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Biomedical subjects

A A Adgey

Publications and source records attributed to A A Adgey.

At least 145 records · Page 8Linked to original sources
PubMed1985

Changes in circulating immune complex concentrations and antibody titres during treatment of Q fever endocarditis.

Serum samples from 20 patients with Q fever endocarditis were tested for the presence of circulating immune complexes to see whether their concentrations correlated with antibody titres during treatment and whether they could be used to monitor the response to antimicrobial treatment. Circulating immune complexes were found in all 20 patients. The concentrations in 15 patients correlated with either or both of the Q fever phase 1 and phase 2 antibody titres obtained during treatment. In the other five patients no correlation with the antibody titres was found. There was no association between circulating immune complex concentrations and clinical response to treatment.

Adult↗
PubMed1984

Prophylactic lidocaine in suspected acute myocardial infarction.

We gave 50 consecutive patients with suspected acute myocardial infarction prophylactically lidocaine 300 mg intramuscularly and 100 mg intravenously. Although therapeutic plasma levels were reached, 2 of 24 (8%) patients with acute myocardial infarction had ventricular tachycardia or ventricular fibrillation and 3 of 50 (6%) became hypotensive during the first hour of lidocaine.

Adult↗
PubMed1984

Aortic valve endocarditis complicated by complete heart block.

A 34-year-old man with severe aortic incompetence caused by Streptococcus viridans developed severe central chest pain followed by complete heart block, multifocal ventricular extrasystoles, lengthening of the QTc and signs of cerebral emboli and pulmonary oedema. Early antibiotic therapy along with pacing, non-invasive investigations coupled with early surgery contributed significantly to the patient's survival.

Adult↗
PubMed1984

Group C streptococcal endocarditis associated with intubation-induced tracheal stenosis.

We describe a 44-year-old woman with Group C haemolytic streptococcal endocarditis who developed tracheal stenosis as a result of endotracheal intubation. She recovered fully following valve replacement for continuing left ventricular failure due to mitral and aortic incompetence and subsequent resection of the stenosed tracheal segment with reanastomosis of the trachea.

Adult↗
PubMed1984

The Belfast experience with resuscitation ambulances.

The majority of sudden deaths are due to ventricular fibrillation. In the initiation of ventricular fibrillation, an R on T extrasystole was the most important factor. A late cycle ectopic, ventricular tachycardia and idioventricular rhythm initiated ventricular fibrillation less frequently. An increase or marked slowing of the heart rate were predisposing factors in the initiation of ventricular fibrillation. The first successful correction of ventricular fibrillation outside the hospital was achieved by the Belfast Mobile Coronary Care Unit in 1966. A single shock of 100 or 200 watt seconds (stored) was highly successful in the correction of ventricular fibrillation. The most likely factor in unsuccessful defibrillation is incorrect paddle application. For the correction of ventricular fibrillation during the first hour of the onset of symptoms, less than or equal to 2DC shocks were required in 41% of patients. Only 8% of patients required more than ten shocks. Smaller portable defibrillators are now available for use by family practitioners. Lidocaine 100 mg intravenously and 300 mg intramuscularly failed to prevent the development of ventricular tachycardia and ventricular fibrillation during the first hour of the drug's administration. Patients who survived ventricular fibrillation that occurred within four hours of the onset of symptoms of myocardial infarction were younger, tended to have had a mild coronary attack, and had the most favorable long-term prognosis. The early control of chest pain, autonomic disturbances, arrhythmias, and hemodynamic disturbance leads to a reduced incidence of cardiogenic shock and hospital mortality.

Ambulances↗
PubMed1984

Myoglobin and creatine kinase in acute myocardial infarction.

Serum myoglobin concentration and creatine kinase activity were measured serially in 70 consecutive patients presenting within four hours of the onset of symptoms of suspected acute myocardial infarction. Of 36 patients with definite or possible myocardial infarction (WHO criteria), the serum myoglobin concentration was raised (greater than 85 micrograms/l) one hour after the onset of symptoms in 25% and at four hours in 89%. Creatine kinase activity was raised (greater than 140 U/l) one hour after the onset in 25% and at four hours in only 56%. Within 12 hours of the onset of symptoms the myoglobin concentration reached a peak in 83% and the creatine kinase a peak in only 14%. Within 36 hours the myoglobin concentration fell to normal values in 67% while creatine kinase activity fell to normal values in only 3%. Four hours after the onset of symptoms the serum myoglobin concentration distinguished easily those patients with myocardial infarction from those without, whereas when creatine kinase values were used the sensitivity was poor but the specificity high. From the combined results of the two studies and using a single measurement of serum myoglobin concentration at six hours from the onset of symptoms to predict the diagnosis in 114 patients with suspected infarction, the sensitivity was 93% and specificity 89%.

Clinical Enzyme Tests↗
PubMed1982

Initiation of ventricular fibrillation outside hospital in patients with acute ischaemic heart disease.

Factors which may predispose to ventricular fibrillation were assessed in 48 consecutive patients who developed ventricular fibrillation outside hospital after the arrival of a mobile coronary care team. Before the initiation of ventricular fibrillation, late cycle ventricular extrasystoles were recorded in 38 patients (79%) and R on T extrasystoles in 27 patients (56%). R on T extrasystoles were relatively infrequent--an average of three occurred during a mean monitoring time of 27 minutes. Multifocal extrasystoles occurred in only three patients (6%), consecutive extrasystoles in 14 (29%), and self-terminating ventricular tachycardia in three (6%). Ventricular extrasystoles occurring at more than five a minute were uncommon during this phase. The time from "warning arrhythmias" to the development of ventricular fibrillation in many patients was short, thus limiting the administration of antiarrhythmic agents. There was a significant increase in the heart rates recorded immediately before ventricular fibrillation when compared with those documented initially. Thus, an increase in heart rate appeared to be a predisposing factor in the initiation of ventricular fibrillation. An R on T extrasystole was the most important factor in the initiation of ventricular fibrillation: it occurred in 33 patients (69%). In nine (19%) ventricular tachycardia and in six (12%) a late cycle extrasystole or idioventricular rhythm initiated ventricular fibrillation.

Adult↗
PubMed1981

Ventricular fibrillation and its recurrence in early acute myocardial infarction.

At the initial arrest in 73 consecutive survivors of primary ventricular fibrillation who were seen within 1 h of myocardial infarction, 67% had much less than 2 episodes of ventricular fibrillation and 57% required much less than 2 shocks: only 7% required greater than 10 shocks to correct ventricular fibrillation. 12 (16%) of the 73 had recurrent ventricular fibrillation. The incidence of recurrent ventricular fibrillation, number of recurrences, and interval from the initial episode to recurrent ventricular fibrillation were similar whether the initial episode occurred within the first hour of the onset of symptoms or later. Age, sex, history of previous infarction, site of infarction, adequacy of initial resuscitation, place of arrest, time from onset of symptoms to initial arrest, and delay before initial attempted defibrillation were not significantly related to the recurrence of ventricular fibrillation. The incidence of recurrent ventricular fibrillation among patients seen within 1 h of the onset of symptoms was not greater than among comparable patients seen later.

Acute Disease↗
PubMed1981

Management of recurrent ventricular tachyarrhythmias associated with Q-T prolongation.

Eleven patients with acquired prolongation of the Q-Tc interval and recurrent ventricular tachyarrhythmias were studied. Five patients required 5 to 44 direct current shocks to correct prolonged ventricular tachyarrhythmias, and five were given at least two antiarrhythmic agents in an attempt to control the arrhythmias. In 4 of the 11 patients, when thioridazine, diuretic drugs and antiarrhythmic agents were withdrawn and hypokalemia or hypocalcemia corrected, ventricular tachyarrhythmias did not recur. The Q-Tc interval normalized in 2 to 3 days. Ventricular tachyarrhythmias were recurrent in the remaining seven patients, despite withdrawal of the drugs that caused the Q-Tc prolongation, attempted correction of hypokalemia when present and the administration of antiarrhythmic agents to four of the seven. All antiarrhythmic agents were then withdrawn in this group. Immediately on the establishment of overdrive ventricular or atrioventricular sequential pacing in these patients, ventricular tachyarrhythmias were abolished. No breakthrough ventricular tachyarrhythmias occurred during temporary pacing. Temporary pacing was required for an average of 10 days and the Q-Tc interval normalized an average of 5 days from the onset of pacing. Three patients required a permanent pacemaker, one because of chronic complete heart block, one because of the sick sinus syndrome, and one because of frequent ventricular ectopic complexes complicating ischemic heart disease. All 11 patients survived their period of hospitalization.

Adult↗
PubMed1981

Discrete subaortic stenosis.

Data concerning 17 consecutive patients with discrete subaortic stenosis are recorded. Twelve patients underwent operative resection of the obstructing lesion. Of these all except one were symptomatic and all had electrocardiographic evidence of left ventricular hypertrophy or left ventricular hypertrophy with strain. They had a peak resting systolic left ventricular outflow tract gradient of greater than 50 mmHg as predicted from the combined cuff measurement of systolic blood pressure and the echocardiographically estimated left ventricular systolic pressure and/or as determined by cardiac catheterisation. The outflow tract gradient as predicted from M-mode echocardiography and peak systolic pressure showed close correlation with that measured at cardiac catheterisation or operation. During the postoperative follow-up from one month to 11 years, of 11 patients, one patient required a further operation for recurrence of the obstruction four years after the initial operation. All patients are now asymptomatic. Five patients have not had an operation. The left ventricular outflow tract gradient as assessed at the time of cardiac catheterisation was greater than 50 mmHg. One patient has been lost to follow-up. The remaining four have been followed from four to eight years and have remained asymptomatic and the electrocardiograms have remained unchanged. Careful follow-up of all patients is essential with continuing clinical assessment, electrocardiograms, M-mode and two-dimensional echocardiograms, and if necessary cardiac catheterisation. Prophylaxis against bacterial endocarditis is also essential.

Adolescent↗