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Biomedical subjects

P Woolf

Publications and source records attributed to P Woolf.

18 recordsLinked to original sources
PubMed2000

Atrioventricular nodal reentry tachycardia: slow pathway ablation using the transseptal approach.

Four hundred twenty consecutive patients with symptomatic slow/fast atrioventricular nodal reentry tachycardia had attempted slow pathway radiofrequency ablation. All patients had successful slow pathway ablation and no inducible tachycardia after ablation using the standard right-sided approach except for three patients. The three unsuccessful patients had inducible slow/fast atrioventricular nodal tachycardia after attempted right-sided posterior and inferoposterior anatomic ablative techniques and with slow pathway potential electrogram guidance. Lesions were also delivered linearly in the triangle of Koch and within the coronary sinus ostium. A transseptal puncture was performed and slow pathway ablation was obtained in each of these patients. Ablation was performed from the septal mitral valve annulus, anterior to the os of the coronary sinus and inferior to the His-bundle catheter with elimination of slow pathway conduction. Prior to the ablation, two of the three patients exhibited initiation of tachycardia with a double fast/slow antegrade response, and all three patients had long AH intervals (mean 378 ms) during slow pathway conduction. These electrophysiological findings may be consistent with a large area of slow pathway conduction that may include the left atrial septum not approachable by conventional right-sided ablative techniques. Slow pathway ablation to eliminate atrioventricular nodal reentry tachycardia at times may require a left atrial/transseptal approach when conventional right-sided techniques are ineffective.

Adult↗
PubMed1999

Safety and efficacy of outpatient transseptal radiofrequency ablation of atrioventricular accessory pathways.

A retrospective analysis of 60 consecutive patients who underwent outpatient transseptal radiofrequency ablation of left sided accessory pathways at Westchester County Medical Center/New York Medical College from September 1994 to December 1997 was performed. Patients were followed for a mean duration of 22 months. No complications either local or related to the transseptal method were observed. All patients had successful ablation of the accessory pathway. One patient had a recurrence of symptoms. This study suggests transseptal radiofrequency ablation of the left sided accessory pathways to be safe, feasible and an effective procedure when performed in an outpatient setting. These results were obtained at a high volume center with experience using the transseptal technique.

Adult↗
PubMed1996

Remission of acromegaly caused by pituitary carcinoma after surgical excision of growth hormone-secreting metastasis detected by 111-indium pentetreotide scan.

GH-secreting carcinomas of the pituitary are extremely rare. We describe a 37-yr-old woman with refractory acromegaly 15 yr after transphenoidal surgery and radiotherapy, with no evidence of a recurrent pituitary mass. Scanning with 111-indium pentetreotide revealed an area of intense activity in the left neck. A 3.5 x 2.5-cm mass was excised from the neck after demonstrating an arterio-venous GH gradient of 7:1. GH levels (50 ng/mL) dropped to 0.8 ng/mL 3 h after surgery and remained normal. GH gene expression was demonstrated in the metastasis by Northern and Western blot analyses and by positive immunocytochemistry and immunoelectron microscopy. In vitro cultured cells responded to GHRH and TRH by increasing GH levels (P < 0.01). Medium GH was identical to authentic pituitary GH, as demonstrated by high pressure liquid chromatography. RT-PCR of hypothalamic hormone receptor messenger RNA in the mass revealed somatostatin receptor subtypes 2, 3, and 5 and GHRH, TRH, and dopamine receptor expression. No GH gene amplification, rearrangement, or gsp mutation was found. RB gene deletion and H-ras mutations, previously reported in PRL- and ACTH-secreting carcinomas, were not detected. In conclusion, clinical and molecular features of a GH-secreting pituitary carcinoma are presented. This metastatic lesion synthesized GH and expressed functional hypothalamic hormone receptors.

Acromegaly↗
PubMed1988

Selective hypervagotonia isolated to the atrioventricular node.

Thirteen patients with recurrent unexplained syncope or presyncope underwent electrophysiological evaluation. A prolonged effective refractory period and functional refractory period of the atrioventricular node as well as slow paced rate to atrioventricular block were the only abnormalities found. Ventricular tachycardia could not be induced. All electrophysiological abnormalities reverted to normal following atropine administration. These patients have selective hypervagotonia isolated to the atrioventricular node. Three of thirteen patients required permanent pacing, and one required propantheline to control recurrent symptoms. Selective hypervagotonia may be a distinct clinical entity that can cause symptoms and require therapy.

Adult↗
PubMed1984

Thyrotropin (TSH)-induced hyperthyroidism: response of TSH to dopamine and its agonists.

A 12-yr-old girl with the syndrome of hyperthyroidism due to inappropriate TSH secretion, who had no evidence of pituitary tumor, was studied in detail. She had undergone two thyroidectomies for recurrent goiter and hyperthyroidism before referral. Basal serum TSH levels were extremely high (maximum 173 microU/ml), and the TSH response to TRH was exaggerated (peak, 675 microU/ml). The serum alpha-subunit of TSH was normal. PRL and other anterior pituitary hormone studies were normal. Dopamine infusion at 2 and 4 micrograms/kg X min partially suppressed TSH and PRL secretion and their responses to TRH. Bromocriptine had a paradoxical effect, resulting in an increase in TRH-stimulated TSH levels. Pergolide, a newer dopamine agonist, significantly decreased per basal serum TSH and blunted the TSH response to TRH; however, despite progressive dose increases, her TSH level was not reduced to normal.

Child↗
PubMed1983

Loss of adrenocortical suppression after acute brain injury: role of increased intracranial pressure and brain stem function.

The function of the pituitary-adrenal axis was studied in 23 acutely brain-injured, comatose patients (14 head trauma and 9 intracranial hemorrhage), who were treated with dexamethasone (16-64 mg/daily). Patients with normal intracranial pressure (ICP) and normal brain stem function (group 1) had decreased plasma cortisol levels (less than or equal to 5 micrograms/dl) within 36 h (mean +/- SEM, 2.4 +/- 0.3 microgram/dl; t 1/2, 18 h). In contrast, patients with elevated ICP (i.e. greater than 20 mm Hg; midline shift, or compressed ventricles) and normal brain stem function (group 2) had persistently elevated cortisol concentrations (15.4 +/- 2.6 micrograms/dl; P less than 0.001). Superimposition of brain stem dysfunction resulted in generally low cortisol levels regardless of the presence (group 4; 3.9 +/- 1.0 microgram/dl; P less than 0.001 compared to group 2) or absence (group 3; 2.1 +/- 0.5 microgram/dl) of elevated ICP. Plasma ACTH levels in 31 samples obtained before or during dexamethasone therapy in 14 patients irrespective of group were not elevated (45.6 +/- 12.5 pg/ml); there was no correlation between plasma ACTH and cortisol levels. Despite elevated cortisol values in group 2, ACTH levels were low (22.4 +/- 10.1 pg/ml). It is concluded that elevated ICP in the presence of normal brain stem function is a potent stimulus for adrenocortical activation which is not associated with elevated ACTH levels, and that the brain stem is involved in this response.

Adrenal Cortex↗
PubMed1979

Cardiovascular malformations in the fetal alcohol syndrome.

Cardiovascular anomalies are a frequently reported feature of the fetal alcohol syndrome, but only rarely have such children been catheterized. This article fully described the cardiac anomaly in two infants with this syndrome. The malformations found in both cases include a ventricular septal defect, and the rather unusual finding of pulmonary artery dysplasia.

Cardiac Catheterization↗
PubMedDate not supplied

Syncope and preexcitation: a case of a Kent and fasciculoventricular Mahaim fibers.

A case involving an 8-year-old girl with syncope and preexcitation on a surface electrocardiogram (ECG) that was suggestive of Wolff-Parkinson-White syndrome is presented. An intracardiac electrophysiologic study revealed a posteroseptal bidirectionally conducting Kent fiber. Radiofrequency ablation of the Kent fiber was successful, but the patient had a residual short His-ventricular (HV) interval and a new preexcitation pattern. Atrial extra stimuli and ventricular pacing revealed a fixed, preexcited QRS. Nodal block and loss of preexcitation was provoked with adenosine. The surface QRS and electrophysiologic features are consistent with a left septal fasciculoventricular Mahaim fiber.

Child↗