Translunate scapho-radial fracture. A case report.
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Adolescent↗
Biomedical subjects
J Noble
Publications and source records attributed to J Noble.
Early posterior subtalar fusion in the treatment of fractures of the os calcis.
Displaced fractures of the os calcis involving the subtalar joint frequently cause chronic disability due to subsequent osteoarthritis. Early posterior subtalar fusion may prevent this outcome. We have reviewed forty-seven fractures in forty-three patients at an average of seven years after operation. Over 90 per cent of patients had an excellent, good or satisfactory result.
Adult↗
[Permeability of venous aortocoronary bypass 5 years later].
47 consecutive patients who had undergone aorto-coronary venous bypass surgery (mean: 1.6 graft per patient) have been investigated after a mean follow-up period of 5 years and 9 months (range: 44-108 months). 52 grafts out of 73 were found to be patent (71 p. 100), the best patency rate being shown by grafts on the LAD artery (27/32 = 85 p. 100). Long-term graft patency may be associated with an improved left ventricular ejection fraction; 77 p. 100 of the total patients experienced a lasting clinical benefit from the operation.
Adult↗
Cellular content of amniotic fluid as predictor of central nervous system malformations.
Prospective observations on 442 consecutive samples have confirmed that pregnancies with CNS malformations are regularly associated with an abnormal cellular content of amniotic fluid. A crude semiquantitative test of the cell content can give valuable clinical information in relation to borderline amniotic fluid alpha-fetoprotein values, and help to detect false positive AFP's.
Amniocentesis↗
[Myocardial perfusion in myocardiopathies: study at rest and during induced tachycardia].
The authors have compared myocardial perfusion, i.e. the coronary blood flow per unit of myocardial mass, in 9 patients with cardiomyopathy and 5 normal subjects, both at rest and during coronary sinus pacing-induced tachycardia at a rate of 150 beats/mn. In the cardiomyopathies, myocardial perfusion was found to be decreased at rest, and to remain abnormally low during induced tachycardia despite the evidence for a significant coronary reserve. During pacing there were, in addition to induced chest pain, indirect signs of sub-endocardial ischaemia which could explain the angina of effort found in certain cardiomyopathies, especially those of the obstructive hypertrophic type.
Cardiac Pacing, Artificial↗
Responsibilities and strategies for maintaning standards of nursing practice.
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Accreditation↗
Dysprosium-165 ferric hydroxide macroaggregates for radiation synovectomy.
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Animals↗
Experimental limb lengthening by epiphyseal distraction.
Kirshner wires were placed either side of the right distal femoral epiphysis and a constant tension device applied a distracting force across the plate in rabbits. Growth increase was measured between the wires and found to be about 150% greater than the concurrent normal growth between 2 control (undistracted) wires on the left; such growth increase can occur in the absence of fracturing. The forces required to do this were between 1/5 and 1/10 of those shown to cause fracturing in vitro. The growth increase was shown to be associated with hyperplasia and hypertrophy of the plate, as well as an increased rate of cell division and sulfated polysaccharide synthesis. This was in turn shown to be associated with an increase in new bone formation.
Animals↗
[Modifications of the coronary blood flow and of myocardial lactate metabolism due to pacing in coronary disease].
The variation of coronary sinus blood flow during pacing-induced tachycardia shows no direct correlation with the number of affected coronary arteries. As a functional test, total coronary blood flow is a parameter with low sensitivity in characterizing patients with coronary artery disease and thus appears unsuitable in the selection of patients for medical or surgical treatment. The thermodilution technique remains useful for the assessment of the effects of new drugs on the heart, for the evaluation of a therapeutic intervention, and for the selective measurement of regional myocardial perfusion in the anterior interventricular vein.
Adult↗
Successful course after supraarterial myotomy for myocardial bridging and milking effect of the left anterior descending artery.
We report 3 patients having a grade II milking effect of the proximal left anterior descending artery (LAD) and suffering from angina. Preoperative myocardial ischemia was demonstrated by stress ECG in all 3 and by pacing and lactates studies in 2. Surgical decompression of the systolically constricted artery has resulted in disappearance of angina, milking, and ischemia. Severe milking of the LAD is a rare entity, probably congenital in origin, capable of producing myocardial ischemia and possibly causing sudden death. More studies regarding its etiology and pathophysiology are necessary. Biopsy of the myocardium surrounding the artery could be useful.
Adult↗
Atrial tachycardia without P waves masquerading as an A-V junctional tachycardia.
Two patients who presented by scalar ECG with an A-V junctional tachycardia were demonstrated during an electrophysiologic evaluation to have an atrial tachycardia without P waves in the surface ECG. Case 1 had an atrial tachycardia that conducted through the A-V node with a Wenckebach block. Atrial activity was recorded only from the proximal portion of the coronary sinus and from right atrial areas near the tricuspid valve. Case 2 had an atrial tachycardia that abruptly began and terminated following carotid sinus massage. Atrial activity was recorded only in the coronary sinusos, and pacing at that site resulted in atrial capture, with Wenckebach conduction to the ventricles. These observations demonstrate that an atrial tachycardia without P waves can simulate A-V junctional tachycardia with or without Weckebach block. Such findings may have a bearing on some important electrophysiologic concepts such as the origin of A-V junctional rhythms and the need for atrial participation in A-V nodal re-entry.
Atrioventricular Node↗
Lesions of the menisci. Autopsy incidence in adults less than fifty-five years old.
The menisci were removed from the knees of seventy autopsy subjects less than fifty-five years old and 18.6% exhibited at least one horizontal cleavage lesion. Seven per cent of 200 autopsy subjects showed at least one discoid lateral meniscus, and it is suggested that neither these nor the horizontal cleavage lesions had caused symptoms during the lifetime of each subject. Microscopic signs of degeneration were seen in 76% of the grossly normal medial menisci examined. Medial menisci not only have a larger surface area than lateral menisci but are broader and thicker posteriorly. It may be that the greater thickness of the medial meniscus posteriorly renders it more vulnerable because there is less nutritional diffuse of synovial fluid.
Adolescent↗
[Diagnosis of myocardial infarct by means of a quick determination of the MB fraction of serum creatinephosphokinase].
A rapid method of determining creatine phosphokinase (CPK) isoenzymes using dithiothreitol, a reducing agent which activates the main fractions of the CPK molecule (MM and MB), was assessed in 68 subjects (34 with myocardial infarction, 18 with skeletal muscle lesions, 16 normal). In acute myocardial infarction, the mean peak of CPK-MB in serum increases to 13.3% of the total CPK (range 8.8% to 21%) from the 18th to the 24th hour after onset of symptoms, whereas in skeletal muscle lesions CPK-MB reaches only 1% of total CPK (range 0% to 2.9%), and in normal subjects CPK-MB is absent. This highly significant difference (p less than 0.001) makes it possible to distinguish accurately between myocardial infarction and skeletal muscle lesions (trauma, hematoma, myositis, hypothyroidism). By its sensitivity (100%) and specificity (97%) this rapid and inexpensive method finds its optimal sphere of application in emergency wards and coronary care units.
Creatine Kinase↗
[Hemodynamic significance of myocardial bridging and milking effect of the anterior interventricular artery: a mild variant or source of angina?].
A hemodynamic study was conducted in 11 patients with myocardial bridging and milking effect (ME) of the left anterior descending artery (LADA), but with otherwise normal coronary arteries. During pacing, patients with grade III ME (over 75% narrowing of arterial size during systole) showed anterior wall ischemia, lactate production and severe angina. Thus, grade III ME observed on coronary arteriography may result in significant obstruction of the LADA with typical angina. Surgical treatment is worth considering in symptomatic patients with this rare anomaly.
Angina Pectoris↗
Systemic vasodilatation following diazepam after combined sympathetic and parasympathetic blockade in patients with coronary heart disease.
Clinical and hemodynamic benefits have been documented after giving diazepam to patients with coronary heart disease. The mechanisms by which this agent produces its hemodynamics effects are poorly understood. Partial autonomic blockade was induced in 10 patients by the intravenous administration of 5 mg propranolol and 0.8 mg atropine. Coronary and systemic hemodynamics were normal before and unchanged (p greater than 0.05) after propranolol and atropine administration. However, myocardial extraction of lactate improved in 9 out of 10 patients (from 11% to 24%, p less than 0.05). The patients then received 0.1 mg/kg diazepam intravenously. Diazepam had no effect on the coronary sinus blood flow and resistance while myocardial extraction of lactate further improved in all but one patient (from 24% to 35% at 5 min and 34% at 15 min, p less than 0.05). Heart rate increased by a mean of 4 beats at 5 min (p less than 0.01). Cardiac output was unchanged. Systolic arterial pressure (SAP) decreased significantly (p less than 0.001) at 5 and 15 min (6-10%) and left ventricular end-diastolic pressure (LVEDP) also diminished significantly (p less than 0.001) at 5 and 15 min (18-19%). These changes occurred despite autonomic blockade. These findings suggest, in the absence of change of myocardial blood flow and contractility, a direct peripheral action of the drug on arteries and/or veins.
Adult↗
Myocardial bridging and milking effect of the left anterior descending coronary artery: normal variant or obstruction?
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Adult↗
Open palm technique for Dupuytren's contracture.
A study of the pre-operative condition of seventy-five hands afflicted with Dupuytren's contracture is followed by an analysis of the results of limited fasciectomy approached by midlateral digital and transverse palmar excisions. The palmar wounds were left open and healing occurred with minimal complications. The correction of contractures compares favourably with that achieved using other techniques of access and wound closure.
Adult↗