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Biomedical subjects

R Gray

Publications and source records attributed to R Gray.

At least 325 records · Page 18Linked to original sources
PubMed1983

Diagnostic and therapeutic uses of the arthroscope in rheumatoid arthritis and osteoarthritis.

Both the technique and the technology involved in knee arthroscopy have undergone considerable development over the last 10 years. Diagnostically, the procedure allows visualization of synovium, hyaline cartilage, fibrocartilage (menisci), and ligaments (cruciate, patellofemoral alignment). Synovitis of rheumatoid arthritis is suspected by boggy, hyperemic, and edematous hypervilli that may undergo necrosis. In osteoarthritis, the synovium is often mildly inflamed and the cartilage demonstrates ulcerations, yellowing, softening, and areas of denuded bone. Synovectomy for rheumatoid arthritis was first performed about 1900. The apparent reduction in morbidity resulting from performing synovectomy through the arthroscope accounts for the resurgence of interest in this procedure. Removal of loose bodies, fragments of cartilage, or synovium helps to reduce synovitis and symptoms in both rheumatoid arthritis and osteoarthritis. Shaving of articular cartilage is often performed in patients with osteoarthritis. There is a suggestion that coring or shaving osteoarthritic denuded bone stimulates repair of a type of fibrocartilage that may be functional. Surgical technology and technique in the field of arthroscopy are advancing faster than the clinical studies necessary to prove their value. Guidelines for the use of these potentially destructive techniques are still needed. Arthroscopy is a rapidly developing field in medicine. The next 10 years will almost assuredly provide enhanced diagnostic and surgical capabilities with reduced morbidity in the rheumatic diseases, and particularly in rheumatoid arthritis and osteoarthritis.

Arthritis, Rheumatoid↗
PubMed1983

Abnormal involuntary movements in patients on long-acting neuroleptics.

Two hundred and thirty eight patients (144 males, 94 females) on long-acting neuroleptics; mainly fluphenazine decanoate, were surveyed and evaluated for abnormal involuntary movements and associated risk factors. A highly significant correlation was found between the three scales used in the evaluation. The prevalence rate for the transient, acute extrapyramidal syndrome was 37.38%, while that of tardive dyskinesia was 57%. Half of the tardive dyskinesia cases were of minimal severity. Most of these were located in orofacial region. Tardive dyskinesia was more frequent in younger patients but more severe in older age groups. Other associated risk factors were tremors and rigidity, and use of antiparkinsonien drugs. Tardive dyskinesia is a common abnormal involuntary movement in patients on long-acting neuroleptic. Early recognition of TD in this population could help in planning for its prevention by the use of minimum effective dose of medication.

Adolescent↗
PubMed1983

Postoperative residual ovary syndrome: an uncommon cause of pelvic mass.

We report two patients with an ovarian mass following hysterectomy. These represent part of the spectrum of the "residual ovary syndrome." The retroperitoneal incarceration of a residual ovary and the presence of adhesions, preventing free access to the peritoneal cavity, result in an accumulation of follicular products locally and, thus, a mass with cystic and solid components. Differential diagnostic considerations include functional and dysfunctional ovaries, benign and malignant ovarian tumors, and endometriosis.

Diagnosis, Differential↗
PubMed1983

Reduction in infarct size, arrhythmias and chest pain by early intravenous beta blockade in suspected acute myocardial infarction.

Four hundred seventy-seven patients suspected of having had acute myocardial infarction within less than 12 hours were randomized to receive i.v. atenolol followed by oral treatment for 10 days or to a control group. In patients with ECG changes indicative of infarction at entry, i.v. atenolol significantly reduced enzyme release by one-third and enhanced R-wave preservation. In patients without such ECG changes, treatment significantly prevented the development of infarction in a proportion of patients. There was also a significant reduction in R-on-T ectopics, repetitive ventricular arrhythmias and supraventricular arrhythmias. Treated patients had significantly greater pain relief and required fewer opiate analgesics. Significantly fewer atenolol-treated patients died by 10 days (the treatment period), had nonfatal cardiac arrests, developed heart failure, or suffered reinfarction.

Administration, Oral↗
PubMed1983

Post-myocardial infarction ventricular septal defect. Improved outlook.

Eight patients (mean age 63.75 years) were operated upon for post-myocardial infarction ventricular septal rupture (PMI-VSD) within 1 to 21 days of the infarction and 8 hours to 18 days of rupture. All but one were in low cardiac output syndrome necessitating intra-aortic balloon pumping; all had cardiac catheterization. The VSD was closed via a transinfarct ventriculotomy with an oversized folded double patch, the folded edge being incorporated in the ventriculotomy closure. Five patients received seven saphenous vein coronary bypass grafts. None had recurrent shunts. Six patients (anterior VSD, five; posterior VSD, one) are survivors (18 months to 2.5 years) in Class I (five) or Class II (one). Two patients died postoperatively, one (anterior VSD) of an arrhythmia and the other (posterior VSD) while on biventricular bypass support. Two survivors in whom prolonged preoperative stabilization was attempted required emergency operation before the planned waiting period of 3 weeks had elapsed, and both had postoperative multiorgan complications. Our present approach is to operate as soon as clinical and catheterization diagnosis of VSD is made.

Aged↗
PubMed1982

Preoperative prediction of reversible myocardial asynergy by postexercise radionuclide ventriculography.

Myocardial asynergy is sometimes reversed by coronary bypass, and a noninvasive method of predicting which assess are reversible would be desirable. To assess whether changes in myocardial wall motion observed immediately after exercise can differentiate reversible from nonreversible myocardial asynergy, we evaluated 53 patients by radionuclide ventriculography before and after exercise and again at rest after coronary bypass surgery. Preoperative improvement in wall motion immediately after exercise was highly predictive of the surgical outcome (average chance-corrected agreement, 91 per cent). At surgery the asynergic segments that had improved after exercise were free of grossly apparent epicardial scarring. The accuracy of these predictions for postoperative improvement was significantly greater (P less than 0.01) than that of analysis of Q waves on resting electrocardiography (average chance-corrected agreement, 40 per cent). In contrast, preoperative changes in left ventricular ejection fraction after exercise were not predictive of postoperative resting ejection fraction. We conclude that postexercise radionuclide ventriculography can be used to identify reversible resting myocardial asynergy. This test should prove effective in predicting which patients with myocardial asynergy are most likely to benefit from aortocoronary revascularization.

Adult↗
PubMed1982

Effects of digoxin on myocardial oxygen supply and demand in patients following coronary artery bypass surgery.

Although digoxin is used frequently in patients in the prophylaxis of postoperative supraventricular tachyarrhythmias, the effects of the drug on myocardial oxygen supply and demand after coronary bypass have not been described. Seven adult patients with good ventricular function who underwent myocardial revascularization were studied before and three hours after digoxin (0.5 mg, iv). There were no significant changes observed in any measured systemic hemodynamic variable. Evaluation of global myocardial metabolism showed an increase in myocardial oxygen consumption (P less than 0.05) which was compensated satisfactorily, as no significant alteration was noted in the coronary sinus oxygen content, or in the lactate gradient across the myocardium. Since the authors studied the effects of only one dose of digoxin, the effects of full digitalization in these patients remains to be defined.

Aged↗
PubMed1982

Determination of the optimal concentration of lithium for the prophylaxis of manic-depressive disorder.

A group of 29 bipolar manic-depressives completed a 12-month double-blind cross-over trial of low-dose and high-dose lithium prophylaxis. Twelve patients relapsed, and significantly more of the relapses occurred during the low-dose 6-month phase of the trial. There was a trend for relapse to occur within 2 months of an abrupt drop in plasma lithium level, and to occur more often in women than in men. The efficacy of low-dose lithium prophylaxis and the significance of rebound relapse are discussed.

Adolescent↗