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Biomedical subjects

N Lever

Publications and source records attributed to N Lever.

8 recordsLinked to original sources

Abnormal glucose metabolism and features of the metabolic syndrome are common in patients presenting for elective cardiac catheterization.

BACKGROUND: Abnormalities of glucose metabolism and the metabolic syndrome, including excess bodyweight, are potentially modifiable risk factors for cardiac morbidity and mortality. This study aimed to determine the prevalence of these in a group of patients presenting for elective cardiac catheterization or percutaneous intervention. METHODS: Data were prospectively collected on 297 consecutive patients presenting for elective cardiac catheterization or percutaneous intervention at a single tertiary referral centre. Demographic data, risk factors, medications and coronary angiogram results were recorded. Fasting lipids, fasting glucose, HbA1c levels were measured and if necessary an oral glucose tolerance test was carried out. Logistic regression and contingency table analysis examined associations of these with ethnicity. RESULTS: Impaired glucose metabolism (diabetes, impaired glucose tolerance or impaired fasting glucose) was present in 46.1% with our screening programme detecting previously unknown impaired glucose metabolism in 22.9%. Impaired glucose metabolism was strongly associated with non-European ethnicity (P < 0.0001). The metabolic syndrome was present in 49.2%. When defined by ethnic specific cut-offs, overweight or obesity was present in >80% of patients in all ethnic groups. CONCLUSION: There is a very high prevalence of impaired glucose metabolism and the metabolic syndrome in patients presenting for cardiac catheterization. Impaired glucose metabolism is particularly prevalent in the Polynesian and the Indian and the Sri Lankan ethnic groups. Screening of patients undergoing elective cardiac catheterization identifies a significant number of patients with undiagnosed impaired glucose metabolism and should be carried out routinely.

Aged↗

A simplified approach to temporary DDD pacing using a single lead, balloon-tipped catheter with overlapping biphasic impulse stimulation.

Temporary DDD pacing offers significant hemodynamic benefits in emergency management of bradyarrhythmias but is underused because of its complexity (two leads) and unreliability. Single lead VDD pacing with atrial sensing via a floating dipole is feasible, but atrial pacing is limited by high thresholds and phrenic nerve stimulation (PNS). Overlapping biphasic impulse (OLBI) stimulation may avoid these problems. The authors designed a single lead balloon-tipped catheter for temporary transvenous DDD pacing, incorporating noncontact atrial dipoles for OLBI stimulation. This catheter was deployed using fluoroscopic guidance in 74 patients (43 men, 31 women) with mean age 56.9 +/- 17.0 years. Pacing parameters were assessed at implantation and follow-up. The median procedural time was 6.6 (range 1.2-25.0) minutes and fluoroscopy time 1.9 (range 0.2-7.8) minutes. Stable VDD pacing was achieved in all cases. Atrial capture was achieved in 73 of 74 cases with both modes at maximum output but was restricted by PNS at outputs below atrial capture threshold in 3 of 74 cases with OLBI and 10 of 74 cases with standard bipolar mode (P = 0.04). At outputs > or = 1.0 V above atrial threshold, reliable DDD pacing without PNS was achieved and maintained in 67 (91%) of 74 patients in OLBI compared to 53 (72%) of 74 patients in bipolar mode (P = 0.003). Pacing parameters were stable during follow-up (median 53 hours, range 6-168 hours). In conclusion, the single lead catheter with OLBI stimulation allows temporary VDD and DDD pacing without PNS to be achieved in > 90% of patients. This rapid and convenient approach should facilitate DDD pacing in emergency settings.

Cardiac Pacing, Artificial↗

Serial MRI in listeria mesenrhombencephalitis: a case report.

Listeria mesenrhombencephalitis is a rare disorder, especially in the non-immunocompromised host. The predilection for brain stem involvement is unexplained. The anatomical correlation of brain stem signs with serial MRI over three months is shown in a 64 year old white man. The pathological lesions seemed to be a combination of micro-abscesses and associated oedema.

Encephalitis↗

[Values of certain prosodic parameters obtain with French-speaking probands without communication problems].

Acoustic data are provided in order to facilitate evaluation of the speech of adult patients with prosody disorders such as dysarthria. Forty French-speaking subjects between 45 and 75 years of age, with neither neurological disease nor a communication disorder, were grouped on the basis of sex and age. Subjects were required to produce four series of 20 matched interrogative and declarative sentences. Their productions were recorded and analyzed with an IBM Speech Viewer. Measures of fundamental frequency, of variation in fundamental frequency, of rate over the entire sentence, as well as a measure of intonation (defined as the difference in fundamental frequency between the last syllable of matched declarative and interrogative sentences) are reported in tables for clinical use. These data provide information for the evaluation of the prosody of French-speaking persons.

Aged↗