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Biomedical subjects

T H Diamond

Publications and source records attributed to T H Diamond.

At least 37 records · Page 2Linked to original sources
PubMed1987

Hyperkalaemia secondary to hypo-aldosteronism. A report of 2 cases differentiating hyperreninaemic from hyporeninaemic hypo-aldosteronism.

Hypo-aldosteronism has been considered an important pathophysiological mechanism in the development of hyperkalaemia. This may occur as a consequence of defective regulatory mechanisms in the plasma renin-angiotensin-aldosterone system. Two case reports of hyperkalaemia are described which illustrate the differentiation of hyperreninaemic from hyporeninaemic hypo-aldosteronism. Laboratory investigations, together with measurements of plasma renin activity and aldosterone concentrations during adrenocorticotrophic hormone stimulation and sodium depletion, demonstrated this difference. Appropriate therapy with fludrocortisone (Florinef; Squibb) and furosemide (Lasix; Hoechst) respectively returned the situation to normal.

Aldosterone↗
PubMed1986

Primary hyperparathyroidism. A study of 100 patients in Johannesburg.

This study comprised 100 white patients with primary hyperparathyroidism treated between 1975 and 1984. Of these, 75 attended Johannesburg Hospital and 25 were managed by private practitioners. The mean age was 56.4 +/- 1.4 years at the time of diagnosis. There were almost twice as many women as men. In patients attending Johannesburg Hospital there was a progressive increase in the detection rate after 1979, which corresponded with the introduction of automated multichannel serum analysis. The commonest major complications were renal stones (54%), renal insufficiency (27%), a history of skeletal fractures (12%), radiographic evidence of osteopenia (38%) and peptic ulcers (20%). Bone disease was particularly common in postmenopausal women (64%). Other notable features were the frequency of weakness and fatigue (40%) and hypertension (45%). Coincidental thyroid abnormalities were frequent (18%). Ninety-three patients were treated surgically; 76 (81.7%) had a single adenoma. Our findings are compared with those of other large series. This study indicates the need for a greater awareness of this condition and earlier diagnosis to forestall the development of its harmful complications, and for the collection of additional information from a prospective study.

Adolescent↗
PubMed1985

Persistent ST-segment elevation in patients with anterior myocardial infarctions. Evaluation by exercise electrocardiography, echocardiography and Holter monitoring.

One hundred and seventy patients who suffered an acute myocardial infarction (MI) were followed up at 3-monthly intervals by a full clinical evaluation, exercise electrocardiography and ambulatory Holter monitoring. Fifty-eight patients (34%) had anterior MIs, and of these 23 (40%) had persistent ST-segment elevation over the infarct zone, reflected by leads presenting with Q-S configuration. Fifteen (65,2%) of the latter demonstrated further ST-segment elevation during exercise. They were further investigated by cross-sectional echocardiography. Left ventricular (LV) dysfunction was diagnosed in 87% of patients with persistent ST-segment elevation, and in 93% of the patients with additional exercise-induced ST-segment elevation. Organized thrombi occurred in 2 patients (8,7%) and 1 experienced a transient ischaemic attack. Ventricular arrhythmias occurred frequently (ventricular ectopy--91,3%, ventricular tachycardia--17,4%, and couplets--47,8%). Death occurred in 3 patients (13,1%) and 1 patient (4,3%) had a second MI over a mean follow-up period of 83,6 months. This study suggests that persistent ST-segment elevation on the resting ECG of patients with anterior MIs is a reliable indicator of LV wall motion abnormalities, and that this correlation further increases if it is associated with exercise-induced ST-segment elevation. Furthermore, the role of echocardiography as a diagnostic tool in evaluating LV function is stressed. The prognosis of patients with post-infarction LV dysfunction is notably poor and may be the result of frequent complex ventricular arrhythmias.

Arrhythmias, Cardiac↗
PubMed1985

Acute myocardial infarction with normal coronary arteries--viral myopericarditis and possible coronary vasospasm. A case report.

A young man with normal coronary arteries presented with a transmural apical myocardial infarction. This diagnosis was based on elevated serial cardiac enzyme values, ECG changes, exercise scanning with thallium-201, left ventricular angiography and selective coronary arteriography. Some of the pathophysiological mechanisms implicated in myocardial infarction in patients with normal coronary arteries are discussed and the probable diagnosis of a virus-induced myopericarditis together with coronary artery vasospasm is favoured.

Adult↗
PubMed1983

A comparison of the efficacy of sotalol and nadolol in the suppression of ventricular ectopic beats.

The anti-arrhythmic efficacy of sotalol, a beta-blocking agent which possesses class III anti-arrhythmic properties, was compared with that of nadolol. Nadolol, like sotalol, is non-cardioselective, is water-soluble, has no first-pass effect, is excreted unchanged in the urine, has a comparatively long half-life requiring only once-daily dosage, and has no intrinsic sympathomimetic activity and no membrane-stabilizing action. Twenty-two patients with stable chronic ventricular arrhythmias after myocardial infarction were studied; to qualify for entry they had to exhibit a minimum frequency of 30 ventricular ectopic beats per hour over a 24-hour Holter monitoring period. The study was of single-blind, cross-over format with placebo periods before active drug administration and during the cross-over periods. Nadolol 80 and 160 mg and sotalol 160 and 320 mg were administered for 7-day periods. Routine laboratory tests were performed and serum drug concentrations measured at regular intervals. Both drugs at all dosages suppressed ventricular ectopic beats significantly (P less than 0,001). No statistically significant prolongation of the QTc interval could be demonstrated with either drug. Side-effects were negligible.

Adult↗
PubMed1983

The dilemma of the creatine kinase cardiospecific iso-enzyme (CK-MB) in marathon runners.

Serum creatine kinase iso-enzyme (CK-MB) levels were measured in 51 marathon runners before and after a 50 km marathon event. Ninety-five per cent of the runners were found to have pathologically elevated values, i.e. CK-MB concentrations were elevated to the range normally considered indicative of myocardial necrosis. Results indicate that a rise in the CK-MB level is common after marathon running. We therefore believe that cardiac enzymes are an unreliable indicator of myocardial infarction in patients who experience chest pain following strenuous muscular exercise.

Adult↗
PubMed1983

Holter monitoring--a necessity for the evaluation of palpitations.

Eighty-five patients complaining of palpitations were evaluated by means of 24-hour dynamic electrocardiography. A sensitivity of 0,69 and a specificity of 0,90 were calculated. This illustrates the value of Holter monitoring in the assessment of patients complaining of palpitations.

Adolescent↗
PubMed1982

The natural history of the Q wave in inferoposterior myocardial infarction.

One hundred and twenty-five patients who had suffered transmural inferior myocardial infarctions were followed up for a mean period of 55 months. On electrocardiography the area under the pathological Q waves in the inferior leads was measured serially. Eighty-one patients (65%) showed a highly significant time-related diminution in Q-wave area. The ECGs of 17 subjects (14%) became normal and there was no electrocardiographic evidence of the previous myocardial infarction. The Q waves of the remaining 44 subjects (35%) remained constant or increased. A discussion of the possible mechanisms of changes in Q-wave size follows.

Adult↗
PubMed1982

Correlation of ventricular ectopic activity and exercise-related ST-segment changes.

Same-day exercise electrocardiography and ambulatory electrocardiographic (Holter) monitoring were performed on 167 patients, all of whom had suffered myocardial infarctions over the past 12 years. A significant correlation (P less than 0,0001) was found when comparing exercise testing for ischaemic ST-segment changes and the number of complexity of ventricular arrhythmias found on Holter monitoring. Two different methods of arrhythmia classification were used and the results were similar. The value of simultaneous Holter monitoring and exercise electrocardiography to detect 'late' exercise-related ventricular arrhythmias was not found to be sufficient to warrant their widespread simultaneous use.

Adult↗
PubMed1982

Lack of correlation between the clinical assessment of cardiovascular status and exercise electrocardiography.

One hundred and seventy-one patients who had had a myocardial infarction were evaluated at the Institute for Aviation Medicine, Pretoria. Patients were graded according to the New York City Heart Association classification of cardiac functional capacity and then subjected to exercise electrocardiography. Only 20% of the 74 patients whose exercise electrocardiograms revealed ischaemic heart disease felt that their cardiovascular function was limiting their daily activity. This lack of correlation between the two forms of assessment was highly significant (P less than 0,0001). It is therefore concluded that clinical evaluation of an individual with known ischaemic heart disease may be misleading.

Adult↗