. Thus, alpha-blockers with selectivity for the alpha 2-adrenoceptor may be detrimental to acutely ischaemic myocardium, presumably through increased local catecholamine release at the nerve terminal.

Animals↗