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Biomedical subjects

F Kerr

Publications and source records attributed to F Kerr.

At least 19 recordsLinked to original sources
PubMed2002

Atypical presentation of tuberculosis meningitis: a case report.

A 19 year old woman presented with atypical symptoms of tuberculous meningitis. Meningitis is the most serious form of tuberculosis (TB) and it often presents with nonspecific signs and symptoms. Delayed diagnosis can result in rapid progression of neurological deficits and poor prognosis. Polymerase chain reaction and other nucleic acid amplification methods are becoming increasingly useful for the rapid detection of Mycobacterium tuberculosis in the cerebrospinal fluid. Early treatment reduces morbidity and mortality of this serious condition.

Adult↗
PubMed2001

Neurogenic pulmonary oedema induced by bacterial meningitis: a case report.

We report a case of neurogenic pulmonary oedema occurring in association with bacterial meningitis. An 87 year old man suddenly developed severe dyspnoea without cardiac failure (MUGA scan ejection fraction 47%). Radiographs showed pulmonary oedema. A few hours later he developed signs of meningitis and lumbar puncture suggested a partially treated bacterial meningitis. We suspect that the bacterial meningitis had induced neurogenic pulmonary oedema.

Aged↗
PubMed2001

Experience of a small British pacing centre between 1994 and 2000: some answers to the problem of low UK implantation rates.

Raigmore is a district general hospital offering a permanent pacemaker service to its catchment population of 233,500. This report reviews the pacemaker practice over a seven year period (1994 to 2000) and makes a comparison with the national database and other hospitals in the UK. The records of all patients receiving new implantions for the period under observation were reviewed retrospectively. Data collected included number of patients paced each year, age, sex, indications and complications. In the 84 months studied 3/71 patients received new permanent pacemakers (the mean age was 74 years and 51% were male). The most common presenting symptoms were syncope (62%), dizzy spells (24%), and heart failure (11.5%). The most common indication for permanent pacemaker insertion was complete atrioventricular block (58%) followed by sick sinus syndrome (20%). The implantation rate was 419.3/million population/year in 2000. Pacemaker modes used were appropriate and the early and late complication rates were low (2.7%). This current audit demonstrates continued growth of the service with low-complication rates and implantation rates which approach those in Western Europe and North America.

Aged↗
PubMed2001

Lessons to be learned: a case study approach a case study of the temporal onset of pulmonary hypertension with pre-existent cirrhotic portal hypertension.

We report the occurrence of pulmonary hypertension in a 37-year-old male patient with cirrhosis of the liver, portal hypertension and oesophageal varices. Although this is a rare combination, previous reports have shown that the association of portal and pulmonary hypertension is not coincidental; the temporal onset of primary pulmonary hypertension is hard to predict and our patient was asymptomatic for a number of years. The pathogenesis of portal hypertension leading to pulmonary hypertension is not known. Diagnosis is difficult because the clinico-pathological symptoms in both conditions are similar. Treatment is limited to calcium channel blockers, vasodilators, nitrous oxide and prostacyclin, although most patients will eventually require visceral transplantation.

Adult↗
PubMed2000

Normalisation of abnormal coronary fractional flow reserve associated with myocardial bridging using an intracoronary stent.

Although intracoronary stenting procedures have been advocated for the successful treatment of myocardial ischaemia associated with myocardial bridging, the physiological rationale for this approach remains unexplored. The case of a 70 year old man with symptoms of cardiac ischaemia associated with a left anterior descending coronary artery bridge is described, where use of an intracoronary stent abolished the angiographic abnormalities and also restituted pronounced abnormalities of coronary fractional flow reserve.

Aged↗
PubMed1996

Miliary tuberculosis presenting as infection of a pacemaker pulse-generator pocket.

A seventy year old woman had a permanent VVI pacemaker inserted in 1983 for complete heart block and presented ten years later with purulent discharge from the generator pocket. During a prolonged pyrexial illness, she developed renal and respiratory failure and her illness was complicated by recurrent ventricular fibrillation. The patient died on her 31st hospital day. Subsequent histological and microbiological investigation revealed widespread miliary tuberculosis which included involvement of myocardial tissue, great vessels and the pacemaker pocket. To our knowledge, this is the first reported occurrence of miliary tuberculosis involving a permanent pacemaker system. Furthermore, the granulomatous myocarditis which occurred as part of the miliary picture is a rare occurrence and possibly explains the recurrent ventricular fibrillation.

Aged↗
PubMed1995

Permanent pacemaker practice at a Scottish district general hospital between 1987 and 1993.

BACKGROUND: Raigmore is a district general hospital offering a permanent pacemaker service to its catchment population of 233,500. It has been argued that the British public would be better served by a less centralised pacing service. There also exists the view, however, that a lower rate of complications and best follow up practice are achieved by specialised centres. The pacemaker practice over a 79 month period (January 1987 to July 1993) was thus reviewed with these issues in mind. METHODS: The pacemaker records of all new implantations for the period under observation were reviewed retrospectively. Data were acquired under the headings age, sex, symptoms, electrocardiographic (ECG) indications, and complications (early and late). Comparison was made with United Kingdom national data, a previous audit from Raigmore, and two recently published large series from specialist centres (one British and the other French). RESULTS: The mean age of patients who underwent implantation was 74 years and 47.5% were male. The most common presenting symptoms were syncope (46%), dizzy spells (24.5%), and heart failure (11.5%). The most common ECG indications for pacing were complete heart block (wide QRS) (28%), atrial flutter/fibrillation with bradycardia (21.6%) and complete heart block (narrow QRS) (9.6%). The implantation rate was 184/million population/year in 1993. The early and late complication rates were low (2.48%). CONCLUSIONS: The presence of a pacing centre in a remote part of the United Kingdom fulfils a necessary service and has low complication rates, with implantation rates and patterns that are comparable with those in other parts of the country.

Adult↗
PubMed1993

Arrhythmogenic right ventricular dysplasia: an uncommon cause of ventricular tachycardia in young and old?

Right ventricular dysplasia is a little understood condition and is almost certainly underdiagnosed as an important cause of recurrent ventricular tachycardia and sudden death. This report describes two patients with right ventricular dysplasia. Their clinical presentation reflects the remarkable diversity of the disease while the potentially life-threatening nature of their arrhythmias and their lack of response to medical treatment justified the antiarrhythmic surgical procedure of right ventricular disarticulation.

Adolescent↗
PubMed1992

Safety of fibreoptic endoscopy: analysis of cardiorespiratory events.

Cardiorespiratory function during upper gastrointestinal endoscopy and colonoscopy was studied prospectively in 164 patients. Cardiorespiratory events, which were defined as oxygen saturation < 90 per cent, electrocardiographic changes, heart rate < 50 or > 100 beats/min and systolic blood pressure < 100 mmHg, occurred in 111 patients. In 24 of these, changes were attributed solely to intravenous sedation. In the remaining 140 patients, events were noted in 34 (52 per cent) of 66 upper gastrointestinal endoscopies and during 53 (72 per cent) of 74 colonoscopies. One patient suffered a myocardial infarction during colonoscopy. Although cardiorespiratory events were common (111 of 164; 68 per cent), the actual morbidity rate was low (one of 164; 0.6 per cent). Cardiorespiratory events were significantly more common in patients with a history of cardiac disease for both upper gastrointestinal endoscopy and colonoscopy (overall chi 2 = 7.41, 1 d.f., P < 0.05) and more common for oesophageal dilatation than for diagnostic endoscopy (chi 2 = 5.56, 1 d.f., P < 0.05). It is recommended that patients with a history of cardiac problems undergoing upper gastrointestinal endoscopy or colonoscopy and all those requiring therapeutic endoscopy should be monitored carefully to allow early detection of cardiorespiratory events, and that oxygen should be administered routinely.

Adult↗
PubMed1992

Could it be myotonic dystrophy? Myotonic dystrophy presenting with atrial flutter.

Myotonic dystrophy is a well recognised and well defined multisystem disorder which is inherited in an autosomal dominant fashion through a locus on chromosome 19. The disease itself is characterised by rigidity and degeneration of skeletal muscle, cataract formation, gonadal atrophy, frontal baldness and mental retardation. Like many inherited disorders there is a variable expression and so diverse clinical presentations can occur.

Adult↗
PubMed1990

Community defibrillation in the Scottish Highlands.

Prompt defibrillation after cardiac arrest is necessary to save life. Inexpensive systems providing defibrillation facilities in the community of the Highlands have been devised, one for Inverness town practices, and one for rural practices. Both systems work by 'blind' defibrillation, once the clinical diagnosis of cardiac arrest is confirmed. Acute anti-arrhythmic drugs and intravenous infusions were not available. The systems functioned satisfactorily with general acceptance by the general practices concerned.

Attitude of Health Personnel↗
PubMed1989

Long-term follow-up of patients with the QT rate adaptive pacemaker.

We report a 5-year follow-up of eight patients implanted with the QT sensing rate adaptive pacemaker, the Vitatron TX. Careful programming was undertaken shortly after implantation utilizing repeated exercise testing to ensure optimal settings. Further exercise testing was not carried out during follow-up as the patients remained symptomatically well. Of six patients assessed with repeat exercise testing at 5 years, four demonstrated a satisfactory rate adaptive response with improved exercise performance compared to fixed rate ventricular pacing, one patient had an abrupt onset of increased pacing rate with exercise associated with improved exercise ability, and another developed an increased pacing rate after exercise but an appropriate rate adaptive response after reprogramming. One patient developed an inappropriately high pacing rate associated with congestive heart failure several months after a large myocardial infarction. One patient died from carcinoma. The QT sensing rate adaptive pacemaker appears to be reliable in lon-term clinical use when carefully programmed using exercise testing after implantation.

Aged↗
PubMed1987

Stenosed bicuspid aortic valves in twins.

Hereditary factors may have a part to play in the development of bicuspid aortic valve. This report concerns a pair of identical twins, probably monozygotic, who required aortic valve replacement as a result of aortic stenosis occurring in bicuspid aortic valves. This supports the contention that there may be a genetic influence in the development of bicuspid aortic valve, though environmental factors may be of greater importance.

Aortic Valve↗
PubMed1987

Correcting a block?: successful experience of a small British pacing centre.

The establishment of a local permanent pacemaker service in a district general hospital increased the pacemaker implantation rate from 22 per million population per year to 152 per million population per year over the first 6 years of the service. Forty eight per cent of patients were referred by general practitioners and 52% by hospital specialists. Single chamber demand pacing (VVI) was used exclusively. Indications for pacing and complications were comparable to those of specialist cardiac centres. Management of symptomatic bradycardia by cardiac pacing in the United Kingdom may be facilitated by further development of small pacing centres.

Aged↗