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Biomedical subjects

W Parry

Publications and source records attributed to W Parry.

18 recordsLinked to original sources

Bilateral clicking ribs.

Congenital abnormalities of the ribs, including slipping or clicking rib, are well recognised but rarely give rise to symptoms. Slipping rib has previously been described as a unilateral condition. We report an unusual case of symptomatic bilateral slipping ribs treated successfully by surgery.

Adult

The echo Doppler spectrum of valvular abnormalities in the hospitalized octogenarian.

Cardiac valves thicken and become more opaque with advancing age. As more individuals live longer and as more treatment modalities such as valvuloplasty evolve, the presence and significance of these valvular abnormalities become important. We retrospectively studied 628 octogenarian patients to try and define further the presence and significance of these abnormalities detected by Doppler echocardiography. A group of 547 patients were suitable for analysis. Age ranged from 80 to 96 years (mean 84.4). The female:male ratio was 1.9:1. Mitral, aortic, and tricuspid regurgitation (MR, AR, and TR) were significant if the jet moved greater than 2 cm from the plane of the valve away or toward the transducer, depending on transducer position. Mitral regurgitation was detected in 331 patients (60.5%) and was significant in 82 patients (15%). Aortic regurgitation was detected in 276 patients (50.5%) and was significant in 70 patients (12.8%). Tricuspid regurgitation was detected in 131 patients (23.9%) and was significant in 30 patients (5.5%). Regurgitant lesions were detected in two valves in 150 patients (27.4%) three valves in 57 patients (10.4%), in all four valves in 17 patients (3.1%). Aortic stenosis was detected in 160 patients (29.3%). The gradient range was 16-156 mmHg (mean 47.8). Significant aortic stenosis was present in 70 patients (12.8%) (gradient greater than 50 mmHg), of whom 54 had isolated pure aortic stenosis and 16 had mixed lesion. In 40% of these patients, significant aortic stenosis was an unexpected finding at two-dimensional echocardiography. Valvular pathology is common in the octogenarian population.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged

Echocardiographic analysis of left ventricular filling in isolated pure chronic aortic regurgitation.

Left ventricular (LV) diastolic filling was assessed using digitized M-mode echocardiography in 12 patients with aortic regurgitation (AR) and in 12 normal subjects. Ten patients with AR were asymptomatic and 2 patients had congestive heart failure. LV chamber dimensions, fractional shortening and the rate of change of LV dimensions during systole and diastole were determined. In addition, the timing of the rate of change of LV dimensions in diastole (peak dD/dt, 50% peak dD/dt and 20% peak dD/dt) was also measured. Patients with AR had a significant reduction in dD/dt (12.2 +/- 3.5 cm/s in patients with AR vs 15.9 +/- 1.9 cm/s in normal subjects, p less than 0.01) and a delay in the timing of peak dD/dt (160 +/- 35.2 ms in patients with AR vs 86 +/- 17.6 ms in normal subjects, p less than 0.01) from the minimum LV dimension. These diastolic abnormalities were present in patients with symptomatic as well as those with asymptomatic AR, occurred even when the fractional shortening and peak systolic emptying rate (peak -dD/dt) were normal, and showed no correlation with the calculated LV mass (r = 0.14). The delay in the diastolic filling velocities (peak dD/dt, 50% and 20% peak dD/dt) was associated with a decreased rate of change of LV dimension in diastole, suggesting delayed early LV filling. These findings indicate an abnormality of LV diastolic filling in patients with symptomatic as well as asymptomatic AR and suggest that diastolic abnormalities may precede echocardiographic indexes of systolic LV dysfunction.

Adolescent

The uses of two-dimensional Doppler echocardiographic techniques preoperatively and postoperatively in a ventricular septal defect caused by penetrating trauma.

Doppler echocardiography was used to determine the site and size of a ventricular septal defect in a patient with a penetrating wound of the heart. Additional physiological measurements by Doppler study, including pulmonary artery pressure and degree of left-to-right shunting, were helpful in deciding on surgical closure of the defect as the definitive therapy in this patient. Associated intracardiac defects (e.g., mitral or tricuspid regurgitation) can be excluded by Doppler echocardiography.

Adult

Two dimensional echocardiographic recognition of the descending thoracic aorta: value in differentiating pericardial from pleural effusions.

The course of the descending thoracic aorta has recently been visualized with two dimensional echocardiography and its presence confirmed with contrast studies. In the parasternal short axis view, we used the location of the descending thoracic aorta to differentiate pericardial from pleural effusions in 40 patients. Sixteen patients, each with an isolated pericardial effusion, had an echo-free space between the descending thoracic aorta and left ventricular posterior wall. Nine patients, each with an isolated pleural effusion, had an echo-free space posterior to the descending aorta. Fifteen patients, each with both a pericardial and pleural effusion, had echo-free spaces both between the descending thoracic aorta and left ventricular posterior wall and also posterior to the descending thoracic aorta. With one exception, all patients had anatomic confirmation of these findings. Forty-one patients undergoing cardiac surgery served as controls and none had a posterior echo-free space in relation to the descending thoracic aorta. At operation, no pericardial or pleural effusion was evident. The location of the descending thoracic aorta on two dimensional echocardiography serves as a valuable landmark in localizing the pericardial-pleural interface, thereby differentiating pericardial from pleural effusions.

Adolescent

Echocardiographic diagnosis of acute aortic valve endocarditis and its complications.

Staphylococcus aureus aortic valve endocarditis and its complications in a patient were readily recognized by echocardiography. "Shaggy" echoes recorded from the aortic leaflets in diastole as well as irregular diastolic densities in the left ventricular outflow tract suggested flail aortic leaflets secondary to bacterial endocarditis. The presence of a double echo of the anterior aortic wall was an unusual finding. Initially thought to represent a localized dissection, abscess formation and pocket of edematous fluid accumulation was found between the anterior aortic wall and pulmonary artery. Premature closure of the mitral valve was evident shortly before the patient died. The specific echocardiographic features of flail aortic leaflets and premature mitral valve closure should alert the physician to consider immediate aortic valve replacement.

Adult

Echocardiographic findings in constrictive pericarditis. A case report.

The echocardiographic findings in a 73-year-old woman with constrictive calcified pericarditis are presented. The diagnosis was confirmed by physical examination, chest X-rays and cardiac catheterization. The echocardiogram demonstrated abnormal motion of the interventricular septum and of the left ventricular posterior wall, multiple thickened echoes of the posterior pericardium, and a localized dense band of anterior pericardial echoes, which corresponded to the calcification seen on the chest X-ray.

Aged

Leprosy.

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Leprosy

Q fever.

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Nursing