Identification of immunoreactive atrial natriuretic peptide in atrial amyloid.
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Amyloidosis↗
Biomedical subjects
S J Edmondson
Publications and source records attributed to S J Edmondson.
Identification of right ventricular rupture by radionuclide ventriculography.
Right ventricular rupture is rare. We report its identification by radionuclide ventriculography and subsequent confirmation by contrast angiography and at operation. The aetiology in this case was a primary cardiac malignancy.
Heart Neoplasms↗
Myocardial revascularisation in elderly patients with refractory or unstable angina and advanced coronary disease.
BACKGROUND: Elderly patients with ischaemic heart disease are often treated more conservatively and for longer than younger patients, but this strategy may result in subsequent invasive intervention of more advanced and higher risk coronary disease. METHODS: We performed a retrospective analysis of 109 patients aged > or = 70 years (mean age 74 years, 66% men), who presented with angina refractory to maximal medical treatment or unstable angina over a 2-year period (1988-1990), to compare the relative risks and benefits of myocardial revascularisation [coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA)] in this higher-risk age group. RESULTS: Sixty patients underwent CABG and 49 patients PTCA. There were eight periprocedural deaths in total (six in the CABG group, and two in the PTCA group, P = 0.29). Six patients in the CABG group suffered a cerebrovascular accident (two fatal). Acute Q-wave myocardial infarction occurred in one patient in the CABG group and in two patients in the PTCA group. The length of hospital stay was longer for the CABG group (CABG group 11.4 +/- 5.4 days, range 7-30 days, PTCA group 7.4 +/- 7.6 days, range 1-39 days, P = 0.01). Outcome was assessed using the major cardiac event rate (MACE; i.e. the rate of death, myocardial infarction, repeat CABG or PTCA). The cumulative event-free survival in the CABG group in 1, 2 and 3 years was 87, 85 and 85%, respectively. In contrast, in the PTCA group it was 55, 48 and 48% (P = 0.0001). Age, sex, number of diseased vessels, degree of revascularisation and left ventricular function were not predictive of the recurrence of angina in both groups. Actuarial survival (total mortality, including perioperative mortality) was lower at 1 year in the CABG group due to the higher perioperative mortality, but similar in both groups after the second year (P = 0.62). CONCLUSIONS: Elderly patients with refractory or unstable angina who are revascularised surgically have a better long-term outcome (less frequent event rate of the composite end-point--myocardial infarction, revascularisation procedures and death) compared with those who are revascularised with PTCA. This benefit is been realised after the second year. Total mortality is similar in both groups after the second year. Therefore elderly patients who are fit for surgery should not be denied the benefits of CABG. PTCA may be regarded as a complementary and satisfactory treatment, especially for those whose life expectancy is limited to less than 2 years. The use of stents may improve outcome in the PTCA group and this needs to be evaluated.
Aged↗
Teratoma associated with endodermal sinus tumor.
A 3-1/2-year-old girl was diagnosed as having a mediastinal endodermal sinus tumor with pulmonary, bony, and hilar lymph node metastases. Following 7 months of treatment with chemotherapy, thoracic CT (computerized tomogram) scan showed the presence of a residual mass. Upon further surgical exploration the residual mass, which was found to be intrapericardial and arising from the ascending aorta, was resected. This second lesion was shown to be a benign cystic teratoma. The combination of an intrapericardial teratoma and a mediastinal endodermal sinus tumor in a female child is probably unique. The possible etiology for the combination of these two pathologies is discussed.
Antineoplastic Combined Chemotherapy Protocols↗
Is the waiting list a safe place for outpatients awaiting coronary bypass surgery?
This study was undertaken to identify the safety of outpatients awaiting coronary bypass surgery. An audit of the outcome of 92 such outpatients at one Regional centre was undertaken by a retrospective review of medical records. Outcome measures were: time on the waiting list, anti-ischaemic medications, readmission for unstable angina, myocardial infarction and death. Almost half of the patients underwent surgery within three months, and three-quarters waited less than six months. No outpatient death occurred. However, 4 of the 7 adverse events occurred within this period. Despite advanced disease, the safety of outpatients awaiting coronary surgery within such a short time frame appeared to be acceptable, the only adverse events being non-fatal and occurring unpredictably.
Adult↗
Chronic traumatic aneurysm of the aorta: to resect or not. The role of exploration operation.
A case is reported of a chronic traumatic aneurysm of the aorta believed to be of 24 years duration in an asymptomatic 43 years old male. At operation the aneurysm was found to be fusiform, rigidly calcified and extending for approximately 8 cm beyond the left subclavian artery. In view of its extent and apparent rigidity of its walls resection and grafting did not proceed. The role of exploratory thoracotomy in the management of chronic traumatic aneurysms of the aorta is discussed.
Adult↗
Reoperation for failed aorto-coronary bypass grafts.
Despite the initial overall good results of aorto-coronary bypass grafting for myocardial revascularisation, a small but increasing number of patients require consideration for reoperation after the first procedure. In the period 1973 to 1981, 36 reoperations were performed in 34 patients with one operative death. In all of them the clinical indication for reoperation was recurrence of angina pectoris. In this special group of patients a high incidence of risk factors was present. Three major probable causes for the recurrence of angina were found: (1) Progression of the coronary atherosclerotic disease; (2) Graft failure; (3) Incomplete original revascularisation. Combined factors were present in 18 (53%) patients. There were no statistically significant differences in the incidence of postoperative complications at the first and second operation. Follow-up of 79% of the 33 survivors over a mean time period of 18 months, demonstrated no late mortality and a low subsequent infarction rate. Overall 69% of patients either lost their angina or were improved. We therefore conclude that reoperation can be accomplished with low mortality and morbidity and has a potential therapeutic benefit in the majority of cases.
Adult↗