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At least 703 records · Page 39Linked to original sources
PubMed1990

Impact of childhood cancer on return to normal schooling.

Most of the research into the psychosocial impact of treatment for cancer in children has concentrated on effects on the family rather than on the children's return to school. Thus parents and teachers were questioned about the problems experienced by 117 children who returned to school after spending time in hospital. The children comprised 51 with cancer and two groups of control children (34 with chronic diseases such as renal disease and cardiac conditions and 32 with orthopaedic conditions such as thoracic scoliosis, club foot, and injuries resulting from trauma). Children in all three groups experienced problems on returning to school, the greatest number and variety occurring in the children treated for cancer and the fewest in the children with orthopaedic conditions. The variety of physical problems was greatest and the variety of academic problems was least, with psychological and behavioural problems intermediate. Several problems seemed to be related to drug treatment. Several children missed a considerable amount of full time education. Many teachers were unsure of the academic expectations and physical capabilities of children returning to school. To facilitate a smooth return to school for a child with cancer improved liaison is needed between the hospital, school, and home during the child's absence and teachers need to be better informed.

Adolescent↗
PubMed1997

Use of methohexital for elective intubation in neonates.

The effectiveness and safety of a short acting barbiturate, methohexital, was assessed for its use at the time of elective intubation in 18 newborn infants with severe respiratory or cardiac conditions. Evaluation included the speed of action and the degree of relaxation, sedation, and sleep in the first five minutes after administration. All newborn infants were intubated in a fully relaxed and somnolent state. In most infants recovery was completed within five minutes. A slight to moderate oxygen saturation drop was observed during the period of intubation, especially in patients with cyanotic heart disease. The side effects of the drug were twitching and a slight drop in blood pressure. In conclusion, methohexital seems to be a useful drug for short term anaesthesia in neonates, during which, short procedures like elective intubation can be safely performed.

Anesthesia Recovery Period↗
PubMed2001

Torsade de pointes tachycardia as a rare manifestation of acute enteroviral myocarditis.

A patient with cardiac arrest and documented torsade de pointes ventricular tachycardia is presented in whom acute coxsackievirus B2 myocarditis was identified as the most likely underlying cardiac condition. This case shows that torsade de pointes may occur as a rare manifestation of viral myocarditis. Serial serological tests and endomyocardial biopsies may be helpful in establishing a diagnosis in such patients.

Acute Disease↗
PubMed1981

Non-fatal healed transmural myocardial infarction and fatal non-cardiac disease. Qualification and quantification of coronary arterial narrowing and of left ventricular scarring in 18 necropsy patients.

A qualitative and quantitative analysis of the amount of myocardial scarring and the degree and extent of coronary arterial narrowing by atherosclerotic plaque in the entire lengths of each of the four major epicardial coronary arteries is described in 18 necropsy patients with healed transmural myocardial infarcts and death from a non-cardiac condition. An average of 30 per cent of the basal half and 38 per cent of the apical half of the left ventricular wall was scarred. The nine patients with clinical evidence of previous acute myocardial infarction tended to have larger left ventricular scars than the nine patients without such evidence but the difference was not significant. An average of 26 cm (51 5 mm segments) of coronary artery were examined from each patient ad 25 cm (49 5 mm segments) from each of 19 control subjects. Of 924 segments examined in the 18 patients, 292 (32%) were 76 to 100 per cent narrowed in cross-sectional area (controls = 5); 321 (35%) were 51 to 75 per cent narrowed (controls = 34%); 210 (23%) were 26 to 50 per cent narrowed (controls = 44%), and 101 (11%) were 0 to 25 per cent narrowed (controls = 17%). The extent of severe narrowing of 75 per cent or more was similar (25%) in the left anterior descending and left circumflex coronary arteries; the right was the most severely narrowed artery and the left main was not severely narrowed in any patient. Excluding, then, the left main artery, the amount of severe narrowing in the proximal and distal halves of the other three vessels was similar. The amount of severe narrowing was not related to the age at death or to heart weight, but was greater in patients with hypertension or with a history of acute myocardial infarction.

Aged↗
PubMed1983

Two dimensional echocardiography and the tricuspid valve. Leaflet definition and prolapse.

The tricuspid valve was studied in 143 subjects using two dimensional echocardiography. The groups studied were 40 normal subjects, 31 patients with mitral valve prolapse, 22 with clinically probable tricuspid valve prolapse, 20 with congestive cardiac failure, and 30 with miscellaneous cardiac conditions but no features of right heart disease. Using multiple views it was possible to record all three leaflets in 74.8% of cases and anterior and septal leaflets in 95%. Prolapse of the tricuspid valve was recognised in 13 patients: six (19.5%) of the group with mitral valve prolapse and seven (6%) of the remaining patients. Prolapse of all three leaflets was shown in one patient, anterior and septal prolapse in six patients, anterior and posterior in three patients, septal leaflet prolapse alone in two patients, and anterior alone in one patient. Two dimensional echocardiography allows definition of individual tricuspid leaflets and prolapse of any or all leaflets can be diagnosed. Tricuspid valve prolapse is commonly associated with prolapse of mitral valve leaflets but isolated cases are recognised.

Adolescent↗
PubMed1998

Radiofrequency ablation of a fascicular tachycardia after orthotopic cardiac transplantation.

A 51 year old male received an orthotopic transplant because of end stage ischaemic heart disease. The donor was a healthy male teenager with no history of arrhythmias or other cardiac conditions. The patient presented with haemodynamically stable tachycardia and dyspnoea five weeks post-transplant. The ECG showed a regular tachycardia of 140 beats/min with a right bundle branch block morphology, left axis deviation, and a QRS duration of 135 ms. There were independent P waves, capture, and fusion beats confirming the diagnosis of ventricular tachycardia. Endomyocardial biopsy showed moderate focal rejection that was thought to be responsible for the arrhythmia. During the following six months the patient had recurrent tachyarrhythmias; on each occasion the ECG morphology was the same and there was no cellular rejection. The patient continued to have frequent hospital admissions with ventricular tachycardia requiring DC cardioversion despite the empirical use of amiodarone, sotalol, disopyramide, and procainamide. Eighteen months after transplantation the diagnosis of fascicular tachycardia was suspected by ECG morphology and supported by successful termination with intravenous verapamil. The arrhythmia was successfully managed by radiofrequency ablation. This patient shows that arrhythmias following transplantation are not always related to rejection, and that other potentially reversible causes should be considered, particularly when the ECG during arrhythmia conforms to a classic configuration.

Catheter Ablation↗
PubMed2006

An approach to endomyocardial biopsy interpretation.

The endomyocardial biopsy (EMB) remains the gold standard mode of investigation for diagnosing many primary and secondary cardiac conditions. Through a percutaneous and transvenous route, tissue fragments are generally procured from the right ventricular septum, with very few complications. Widespread use of EMB followed the development of heart transplantation as a means to follow allograft rejection. It has since been useful in helping to diagnose conditions affecting the heart, including cardiomyopathies, myocarditis, infiltrative lesions, arrhythmias, and drug toxicities. The procedure has also been used as a research tool to investigate the natural history of disease and the cardiotoxicity of new medications. This review presents an approach to the evaluation of the EMB, which is particularly directed towards those who may be asked to interpret such biopsies, but are not dedicated cardiovascular pathologists. Through a systematic evaluation of the endocardium, myocardium, interstitium, and intramural vessels, in the context of a complete clinical history, enough information can be deduced to diagnose or exclude specific conditions of clinical value.

Biopsy↗
PubMed1997

Costs and effectiveness of a nurse specialist anticoagulant service.

AIMS: To determine the costs and effectiveness of an anticoagulant nurse specialist service compared with a conventional consultant service based on two hospital sites in northwest Hertfordshire. METHODS: Sequential design comparing retrospectively the conduct and outcomes of a consultant service with a nurse specialist service over two six month periods. In each of the six month study periods, all new patients consecutively referred for anticoagulation over a three month period (group A) at the start of each study period and a random selection of patients who had already been attending the anticoagulant service for one year or more (group B) were included in the study. Group A patients wre followed for up to three months and group B patients for six months. The main outcome measures were costs of service provision and effectiveness. Costs included those for the use of the anticoagulant service, those related to general practitioner (GP) visits and hospitalisations, and running costs (staff time, laboratory tests, patient transport). Measures of effectiveness were the mean proportion of time patients spend in the therapeutic range, the number of drugs being taken that could interact adversely and/or inhibit haemostatic function, and patient and GP satisfaction with service provision. RESULTS: In the consultant service, for group A there were more patients aged 66-75 years (p = 0.004) and fewer patients aged more than 76 years (p = 0.001); and for group B, there were fewer patients on anticoagulation for cardiac conditions (p = 0.001), but more on anticoagulation for thromboembolic conditions (p = 0.02) than in the nurse specialist service. The clinic running costs of the nurse specialist service were 4.99 Pounds per attendance, compared with 4.75 Pounds in the consultant service. Including all other costs related to treatment, there was no statistically significant difference in cost per patient. There was no significant difference in the proportion of time patients spent in the therapeutic range between the consultant service and the nurse specialist service. In the nurse specialist service, fewer patients in group A were taking drugs that could interact adversely and/or inhibit haemostatic function (p = 0.01) and more patients were satisfied with service provision (p = 0.04) compared with the consultant service. There was no significant variation in GP satisfaction between the two services. CONCLUSION: In the provision of outpatient anticoagulation, the nurse specialist service was no more expensive than the consultant service and, using our primary outcome, at least as effective. The nurse specialist service has some clear advantages compared to the consultant service: provision of domicilliary care for housebound patients, fewer new patients taking drugs that could interact adversely and/or inhibit haemostatic function patients, it is preferred by newly referred patients to the consultant service, and it is as acceptable to their GPs.

Aged↗
PubMed1998

Novel attributes of an androgenic steroid-mediated increase in cardiac end diastolic stiffness in rats.

Although cardiac early and mid-diastolic stiffness constants are well accepted as being modulated by alterations in myocyte active processes, increments in left ventricular end diastolic (LVED) stiffness (LVED k; g x cm(-2)) in classical pathological models of a reduced LVED k (e.g., diabetes mellitus (DM) and hypertension) are determined largely by the properties of the myocardial extracellular matrix (ECM). As such, increases in LVED k in the latter cardiac pathologies are insensitive to acute changes in cardiac load, heart rate, and contractility. We examined whether the same attributes that apply to changes in LVED k in DM and in spontaneously hypertensive rats (SHRs) also apply to an androgenic steroid (nandrolone decanoate; 5 mg x kg(-1) biweekly) induced increase in LVED k. Myocardial collagen (ECM) characteristics and the capacity of acute verapamil-mediated changes in cardiac dynamics to impact on LVED k were evaluated after 3 months of steroid treatment to rats, 4 months of DM in rats, and in 45-week-old SHRs. Chronic steroid administration increased LVED k (steroid = 42 +/- 4, control = 25 +/- 2; p < 0.01). An acute infusion of verapamil to steroid-treated rats decreased LVED k to values not different from controls (29 +/- 3; p < 0.05 as compared with LVED k at baseline). Measures of myocardial collagen concentrations, phenotype ratios, and cross-linking were unchanged following steroid administration. Verapamil failed to alter the increased LVED k that occurs in either rats with DM or in SHRs, despite similar effects on cardiac dynamics as those noted in steroid-treated rats. The increased LVED k in the former animal models was associated with alterations in the ECM. In conclusion, the unique lack of association of the androgenic steroid-induced increase in LVED k with alterations in the myocardial ECM and the novel sensitivity of the steroid-mediated increment in LVED k to acute alterations in cardiac dynamics further supports the notion that changes in LVED k should not be considered to be a reflection of ECM characteristics in all cardiac conditions.

Androgens↗
PubMed1979

Let us not lose echocardiography.

Despite the unquestioned value of echocardiography in the diagnosis of valvular disease, pericardial effusion, cardiomyopathy and many other cardiac conditions, few residency programs in radiology are offering training in echocardiography. Echocardiograms of the last 100 consecutive patients in a small community hospital demonstrated a surprising breadth of clinical material. Echocardiography should be included in every residency program lest our role in this technique is lost altogether.

Echocardiography↗
PubMed1995

Bilateral lower extremity US in the patient with bilateral symptoms of deep venous thrombosis: assessment of need.

PURPOSE: To assess the frequency of lower extremity deep venous thrombosis (DVT) detected with ultrasound (US) in patients with bilateral symptoms suggestive of DVT. MATERIALS AND METHODS: Fifty patients with bilateral lower extremity symptoms suggestive of DVT were examined prospectively for predisposing factors and type of symptoms. Charts were reviewed for previous lower extremity disease or chronic illness that could explain the patient's symptoms. The frequency of DVT diagnosed with US in this patient group was determined. RESULTS: No DVT was identified in the patients with bilateral symptoms suggestive of DVT. Retrospective review demonstrated that 34 (68%) of the patients had a preexisting condition (cardiac disease, venous insufficiency, chronic swelling, cellulitis or thrombophlebitis, peripheral arterial disease). Because compression US has a greater than 90% sensitivity and specificity for the diagnosis of DVT, these results were statistically significant (P < .001). CONCLUSION: The likelihood of DVT in patients with bilateral lower extremity symptoms is extremely low. Alternative causes should be carefully explored before lower extremity US is considered.

Aged↗
PubMed1997

Reports on contrast media reactions: analysis of data from reports to the U.S. Food and Drug Administration.

PURPOSE: To compare U.S. Food and Drug Administration (FDA) and manufacturer data about patient reactions to ionic and nonionic, low- and high-osmolar contrast media from 1990 through 1994. MATERIALS AND METHODS: Reactions to all available high-osmolar and four low-osmolar contrast media (ioxaglate, iohexol, iopamidol, and ioversol) were compared. Ioxaglate is composed of charged particles, and data are reported separately. Reactions were also compared with data from 1980 to 1984, when only high-osmolar contrast media were available. RESULTS: With high-osmolar contrast media compared with the three noncharged low-osmolar media, the incidence (per million examinations) was highest for all reported reactions (193.8 vs 44.4), severe reactions (37.4 vs 10.5), and deaths (3.9 vs 2.1). With high-osmolar media compared with ioxaglate, respectively, the incidence of total reactions was higher (193.8 vs 142.5), of severe reactions was almost the same (37.4 vs 33.6), and of death was lower (3.9 vs 6.4). The incidence of severe reactions to total reactions was higher with nonionic media (23.7%) and ioxaglate (23.6%) than with ionic media (19.3%). The incidence of death to severe reactions was 19.7% with nonionic media, 19.0% with ioxaglate, and 10.4% with high-osmolar media. The incidence of renal failure (as a percentage of total reports) was approximately 3.6 times higher with all low-osmolar contrast media (2.3%) than with high-osmolar media (0.6%), usually in patients with pathologic cardiac conditions. CONCLUSION: All of these factors merit consideration in the evaluation of the utility of a given contrast medium.

Adolescent↗
PubMed1981

Starvation suppresses sympathoadrenal medullary response to cold exposure in rats.

The effect of 2 days (55 h) of starvation on the functional state of the sympathetic nervous system (SNS) and adrenal medulla in male rats was evaluated in both normal (24 degrees C) and cold (4 degrees C) environments. Fasting (24 degrees C) significantly decreased NE turnover in heart and spleen, and the concentration of plasma epinephrine (E) and norepinephrine (NE). Cold exposure in the fed animals significantly increased NE turnover in the heart and plasma E, but had no effect on plasma NE or spleen NE turnover compared to normal (no stress) conditions. Cardiac NE turnover was 50% less in fasted cold-stressed animals than in fed cold-stressed animals. Plasma E remained at low levels. Plasma concentration of free fatty acids was significantly elevated in the fasted state in both warm and cold environments. These results suggest that 2 days of starvation in adult male rats suppresses the activity of the SNS and adrenal medulla and interferes with the normal adrenergic response to cold stress. Moreover, E appears not to be essential for mobilization of fat stores for energy metabolism in the fasted state in either warm or moderately cold environments.

Adrenal Medulla↗
PubMed1999

Modulation of Na+/H+ exchange isoform 1 mRNA expression in isolated rat hearts.

Na+/H+ exchange (NHE) has been demonstrated to mediate myocardial ischemia and reperfusion injury as well as injury produced by hydrogen peroxide (H2O2) or lysophosphatidylcholine (LPC). However, changes in gene expression in response to injurious factors have not been extensively studied. We examined Na+/H+ exchange isoform 1 (NHE-1) expression using Southern detection of the RT-PCR product in response to 30 min of global ischemia with or without reperfusion in isolated rat hearts or to 30 min of exposure to either H2O2 (100 microM) or LPC (5 microM). We also determined whether ischemic preconditioning (2x 5-min ischemia) alters basal NHE-1 expression or the subsequent response to insult. Ischemia with or without reperfusion increased NHE-1 expression approximately sevenfold (P < 0.05), whereas either H2O2 or LPC increased expression approximately twofold. Preconditioning reduced NHE-1 message by approximately 70% (P < 0.05) and significantly attenuated the effects of ischemia, H2O2, or LPC. The internal standard, beta-globin was unaffected by any treatment. Our results indicate that NHE-1 expression is rapidly increased in response to ischemia with or without reperfusion as well as in response to H2O2 or LPC. In contrast, preconditioning was associated with downregulation of NHE-1. These results may be important in furthering our understanding of NHE-1 in cardiac disease states and suggest that the antiporter adapts rapidly to cardiac conditions associated with pathology.

Animals↗
PubMed2002

Role of hypoxemia for the cardiovascular responses to apnea during exercise.

We sought to define the role of hypoxemia in eliciting the cardiovascular responses to apnea during exercise. Eleven men performed repeated apneas during 100-W steady-state exercise, either with normoxic gas (air) or 95% oxygen (oxygen). Beat-by-beat arterial blood pressure, arterial oxygen saturation, and heart rate (HR) were determined, and stroke volume (SV) was estimated from impedance cardiography calibrated with soluble gas rebreathing. There were large interindividual variabilities of HR, mean arterial pressure (MAP), and total peripheral resistance (TPR) at end-apnea (ea). However, for each individual, HR(ea), MAP(ea), and TPR(ea) were highly correlated between air and oxygen (R = 0.94, 0.78, and 0.93). HR decreased and MAP increased faster during apnea with air than with oxygen (ANOVA, P < 0.05), but MAP(ea) was not different between conditions. Cardiac output was reduced by 33% with air and by 11% with oxygen (P < 0.001 for air vs. oxygen). We conclude that the hypoxemia component cannot account for the wide interindividual differences of HR and TPR responses to apnea. However, hypoxemia augments the HR and TPR responses and may limit the MAP response to apnea by preventing a bradycardia-associated increase of SV.

Adolescent↗
PubMedDate not supplied

Spontaneous regression of multiple emphysematous bullae.

The etiology of emphysematous bullae is not well known; thus, the management of bullous lung disease is often difficult because of concomitant underlying emphysema and coexisting cardiac conditions. The present paper reports a case in which near complete resolution of multiple emphysematous bullae in the right lung occurred spontaneously. This case is of interest, not only because of the rarity with which spontaneous regression of multiple emphysematous bullae has been reported in the literature, but also because of the accompanying dramatic improvements in radiological results and pulmonary function of the patients.

Chest Tubes↗
PubMed2000

Transient mediastinal enlargement: an unusual computed tomographic manifestation of pulmonary venous hypertension and congestive heart failure.

We describe a case of diffuse superior and middle mediastinal enlargement of soft tissue attenuation noted on helical computed tomography (CT) of a patient with clinical and radiographic findings of congestive heart failure (CHF). Upon treatment and improvement of his pulmonary venous hypertension, a repeat CT scan revealed resolution of the mediastinal abnormalities. We, therefore, advocate a search for primary CT signs of CHF in patients with findings of widespread mediastinal distension. If present, repeat CT scanning after resolution of the cardiac condition should be performed before further intervention for the mediastinal abnormality is attempted.

Heart Failure↗
PubMed2001

Epileptic seizures following subcortical infarcts.

Stroke is one of the most frequent causes of seizures in adulthood. Subcortical infarcts have been associated with post-stroke epileptic seizures, although less frequently than cortical ischaemia. We studied 113 patients from a hospital stroke registry. The patients had subcortical non-lacunar infarcts (64 striatocapsular infarcts, 13 thalamic, 8 choroidal artery territory, 28 internal border zone and white matter medullary infarcts) and at least 1 year of follow-up. Only 4 patients (3.5%) with striatocapsular infarcts suffered an epileptic seizure. Two seizures occurred within the first 24 h, 1 within the first month and 1 within the first year of stroke onset. Emboligenic cardiac conditions were significantly more common in patients with seizures (difference 37%; 95% confidence intervals 2-72%). Subsequently to subcortical infarct, epileptic seizures are infrequent, tend to occur early after stroke and have a very low 1-year recurrence risk.

Cerebral Infarction↗