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Biomedical subjects

W C Roberts

Publications and source records attributed to W C Roberts.

At least 523 records · Page 29Linked to original sources
PubMed1980

Status of the coronary arteries at necropsy in diabetes mellitus with onset after age 30 years. Analysis of 229 diabetic patients with and without clinical evidence of coronary heart disease and comparison to 183 control subjects.

Clinical and morphologic observations were made in 229 necropsy patients with diabetes mellitus (DM) with onset of diabetes mellitus after 30 years of age--65 without (DM-CHD) and 164 with (DM + CHD) clinical evidence of coronary heart disease (CHD). These observations were compared to those in 183 age-sex-matched nondiabetic control subjects who died from a fatal coronary event (CHD-DM). The average number of three major (right, left anterior descending, left circumflex) coronary arteries per patient narrowed > 75 percent in cross-sectional area by atherosclerotic plaques was identical in the 229 diabetic patients (DM-CHD and DM + CHD) and in the control subjects (CHD-DM), namely, 2.5/3.0. This similarity in the amount of coronary arterial narrowing was present irrespective of the age at onset (after 30 years) or duration of diabetes mellitus. The DM + CHD patients had more severe narrowing of the three major coronary arteries than did the DM-CHD patients (p < 0.01). The amount of severe narrowing in the proximal halves of each of these three arteries was similar to that in the distal halves. The amount of severe (> 75 percent in cross-sectional area) narrowing of the left main coronary artery was greater in the patients with diabetes mellitus than in the nondiabetic controls: 13 percent versus 6 percent (p < 0.01). The type of treatment received by the patients with diabetes mellitus or their adherence to the therapeutic program as measured by the level of random fasting blood sugar did not alter the amount of severe coronary narrowing observed at necropsy.

Adult↗
PubMed1980

Quantification of coronary arterial narrowing at necropsy in acute transmural myocardial infarction. Analysis and comparison of findings in 27 patients and 22 controls.

We quantitatively analyzed the degree and extent of coronary arterial narrowing by atherosclerotic plaques in the entire length of each of the four major coronary arteries in 27 necropsy patients with transmural acute myocardial infarction (AMI) and compared the findings with those in 22 control subjects. Of the 1403 5-mm segments examined in the 27 AMI patients, 484 (34%; controls 3%) were 76-100% narrowed in cross-sectional area by atherosclerotic plaques, 528 (38%; controls 25%) were 51-75% narrowed, 319 (23%; controls 44%) were 26-50% narrowed, and only 72 segments (5%; controls 28%) were less than or equal to 25% narrowed. The amount of severe (greater than 75%) narrowing of the right, left anterior descending and left circumflex coronary arteries by atherosclerotic plaques was similar, as was the amount of severe narrowing in the distal and proximal halves of these three arteries. The number of severely narrowed 5-mm segments did not correlate significantly with the patient's age at death, the presence or absence of a history of angina pectoris or healed myocardial infarction, or with heart weight. The men, however, had a significantly greater number of severely narrowed 5-mm segments of coronary artery than the women (p less than 0.05), and the patients with associated transmural left ventricular scars had significantly more severely narrowed segments than did patients without transmural scars.

Acute Disease↗
PubMed1980

Sudden death in young athletes.

The causes of sudden and unexpected death in 29 highly conditioned, competitive athletes, ages 13-30 years, are summarized. Sudden death occurred during or just after severe exertion on the athletic field in 22 of the 29 athletes. Structural cardiovascular abnormalities were identified at necropsy in 28 of the 29 athletes (97%), and in 22 (76%) were almost certainly the cause of death. The most common cause of death in this series was hypertrophic cardiomyopathy, which was present in 14 athletes. Other cardiovascular abnormalities that occurred in more than one athlete were anomalous origin of the left coronary artery from the right (anterior) sinus of Valsalva, idiopathic concentric left ventricular hypertrophy, coronary heart disease and ruptured aorta. Cardiac disease was suspected during life in only seven of the 29 patients, and in only two of the seven was the correct diagnosis made clinically. Hence, in this series of young athletes, sudden death was usually due to structural cardiovascular disease, and hypertrophic cardiomyopathy was a frequent cause of sudden death; atherosclerotic coronary heart disease was relatively uncommon.

Adolescent↗
PubMed1980

Collagen concentration and rates of synthesis in idiopathic pulmonary fibrosis.

To define the biochemical correlates of the apparent morphologic increase in lung interstitial collagen in idiopathic pulmonary fibrosis (IPF), collagen content was quantitated, and the morphologic degree of fibrosis was assessed in 9 patients with IPF and 6 control subjects. There were no significant differences in the collagen content among patients with IPF compared with that of control subjects. In addition, there was no correlation between collagen content and the morphologic assessment of the degree of fibrosis. Analysis of the collagen content from multiple sites made from base to apex of postmortem material from 3 patients with IPF and 2 control subjects demonstrated a wide, but similar, variation in collagen content in both groups; no definite pattern of anatomic distribution was found in either the patients with IPF or the control subjects. Furthermore, the rates of collagen and noncollagen protein synthesis in explants of lung of patients with IPF demonstrated no significant differences compared with those of the control subjects. The results of this study are consistent with the concept that IPF is a disease of an alteration in quality, form, and location of collagen rather than simply a disease of increased interstitial collagen.

Adult↗
PubMed1980

Postoperative aortic regurgitation from incomplete seating of tilting-disc occluders due to overhanging knots or long sutures.

Certain clinical and morphologic features are described in three patients who developed severe aortic regurgitation after aortic valve replacement. The regurgitation, fatal in two of the three patients, resulted from long sutures or their knots or both overhanging the metallic ring of the prosthesis preventing complete seating of the occluder. In one patient, simply cutting the overhanging suture eliminated the aortic regurgitation. The problem of suture overhang appears more likely to occur when aortic valve replacement is carried out in patients with relatively small aortic roots. Before closing the aortotomy after aortic valve replacement, it is advisable to move the occluder back and forth to make sure its movement, and specifically, its ability to seat completely, is not limited by sutures which are too long.

Adult↗
PubMed1980

Comparison of degrees of coronary arterial luminal narrowing determined by visual inspection of histologic sections under magnification among three independent observers and comparison to that obtained by video planimetry: an analysis of 559 five-millimeter segments of 61 coronary arteries from eleven patients.

The accuracy of determining degrees of luminal narrowing of 559 histologic sections from 61 human coronary arteries was evaluated by visual inspection under magnification (light microscopy) by three independent observers, and the results were compared to those obtained by video planimetry. With the per cent of cross-sectional area narrowing divided into four categories (0 to 25, 26 to 50, 51 to 75, and 76 to 100), both the extent of agreement between each independent observer and video planimetry, i.e., the accuracy of visual inspection under magnification and the extent of agreement among the independent observers, interobserver agreement, evaluated by the Kappa (K) statistic, were excellent. With a K value of 50 per cent indicating reasonably good agreement and values of greater than or equal to 70 per cent indicating strong agreement, the K values between the results of light microscopy and video planimetry by three observers were 61, 67, and 75 percent, respectively, and the extent of interobserver agreement was 72 per cent.

Arteriosclerosis↗
PubMed1979

Mitral valve commissurotomy versus replacement. Considerations based on examination of operatively excised stenotic mitral valves.

Among 164 patients who underwent mitral valve replacement because of mitral stenosis (with or without mitral regurgitation) and had radiographs taken of their operatively excised mitral valves, 20 had absent or minimal calcific deposits in the excised valves and absent or minimal mitral regurgitation as determined, except for one patient, by left ventricular angiography preoperatively. This report focuses on these 20 patients to ask if mitral valve replacement was preferable to mitral valve commissurotomy. Although in the pre-valve replacement era, all 20 patients almost surely would have been considered good candidates for mitral commissurotomy, other factors, namely, the need to replace one or more other cardiac valves (13 patients), the utilization of cardiopulmonary bypass allowing visual inspection rather than simple palpation of the diseased mitral valve (all 20 patients), relatively little experience with mitral commissurotomy in four of the five surgeons (17 patients), displeasure with attempted commissurotomy (three patients), previous mitral commissurotomy (11 patients), and incorrect identification of mitral calcific deposits (two patients), each contributed in one or more patients to the final decision of replacement versus commissurotomy. Even though mitral commissurotomy has been in use for 30 years, the mere alternative of valve replacement may have altered somewhat the definition of the stenotic mitral valve previously considered ideal for mitral commissurotomy.

Adult↗
PubMed1979

Hypertrophic cardiomyopathy and transmural myocardial infarction without significant atherosclerosis of the extramural coronary arteries.

Clinical and morphologic features of transmural myocardial infarction (associated with insignificant or absent atherosclerosis of the extramural coronary arteries) are described in seven patients with hypertrophic cardiomyopathy. Marked chronic congestive heart failure associated with supraventricular arrhythmias occurred in six of the seven patients, each of whom had no or mild left ventricular outflow tract obstruction under basal conditions. No patient had typical angina pectoris, and only one patient had clinically evident acute myocardial infarction. Infarction may have caused cardiac arrest in one other patient, but was "silent" in the remaining five patients. At necropsy, six of the seven patients had extensive myocardial scarring involving the ventricular septum, left ventricular free wall and one or both left ventricular papillary muscles; in four patients portions of the right ventricular wall were also scarred. Six patients had dilated ventricular cavities, including two who were known to have nondilated ventricular cavities earlier in their clinical course. It is concluded that transmural myocardial infarction in the absence of significant coronary atherosclerosis is a not uncommon finding (prevalence rate 15 percent) in a population of patients who had died from hypertrophic cardiomyopathy. Although transmural infarction is possibly a secondary event, it more likely contributes causally to the clinical deterioration of some patients with hypertrophic cardiomyopathy, leading to ventricular dilatation and progressive fatal cardiac failure.

Adolescent↗