Search PubMed⌕ Search

Biomedical subjects

J S Child

Publications and source records attributed to J S Child.

At least 91 records · Page 5Linked to original sources
PubMed1981

M-mode and cross-sectional echocardiographic diagnosis of right ventricular cavity masses.

Two patients with metastatic carcinoma (one cervical and one testicular) in whom echocardiography was instrumental in diagnosing a right ventricular cavity mass are presented. In first case the M-mode echocardiogram revealed dense echoes in the right ventricle and right ventricular outflow tract during systole and diastole. Surgical confirmation of the mass lesion was obtained. The second case also revealed abnormal echoes in the right ventricle and right ventricular outflow tract, but they were less dense and distinct. Two-dimensional echocardiography clearly delineated a highly mobile mass of tissue in the right ventricle which corresponded to the necropsy findings.

Adult↗
PubMed1981

Mitral valve A wave and mitral stenosis.

We examined M-mode echocardiograms on 35 patients with catheterization-proven mitral stenosis and normal sinus rhythm to determine whether the presence or absence of an A wave on the mitral echogram predicted mild versus severe mitral stenosis. Mitral valve area (MVA) was determined by the Gorlin formula. Presence of a mitral A wave was defined as 2 mm or greater anterior motion (after a well-defined F point) of the anterior mitral leaflet. In six of 35 patients, the presence of an A wave was equivocal. Of the remaining 29 patients, 16 had no A wave and mean MVA = 1.18 cm2 +/- 0.45 (SD), and 13 patients had a definite A wave and mean MVA = 2.04 cm2 +/- 0.71. There was a significant difference (p less than 0.001) between the mean MVA for patients with and without definite A waves. No patients with a definite A wave had an MVA less than 1.2 cm2. An A wave on the mitral echogram (in sinus rhythm) excludes severe mitral stenosis; when an A wave is not seen, no definite statement concerning severity of mitral stenosis can be made.

Adult↗
PubMed1981

Effect of left ventricular size on mitral E point to ventricular septal separation in assessment of cardiac performance.

Increased mitral valve E point to ventricular septal separation (EPSS) is widely used as an echocardiographic index of depressed left ventricular (LV) ejection fraction (EF), yet LV size has not been examined as an independent variable potentially affecting EPSS. Accordingly, we studied end-diastolic dimensions (EDD). Twenty normal controls had EPSS 3.2 +/- 2.2 mm (mean +/- SD), EDD 47 +/- 5 mm, EPSS/EDD ("normalized" EPSS) 0.07 +/- 0.04, and fractional shortening (FS%) 38 +/- 6%. Nine patients with pure chronic mitral regurgitation had dilated LV (EDD = 65 +/- 7 mm) with normal LV function (FS% 41 +/- 5%; angiographic EF 62 +/- 9%); eight patients had dilated cardiomyopathy (EDD 69 +/- 8 mm) with decreased LV function (FS% 16 +/- 7%; angiographic EF 32 +/- 8%); and eight patients with amyloid cardiomyopathy had nondilated LV (EDD 42 +/- 5 mm) with decreased LV function (FS% 19 +/- 6; angiographic EF 35 +/- 7%). Mitral E point to ventricular septal separation and EPSS/EDD accurately separated individuals with normal and abnormal LV function irrespective of LV size (chi 2 = 36.7; p less than 0.00001). Increased internal dimensions per se did not affect EPSS unless depressed LV function coexisted. EPSS is therefore a valid predictor of depressed ejection phase indices independent of LV size.

Adult↗
PubMed1981

Digital image processing of two dimensional echocardiograms: identification of the endocardium.

Digital computer image-processing techniques were applied to two dimensional echocardiograms to improve the accuracy of cardiac spatial measurements by enhancing endocardial recognition. Images were photographed from the two dimensional echocardiographic monitor and digitized using an optical densitometer. Image-processing algorithms were applied to the digitized images as follows: (1) Multiple images were averaged; (2) a gray level threshold was chosen to separate the image into tissue and cavity regions on the basis of amplitude (brightness) of the returning echoes; (3) endocardium was traced between the regions; (4) endocardial position was confirmed by matching this boundary with a contrast edge map of the original images; and (5) the endocardial boundaries were tested by comparison with simultaneous M mode echocardiograms. A linear correlation was found between M mode and computer-processed two dimensional echocardiographic measurements of ventricular septal thickness (r = 0.88); this was superior to the correlation between M mode and unprocessed two dimensional echocardiographic septal measurements (r = 0.55). The correlations between M mode and processed or unprocessed two dimensional echocardiographic measurements of left ventricular internal dimension were similar (r = 0.89 and 0.85, respectively), but the slope of the regression line for the processed data more closely approximated the line of identity (p less than 0.05). It is concluded that endocardial outlines derived with use of digital image-processing techniques lead to left ventricular measurements that correlate more closely with M mode measurements than do dimensions derived from unprocessed two dimensional echocardiography.

Computers↗
PubMed1980

Flail aortic valve leaflets: M-mode and two-dimensional echocardiographic manifestations.

Four patients with documented flail aortic valve leaflets were studied using M-mode and two-dimensional echocardiography (2-D echo). Two had aortic valve endocarditis, one had endocarditis involving a congenital heart defect, and one had a myxomatous aortic valve. Mitral valve flutter and early mitral valve closure led to the diagnosis of severe aortic insufficiency in three patients. Diastolic aortic valve flutter, considered to be specific for a flail aortic leaflet, was present in three patients. In the fourth patient left ventricular outflow tract (LVOT) echoes were present, but did not distinguish between a flail aortic leaflet and an aortic vegetation. Two-D echo confirmed LVOT echoes in all patients. Discrimination between a flail leaflet and a vegetation(s) without leaflet disruption was accomplished by noting the hinge point of the LVOT diastolic echoes, which was the aortic wall in patients with a flail leaflet. The combination of these M-mode and 2-D echocardiographic findings permitted the diagnosis of a flail aortic leaflet to be made accurately and noninvasively. In two patients surgery was performed without prior cardiac catheterization.

Adolescent↗
PubMed1980

Malondialdehyde alteration of low density lipoproteins leads to cholesteryl ester accumulation in human monocyte-macrophages.

Glutaraldehyde treatment of (125)I-labeled low density lipoprotein ((125)I-native-LDL) produced a modified LDL ((125)I-glut-LDL) with a molecular weight of 10 x 10(6) or more. Malondialdehyde treatment of (125)I-native-LDL produced a product ((125)I-MDA-LDL) with a molecular weight not appreciably different from that of the original lipoprotein. However, the electrophoretic mobility of MDA-LDL indicated a more negative charge than native-LDL. (125)I-MDA-LDL was degraded by two processes: a high-affinity saturable process with maximal velocity at 10-15 mug of protein per ml and a slower, nonsaturable process. The degradation of (125)I-MDA-LDL was readily inhibited by increasing concentrations of nonradioactive MDA-LDL but was not inhibited by acetylated LDL or native-LDL even at concentrations as high as 1600 mug of protein per ml. After exposure of native-LDL to blood platelet aggregation and release in vitro, 1.73 +/- 0.19 nmol of malondialdehyde per mg of LDL protein was bound to the platelet-modified-LDL. No detectable malondialdehyde was recovered from native-LDL that had been treated identically except that the platelets were omitted from the reaction mixture. After incubation with glut-LDL, MDA-LDL, or platelet-modified-LDL for 3 days, human monocyte-macrophages showed a dramatic increase in cholesteryl ester content whereas the cholesteryl ester content of cells incubated with the same concentration of native-LDL did not. Based on these experiments we propose that modification of native-LDL may be a prerequisite to the accumulation of cholesteryl esters within the cells of the atherosclerotic reaction. We further hypothesize that one modification of LDL in vivo may result from malondialdehyde which is released from blood platelets or is produced by lipid peroxidation at the site of arterial injury.

Arteriosclerosis↗
PubMed1979

Coronary ostial embolus and mitral vegetation simulating a left atrial myxoma: a case of probable cryptococcal valvulitis.

A 56 year old man died with disseminated cryptococcosis after immunosuppressive therapy for a hematologic disorder of unknown etiology. The immediate cause of death was cardiogenic shock, probably resulting from a large right coronary ostial embolus and subsequent ischemic myocardial injury. The embolus originated from a bulky mitral vegetation (possibly cryptococcal) demonstrated ante mortem by echocardiography and cardiac angiography, and at autopsy. The differential diagnosis of such an echocardiographic pattern is discussed.

Coronary Disease↗
PubMed1979

M mode and cross-sectional echocardiographic features of flail posterior mitral leaflets.

Seventeen patients with accepted M mode echocardiographic criteria for flail mitral leaflet were studied. M mode echocardiograms revealed characteristic disordered mitral valve motion: (1) 16 (94 percent) had chaotic diastolic mitral motion; (2) 14 (82 percent) had systolic mitral flutter; (3) 14 (82 percent) had systolic left atrial echoes; and (4) 12 (71 percent) had systolic mitral valve prolapse. In 8 patients (47 percent) all four findings were present, with three findings present in 16 (35 percent) and two findings present in 13 (18 percent); none had fewer than two findings. Cross-sectional echocardiographic studies in 10 patients revealed a systolic whipping motion of the posterior mitral leaflet into the left atrium in all, abnormal systolic mitral coaptation in all and an abnormal mass of systolic left atrial echoes in 4. None of the first three M mode criteria were observed in 230 patients with uncomplicated "mid systolic click-late systolic murmur" syndrome; cross-sectional echocardiography in 30 of 230 patients revealed normal systolic mitral coaptation and no systolic whipping of the tip of the posterior mitral leaflet into the left atrium.

Adolescent↗
PubMed1979

Increased right ventricular wall thickness on echocardiography in amyloid infiltrative cardiomyopathy.

In six patients with clinically significant amyloid infiltrative cardiomyopathy, echocardiographic right ventricular anterior wall thickness was significantly increased (mean 7.5 +/- 2.3 mm; range 5 to 10 mm). This finding in conjunction with the previously described abnormalities of the left ventricle (symmetric increase in wall thickness, diffuse hypokinesia, and small to normal left ventricular diastolic dimension) is consistent with the findings of a diffuse myocardial infiltrative process and should minimize confusion with constrictive pericarditis.

Adult↗
PubMed1979

Chronic pericarditis due to a streptomyces species.

Streptomyces species include a group of aerobic actinomycetes that are generally considered to be saprophytes. Effusoconstrictive pericarditis of mixed etiology developed in a previously healthy patient. The cause of the chronic pericarditis was a Streptomyces species.

Adult↗
PubMed1979

Noninvasive diagnosis of prosthetic mitral valve malfunction.

A patient with a Kay-Shiley mitral prosthesis had abnormal intermittent systolic tilting of the prosthetic disc by cinefluoroscopy. Echocardiography revealed an abnormal "atrial emptying index" consistent with mitral obstruction. Catheterization revealed mitral regurgitation without stenosis. At surgery, there was no prosthetic orifice obstruction. It was concluded that the atrial emptying index may be abnormally low in prosthetic mitral regurgitation without stenosis.

Cardiac Catheterization↗
PubMed1979

Cardiac effects of acute ethanol ingestion unmasked by autonomic blockade.

We assessed the effects of ethanol and autonomic blockade on left ventricular function in nine normal subjects, age 20--35 years, using M-mode echocardiography and systolic time intervals. On day 1, measurements were made of heart rate, mean velocity of circumferential fiber shortening, and left ventricular pre-ejection period and left ventricular ejection time ratio (PEP/LVET), during a control period and after autonomic blockade. Autonomic blockade was produced with intravenous propranolol (0.2 mg/kg body weight) and atropine (0.04 mg/kg body weight). On day two, measurements were again made during a control period, then with ethanol alone, followed by addition of autonomic blockade to ethanol. One hundred eighty milliliters of ethanol were ingested over 60 minutes, resulting in a mean blood ethanol level of 110 mg/dl (range 77--135 mg/dl) at 60 minutes post-ingestion. There were no significant differences between the control data on days 1 and 2. Blood pressure was unchanged throughout the study. study. On day 1, autonomic blockade alone resulted in the expected increase in heart rate (p less than 0.001), with a proportional increase in mean velocity of circumferential fibr shortening (p less than 0.01), and an increase in PEP/LVET (p less than 0.01). On day 2, ethanol alone resulted in no significant changes except for a slight increase in PEP/LVET (p less than 0.02). Ethanol plus autonomic blockade, (day 2), compared with autonomic blockade alone (day 1), revealed a decrease in mean velocity of circumferential fiber shortening (p less than 0.05), and an increase in PEP/LVET (p less than 0.01), with a decrease in intrinsic heart rate (p less than 0.001). We conclude that in normal subjects: 1) autonomic blockade does not directly affect contractility; 2) acute ethanol ingestion alone does not produce important changes in cardiac function; and, 3) ethanol in the autonomic blockaded heart causes a significant decrease in contractility. Thus, we infer that ethanol has a negative inotropic effect which is masked by catecholamines and/or autonomic nervous system discharge.

Adult↗