Biomedical subjects
Publications and source records attributed to P Lander.
A knee effusion suddenly appeared in a 44-year-old woman one month after she suffered a neurological catastrophe. Heterotopic ossification (HO) subsequently developed above her knee. Because treatment of HO with disodium etidronate may be successful if started early, awareness of the association between acute arthritis and new bone formation in certain clinical settings is important.
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Rib notching and the figure-three configuration and the most often cited signs of coarctation of the thoracic aorta in the adult. In our experience, these so-called classic signs are absent in many patients. Abnormalities of the ascending aorta, aortic arch, and superior mediastinum are also major findings and indeed may be the only findings in coarctation. This has not been sufficiently emphasized in standard radiology texts. In order to elucidate these points, we reviewed the chest radiographs of 13 patients with adult-type coarctation of the aorta presenting to the Jewish General Hospital over a 10-year period. In addition, the chest radiographic findings of five patients with pseudocoarctation were compared to those of true coarctation.
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The diagnosis of a primary cardiac sarcoma with bone metastases was suspected in a previously normal patient because of the development of unremitting pulmonary edema and lytic bone lesions. Echocardiography substantiated the diagnosis, which proved at autopsy to be a primary fibrosarcoma of the heart. This represents only the third such case reported with bone metastases.
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The ST-T segment of the surface ECG reflects cardiac repolarization, and is quite sensitive to a number of pathological conditions, particularly ischaemia. ST-T changes generally affect the entire waveshape, and are inadequately characterized by single features such as depression of the ST segment at one particular point. Metrics which represent overall waveshape should provide more sensitive indicators of ST-T wave abnormalities, particularly when they are subtle, intermittent or periodic. This study discusses a Karhunen-Loève transform (KLT) technique for the analysis of the ST-T waveform. The KL technique was used to analyse the ST-T complexes in the ESC ST-T database. KL coefficients were plotted as a function of time, and were effective in detection of transient ischaemic episodes. Twenty per cent of the records showed bursts of periodic ischaemia suggesting local vascular instability. A comparison between kl and ST depression series has shown the KL technique as more appropriate to the study of ST-T complex variations. Using the kl series, an ischaemia detector has been developed based on a resampled, filtered, and differentiated KL series. This technique demonstrates a sensitivity of 65% and a specificity of 54%. These low values can be due to shifts of the electrical axis which are detected as ischaemic changes, real ischaemic episodes that were not annotated with the protocol used at the European ST-T database, or erroneous detections. An increase in sensitivity can be obtained at the expense of a decrease in the positive predictive value and thus becomes a useful technique for previous scanning of the ECG record and subsequent review by the expert. The technique has also been used to monitor patients during a PTCA process, demonstrating that this technique allows us to monitor PTCA-induced ischaemia. A detailed analysis has shown that in some cases a repetitive oscillatory behaviour appears, lasting for a period of around 20 s, and highly related to the oscillatory behaviour of the HR. In other cases, transient changes in KL series with salves behaviour associated with the injection of contrast are shown on the ST-T waveform. We conclude that the KL-based analysis of the ST-T segment is a robust and sensitive technique, with considerable advantages over single feature measures in characterizing the subtle waveform changes which may be of importance in clinical risk detection.
We describe a patient with all the features of the CREST syndrome variant of scleroderma who developed a destructive arthropathy typical of rheumatoid arthritis (RA). A pulmonary rheumatoid nodule was found confirming the presence of RA. The rarity of the coexistence of these two diseases in the same patient suggests that, despite commonly found overlapping features, these illnesses are distinct entities.