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Biomedical subjects

J E Edwards

Publications and source records attributed to J E Edwards.

At least 325 records · Page 18Linked to original sources
PubMed1975

Cor triatriatum: study of 20 cases.

Twenty cases of cor triatriatum are reported. The diagnosis was confirmed by necropsy in 16 cases and at the time of operation in 4. The lesion occurred as an isolated anomaly in 7 cases; in 13, other associated cardiac anomalies were present. Three anatomic types of cor triatriatum were identified in the cases studied at necropsy: diaphragmatic (10 cases), hourglass (3) and tubular (3). The diaphragmatic type was also present in all four cases in which the diagnosis was confirmed at operation. Associated anomalies were found in five cases of the diaphragmatic type and in each case of the hourglass of tubular types. In isolated cor triatriatum the clinical findings were characteristic of pulmonary venous and arterial hypertension. In two cases, one with a communication between the right atrium and the accessory left atrial chamber and one with partial anomalous pulmonary venous connection associated with cor triatriatum, the clinical findings suggested a large left to right shunt with pulmonary arterial hypertension. The clinical findings varied in the cases with associated anomalies, and it was difficult to determine the cause of disturbance of the circulation.

Adolescent↗
PubMed1975

Hematogenous candida osteomyelitis. Report of three cases and review of the literature.

Candida osteomyelitis of the spine and intervertebral disc developed in three patients without evidence of back trauma of overlying cutaneous infection. Two patients were prone to the development of disseminated candidiasis by the use of multiple antibiotics and other predisposing modalities following abdominal surgery. One patient had no identifiable cause for development of the infection. The diagnosis was established in all three cases by x-ray evidence of osteomyelitis and culture from needle aspirate. Two patients had bone scans consistent with infection. Each patient received different therapy. One was treated with amphotericin B, one with spinal fusion and 5-fluorocytosine, and one with no antifungal therapy. All patients had complete healing of the involved vertebrae. Candida organisms have the potential to cause destructive bone infection following hematogenous dissemination. The presence of Candida osteomyelitis may be helpful in diagnosing disseminated candidiasis.

Aged↗
PubMed1975

Experimental hematogenous endophthalmitis caused by Candida albicans.

For a rabbit model of hematogenous endophthalmitis caused by Candida, 80 New Zealand white rabbits were given intravenous injections of 10-5 Candida albicans. Two weeks after infection 88 percent of infected rabbits had ocular lesions with clinical appearance identical to that of human lesions. Cultures of the chorioretina and kidneys averaged 10-4.3 and 10-3.9 organisms per g of tissue, respectively, three days after infection and remained positive for 38 days. Ninety-five percent of rabbits with positive cultures of the chorioretina had positive cultures from other organs. The ocular lesions were focal chorioretinitis characterized by a combination of granulomatous and acute suppurative reactions. Hematogenous endophthalmitis caused by Candida in the rabbit is a useful model for study of the pathogenesis and treatment of the disease in humans.

Animals↗
PubMed1975

Synergism of amphotericin B and 5-fluorocytosine for candida species.

The in vitro activity of amphotericin B and 5-fluorocytosine against 40 isolates of different species of Candida was studied. Synergism was seen in 35 of 40 organisms studied (88%) with achievable serum concentrations of the antibiotics. Synergism was striking in many strains that were resistant to 5-fluorocytosine. When the minimal inhibitory concentration of 5-fluorocytosine was greater than 400 mug/ml, synergism was seen in 18 of 20 isolates of Candida (90%).

Amphotericin B↗
PubMed1975

Bacterial endocarditis in subjects 60 years of age and older.

Forty-two cases of bacterial endocarditis with pathologic confirmation are reviewed. Infection was restricted to one or both left-sided valves in 31 cases, right-sided valves in five cases, and valves in both sides of the heart in six cases. In those specimens available for review, underlying valvular disease was identifiable in 24 of 38 cases (63%). The common underlying diseases, in order of decreasing frequency, were calcified or otherwise deformed aortic valves (11 cases) and rheumatic fibrosis of the mitral valve (eight cases). The floppy mitral valve was the underlying condition in two cases and amyloid infiltration of the tricuspid valve in one. Among the 34 cases from which a specific organism was identified, the dominant organisms were Staphylococcus (14 cases) and various types of Streptococci(ten cases). Fungi were the causative organisms in two cases. The clinical suspicion for the presence of bacterial endocarditis was low (40% of 40 cases with adequate data). In those cases with adequate data, murmurs were present in 68% and fever in 93%. Of those patients with fever, clinical diagnosis was made or suspected in only 38%. When a murmur was present, the clinical diagnosis was made or suspected in 54% of the cases, while when a murmur was absent the disease was suspected in only 9% of the cases. The clinical diagnosis of bacterial endocarditis in older subjects depends upon 1) knowledge that the disease may occur in such subjects and 2) recognition that, although fever is commonly present, murmurs may be absent.

Age Factors↗
PubMed1975

True and false left ventricular aneurysms. Propensity for the altter to rupture.

Two cases are described of sudden death resulting from rupture of small chronic false aneurysm of the left ventricle with secondary hemopericardium. The cases support the point that rupture of chronic false left ventricular aneurysm tends to occur. This appears to be contrary to the potential for chronic true aneurysms of the left ventricle which tend not to rupture. Rupture of true left ventriuclar aneurysm in its deveoping stahe may, however, occur.

Aged↗
PubMed1975

Prosthetic aortic valvular endocarditis.

Infective endocarditis (IE) continues to be one of the most serious complications following cardiovascular surgery, particularly that for replacement of valves. In order to define more clearly the clinical course and the role of surgical therapy, clinical and necropsy data were reviewed in 16 adult patients with prosthetic aortic valvular endocarditis (PAVE) and compared with the experience cited in the literature. Positive blood cultures were obtained in each of the patients with bacterial endocarditis. Gram positive bacteria predominate and the onset of infection is usually later than 25 days postoperatively. In 11 of 16 patients, aortic insufficiency was recognized. Autopsy material demonstrated large perivalvular abscesses which loosened the attachment of the prosthetic valve in each case and which made successful operation unlikely. Aortic insufficiency appears to be of prognostic importance, since patients who developed aortic insufficiency early in the course of PAVE died. Survivors included patients who made an excellent response to medical therapy and who either did not develop aortic insufficiency or developed aortic insufficiency either late in the course or even after cure of PAVE, Poor response to medical therapy and progressive aortic insufficiency even in the absence of left ventricular failure appear to be indications for prompt surgical replacement of the prosthetic aortic valve.

Adult↗
PubMed1975

Pathology of stable and unstable angina pectoris.

The clinical and pathological data from 46 patients who died during or shortly after coronary bypass surgery and one patient who died shortly after angiography were studied. Each patient was placed into one of three clinical categories of angina pectoris. Twelve were classified as having unstable angina pectoris, 20 as stable severe angina, and 15 as stable moderate angina. No significant difference was found between the three catagories whem age, sex, presence of hypertension, lipid abnormalities, diabetes, smoking, family history of myocardial infarction, or history of previous mycardial infarction were examined. Most patients in all classes of angina had extensive atherosclerotic coronary disease: 12 patients had triple vessel plus left main disease; 25, triple vessel disease; nine double vessel disease; and only one, single vessel disease. There was no difference in severity or distribution of coronary disease when the three catagories of angina were compared. Thirty-six of the 47 patients had evidence of scarring of one or more aspects of the left ventricular wall. There was likewise no significant difference between extent and distribution of myocardial scarring between the three clinical categories. Four of the 12 patients with unstable angina pectoris had pathologic evidence of preoperative myocardial infarction, whereas this was not found in any of the 35 patients with stable angina.

Age Factors↗
PubMed1975

Hypertensive pulmonary vascular disease associated with patent ductus arteriosus. Primary or secondary?

In an infant with patent ductus arteriosus and pulmonary hypertension, elevated pulmonary vascular resistance persisted following ligation of the ductus. Histologic examination of a pulmonary biopsy at two years of age and tissue obtained at autopsy at three years of age showed obstructive pulmonary vascular disease. The question as to whether the organic vascular lesions are secondary to the effects of the patent ductus or part of pulmonary hypertension cannot be resolved. The age of the patient favors a primary etiology.

Age Factors↗
PubMed1975

Alternate pathways to pulmonary venous flow in left-sided obstructive anomalies.

In cardiac anomalies causing severe obstruction in the left side of the heart, such as aortic atresia, mitral atresia, or occasionally severe aortic stenosis, maintenance of circulation depends upon shunting of pulmonary venous blood into the right atrium. The usual pathway by which the shunt is achieved is across the atrial septum through the foramen ovale. When this route is closed or severely narrowed, alternate but less common pathways may exist. These involve either anomalous connections of pulmonary veins to systemic veins or communications with the coronary venous system. In the latter, as commonly occurs in aortic atresia, left ventricular myocardial sinusoids carry pulmonary venous blood from the left ventricular cavity and into the cardiac veins. In other instances of severe left-sided obstruction, a direct communication may exist between the left atrium and the coronary sinus.

Aortic Valve↗
PubMed1975

Congenital heart malformations associated with disproportionate ventricular septal thickening.

Asymmetric septal hypertrophy, or ASH, is a genetically determined myocardial disorder that is transmitted as an autosomal dominant trait. ASH is characterized by a disproportionately thickened ventricular septum that contains numerous hypertrophied, bizarrely-shaped and disorganized cardiac muscle cells. Disproportionate hypertrophy of the ventricular septum has also been observed in association with certain congenital cardiac malformations. To determine whether such congenital cardiac malformations are part of the disease spectrum of genetically determined ASH, cardiac pathologic observations were made in eight patients with disproportionate septal thickening (ventricular septal to posterobasal left ventricular free wall thickness ratios of 1.5 to 2.5) and the following three categories of associated lesions: 1) parachute deformity of the mitral valve (occurring either as an isolated lesion or with ventricular septal defect, coarctation of the aorta, supravalvular ring of the left atrium, or double outlet right ventricle); 2) complete interruption of the aortic arch; and 3) ventricular septal defect. The arrangement of cardiac muscle cells in the disproportionately thickened ventricular septum was normal in six of the eight patients; in the other two patients (one with parachute deformity of the mitral valve and one with ventricular septal defect) numerous bundles of hypertrophied cardiac muscle cells were interlaced in a disorganized fashion among more normally arranged bundles of cells. First degree relatives of six of the eight patients were studied by echocardiography and found to have normal ventricular wall thicknesses and septal-free wall ratios. It is concluded that disproportionate ventricular septal thickening may occur in patients with a variety of congenital heart malformations, but that such a finding is not necessarily a manifestation of the disease spectrum of genetically determined ASH.

Adult↗
PubMed1975

Double-outlet right ventricle associated with persistent common atriventricular canal.

A variant of double-outlet right ventricle (DORV) associated with common atrioventricular (A-V) canal was identified. As yet, this syndrome has not been successfully repaired. Of 16 patients with this diagnosis, 14 had the diagnosis confirmed at postmortem examination and two had the diagnosis confirmed by exploratory cardiotomy. The 16 patients were divided into two groups according to the position of the cardiac apex: group 1, ten patients with levocardia, and group 2, six patients with dextrocardia and ventricular inverson. When pulmonary stenosis was present, the clinical presentation was similar to that in tetralogy of Fallot, and when such stenosis was not, the presentation was similar to that in ventricular septal defect with bidirectional shunting. The electrocardiogram had the typical feature of common A-V canal. The right ventricular angiocardiogram had features typical of DORV. The left ventricular angiocardiogram revealed left ventricular outflow deformity typical of A-V canal in patients with levocardia but not in those with dextrocardia. Splenic anomalies were commonly seen (nine of the 16 patients). Asplenia was present in seven, and polysplenia in two. Ten patients had persistent left superior vena cava, seven had common atricum, six had anomalous pulmonary venous connection, and three had subaortic stenosis. Twelve of the 16 patients had pulmonary stenosis. Of the 16, 14 had common A-V canal (Rastelli type C) and two had a ventricular septal defect of the persistent common A-V type.

Adolescent↗
PubMed1975

Studies of adoptees from psychiatrically disturbed biological parents: psychiatric conditions in childhood and adolescence.

Psychiatric problems were assessed in two groups of adoptees by interviewing the adopting parents. One group of 59 adoptees, the "experimental', were born of psychiatrically disturbed biological parents; the other group, the "control' of 54 adoptees, had psychiatrically "normal' biological parents. Both groups had been separated from biological parents at birth. The incidence of psychiatric conditions requiring professional care was significantly higher in the experimental than in the controls (37 per cent vs. 14 per cent). In the experimental group more males than females were disturbed (59 per cent vs. 30 per cent). Most of the excess of disordered males were diagnosed hyperactive. There was some evidence of correlation of the type of psychiatric diagnosis of the biological parent with that of the adoptee.

Adolescent↗
PubMed1975

Ventricular inversion associated with normally related great vessels.

A patient with ventricular inversion with normally related great vessels and double inlet left ventricle is presented. the patient also showed features of Down's syndrome. Association of ventricular inversion with normally related great vessels is rare and leads to a basic functional state like that of complete transposition of great vessels derived from the connections between the ventricles and great vessels. The association of ventricular inversion with Down's syndrome observed in the case reported represents a rarity.

Aorta↗
PubMed1975

Recurrent myxosarcoma of left atrium.

The surgical treatment of cardiac myxosarcoma is reviewed with emphasis placed on palliative response to radiation therapy. A case of primary myxosarcoma of the left atrium in a 16-year-old girl is presented. The tumor was surgically removed in October, 1967. Recurrently myxosarcoma was removed in August, 1968, at which time involvement of the pulmonary veins and the pericardium was noted. Subsequent to postoperative radiation therapy, the patient remained symptom-free for more than three years. Death occurred 4 1/2 years after the original operation from local and systemic recurrence of the tumor.

Adolescent↗