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Biomedical subjects

N C Taylor

Publications and source records attributed to N C Taylor.

9 recordsLinked to original sources
PubMed2005

Limited benefits of ambulance telemetry in delivering early thrombolysis: a randomised controlled trial.

OBJECTIVES: To evaluate the potential of a continuous telemetry system linking rural ambulances to a coronary care unit to reduce call to thrombolysis times. METHODS: This prospective randomised controlled trial recruited patients using the 999 ambulance service in a rural area of the UK with signs or symptoms of coronary heart disease. Subjects were assigned to receive either standard paramedic treatment or transmission of 12 lead ECG, blood pressure, pulse oximetry, and relevant medical history to a general hospital coronary care unit. Cardiology senior house officers then determined each patient's suitability for pre-hospital thrombolysis time, and transmitted this decision back to the ambulance. This was documented as the potential thrombolysis, although no thrombolytic agents were administered by paramedics. The between groups difference in time to potential thrombolysis (intervention group) and actual thrombolysis (controls) was compared. The proportion of intervention group subjects ultimately receiving thrombolysis in hospital was compared with that recommended for pre-hospital thrombolysis. RESULTS: The potential reduction in call to treatment time for telemetry patients recommended for pre-hospital thrombolysis was 55 minutes (p = 0.022). Following hospital admission,21/213 of the telemetry patients were thrombolysed (10%, 95% confidence interval (CI) 6% to 15%). Of these patients, 3/21 received a recommendation for thrombolysis in the ambulance (14%, 95% CI 3.1% to 36.3%). The sensitivity and specificity of the telemetry system in detecting patients requiring thrombolysis was 13.6 and 99.5% respectively. Errors were made in the pre-hospital treatment recommendations for two patients. CONCLUSIONS: Continuous telemetry systems may significantly reduce call to treatment times for patients recommended for pre-hospital thrombolysis in a rural setting. However, this benefit must be balanced against the very small proportion of eligible patients identified as suitable for pre-hospital thrombolysis. This limitation may be due to communications problems, the criteria used to identify eligible patients, or the seniority of physicians tasked with making treatment decisions.

Aged↗
PubMed1985

Improved selection of patients for aneurysmectomy by combined phase and amplitude analysis of gated cardiac scintigraphy.

Twelve patients undergoing left ventricular aneurysmectomy were studied by combined phase and amplitude analysis of gated blood pool scintigraphy before and after operation, to establish whether the presence of paradoxical systolic movement, as defined by this method, influenced the result of surgical treatment. There was a significant increase in the ejection fraction after operation in those patients with paradoxical systolic movement and no improvement in those with akinesis. The extent of the increase in ejection fraction was related to the size of paradoxical segment resected. It is argued that this improvement in left ventricular function reflects a reduction in the left ventricular and diastolic volume and improved efficiency of ejection of the stroke volume, resulting from resection of the scar. Combined phase and amplitude analysis may help in selecting patients most likely to benefit from aneurysmectomy.

Adult↗
PubMed1985

Does left ventricular aneurysmectomy improve ventricular function in patients undergoing coronary bypass surgery?

Fourteen consecutive patients undergoing left ventricular aneurysmectomy and coronary artery bypass grafting were studied by multiple gated ventricular scintigraphy at rest and during exercise before and at six weeks and six months after surgery. All had congestive heart failure and 12 angina pectoris. Before operation left ventricular ejection fraction fell significantly with exercise, as did the regional wall motion score. Six weeks after surgery all surviving patients were free of angina, with an improvement in functional class; the total exercise workload improved significantly, but resting left ventricular ejection fraction was unchanged; the regional wall motion score improved in both the anterior and left anterior oblique projections, although extensive areas of abnormal contraction persisted. Exercise left ventricular ejection fraction improved significantly after operation at six weeks, and previous exercise induced abnormalities of regional contraction were abolished. Six months after operation angina pectoris had recurred in one patient, but there was no further change in ventricular function in the remainder. Although resting ejection fraction is not improved, symptoms, exercise workload, and exercise ventricular function can be improved by aneurysmectomy and coronary artery bypass grafting, but the respective contribution of these two procedures remains uncertain.

Adult↗
PubMed1983

Effects of coronary artery bypass grafting on left ventricular function assessed by multiple gated ventricular scintigraphy.

The effect of coronary artery bypass grafting on global left ventricular ejection fraction and regional contraction was studied in 56 consecutive patients with chronic stable angina pectoris by means of multiple gated ventricular scintigraphy at rest and during dynamic supine exercise before and six weeks after myocardial revascularisation. Before operation, exercise induced a significant fall in ejection fraction and regional wall motion score. Six weeks after operation 52 patients were symptomless. Resting ejection fraction and regional wall motion score were unchanged but during exercise ejection fraction increased significantly, and the previous exercise induced regional wall motion abnormalities were abolished. All four patients with persisting angina showed the same pattern as before operation, with a fall in left ventricular ejection fraction and regional wall motion score during exercise. Multiple gated ventricular scintigraphy affords a safe, objective, reproducible, and non-invasive means of assessing serial ventricular function at rest and during exercise in patients with ischaemic heart disease. The technique confirms that coronary bypass surgery abolishes exercise induced abnormalities of left ventricular function, but has no influence on resting function.

Angina Pectoris↗
PubMed1981

Fixed subaortic stenosis after repair of ostium primum defects.

Three patients who had closure of an ostium primum defect developed severe fixed subaortic stenosis requiring surgical removal three to 11 years late. In two, the basic anatomy of the attachment of the superior portion of the anterior mitral cusp and submitral apparatus predisposed to the formation or deterioration of this complication. Both had subvalvar gradients and angiographic narrowing of the outflow tract in systole and diastole. In the third patient the strut of the Hancock prosthesis used to replace a double orifice mitral valve impinged on the outflow tract to stimulate the formation of a serious fixed obstruction. Subaortic gradients before operation must be specifically looked for, particularly in those with the characteristic radiological deformity of the submitral apparatus, and at operation the subaortic region must be inspected. Postoperatively the search for developing subaortic stenosis must include regular M-mode and 2-dimensional echocardiography, and cardiac catheterisation may be required. Although a rare complication, subaortic stenosis is a progressive and damaging lesion which requires early recognition and treatment despite the apparent well-being of the patient.

Angiocardiography↗
PubMed1978

Use of subclavian vein for permanent cardiac pacing.

The subclavian vein has been used to implant permanent pacing catheters in 40 patients with symptomatic heart block. Though the cephalic and external jugular veins are usually preferred for this purpose in Britain, the use of these veins has certain disadvantages. In this study subclavian venepuncture by the infraclavicular approach was performed without diffculty and found to be a safe procedure. Three months after implantation, 7.5 per cent of patients had developed catheter tip dislocation and 87.5 per cent of patients were entirely free of complications.

Adams-Stokes Syndrome↗