Biomedical subjects
Publications and source records attributed to M Luxton.
Disseminated cryptococcal disease is known to occur in patients with altered immune status. We have reported an unusual case of cryptococcal disease manifested solely by sacroiliitis, which occurred in a patient on chronic steroid therapy for autoimmune haemolytic anaemia. This case stresses the importance of considering unusual organisms as a cause of sepsis in patients with altered immune status.
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The prognostic implications of a past history of ischaemic heart disease, site of infarction, ectopic ventricular dysrhythmias (ventricular premature beats (VPB) more than one in 10 sinus beats, and/or ventricular tachycardia (VT), ventricular fibrillation (VF), atrioventricular blocks (AVB), bundle branch blocks (BBB)) and the occurrence of electrical and/or mechanical complications during stay in the Coronary Care Unit (CCU) were analysed in 154 women with definte (WHO Class 1) acute myocardial infarction, admitted sequentially to the CCU over a four-year period. The prognosis in these women was then compared with the prognosis in a group which represented the general male population in the CCU and an age-matched group of men. The results showed that the long-term prognosis in women with acute myocardial infarction is remarkably similar to age-matched groups of men.
A prospective, randomised, open trial was performed in 150 patients to test for any beneficial effects on 2-year mortality of long-term antiarrhythmic therapy with phenytoin in patients with acute myocardial infarction. Patients were stratified according to age, sex, past history of myocardial infarction, and the presence of absence of electrical or mechanical complications in the course of acute infarction. They were then randomised to treatment or control groups (74 v. 76). The former received phenytoin in doses aimed at maintaining plasma phenytoin levels between 40 and 80 mumol/litre. All patients entered the study before discharge from the coronary care ward. Plasma phenytoin levels were in the therapeutic range in between 51 and 75 per cent of subjects at any follow up visit. There were 19 withdrawals from the treatment group, 10 of which were the result of side effects. There were 5 withdrawals from the control group. According to the original intention to treat, there were 18 deaths at 2 years in the treatment group and 14 deaths in the control group. There was no reduction in the incidence of instantaneous or sudden deaths. Deaths on treatment were not associated with a low phenytoin plasma level. Phenytoin treatment showed no beneficial effects on mortality and was associated with a high incidence of side effects.
As the majority of deaths after infarction occur in the first hour, a mobile intensive care ambulance service has been instituted in Melbourne to enable adequate care and early monitoring facilities. Initially the service was manned by doctors and ambulance officers, but currently each ambulance is manned by two specially trained officers. Over a 27-month period 52 patients have been resuscitated from ventricular fibrillation or ventricular standstill. Half of the patients had sustained a definite acute myocardial infarction and another 16 had probable but not proven myocardial infarction. Of the 52 patients, 31 survived to leave hospital and all patients known to be alive are leading active and useful lives. In spite of an initial fear that medical treatment might be overused or misused by the officers, this has not been the case, and only about 13% of patients have received drugs from the officers. This paper deals with the setting up, staffing and training of the ambulance service and reviews its results.
The correlation of clinical features with the operative findings in 14 patients with a floppy mitral valve is discussed. The clinical course is typified by rapidly progressive disability. An abrupt deterioration was present in five of our subjects and this may be due to rupture of chordae tendinea or stretching of the valve apparatus. The redundancy of the anterior cusp in 13 of our series may explain the absence of mid systolic clicks in all except one patient. The diagnosis of prolapse can be difficult to make prior to surgery because the prolapsed cusp may be masked by the regurgitant contrast medium. Hypokinesis and prominent inflow sacculation of the left ventricular inflow tract suggest an associated myocardial abnormality. Calcium was present in one valve and thus mitral valve calcification does not exclude the possibility of a floppy valve in patients with mitral regurgitation.
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