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Biomedical subjects

W C Roberts

Publications and source records attributed to W C Roberts.

At least 199 records · Page 11Linked to original sources
PubMed1990

Sudden cardiac death: a diversity of causes with focus on atherosclerotic coronary artery disease.

There are many causes of sudden cardiac death, and the younger the patient the more diverse the cause. Among persons dying suddenly in the Western World atherosclerotic coronary artery disease is the most common. This group might best be called atherosclerotic sudden coronary death. This article summarizes a previously published necropsy study by Warnes and Roberts of 70 victims aged 22 to 81 years (mean 50) of sudden coronary death. Of 3,484 five-mm coronary segments examined (mean 50 per patient) from the 4 major (left main, left anterior descending, left circumflex and right) coronary arteries, 950 (27%) were narrowed 76 to 100% in cross-sectional area by plaque; 1,127 (32%), 51 to 75%; 689 (20%), 26 to 50%, and 718 (21%), 0 to 25%. More extensive severe narrowing occurred in the proximal compared with the distal halves to the left anterior descending, left circumflex and right coronary arteries. Comparison between the 31 previously symptomatic victims (either angina pectoris and/or a clinical acute myocardial infarction) to the 39 victims who had previously been asymptomatic disclosed a significantly higher mean percent of severely (76 to 100% in cross-sectional area) narrowed 5-mm segments (30 vs 25% [p less than 0.0051]) and a lower mean percent of minimally (0 to 25%) narrowed segments in the symptomatic group (15 vs 25%, p less than 0.001). Thus, the major coronary arteries at necropsy in victims of sudden coronary death are diffusely involved by atherosclerotic plaque and in nearly one-third of the lengths of the major arteries the lumens are narrowed greater than 75% in cross-sectional area by plaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Coronary arterial morphology 10 years after "endarterectomy".

Little information is available regarding coronary artery morphology after endarterectomy. In this report, we describe coronary artery morphology seen at necropsy 10 years after coronary artery endarterectomy and compare it with the morphology of the original endarterectomy specimen. Surprisingly, in some areas, all of the internal elastic membrane and most of the media were observed in the "endarterectomy" specimen.

Coronary Artery Bypass↗
PubMed1990

Aortic dissection with the entrance tear in transverse aorta: analysis of 12 autopsy patients.

Clinical and autopsy findings are described in 12 patients who had fatal aortic dissection with the entrance tear in the transverse aorta. The 12 patients represent 7% of 182 autopsies of spontaneous aortic dissection studied by us. The ages of the 12 patients at death ranged from 37 to 87 years (mean, 67 years). Eight were men; 8 had a history of systemic hypertension, and 10 had hearts of increased weight. Diagnosis of aortic dissection was made during life in only 4 of the 12 patients. All 12 patients died of rupture of the false channel within 2 weeks of onset of signs or symptoms compatible with dissection. The direction of aortic dissection from the entrance tear was entirely retrograde in 4 patients, entirely anterograde in 4 patients, and in both directions in 4 patients. Hemopericardium occurred in the first group, left hemothorax in the second group, and either in the last group. Of the 8 patients in whom the ascending aorta was involved, the retrograde dissection in each extended to the aortic root, 6 had pulmonary adventitial hemorrhage, and 4 had involvement of the arch arteries by dissection. In the 4 patients with strictly anterograde dissection, none had dissection in the arch arteries. Thus, tear in the transverse aorta causes a dissection that is usually fata, that often dissects retrogradely, and that may mimic dissection from a tear in ascending aorta. Aortic dissection from a tear in transverse aorta requires early operative intervention.

Adult↗
PubMed1990

Pathologic findings associated with interleukin-2-based immunotherapy for cancer: a postmortem study of 19 patients.

The use of interleukin-2 (IL-2), either alone or in combination with lymphokine-activated killer cells, tumor infiltrating lymphocytes, or other immunotherapeutic agents has added a new list of alternatives to conventional antineoplastic regimens. Little information is available about the pathologic changes occurring in patients treated with these agents. In this study, we reviewed the necropsy materials from 19 patients, 12 men and 7 women, with a variety of malignancies including melanoma, renal cell carcinoma, gastrointestinal and pulmonary adenocarcinoma, and metastatic gastrinoma, who died after receiving IL-2-based immunotherapy. Death occurred at intervals ranging from less than 1 hour to 143 days following the last dose of therapy. All patients dying at or less than 43 days following cessation of therapy had lymphoid infiltrates of varying intensity in residual tumor. At necropsy, the major cause of death unrelated to the presence of metastatic tumor was bacterial sepsis. In addition, we found evidence of significant cardiac and pulmonary toxicity: two patients with acute myocardial infarction, one with and one without significant coronary artery disease, two cases of unexplained lymphocytic myocarditis, and one case of fatal pulmonary capillary plugging following an infusion of lymphokine-activated killer cells. Thus, not unlike other forms of therapy for cancer, IL-2-based immunotherapy does not appear to be without significant toxicity.

Adult↗
PubMed1990

Mode of death, frequency of healed and acute myocardial infarction, number of major epicardial coronary arteries severely narrowed by atherosclerotic plaque, and heart weight in fatal atherosclerotic coronary artery disease: analysis of 889 patients studied at necropsy.

Mode of death, frequency of a healed or an acute myocardial infarct, or both, number of major epicardial coronary arteries severely narrowed by atherosclerotic plaque, and heart weight were studied at necropsy in 889 patients 30 years of age or older with fatal atherosclerotic coronary artery disease. No patient had had a coronary bypass operation or coronary angioplasty. The 889 patients were classified into four major groups and each major group was classified into two subgroups: 1) acute myocardial infarct without (306 patients) or with (119 patients) a healed myocardial infarct; 2) sudden out of hospital death without (121 patients) or with (118 patients) a healed myocardial infarct; 3) chronic congestive heart failure with a healed myocardial infarct without (137 patients) or with (33 patients) a left ventricular aneurysm; and 4) sudden in-hospital death without (20 patients) or with (35 patients) unstable angina pectoris. The mean age of the 687 men (77%) was 60 +/- 11 years, and of the 202 women (23%), 68 +/- 13 years (p = 0.0001). Although men included 77% of all patients, they made up approximately 90% of the out of hospital (nonangina) sudden death group. The frequency of systemic hypertension and angina pectoris was similar in each of the four major groups. The frequency of diabetes mellitus was least in the sudden out of hospital death group and similar in the other three major groups. The mean heart weight and the percent of patients with a heart of increased weight were highest in the chronic congestive heart failure group; values were lower and similar in the other three major groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomegaly↗
PubMed1990

Morphologic findings in saphenous veins used as coronary arterial bypass conduits for longer than 1 year: necropsy analysis of 53 patients, 123 saphenous veins, and 1865 five-millimeter segments of veins.

Certain clinical and necropsy findings are described in 53 patients who died from 13 to 185 months (mean 58) after a single aortocoronary bypass operation. Of the 53 patients, 32 (60%) died of a cardiac cause and of their 72 saphenous vein aortocoronary conduits, 36 (49%) were narrowed at some point more than 75% in cross-sectional area by atherosclerotic plaque; the remaining 21 patients (40%) died of a noncardiac cause and of their 50 saphenous vein conduits, 10 (20%) were narrowed at some point more than 75% in cross-sectional area by plaque. Thus the noncardiac mode of death in a large percentage of the patients suggests that the bypass operation prolonged life to a degree sufficient for another condition to develop. The 123 saphenous vein conduits were divided into 5 mm segments, and a histologic section was prepared from each. Of the 1104 five-millimeter segments in the 32 patients dying as a consequence of myocardial ischemia, 291 (26%) were narrowed more than 75% in cross-sectional area by plaque; in contrast, of the 761 five-millimeter segments of veins in the 21 patients with a noncardiac mode of death, 86 (11%) were narrowed more than 75% by plaque. Of the total 1865 five-millimeter segments of vein, only 395 (21%) were narrowed 25% or less in cross-sectional area by plaque. Thus, in patients dying late after coronary bypass the atherosclerotic process continues in all segments of the saphenous veins used as aortocoronary conduits. Therapy after the operation must be directed toward prevention of progression of the atherosclerosis in the "new" coronary "arteries."

Adult↗
PubMed1990

Comparison of early and late onset dysthymia.

The present investigation compares early and late onset community dysthymia groups on insidious onset patterns, cognitive, coping, and symptom measures testing the assumption implicit in DSM-III-R that the two groups are qualitatively dissimilar. The results suggest that, regardless of age of onset, the groups did not differ except on some features of coping style. Homogeneity, not heterogeneity, was the predominant finding. The results call into question the DSM-III-R procedure for classifying dysthymia by age of onset, but also point to the need for additional research.

Adolescent↗
PubMed1990

Plaque characterization of atherosclerotic coronary arteries by intravascular ultrasound.

Intravascular ultrasound provides cross-sectional images of arteries and enables accurate delineation of lumen dimensions and wall structure. Moreover, ultrasound characterization of atherosclerotic plaque subtypes may have important implications in determining the natural history and the clinical outcome of patients with coronary artery disease. The reliability of intravascular ultrasound to differentiate plaque morphology subtypes was studied in 60 coronary segments excised from 33 coronary arteries obtained from 17 patients at necropsy. Ultrasound was performed with a 25-MHz transducer mounted on the distal end of a rigid probe that was rotated manually inside the lumen artery. Plane film radiography was also performed to establish the presence of calcific deposits. A total of 82 histologic transverse sections corresponding to 82 ultrasound imaging sites were studied from the 60 coronary segments. Of the first 54 images, 36 were fibrous plaques and yielded dense homogenous echo reflections, 6 had discrete areas of lipid that were less echogenic and 12 had calcific deposits that cast echo-free shadows beyond areas of intense echo reflections. The predictive accuracy of evaluating plaque composition in the remaining 28 ultrasound imaging sites was 96%. Thus, anatomical structure of coronary arteries and composition of atherosclerotic lesions can be assessed accurately with intravascular ultrasound and may have potential for better understanding of the atherosclerotic process and provide guidance to interventional procedures.

Aged↗
PubMed1990

Sudden death in hypertrophic cardiomyopathy with normal left ventricular mass.

An active, healthy, and symptom free 16 year old boy with a family history of hypertrophic cardiomyopathy died suddenly while walking home from school. Necropsy showed absence of left ventricular hypertrophy (that is, normal heart weight), though the characteristic histological abnormalities of hypertrophic cardiomyopathy, such as cardiac muscle cell disorganisation and abnormal intramural coronary arteries, were present. It is likely that this patient had hypertrophic cardiomyopathy and died before left ventricular hypertrophy developed.

Adolescent↗
PubMed1990

Coronary artery imaging with intravascular high-frequency ultrasound.

Safe and effective clinical application of new interventional therapies may require more precise imaging of atherosclerotic coronary arteries. To determine the reliability of catheter-based intravascular ultrasound as an imaging modality, a miniaturized prototype ultrasound system (1-mm transducer; center frequency, 25 MHz) was used to acquire two-dimensional, cross-sectional images in 21 human coronary arteries from 13 patients studied at necropsy who had moderate-to-severe atherosclerosis. Fifty-four atherosclerotic sites imagined by ultrasound were compared with formalin-fixed and fresh histological sections of the coronary arteries with a digital video planimetry system. Ultrasound and histological measurements correlated significantly (all p less than 0.0001) for coronary artery cross-sectional area (r = 0.94), residual lumen cross-sectional area (r = 0.85), percent cross-sectional area (r = 0.84), and linear wall thickness (plaque and media) measured at 0 degrees, 90 degrees, 180 degrees, and 270 degrees (r = 0.92). Moreover, ultrasound accurately predicted histological plaque composition in 96% of cases. Anatomic features of the coronary arteries that were easily discernible were the lumen-plaque and media-adventitia interfaces, very bright echoes casting acoustic shadows in calcified plaques, bright and homogeneous echoes in fibrous plaques, and relatively echo-lucent images in lipid-filled lesions. These data indicate that intravascular ultrasound provides accurate image characterization of the artery lumen and wall geometry as well as the presence, distribution, and histological type of atherosclerotic plaque. Thus, ultrasound imaging appears to have great potential application for enhanced diagnosis of coronary atherosclerosis and may serve to guide new catheter-based techniques in the treatment of coronary artery disease.

Adult↗