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Biomedical subjects

D Wrisley

Publications and source records attributed to D Wrisley.

13 recordsLinked to original sources
PubMed1991

Left atrial ball thrombus: review of clinical and echocardiographic manifestations with suggestions for management.

Left atrial ball thrombus is an infrequent clinical syndrome, which can have a catastrophic outcome but can be readily treated when recognized. It is usually a complication of long-standing rheumatic mitral stenosis. Symptomatic presentation is variable: fragmentation of the thrombus followed by peripheral embolization will produce ischemia or infarction of myocardium, brain, viscera, or extremities; random, intermittent, partial, or total occlusion of the mitral valve orifice may cause syncope, pulmonary congestion, and occasionally sudden death in other patients. Embolic and obstructive phenomena may also occur together. Cardiac physical findings usually suggest mitral stenosis; variability in the intensity of the diastolic rumble is common. Two-dimensional echocardiography is the gold standard for identifying ball thrombus. Cardiac catheterization provides assessment of coronary artery status when needed. The outcome of untreated ball thrombus is unlikely to be favorable. The results of anticoagulation and thrombolysis are unpredictable and potentially as harmful as no treatment at all. Current evidence although scant suggests that prompt surgical removal of the free thrombus, often in conjunction with mitral valve repair or replacement, is the appropriate therapeutic course in most patients.

Cardiology↗
PubMed1989

Massive left atrial thrombus: a possible paraneoplastic complication of breast carcinoma.

We describe a patient with long-standing rheumatic mitral valve disease, left atrial dilatation, and a precommissurotomy history of left atrial thrombus. Following operation she was maintained on daily aspirin as an antithrombotic measure. For 6 years she had no evidence, echocardiographically, of left atrial thrombus. She underwent surgery for apparently nonmetastatic breast cancer in early 1986. In May 1986 the left atrium was echocardiographically clear. At approximately the same time, recurrence was found at the suture line. In October 1987, two metastatic lung lesions and a very large left atrial mass were detected by computed tomography. The atrial mass was surgically removed and found to be a thrombus. There was a striking temporal correlation between dissemination of carcinoma and development of a massive atrial thrombus.

Atrial Fibrillation↗
PubMed1989

Minitracheotomy in the early respiratory management of patients with spinal injuries.

Minitracheotomy is a new technique of tracheal suction by the introduction under local anaesthetic of a small bore tube into the trachea through the cricothyroid membrane. The use of minitracheotomy in the early management of respiratory problems in patients with spinal injuries is described with a few illustrative cases. This technique is an adjunct to good physiotherapy in clearing secretions from the trachea. Its advantages and disadvantages are discussed.

Adult↗
PubMed1987

The prognostic value of functional capacity in patients with mild to moderate heart failure.

Thirty patients with ischemic (n = 14) or idiopathic dilated (n = 16) cardiomyopathy were followed long-term to determine the prognostic value of measuring entry exercise capacity. At the time of referral for management of symptomatic heart failure, studies included radionuclide angiography, M-mode echocardiography, 24-hour Holter and graded exercise testing with measured oxygen peak consumption (peak VO2). Inclusion criteria were NYHA class II (n = 16) or III (n = 14) despite at least 3 months of treatment with digitalis and diuretics, left ventricular ejection fraction less than 50%, left ventricular end-diastolic diameter (LVEDD) greater than 50 mm, and exercise capacity limited by dyspnea or fatigue. Patients were treated with diuretics (100%), digitalis (83%), and vasodilators (60%) and were followed for at least 6 months (mean 15). The 1-, 2- and 3-year cumulative survival rates were 75.4%, 70.2%, and 70.2%, respectively. Univariate predictors of survival included measured peak VO2 (p = 0.0026), as well as age, estimated peak VO2 (based on exercise time), presence of left bundle branch block, LVEDD, and frequency of ventricular arrhythmias. Multivariate analysis revealed that measured peak VO2 was the single best independent predictor of survival (p less than 0.001). We conclude that assessment of functional capacity provides useful independent prognostic information in patients with mild to moderate heart failure.

Arrhythmias, Cardiac↗
PubMed1984

Physiological profile of national-class National Collegiate Athletic Association fencers.

Selected physiological characteristics of seven national-class fencers (1983 National Collegiate Athletic Association Division I champions) were studied and the results compared with those for normal persons and athletes of similar age. Evaluation included maximal oxygen uptake during arm and leg ergometry, serum lipids, body composition, and standard spirometry. Maximal oxygen uptake during arm work (34.2 mL X kg-1 X min-1) was 68% of that observed during leg work (50.2 mL X kg-1 X min-1). Mean serum triglyceride, total cholesterol, and high-density-lipoprotein cholesterol levels were 68.5, 187, and 54.5 mg/dL, respectively. Hydrostatically determined percent body fat averaged 12.2%. Results of pulmonary function studies were normal. The aerobic capacity of National Collegiate Athletic Association fencers is only slightly higher than active men of comparable age, and substantially lower than world-class endurance athletes. These data suggest that success in fencing may depend more on technique, speed, and agility as opposed to a high aerobic capacity and low percent body fatness.

Adult↗
PubMed1984

Chronic adaptations to physical conditioning in cardiac patients. Implications regarding exercise trainability.

Physical conditioning in patients with coronary heart disease can result in increased functional capacity, symptomatic relief of angina pectoris, favorable reduction of risk factors, enhanced psychological status, and improved quality of life. The mechanisms underlying the adaptations to training are poorly understood, but it is clear that several factors affect exercise trainability. Guidelines are available that suggest the appropriate intensity, frequency, and duration of exercise needed to obtain beneficial physiologic adaptations.

Adaptation, Physiological↗