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Biomedical subjects

J Cleland

Publications and source records attributed to J Cleland.

At least 19 recordsLinked to original sources
PubMed1997

Late results of patch repair of coarctation of the aorta in adults using autogenous arterial wall.

BACKGROUND: Interposition grafting or patch repair of adult coarctations of the aorta are the standard methods of surgical treatment. Both involve use of prosthetic material, and patch repair using prosthetic material may lead to aneurysm formation in the long term. METHODS: Four patients aged 17 to 29 years had been investigated for systemic hypertension and had coarctation of the aorta diagnosed on cardiac catheterization. Between March and November 1984, all 4 underwent a corrective operation. The lesions were widely incised and a broad patch of ipsilateral mammary or Abbott's artery was fashioned across the narrowing. The arteries had been enlarged in diameter because of prolonged exposure to high blood pressure as collateral vessels, although none was intrinsically diseased. RESULTS: After 12 years of follow-up, only 1 patient remains on antihypertensive therapy. Spiral computed tomographic reconstructions revealed only very mild residual stenosis in 1 patient, confirmed by subsequent aortography. CONCLUSIONS: In adult patients with coarctation of the aorta, the use of the enlarged internal mammary artery as a patch graft is a simple, quick procedure, which may give lasting relief of obstruction. Spiral computed tomographic scanning is an ideal noninvasive method of follow-up.

Adolescent↗
PubMed1997

Levels and determinants of gynecological morbidity in a district of south India.

This article presents the results of an assessment of gynecological morbidity among 385 women with young children residing in a district of Karnataka State, South India. All three main modes of assessment (clinical examination, laboratory tests, and self-reports) reveal a high burden of reproductive tract infections. The two most common conditions, identified by laboratory tests, were bacterial vaginosis and mucopurulent cervicitis. Approximately one-fourth of the women had clinical evidence of pelvic inflammatory disease, cervical ectopy, and fistula. The contribution of sexually transmitted diseases to overall gynecological morbidity appears to be relatively modest; 10 percent were so diagnosed. Associated conditions of anemia and chronic energy deficiency were common. Severe anemia was found in 17 percent of cases and severe chronic energy deficiency in 12 percent. These results indicate that radical improvements in women's health in India will require far more than the diagnosis and treatment of reproductive tract infections.

Comorbidity↗
PubMed1996

Obstetric morbidity in south India: results from a community survey.

A sample of 3600 mothers with at least one pre-school age child were interviewed in detail about obstetric problems associated with their last confinement. About 10% reported one or more of the classic symptoms of pre-eclampsia; and 8% reported symptoms of potentially life-threatening conditions during delivery, most notably prolonged labour of over 18 hr. Disorders during the post-partum period were more common; 10% reported excessive bleeding, loss of consciousness or convulsions (all indicative of potentially serious conditions) and an additional 17% reported symptoms of infections. The level of health care received by women is described.

Adult↗
PubMed1996

Population growth in the 21st century: cause for crisis or celebration?

Between now and the end of the next century, the population of the planet is projected to grow from 5.7 billion to somewhere between 9 and 16 billion. In the next 25 years, continued rapid growth is inescapable because of the youthful age structures of many countries. Beyond that point much depends on fertility trends in the coming decades. Continued population growth does not make inevitable any global catastrophe but it will exacerbate greatly problems of underemployment. The prognosis for further fertility declines is good, because the communications revolution is hastening the spread of new ideas and political attitudes are becoming favourable.

Developed Countries↗
PubMed1995

Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group.

BACKGROUND: The aim of the present study was to assess the short- and long-term effects of multiple doses of the angiotensin II receptor antagonist losartan in heart failure. METHODS AND RESULTS: A multicenter, placebo-controlled, oral, multidose (2.5, 10, 25, and 50 mg losartan once daily) double-blind comparison in patients with symptomatic heart failure and impaired left ventricular function (ejection fraction < 40%). Invasive 24-hour hemodynamic assessment was performed after the first dose and after 12 weeks of treatment. Clinical status and tolerability of treatment with losartan over the 12-week period were also evaluated. One hundred fifty-four patients were enrolled, of which 134 met the protocol criterion of baseline pulmonary capillary wedge pressure > or = 13 mm Hg. During short-term administration, systemic vascular resistance (SVR) (largest reduction against placebo of 197 dyne.s-1.cm-5 at 4 hours) and blood pressure fell significantly with 50 mg, lesser decreases were seen with 25 mg, and no discernible effects were seen with 2.5 and 10 mg. After 12 weeks of treatment, similar effects were seen on SVR and blood pressure (maximal fall in SVR against placebo, 318 dyne.s-1.cm-5 at 5 hours with 50 mg). In addition, pulmonary capillary wedge pressure fell with 2.5, 25, and 50 mg (largest reduction against placebo of 6.3 mm Hg at 6 hours with 50 mg), cardiac index rose with 25 and 50 mg, and heart rate was lower with all active treatment groups. Active treatment was well tolerated, and excess cough was not reported. CONCLUSIONS: This study showed that oral losartan administered to patients with symptomatic heart failure resulted in beneficial hemodynamic effects with short-term administration, with additional beneficial hemodynamic effects seen after 12 weeks of therapy. Clear effects were seen with both 25 and 50 mg, with the greatest effect seen with 50 mg.

Aged↗
PubMed1995

Sexual behaviour in developing countries: implications for HIV control.

OBJECTIVE: To provide basic information on pre- and extramarital sex in the general population and other factors related to HIV transmission. DESIGN: Cross-sectional household survey in 18 countries of the developing world, mainly in Africa and Asia. RESPONDENTS: Representative samples of 1300-6995 individuals aged 15-49 years, interviewed in 1989-1993. METHODS: Face-to-face interviewing. RESULTS: We observed a huge variability between study sites, with the proportion of men reporting sexual contact outside regular partnerships in the last year ranging from 4 to 47%. Contacts with sex workers range from 1 to 25%. Women were much less likely to report non-marital sex than men. CONCLUSIONS: This first cross-cultural attempt to examine aspects of sexual lifestyles suggests that broad generalizations about multiple-partner sexual networking in particular regions are misleading. Gender, marital status, age and a few other demographic correlates were disclosed as powerful determinants of sexual behaviour, although the strength of associations varied greatly between specific locations. Condom use was very low in most study sites.

Adolescent↗
PubMed1994

The electrocardiogram is a more sensitive indicator than echocardiography of hypertrophic cardiomyopathy in families with a mutation in the MYH7 gene.

BACKGROUND: Mutations in the cardiac beta myosin heavy chain gene causing hypertrophic cardiomyopathy have been identified, and to assist both diagnosis and prediction of outcome attempts have been made to correlate phenotype and genotype. Two new mutations in codon 403 of the gene in three unrelated families are described and attention drawn to variable or even absent phenotypic expression in different family members. METHODS AND RESULTS: The polymerase chain reaction and heteroduplex analysis on Mutation Detection Enhancement gels were used to search for mutations in the globular head of the beta myosin heavy chain gene in families with hypertrophic cardiomyopathy. Two mutations were found in exon 13 (codon 403) of the gene. In two unrelated Polish families the mutation resulted in the conversion of arginine to tryptophan (CGG: >TGG). A second mutation, found in a British family, converted the same arginine to leucine (CGG: >CTG). These mutations were detected in family members who had electrocardiographic and echocardiographic features typical of hypertrophic cardiomyopathy; however, they were also detected in 7 other adult relatives with an abnormal electrocardiogram but a normal echocardiogram. Two unrelated adult relatives had completely normal clinical findings but carried the gene mutation. CONCLUSIONS: Identification of a specific mutation gives no guide to the clinical phenotype. There is considerable variability in the phenotypic expression of hypertrophic cardiomyopathy. Mutations were detected in adults previously regarded as normal or in whom the diagnosis was questionable. The fact that the clinical significance of the mutation in these people is still unknown emphasises the dilemma facing screening programmes. Isolated, unexplained electrocardiographic abnormalities in first degree relatives in a family with a definitive diagnosis of hypertrophic cardiomyopathy should be regarded as evidence of a carrier state.

Adult↗
PubMed1994

St. Jude Medical prosthesis in children.

From December 1980 through April 1992, 20 children 2 to 18 years of age underwent valve replacement with the St. Jude Medical prosthesis. Nine children underwent aortic valve replacement, eight underwent mitral valve replacement, and the three children with corrected transposition underwent left-sided tricuspid valve replacement. Of the 20 patients, 17 underwent 23 previous procedures. All but five patients received adequate adult-sized prostheses. There was one hospital death (5%). All hospital survivors received maintenance doses of sodium warfarin. Follow-up was 100% complete with a total of 106 patient-years. There were no late deaths and no thromboembolic or anticoagulant-related bleeding. None of the patients had prosthetic valve endocarditis or a periprosthetic leak. Reoperation was not required in any patient. The great majority of the children (16 of 19) were in New York Heart Association functional class I, two were in class II, and one with complex congenital heart disease was in class III at the time this article was written. This study illustrates the excellent results of cardiac valve replacement with the St. Jude Medical prosthesis in children and confirms the safety of sodium warfarin in this age group.

Adolescent↗
PubMed1994

The St. Jude Medical prosthesis. A thirteen-year experience.

From May 1979 until July 1992, 1184 patients, 2 to 86 years of age (median = 59 years), received 1367 St. Jude Medical prostheses (578 aortic, 440 mitral, 3 tricuspid, and 170 multiple). Overall early mortality was 4% with 2.4%, 4.3%, and 8.2% after aortic, mitral and multiple valve replacement, respectively. Follow-up was 100% complete (4936 patient-years). Actuarial survival at 10 years (including both early and late deaths) was 71% +/- 4.1% after aortic valve replacement, 58.8% +/- 5.1% after mitral valve replacement, and 58.9% +/- 9.6% after multiple valve replacement. Multivariate analysis identified age, previous operations, diabetes mellitus, extent of coronary artery disease, preoperative New York Heart Association class, and additional procedures as independent prognostic factors for overall survival. All patients including 20 children (2 to 18 years of age) received sodium warfarin. The linearized risk per 100 patient-years for all embolic events (major and minor) was 2.4, 4.4, and 5.0 after aortic, mitral, and multiple valve replacement, respectively; when only major events were considered, the linearized risks were 0.33, 1.17, 1.54, respectively. Freedom from major systemic embolism at 10 years was 96% +/- 2% after aortic valve replacement, 88% +/- 4% after mitral valve replacement, and 89% +/- 3% after multiple valve replacement. Five patients had valve thrombosis, four of whom definitely received inadequate anticoagulation therapy. Ninety-seven patients had 107 episodes of anticoagulant-related hemorrhage (2.2/100 patient-years) accounting for 17 late deaths; 14 of the deaths involved an international normalized ratio in excess of 3.5. To reduce the rate of thromboembolism without increasing the rate of anticoagulant-related hemorrhage, we propose that the international normalized ratio should be kept between 2.5 and 3.0. No recorded structural failure or significant hemolysis was found in the absence of periprosthetic leak. This experience encourages us to continue using the St. Jude Medical prosthesis.

Actuarial Analysis↗
PubMed1993

Identification of a mutation in the beta cardiac myosin heavy chain gene in a family with hypertrophic cardiomyopathy.

OBJECTIVE: To investigate the molecular genetic basis of the cause of disease in a family with hypertrophic cardiomyopathy. BACKGROUND: Mutation within the beta cardiac myosin heavy chain gene has been shown to be the pathogenetic mechanism underlying the disease in several families, though clear evidence of heterogeneity has been reported. PATIENTS: A family with a history of hypertrophic cardiomyopathy. RESULTS AND CONCLUSION: This paper reports a mutation at aminoacid position 908 within exon 23 of the beta cardiac myosin heavy chain gene, resulting in a conversion of a leucine to valine. This base substitution was identified in an individual with a confirmed family history but with equivocal symptoms of the disease. Inheritance of the mutation by his symptom free juvenile offspring demonstrates the application of the technique to presymptomatic diagnosis.

Adolescent↗
PubMed1992

A comparison of the effects of the selective peripheral alpha 1-blocker terazosin with the selective beta 1-blocker atenolol on blood pressure, exercise performance and the lipid profile in mild-to-moderate essential hypertension.

The effects of six weeks of treatment with the selective peripheral alpha 1-adrenoceptor blocker terazosin, or the selective beta 1-adrenoceptor blocker atenolol on blood pressure, exercise performance and blood lipid profile were compared in a single-blind, randomized, crossover study of 17 patients with mild-to-moderate essential hypertension. Although both drugs significantly reduced blood pressure at rest, atenolol caused a larger fall in supine blood pressure (11/11 and 7.5/7.0 mmHg, atenolol and terazosin, respectively; p < 0.001). Both treatments controlled the pressor response to exercise, although a greater reduction in diastolic blood pressure was observed at the end of exercise on terazosin (74.0 +/- 5.7 and 91.6 +/- 4.0 mmHg, terazosin and atenolol, respectively; p < 0.01). Alpha 1-blocker therapy was not associated with any measurable improvement or deterioration in cardiopulmonary performance and exercise duration. Unlike atenolol, terazosin therapy had the potentially beneficial effect of reducing serum total cholesterol levels and increasing the high-density lipoprotein-cholesterol/low-density lipoprotein-cholesterol ratio.

Adult↗
PubMed1991

Long-term function in University of Cape Town prostheses in the tricuspid position.

A 55-year-old woman undergoing triple-valve replacement was found at operation to have a well preserved and functioning University of Cape Town prosthesis that had been inserted 18 years earlier for tricuspid stenosis. Case reporting, valve reappraisal, and factual updating on another case, the world's first documented tricuspid valve replacement for Ebstein's anomaly, are presented. These two remarkable in vivo successes speak well for this historic collar stud valve.

Female↗