Biomedical subjects
Publications and source records attributed to M Warner.
We describe a patient with two separate vessels having different origins supplying the circumflex coronary artery distribution. This represents a previously undescribed coronary artery anomaly.
Eccentric complex vein graft lesions with abundant luminal thrombus have been generally considered unfavorable for balloon angioplasty. We present 3 patients in whom such lesions were successfully treated by a combined approach: intracoronary urokinase (1 million units over 1 hr) administered in the catheterization laboratory followed by directional atherectomy of the residual lesions in 2 separate procedures; with the patients maintained on heparin infusion between the 2 stages. No distal embolizations were encountered. Two of the 3 patients developed a groin hematoma without vascular compromise. This combined approach may prove to be an attractive alternative to reoperation in select patients with unfavorable vein graft lesions.
The retina can be regarded as an elastic membrane or sheet which stretches and deforms when a force is applied to it. Isolated bovine retina was taken and a graded traction force applied to determine retinal profile as a function of force. The resulting profile can be modelled mathematically and the model then used to determine a value for the elastic constant. The value of the elastic constant obtained by this method is approximately 2 N/m. This value of the elastic constant, combined with the observed retinal thickness, yields a value of Young's modulus for retina of approximately 2 x 10(4) Pa, which is about 2 orders of magnitude weaker than typical rubber. This value can then be used in modelling retinal behaviour in vivo when forces are applied to detached retina.
When force is applied to detached retina it elevates, stretches, and becomes irreversibly deformed. Finally it tears, and the timing and location of tear formation are determined by the distribution of stress within the retina. This stress distribution is dependent upon the retinal contour. We have tested this using retinas of freshly enucleated bovine eyes. A suture was attached to isolated retinal tissue using butylacrylate (Histoacryl) glue and traction was applied to this suture so stretching the retina. We present a mathematical model of the in vitro data obtained, with predictions for local retinal internal tensions. We show that these are altered by the addition of hydrostatic forces due to the presence of heavy liquids. These findings have implications for epiretinal membrane dissection during surgery and for the use of heavy liquids during membrane peeling.
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Nearly half of all deaths in Wales are from cardiovascular disease. Christopher Riley and colleagues set out how health planners aim to change all that with protocols for health gain.
Work in Oregon to develop a system for explicit rationing of healthcare has attracted worldwide attention. But, say Morton Warner and colleagues, it isn't a model the UK should follow.
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We describe a case in which coronary balloon angioplasty failed to improve sequential lesions and resulted in a long area of dissection between the stenoses. Directional coronary atherectomy of the occlusive dissection produced excellent angiographic improvement to achieve a successful result and avoid the need for urgent coronary bypass surgery. Directional coronary atherectomy represents a potentially useful treatment for PTCA-induced coronary dissection.
Among 21,545 adult patients who underwent consecutive coronary angiography, 16 (0.07%) were found during their coronary arteriography to have a significant isolated stenotic lesion (luminal diameter narrowing of 50% or more) located at the left main coronary artery. The remaining major epicardial coronary arteries and their branches were free of disease. A strong predilection for the isolated lesion to occur at the ostium of the left main artery was found (12 patients). The most common presenting symptom was angina of less than 4 weeks' duration, although one third of the group was asymptomatic. Resting electrocardiograms were normal in 12 patients, while three patients had T wave inversion and another had nonspecific ST-T changes. Eleven patients exhibited severe stenosis, with eight having 70% to 89% stenosis and three having 90% to 95% stenosis. Five patients had 50% to 69% stenosis. No significant differences were found between patients with angina and patients without angina with respect to age, left ventricular end-diastolic pressure, left ventricular ejection fraction, and mean percent stenosis of the obstructive lesion. Despite the severity and the crucial location of the obstructive lesion, most patients with an isolated, significant left main stenosis appear to have a preserved left ventricular ejection fraction, normal wall motion, and no significant alteration of the left ventricular end-diastolic pressure.
An angiographic study of eight patients with total occlusion of the left main coronary artery identified six patients with chronic occlusion and two with acute complete occlusion. In each of six patients, there were two to six different intercoronary collateral pathways. Altogether, a total of 13 specific collateral channels were recognized. One patient had evidence of unique homocollaterals represented by enlarged vasa vasorum, which created a vascular cuff that surrounded a totally obstructed left main artery. The ventricular function and hemodynamic parameters in these patients not only depend on the collateral vessels but may also be affected by the severity of coronary artery disease in the artery that supplies collaterals.
Among 20,332 adult patients who underwent consecutive cardiac catheterization and coronary arteriography, 83 (0.4%) were angiographically identified as having an absent left main coronary artery. The angiographic characteristics of this coronary anomaly include: (1) the presence of two well-separated coronary ostia at the left aortic sinus resulting in separate origin of the left anterior descending and circumflex arteries; (2) an increased incidence of left coronary dominance; (3) a higher (6%) than usual (0.5% to 1.5%) incidence of myocardial bridging; (4) lack of a high incidence of congenital heart anomalies; and (5) an incidence of atherosclerotic coronary artery disease similar to that of patients whose left main artery is intact. In 39% of the patients difficulties in selectively cannulating the separate ostium of the circumflex artery and adequately opacifying this vessel resulted in a need to change the diagnostic catheter size. Recognition of this coronary anomaly is needed to ensure accurate angiographic interpretation and is important for patients undergoing cardiac surgery to selectively perfuse these separate vessels during cardiopulmonary bypass.
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The effects of low concentrations of toluene (40-80 ppm, 3 days, 6 h/day) were investigated on spontaneous and on apomorphine-induced locomotor activity in the rat, and were correlated to effects on S(-)[N-propyl-3H(N)]-propylnorapomorphine ([3H]NPA) binding in rat neostriatal membranes, on membrane fluidity, membrane leakage, and calcium levels in synaptosomes from the frontoparietal cortex, the neostriatum and the subcortical limbic area, and on serum hormone levels. Toluene exposure (80 ppm, post-exposure delay 18 h) alone did not affect locomotor activity, but attenuated apomorphine-induced (0.05 mg/kg, s.c.) suppression of rearing, and potentiated apomorphine-induced (1 mg/kg, s.c.) increases in locomotion and rearing. Toluene exposure increased the KD value of [3H]NPA binding without affecting the Bmax. All these effects were absent at 40 ppm of toluene or at a post-exposure delay of 42 h. Toluene exposure (80 ppm, post-exposure delay of 18 h) did not affect the serum levels of prolactin, TSH, corticosterone, or aldosterone, or synaptosomal membrane fluidity and calcium levels, whereas membrane leakage was increased in the neostriatum. The present study indicates that the reduction of D-2 receptor affinity by short-term, low-dose toluene exposure is accompanied by a reduced D-2 autoreceptor function and an enhanced postsynaptic D-2 receptor function.
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The National Health Service in Wales, through the work of the Welsh Health Planning Forum (WHPF), has developed a new and exciting way of planning and managing its services. This encourages consumers to exert influence from the individual right through to the national level. Furthermore, managers are required to seek out and involve people, and to take advice from consumer-led groups. In this paper, Jeremy Felvus and colleagues describe briefly this new way of working and give practical examples of its impact on strategy development at all levels.