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Biomedical subjects

J J Andy

Publications and source records attributed to J J Andy.

27 records · Page 2Linked to original sources
PubMed1977

Trichinosis causing extensive ventricular mural endocarditis with superimposed thrombosis. Evidence that severe eosinophilia damages endocardium.

Clinical and morphologic observations are described in a 46 year old woman with fatal trichinosis. Attention is called to the occurrence of extensive ventricular endocardial damage with superimposed thrombosis; Evidence is presented to indicate that the most likely cause of the endocardial damage is the associated eosinophilia. The mechanism by which eosinophils damage endocardium, however, remains obscure.

Coronary Disease↗
PubMed1977

Cardiovascular effects of dobutamine in severe congestive heart failure.

The effects of continuous infusion of dobutamine 5 to 15 microgram/Kg./min. were studied in 17 patients using right heart catheterizations, echocardiography, and/or the Systolic Time Intervals. HR increase was dose-related, but insignificant (p less than 0.05) rate increase was obtained at infusion rates below 15 microgram/Kg.)min. C.O. increased from 2.9 +/- 0.7 to 5.0 +/- 1.2 liters/min. (p less than 0.001), and the stroke volume from 30 +/- 6 to 49 +/- 14 ml./min. (p less than 0.005). The mean BP did not change, P.A.W.P. decreased from 30 +/- 7 to 20 +/- 8 mm. Hg (p less than 0.001) and R.A.P. from 20.0 to 12.0 mm. Hg (p less than 0.005). The P.E.P.I. decreased from 160.93 +/- 54.91 to 133.4 +/- 28.7 msec. (p less than 0.050). Echo-determined mean VCf increased from 0.387 +/- 0.14 to 0.537 +/- 0.13 cm. (p less than 0.010), diastolic diameter did not change significantly, but the end systolic diameter decreased from 6.020 +/- 0.69 to 5.750 +/- 0.70 cm. (p less than 0.025). During a mean infusion period of 75 hours, the only side effects noted were transient nausea and/or vomiting at 15 microgram/Kg./min. dose range in two patients, and multifocal P.V.C.'s following 68 hours of infusion in another patient. It is concluded that in the dose range of 5 to 15 microgram/Kg./min., dobutamine is well tolerated and is a very potent inotropic agent with only minor effects on the heart rate and blood pressure.

Adult↗
PubMed1977

Staphylococcal endocarditis: clinical observations on 113 patients.

A 10-year analysis of 113 cases of staphylococcal endocarditis seen in two Washington, D.C., hospitals is presented. 96% of the cases occurred in parenteral drug addicts, but 4% complicated septicemia from known foci of infection. Coagulase positive staphylococcus was responsible for 97% of the infection, and the rest were caused by coagulase negative staphyloccus. Except in four patients with previously known cardiac murmurs, infection occurred on normal valves in these patients. Infection was isolated to the tricuspid valve in 71%, to the mitral valve in 6% and to the aortic valve in 3.5% of our cases; and more than one cardiac valve was affected in the remaining patients. All patients were treated with antibiotics based on bacterial sensitivity testing. The mortality from isolated tricuspid endocarditis was 5%, from isolated mitral endocarditis 33%, and from isolated aortic valve endocarditis 100%. The overall mortality was 18%. The better prognosis documented for acute tricuspid endocarditis is related to the much less severe haemodynamic consequences of acute tricuspid regurgitation, and the probably milder consequences of septic pulmonary embolism compared with coronary or cerebral embolism.

Adolescent↗
PubMedDate not supplied

Aetiology of endomyocardial fibrosis (EMF).

On epidemiological basis EMF behaves like a vector transmitted disease. The cardiac pathologies of EMF and HES are identical. In some cases of HES, hypereosinophilia may return to normal, leaving residual heart disease that is exactly like EMF. Most temporary residents from Europe and North America who developed EMF while resident in the endemic areas of Africa had hypereosinophilia that was induced by helminths. In our case studies from the EMF endemic areas of Nigeria, most children with acute idiopathic myocarditis associated with helminth induced hypereosinophilia, developed clinical EMF on follow up. We showed also that the rate of decline in the incidence of hypereosinophilia in EMF cases was significantly related to the duration of symptoms. Our studies and other observations show that EMF, like HES is a multiple system disease with similar organ damage. The morphologic evolution of cardiac damage in EMF appears similar to that reported for HES; with a stage of myocarditis/pericarditis, followed by a stage of cardiac necrosis, a stage of thrombosis and by the chronic fibrotic stage. Also during larval migration, all the helminths associated with EMF induce the same spectrum of damage in the central and peripheral nervous system, in the lungs, kidneys and skin, as are reported for HES. The cardiovascular damage reported for these worms (which include hypersensitivity vasculitis, acute myocarditis/ pericarditis) are also similar to what is reported for HES. Acute endomyocardial necrosis and thrombosis that are similar to what is found in HES, have been documented in Trichinella Spiralis and in filariasis. Increased cerium concentrations have been documented in the endocardium of EMF cases from South India. It remains to be established whether cerium excess, which is known to stimulate collagen synthesis does accelerate the process of endomyocardial fibrosis, following cardiac necrosis (which may have been triggered by helminths and the associated hypereosinophilia).

Animals↗
PubMedDate not supplied

Empyema thoracis in Nigerians: experience with a policy of conservative operative management.

A combined retrospective and prospective review of 150 children and 28 adult Nigerian empyema thoracis patients was conducted between 1978 and 1986. Comorbidity requiring additional treatment was present in 145 patients (82.5%) while 175 patients (98.3%) had no, low or medium family income. In addition to medical management 161 out of 178 patients (90.4%) had tube thoracostomy while eight (4.4%) and seven (3.9%) respectively required additional minor and major thoracic procedures for failure of tube thoracostomy and arrest of, or failure to achieve, progressive pulmonary re-expansion and resolution of concomitant illness. Mean period of in-patient care was 30.5 days +/- 30.3. In spite of limitation of resources and poor clinical condition of most patients reduction of onset-diagnosis and diagnosis-treatment intervals and our overall management significantly reduced the perioperative mortality from 15.1% during the retrospective study period to 4.8% during the prospective period for a 9% overall perioperative mortality rate.

Adolescent↗
PubMedDate not supplied

Helminthiasis, the hypereosinophilic syndrome and endomyocardial fibrosis: some observations and an hypothesis.

It has been shown that chronic African endomyocardial fibrosis (E.m.f.) is most likely the burnt-out phase of parasite-induced hypereosinophilia. It has also been shown that African E.m.f. and Loffler's heart disease are pathologically identical. The mechanism by which these parasites and/or eosinophilia are associated with endomyocardial damage remains, however, unknown. The parasites which have been associated with induction of eosinophilia in E.m.f. include filariasis; trichinosis; ascariasis and hookworm and schistosomiasis. These parasites are known to produce neurologic, cardiac, pneumonic, hepatic and dermal damage during the migration of their larvae; at which time eosinophilia is usually most severe. The tissue damage induced by larval migration of these parasites appears comparable to findings seen in the hypereosinophilic syndrome. The evidence from our observations and this review suggests that the cardiac damage induced by larval migration, like the neurologic, pneumonic and dermal damage, is allergic in nature. Endomyocardial fibrosis has previously been shown to be an allergic heart disease. It appears reasonable to regard African endomyocardial fibrosis as representing the most intense, non-specific cardiac allergic reaction to helminthic larvae.

Adolescent↗