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Biomedical subjects

J R Rees

Publications and source records attributed to J R Rees.

At least 37 records · Page 2Linked to original sources
PubMed1986

Onset of right-to-left shunting through a foramen ovale in a 70-year-old woman: successful surgical treatment.

A 70-year-old woman presented with disabling breathlessness. She was found to have severe arterial hypoxaemia due to isolated right-to-left shunting through a patent foramen ovale. In the absence of pulmonary hypertension or evidence of right ventricular dysfunction this is attributed to reduced right atrial compliance. The phasic nature of the shunt, which occurred only during atrial filling, supports this view. Surgical closure of the foramen abolished the hypoxaemia and her symptoms.

Aged↗
PubMed1986

Dipyridamole combined with exercise for thallium-201 myocardial imaging.

A new stress test for thallium-201 myocardial imaging in which pharmacological coronary vasodilatation with dipyridamole is combined with dynamic exercise is described. In 38 patients with coronary artery disease the sensitivity, total number of defects, degree of redistribution, and visual quality of thallium-201 imaging were greater after dipyridamole with exercise testing than after exercise alone. When the data from these 38 patients were combined with the results of dipyridamole-exercise imaging in 49 patients in whom exercise electrocardiography had been inconclusive then the technique gave a sensitivity for coronary disease of 87% and a specificity of 92%. Dipyridamole also increased the sensitivity of the exercise electrocardiogram, so that no patient with coronary disease had a strictly negative dipyridamole-exercise stress test. Only five of 214 patients who have now undergone this test have had complications requiring reversal of vasodilatation with aminophylline. The combined use of dipyridamole and exercise in this simple technique is a reliable and safe improvement on standard thallium-201 imaging tests.

Adult↗
PubMed1985

Anxiety and depression in patients with chest pain referred for exercise testing.

Anxiety and depression were measured in 87 consecutive patients (65 males, 22 females) with chest pain before diagnostic exercise treadmill testing. Chest pain was assessed as typical or atypical of angina by an independent observer. Fifty exercise tests were positive; thirty-seven were negative (including nineteen submaximal). Patients with negative tests had significantly higher scores for anxiety and higher depression scores than those with positive tests. 12% of patients with positive tests were women compared with 43% with negative tests. 27 patients (73%) with negative tests had atypical pain compared with 6 (12%) with positive tests. Depressed patients walked for a significantly shorter time. The probability of a negative test in patients without anxiety or depression who had typical pain was 8% in males and 32% in females; the probability of a negative test in patients who were both anxious and depressed and had atypical pain was 97% in males and 99% in females. Diagnostic exercise testing in patients with both affective symptoms and atypical chest pain may be unhelpful, misleading, and uneconomical.

Adult↗
PubMed1985

Massive hemoptysis associated with foreign body removal.

Exsanguinating hemoptysis accompanied removal of an endobronchial foreign body in a 12-year-old child. Preparations to treat this complication should be made prior to removal of any foreign body of prolonged sojourn in the tracheobronchial tree.

Bronchi↗
PubMed1982

The assessment of an edge detection algorithm in determining left ventricular ejection fraction using radio-nuclide multiple gated acquisition and contrast ventriculography.

The application of an edge detection algorithm (EDA) in defining the boundary of the left ventricle (LV) in multiple gated (MG) cardiac studies has been assessed by comparison of the left ventricular ejection fraction (LVEF) derived from X-ray contrast ventriculography (CV) in a series of patients. The results demonstrate good correlation between methods irrespective of the projection and LV status when an EDA is used, such that the correlation in anterior and left anterior oblique (45 degrees) views is 0.91 and 0.86 respectively.

Adult↗
PubMed1982

Thallium myocardial imaging: recent experience using a coronary vasodilator.

Thallium-201 myocardial imaging is an important test in the assessment of patients with suspected coronary artery disease. Techniques differ in detail, reliability and in patient acceptability. Three techniques have been compared. Thirty-two-patients were studied in three groups. In the first group (15 patients) exercise thallium scans were compared with scans following an intravenous vasodilator (dipyridamole). In the second group (12 patients) intravenous dipyridamole and oral dipyridamole thallium scans were compared. In the third group (five patients) combined oral dipyridamole and exercise scans were assessed. There were no major differences in the first two groups but the combined test showed a marked increase in image quality and diagnostic yield. Thallium scanning is simplified considerably by the use of oral dipyridamole, without loss of diagnostic quality of safety. It promises to be the method of choice for stress scanning, and is ideal in patients unable to tolerate maximum exercise. The combined exercise--dipyridamole scan helps to evaluate complex problems, particularly those with less severe coronary insufficiency, and can be done without the use of a treadmill.

Administration, Oral↗
PubMed1981

Myocardial ultrastructure and the development of atrioventricular block in Kearns-Sayre syndrome.

A right ventricular endomyocardial biopsy specimen from a 30-year-old male with chromic progressive external ophthalmoplegia, retinal pigmentation and complete atrioventricular block (Kearns-Sayre syndrome) was examined in the electron microscope. There was a proliferation of mitochondria between the myofibrils and beneath the sarcolemma. Many of the mitochondria showed morphologic abnormalities not previously described in this condition. There were associated accumulations of glycogen. A similarly affected female with left anterior hemiblock developed complete atrioventricular block at age 26 years, Despite the ultrastructural changes, clinically detectable myocardial disease is not a feature of Kearns-Sayre syndrome. However, intraventricular conduction defects show an unusually rapid progression to potentially fatal complete atrioventricular block and are an indication for prophylactic cardiac pacing.

Adult↗
PubMed1978

Staphylococcal aortic valve endocarditis with aortic root to right atrial fistula.

Infective endocarditis can be complicated by the development of intra-cardiac shunts. A case of endocarditis secondary to staphylococcal septicaemia is reported where various conduction defects preceded the development of a fistula from the aortic root to the right atrium. Before emergency surgery there was marked worsening of heart failure with the appearance of a new loud murmur throughout diastole.

Adolescent↗
PubMed1977

99Tcm-Sn pyrophosphate scanning in suspected acute myocardial infarction using a mobile rectilinear scanner.

99Tcm stannous pyrophosphate injected intravenously gives a positive image of freshly damaged myocardium but not of normal or scarred myocardium. It is safe, cheap and generally available. One hundred and forty patients admitted to hospital with possible myocardial infarction were scanned with a mobile rectilinear scanner of the type available in most district general hospitals. When the diagnosis of infarction was definite on clinical, electrocardiographic and enzyme criteria the anterior scan was positive in 31 out of 36 patients (86%); and when it was probable, the scan was positive in 28 out of 41 (68%) and when it was doubtful the scan was positive in 23 out of 63 (37%). The optimum time for scanning was between the second and seventh days. Pyrophosphate scanning is a very valuable investigation even though it is not an absolute discriminator of myocardial infarction. It is useful in assessing patients with atypical or doubtful symptoms of infarction where the ECG is already abnormal or where there are other causes of raised enzyme concentrations. False negative scans are not common, but a negative scan does not outweigh strong alternative evidence of infarction. Positive scans occur in some patients with unstable angina without confirmatory evidence of infarction. Positive scans due to extracardiac lesions are distinguished readily.

Humans↗
PubMed1977

Glossopharyngeal neuralgia with syncope.

Thirty-two cases of glossopharyngeal neuralgia complicated by syncope, cardiac arrhythmias or convulsions, singly or together, have been reported in the world literature. A further case is described and the clinical features of these thirty-three are reviewed. It is recommended that treatment should be undertaken as a matter of urgency. In the first place, Carbamezapine, with often the addition of Atropine, may prove effective. However, surgical intervention appears to give a better chance of permanent relief. Four alternative methods of surgery are discussed and the cervical or the intracranial approach recommended. Surgery should not be delayed in patients who fail to respond to medical treatment or in whom recurrence of symptoms occurs.

Adult↗
PubMed1977

Mitral valve replacement: a comparison of two prostheses.

Between November, 1965 and June, 1970, 175 patients underwent mitral valve replacement with the Smeloff-Cutter prosthesis (109 patients) or the toroidal valve (66 patients). The early mortality for patients with a toroidal mitral prosthesis was 18.2 percent (12 patients) and the late mortality 34.8 percent (23 patients). Among patients in whom Smeloff-Cutter mitral valves were inserted, the early mortality was 15.6 percent (17 patients) and the late mortality 23.9 percent (26 patients). During a follow-up period extending at least five years, thromboembolic complications occurred in 25.9 percent (14) of patients with toroidal valves and 7.6 percent (7) of patients with Smeloff-Cutter valves. Reoperation was necessary because of thrombosis of the prosthesis in seven patients with toroidal valves and two patients with Smeloff-Cutter valves. The incidence of endocarditis was the same in both groups. In this study, the Smeloff-Cutter mitral prosthesis proved to be superior to the toroidal valve because of a lower incidence of thromboembolism.

Adolescent↗