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Biomedical subjects

R Patel

Publications and source records attributed to R Patel.

At least 397 records · Page 22Linked to original sources
PubMed1978

Proof by catheterization of mitral valvular origin of a systolic click.

A patient with a loud intermittent midsystolic click presented a problem in differential diagnosis between mitral valve prolapse (intracardiac origin of the click) and left pneumothorax (extracardiac origin). External phonocardiography performed at the time of cardiac catheterization revealed that this loud midsystolic click disappeared whenever a catheter was positioned across the mitral valve. It reappeared whenever the catheter was removed from the transmitral position. Selective left ventriculography confirmed the diagnosis of mitral valve prolapse.

Cardiac Catheterization↗
PubMed1978

Effects of gravitational stresses on mitral valve prolapse. I. Changes in auscultatory findings produced by progressive passive head-up tilt.

The effects of passive head-up tilt on systolic time intervals were assessed in 18 patients with mitral valve prolapse. In addition to causing prolongation of the pre-ejection period and shortening of left ventricular ejection time, this circulatory stress led to progressive shortening of the Q to click interval. In 1 patient, a systolic click became audible which had not been heard in the supine posture. In 7 patients the click disappeared during head-up tilt, usually at 60 degrees or 90 degrees. In 2 patients without a murmur while supine, a mid-late systolic murmur appeared with tilt; 1 of these 2 as well as another patient who had a soft late systolic murmur while supine developed loud systolic whoops at greater angles of tile. The correlations between Q to click interval and aortic valve opening to click interval, and both the angle and the sine of the angle of tilt were highly significant.

Adolescent↗
PubMed1978

Differentiation of posterior myocardial infarction from right ventricular hypertrophy and normal anterior loop by echocardiography.

The differentiation of posterobasal myocardial infarction (PMI) from either right ventricular hypertrophy (RVH) or normal subjects displaying an anterior loop (AL) by electrocardiography (ECG) or vectorcardiography (VCG) is difficult. M-mode echocardiography (echo) via the anterior and subxiphoid methods has been helpful in defining cardiac chamber size and wall motion abnormalities. We tested whether this relatively more direct method would better separate these entities compared with the other two techniques. ECG and VCG using established criteria failed to distinguish the three conditions effectively. By echo, distinguishing characteristics were observed in each of the groups. Thus, right ventricular diastolic dimension and wall thickness were significantly increased only in the RVH group, echo dimensions and wall motion were normal in the AL group and the posterior left ventricular systolic thickening response and ejection phase indices were significantly reduced only by the subxiphoid method in the PMI group. To test the specificity of the latter finding, posterior wall motion in three infarction groups (posterior, combined posteroinferior and inferior) were examined and suggested that the target of the subxiphoid beam focuses on a more superior posterobasal left ventricular segment than the anteriorly placed transducer. Echocardiography can differentiate PMI from either RVH or AL more directly than ECG or VCG, and may be of practical clinical importance.

Adult↗
PubMed1978

The mitral knock with atrial fibrillation. A possible source of auscultatory confusion.

A 29-year-old woman with atrial fibrillation and severe rheumatic mitral regurgitation initially had a very loud third heart sound with high-frequency components (mitral knock), as well as with a first heart sound of widely varying intensity. After long diastoles a faint first heart sound was heard, with distinct separation from the third heart sound of the preceding cycle; however, on short cycles the loud and high-pitched third heart sound combined with a loud first heart sound to simulate the combination of a first heart sound with an ejection click. Phonoechocardiographic studies clarified the identity of the transients.

Adult↗
PubMed1977

Leukocyte antigens and disease: III. Association of HLA-B8 and HLA-BW 15 with insulin-dependent diabetes in three different population groups.

The distribution of 20 HLA antigens in 382 diabetic and 184 control subjects of white, Mexican-American, and black ancestry was studied. In all three populations, the incidence of antigens BB and BW15 was higher in the insulin-dependent diabetics than in the controls. The differences fell short of statistical significance when corrections were made for the number of antigens studied. When the results of previous studies were combined with our own, there was a highly significant association of insulin-dependent diabetes and the antigens BB and BW15 in the white population. It seems highly likely that this association would also hold true for the Mexican-American and the black diabetics if a sufficient number of patients were studied.

Black People↗
PubMed1977

Pulmonary valve vegetations detected with echocardiography.

In a patient with pseudomonas endocarditis a pulmonary regurgitant murmur developed. Sequential echocardiography demonstrated the initial absence of vegetations, the evolution of pulmonary valve vegetations with relapse and finally the apperance of vegetations on all cardiac valves. The findings were confirmed at autopsy. Echocardiography, a useful technique for evaluating mitral, aortic and tricuspid vegetations, can also detect pulmonary valve vegetations.

Adult↗
PubMed1977

Extradiol cleavage of 3-methylcatechol by catechol 1,2-dioxygenase from various microorganisms.

The isofunctional enzymes of catechol 1,2-dioxygenase from species of Acinetobacter, Pseudomonas, Nocardia, Alcaligenes, and Corynebacterium oxidize 3-methylcatechol according to both the intradiol and extradiol cleavage patterns. However, the enzyme preparations from Brevibacterium and Arthrobacter have only the intradiol cleavage activity. Comparison of substrate specificity among these isofunctional dioxygenases shows striking differences in the oxidation of 3-methylcatechol, 4-methylcatechol and pyrogallol.

Journal Article↗
PubMed1977

Coarctation of aorta with special reference to infants. Long-term results of operation in 126 cases.

A review of 126 cases of coarctation of the aorta confirms the need for surgical resection in infants with intractable congestive cardiac failure. The high association with additional cardiovascular abnormalities in patients presenting in early infancy contributes significantly to the mortality. Patients with large ventricular septal defects and coarctation of the aorta are at risk and may require pulmonary artery banding at the time of resection of the aortic coarctation. Long-term complications included restenosis (18 cases) and persistent hypertension (10 cases). In order to prevent persistent hypertension, it is suggested that elective resection of the coarctation be done at 1 year of age.

Adolescent↗
PubMed1977

Cardiovascular anomalies in thoracopagus twins and the importance of preoperative cardiac evaluation.

Four pairs of thoracopagus twins have been described. Cardiac catheterisation was performed in all the cases. Angiocardiographic and necropsy findings suggest that the most common abnormality was some form of univentricular heart. The communication between the 2 hearts was at atrial level in 2 cases. Separation was performed in 1 of these cases but only 1 of the twins survived for 14 hours after operation. It is suggested that full cardiac catheterisation with selective angiocardiogram is essential before separation is considered. Identical heart rates were observed in each pair and there was invariably a major communication between the hearts of the twins.

Female↗
PubMed1977

Pulmonary edema due to tetrachloroethylene.

A patient with massive exposure to tetrachloroethylene fumes presented with coma and severe pulmonary edema. Sequential blood gases, chest x-rays, and clinical findings showed dramatic improvement with conventional but aggressive management and the patient recovered completely. There was no evidence of permanent renal, hepatic, or central nervous system damage.

Adult↗
PubMed1976

Hypercalcaemia in acute renal failure.

A case of myoglobinuric acute renal failure complicated by hypercalcaemia is reported. Data on 13 other such cases published in the English literature since 1964 are summarised. Hypercalcaemia appears to be uniquely confined to rhabdomyolysis-myoglobinuric acute renal failure. Serum calcium concentrations should be monitored in such patients.

Acute Disease↗
PubMed1976

Pathologic correlations in a case of complete heart block with split His potentials resulting from a stab wound of the heart.

A 23 year old previously healthy man was stabbed in the anterior chest. This resulted in a ventricular septal defect and complete atrioventricular (A-V) block. The electrocardiogram revealed complete A-V block with a QRS pattern of right bundle branch block. His bundle recordings 26 days later revealed A-V dissociation with split His potentials (P-H1 interval of 100 msec and H2-V interval of 40 msec). During the study the escape QRS shifted from right to left bundle branch block with H2 potentials still preceding each QRS interval with H2-V intervals of 40 msec. A permanent pacemaker was implanted because of persistent congestive heart failure and bradycardia due to A-V block. The patient subsequently became asymptomatic. He died suddenly 3 1/2 years later. Pathologically there were sizable openings in both the tricuspid and mitral valve substance and a ventricular septal defect involving the pars membranacea and part of the adjacent muscular septum. Serial sections of the conduction system revealed total destruction and fibrous replacement of the bifurcation and beginning of the right and left bundle branches and subtotal fibrous replacement of the branching bundle. Thus, the bifurcation of the bundle of His was totally absent at autopsy despite apparent electrophysiologic evidence of its existence 26 days after the stab wound. A possible explanation for this discrepancy is the subsequent fibrosis of the bifurcation produced by hemodynamic changes at the lower margin of the ventricular septal defect.

Action Potentials↗
PubMed1975

A medial approach to thyroidectomy.

Thyroidectomy initiated by transecting the isthmus and peeling the lobes laterally away from the midline exposes the three vital elements of thyroid anatomy, namely the vessels, the recurrent laryngeal nerves and the parathyroid glands, by an almost bloodless dissection conducted at a distance from these vital structures. Part or all of the lobe or lobes can be removed while the parathyroid glands and recurrent laryngeal nerves remain clearly under view at all times.

Humans↗