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Biomedical subjects

W C Roberts

Publications and source records attributed to W C Roberts.

At least 181 records · Page 10Linked to original sources
PubMed1990

Comparison of coronary and myocardial morphologic findings in patients with and without thrombolytic therapy during fatal first acute myocardial infarction. The TIMI Investigators.

The hearts of 61 patients (39 men aged 64 +/- 11 years) who died from 5 hours to 42 days (median 3 days) after a fatal first acute myocardial infarction without having undergone percutaneous transluminal coronary angioplasty or coronary bypass surgery were studied to compare clinical and cardiac morphologic features of patients receiving thrombolytic therapy with tissue-plasminogen activator (t-PA) to those not receiving thrombolytic therapy. Comparison of findings in the 23 patients who received t-PA intravenously 3 +/- 1 hours after onset of symptoms, with the 38 patients who did not, showed similar baseline characteristics with respect to: age, gender, history of hypertension; location of the infarct; heart weight; severity and numbers of coronary arteries narrowed; and frequencies of plaque rupture, plaque hemorrhage and coronary thrombi. Among the patients receiving t-PA, however, there was a greater frequency of platelet-rich (fibrin-poor) thrombi in the infarct-related coronary arteries (6 of 11 vs 4 of 25 thrombi; p = 0.02), more nonocclusive than occlusive thrombi (6 of 11 vs 4 of 25 thrombi; p = 0.02), and a lower frequency of myocardial rupture (left ventricular free wall or ventricular septum) (5 of 23 [22%] vs 18 of 38 [46%]; p = 0.045).

Aged↗
PubMed1990

Myocarditis or acute myocardial infarction associated with interleukin-2 therapy for cancer.

The hearts of eight patients aged 22 to 67 years (mean, 41 years) who died during or within 4 days of interleukin-2 (IL-2) based immunotherapy for treatment of renal cell carcinoma or melanoma were studied at necropsy. Death resulted from combined cardiorespiratory failure in two patients, sepsis in four patients, acute myocardial infarction in one patient, and myocarditis in one patient. Transmural left ventricular necrosis was present in one of the two patients with significant atherosclerotic coronary artery narrowing. Noninfectious myocarditis was present in five patients: the inflammatory infiltrate was lymphocytic in four and composed of a mixture of eosinophils and lymphocytes in one. Although treatment-related deaths associated with high-dose IL-2 therapy are uncommon (1.5% in 652 consecutive patients), the potential for significant myocardial ischemia or myocarditis exists, and careful monitoring for arrhythmias or myocardial failure is warranted.

Adult↗
PubMed1990

Morphometric analysis of the composition of coronary arterial plaques in isolated unstable angina pectoris with pain at rest.

Coronary artery plaque morphology was studied in 354 five-mm segments of the 4 major (left main, left anterior descending, left circumflex and right) epicardial coronary arteries in 10 patients with isolated unstable angina pectoris with pain at rest. The 4 major coronary arteries were sectioned at 5-mm intervals and a drawing of each of the resulting 354 Movat-stained histologic sections was analyzed using a computerized morphometry system. The major component of plaque was a combination of dense acellular and cellular fibrous tissue with much smaller portions of plaque being composed of pultaceous debris, calcium, foam cells with and without inflammatory infiltrates and inflammatory infiltrates without foam cells. There were no differences in plaque composition among any of the 4 major epicardial coronary arteries. Plaque composition varied as a function of the degree of luminal narrowing. Linear increases were observed in the mean percent of dense fibrous tissue (from 5 to 50%), calcific deposits (from 1 to 10%), pultaceous debris (from 0 to 10%) and inflammatory infiltrates without significant numbers of foam cells (from 0 to 5%), and a linear decrease was observed in the mean percent of cellular fibrous tissue (from 94 to 22%) in sections narrowed up to 25% to more than 95% in cross-sectional area. Multiluminal channels were seen in all 10 patients (28 [19%] of the 146 sections narrowed greater than 75% in cross-sectional area and in 36 [10%] of all 354 segments); occlusive thrombi in no patient; nonocclusive thrombi in 2 patients (1 section each of 2 arteries); plaque rupture in 2 patients (4 segments from 2 arteries); and plaque hemorrhages in 6 patients (11 sections from 10 arteries).

Aged↗
PubMed1990

Cardiac morphologic findings in patients with acute myocardial infarction treated with recombinant tissue plasminogen activator.

The hearts of 52 patients (aged 61 +/- 11 years, 34 men) who participated in the Thrombolysis in Myocardial Infarction (TIMI) Study and died from 5 hours to 260 days (median 2.7 days) after onset of chest pain were studied. One heart became available at cardiac transplantation. Of the 52 patients, 38 received recombinant tissue plasminogen activator (rt-PA) not followed by percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). Eight had PTCA, and 6 had CABG. The infarcts were hemorrhagic by gross inspection (with histologic confirmation) in 23 patients, nonhemorrhagic in 20, not visible grossly in 2 and, in 7, there was no myocardial necrosis by either gross or histologic examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Thrombosis↗
PubMed1990

Diffuse extent of coronary atherosclerosis in fatal coronary artery disease.

In 4 subsets of patients with coronary artery disease, the amounts of narrowing of the 4 major epicardial coronary arteries were compared (left main, left anterior descending, left circumflex and right) by atherosclerotic plaques. Among 129 patients studied at necropsy, an average of 2.7 of the 4 arteries were narrowed greater than 75% in cross-sectional area at some point; in control subjects, narrowing was seen in an average of 0.7 arteries. Patients with unstable angina pectoris had a greater incidence of narrowing (3.2 arteries) than did patients with sudden coronary death (2.8), acute myocardial infarction (MI) (2.7) or healed MI (2.3). Each of the 4 major arteries was divided into segments 5 mm in length, and histologic sections were prepared and stained by the Movat method. A total of 6,461 segments were analyzed from the 129 patients and 1,849 from the 40 controls. In the 129 patients, 35% of the 5-mm segments were narrowed 75 to 100% in cross-sectional area (compared with 3% in control subjects). The group with unstable angina had the highest percentage (48%) of severely narrowed segments compared with the groups with sudden coronary death (36%), acute (34%) and healed MI (31%). Only 8% of the 6,461 segments were narrowed less than or equal to 25% in cross-sectional area, and virtually none of the 6,461 segments was normal; thus, 92% of the coronary segments were narrowed greater than 25% in cross-sectional area by atherosclerotic plaque alone. Among patients with fatal coronary artery disease studied at necropsy, therefore, the atherosclerotic process is severe and diffuse in the major epicardial coronary arteries.

Aged↗
PubMed1990

Quantitative analysis of amounts of coronary arterial narrowing in cocaine addicts.

From January 1979 to February 1989, 22 cocaine addicts were studied at necropsy. The 22 patients were divided into 2 groups: death associated with increased cocaine levels at necropsy (13 patients, aged 23 to 45 years [mean 32], and mean total blood cocaine level, 0.36 mg/dl) and noncocaine-related death (9 patients, aged 15 to 50 years [mean 32]). Of the 22 patients, 17 were men and 5 were women; 19 were black and 3 were white. Gross examination in the 22 patients disclosed that 8 patients (36%) had 1 or more of the 4 major (left main, left anterior descending, left circumflex, and right) coronary arteries narrowed at some point greater than 75% in cross-sectional area by atherosclerotic plaque. In 17 cases, the 4 major epicardial coronary arteries were divided into 805 five-mm long segments and a histologic section was prepared from each segment: of the 12 patients with a cocaine-related death, 41 (8%) of 544 five-mm coronary segments were narrowed 76 to 100% and 106 segments (19%) were narrowed 51 to 75% in cross-sectional area by plaque. Of the 5 cocaine addicts who did not die from cocaine overdose, 8 (3%) of 261 five-mm coronary segments were narrowed 76 to 100% and 19 segments (7%) were narrowed 51 to 75% in cross-sectional area by plaque. The frequency of coronary artery disease was greater in patients dying with cocaine in their blood at necropsy compared to those whose death was not cocaine related.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗