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Biomedical subjects

K A Abraham

Publications and source records attributed to K A Abraham.

At least 19 recordsLinked to original sources
PubMed2003

Familial cardiac myxoma: Carney's complex.

We report a case of Carney's complex in a 12-year-old boy who had the characteristic features of multiple cutaneous tumors, pigmentation, and biatrial myxoma. His large right atrial myxoma almost occluded the tricuspid valve and presented a life-threatening emergency. Surgery saved his life, but recurrence of myxoma was noted on follow-up. The familial nature of the condition is highlighted by the case of the patient's 44-year-old mother, who also presented with features of Carney's complex: multiple cutaneous tumors and a tiny, asymptomatic, left atrial myxoma, which was detected during routine echocardiographic screening.

Child↗
PubMed2002

Left ventricular pseudoaneurysm caused by coronary spasm, myocardial infarction, and myocardial rupture.

We report a very rare case of a 47-year-old man who had coronary spasm that resulted in a silent myocardial infarction, a ruptured myocardial wall, and a nonruptured left ventricular pseudoaneurysm. The patient presented with a 6-month history of dyspnea on exertion, without evidence of fixed coronary artery stenosis. Coronary angiography showed severe coronary spasm of the left anterior descending and left circumflex arteries; the spasm was relieved promptly by nitroglycerin. Echocardiography and left ventricular angiography revealed the large left ventricular pseudoaneurysm posterolateral to the left ventricle. We performed surgical resection of the pseudoaneurysm and patch repair of the ruptured left ventricular wall, with excellent results. We present this case because of the highly unusual sequence of events. Early surgical intervention resulted in the patient's recovery.

Coronary Vasospasm↗
PubMed2001

Successful transplantation of kidneys from a donor with HELLP syndrome-related death.

We report on the successful use of kidneys procured from a donor with HELLP syndrome. The use of organs from a donor with HELLP syndrome has not been reported previously, perhaps because of the renal complications associated with it. Both recipients have been doing well since renal transplantation, with immediate graft function and acceptable graft function at 2 years of follow-up. In view of the continuing shortage of cadaveric kidneys for transplantation, this report highlights how organs from "marginal" donors should not be discarded without worthy consideration.

Adult↗
PubMed2001

The HELLP syndrome, a prospective study.

OBJECTIVE: We undertook this study to evaluate the incidence and outcome of HELLP in Irish patients. In addition, duration and trends of the abnormal laboratory results were studied. STUDY DESIGN: This prospective observational study screened 12068 pregnant women between January 1995 and March 1997. Any pregnant woman with hypertension, proteinuria, thrombocytopenia or anemia was monitored for hemolysis and elevated liver transaminases, from the time of recruitment till six weeks postpartum or resolution. RESULTS: Thirteen of 12068 pregnant women (0.11%) developed HELLP. All had hypertension and 84.6% had proteinuria. Delivery was the only factor found to terminate the syndrome. Acute renal dysfunction was noted in 53.8% but none required dialysis. Laboratory parameters stabilized by the sixth postpartum day. Fetal mortality was 1 out of 14. There were no maternal deaths. CONCLUSIONS: HELLP syndrome is a rare but potentially serious complication of pregnancy. Correlation with laboratory data and early intervention are vital in achieving a favorable outcome for both mother and fetus.

Adult↗
PubMed2001

Influence of ribose on adenine salvage after intense muscle contractions.

The influence of ribose supplementation on skeletal muscle adenine salvage rates during recovery from intense contractions and subsequent muscle performance was evaluated using an adult rat perfused hindquarter preparation. Three minutes of tetanic contractions (60 tetani/min) decreased ATP content in the calf muscles by approximately 50% and produced an equimolar increase in IMP. Effective recovery of muscle ATP 1 h after contractions was due to reamination of IMP via the purine nucleotide cycle and was complete in the red gastrocnemius but incomplete in the white gastrocnemius muscle section. Adenine salvage rates in recovering muscle averaged 45 +/- 4, 49 +/- 5, and 30 +/- 3 nmol. h(-1). g(-1) for plantaris, red gastrocnemius, and white gastrocnemius muscle, respectively, which were not different from values in corresponding nonstimulated muscle sections. Adenine salvage rates increased five- to sevenfold by perfusion with approximately 4 mM ribose (212 +/- 17, 192 +/- 9, and 215 +/- 14 nmol. h(-1). g(-1) in resting muscle sections, respectively). These high rates were sustained in recovering muscle, except for a small (approximately 20%) but significant (P < 0.001) decrease in the white gastrocnemius muscle. Ribose supplementation did not affect subsequent muscle force production after 60 min of recovery. These data indicate that adenine salvage rates were essentially unaltered during recovery from intense contractions.

Adenine↗
PubMed2000

Hemolytic-uremic syndrome in association with both cyclosporine and tacrolimus.

Hemolytic-uremic syndrome (HUS) is a well-recognized complication of cyclosporine (CyA) therapy. Transplant recipients with this complication are frequently switched to tacrolimus, although this drug has also been implicated. We report a case of a renal transplant recipient who developed severe graft dysfunction due to biopsy-proven HUS after receiving CyA. Renal function and hemolytic parameters improved with discontinuation of the drug, but they deteriorated again after commencement of tacrolimus 15 days later. A second transplant biopsy demonstrated fresh lesions diagnostic of HUS. Hemolytic parameters resolved with discontinuation of tacrolimus. This is the first report of metachronous HUS being caused in a renal transplant by both CyA and tacrolimus. We therefore believe that caution should be exercised when using tacrolimus as rescue therapy in patients with CyA-induced HUS.

Biopsy↗
PubMed2000

A novel presentation of cryptococcal infection in a renal allograft recipient.

The population of immunosuppressed patients is growing rapidly because of the HIV epidemic and the rapid expansion in transplant medicine. These patients may present to a variety of clinical specialties with seemingly innocuous infections. We present here the first Irish case of primary cryptococcal cellulitis. The patient was a 62-year old renal transplant recipient and was immunosuppressed with Cyclosporine, Azathioprine and Prednisolone. He presented with an apparent bacterial cellulitis on the dorsum of the hand that had failed to respond to a 3-week course of oral antibiotics. There was no clinical evidence of systemic infection. There was tissue necrosis present and the area was debrided surgically. Histological examination of debrided tissue revealed necrotic granulomata and budding yeast-like organisms. Cryptococcus neoformans was cultured from this specimen. The patient was treated with oral fluconazole 400 mg daily for 6 weeks with complete healing of the infected area and no evidence of recurrence after 12 months of follow up. This case emphasises the need for a high index of suspicion for atypical infection in the immunocompromised patient.

Antifungal Agents↗
PubMed2000

Aortic valve disease and left dominant coronary system a significant association.

OBJECTIVES: To study the dominance of coronary artery distribution in patients with aortic valve disease. MATERIAL AND METHODS: The prevalence of left dominant coronary artery system in patients with aortic valve disease was compared with patients without aortic valve disease undergoing coronary angiography. Group 1 consisted of 237 patients with symptomatic aortic valve disease and Group 2 consisted of 241 consecutive patients without aortic valve disease undergoing cardiac catheterisation. RESULTS: Forty two patients in Group 1 and 20 patients in Group 2 (p < 0.01) showed a left dominant pattern of supply. Fifteen patients in Group 1 and eight patients in Group 2 showed a co-dominant pattern of supply (p = NS). Among patients in Group 1, there was no significant difference in the increased prevalence of left dominant system between patients with congenital or acquired aortic valve disease or between the different categories of aortic valve lesions. CONCLUSION: Patients with aortic valve disease show a statistically significant higher prevalence of left dominant pattern of blood supply. This higher prevalence of left dominance is seen in all categories of aortic valve lesions, namely, predominant aortic stenosis, predominant aortic regurgitation and in combined aortic stenotic and regurgitant lesions.

Adolescent↗
PubMed1999

Percutaneous transvenous mitral commissurotomy for significant calcific mitral stenosis: utility of the stepwise balloon dilatation technique and follow-up results.

The present study examined the utility of the stepwise balloon dilatation technique in 41 patients with significant calcific mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Thirty-five patients (85.4%) had a successful procedure; one patient developed cardiac tamponade and underwent mitral valve replacement. The mitral valve area increased from 0.9 +/- 0.2 cm2 to 1.7 +/- 0.3 cm2 following PTMC. Increase in mitral regurgitation (MR) was seen in 11 patients (26.8%). All patients showed improvement in functional class of > or =1 level following PTMC, which was sustained in 34 patients at follow-up. At a mean follow-up period of 20 +/- 12 months (range 3-51 months) in 35 patients, 26 patients (74.3%) were in New York Heart Association (NYHA) functional Class I, 8 patients (22.9%) were in NYHA Class II, and 1 patient (2.8%) was in NYHA Class III. The cumulative 4-year cardiac event-free survival rate was 81.8%. However, patients with grade 4+ calcification had only 50% event-free survival rate. At follow-up, an increased incidence of cardiac events was seen in female patients as compared with male patients (83.3% versus 16.7%). Restenosis was seen in 3 patients (8.6%). One patient underwent repeat PTMC 37 months after the initial procedure. There was no incidence of death or mitral valve replacement at follow-up. We conclude that the stepwise balloon dilatation technique can be safely and effectively applied for patients with significant calcific mitral stenosis to achieve an optimal mitral valve area with low incidence of significant increase in MR. Favorable long-term benefits also accrue in the form of improved functional status and low incidence of repeat procedures (repeat PTMC or mitral valve replacement). The majority of patients (74.3%) were in NYHA functional class I without medication. Patients with grade 4+ calcification show less benefit from PTMC and may be considered for mitral valve replacement. Cardiac events occur more frequently in female patients than in male patients during follow-up.

Adult↗
PubMed1999

Angioplasty and stenting of solitary supra-aortic artery and aortoplasty by kissing balloon technique.

A child presented with symptoms of compromise to cerebral blood flow and cardiac failure. On diagnostic angiography, he was found to have a discrete coarctation and related ostial stenosis of the left subclavian artery, which acted as the sole source of cerebral blood flow. The subclavian lesion was initially dilated with a 6 mm x 50 mm balloon. The discrete coarctation was then dilated with an 8 mm x 50 mm balloon. Since significant residual stenosis was present at the subclavian origin, it was stented with a 20 mm Palmaz-Schatz stent (Cordis Corporation, Miami Lakes, Florida). Since the coarcted segment required further dilatations, the kissing balloon technique was used, wherein the 6 mm balloon was placed extending from the left subclavian lesion distally to the related aortic lesion proximally, along with another 10 mm balloon in the aorta. The end result was acceptable and the patient's symptoms improved significantly after the procedure.

Angioplasty, Balloon↗
PubMed1995

Tetralogy of Fallot in adults--107 cases.

Clinical and haemodynamic profile of 107 adult patients above the age of 15 years with TOF was analysed. Cardiac catherization and selective cine-angiography were performed in all cases. Infundibular pulmonary stenosis, mal-alignment type of ventricular septal defect, mitral-aortic fibrous continuity and equal systolic pressures in both the ventricles and aorta were considered mandatory for the diagnosis of Tetralogy of Fallot. Aortic regurgitation was seen in 26 cases (24%), tricuspid regurgitation in 22 cases (21%), absent pulmonary valve in 3 cases (3%), branch pulmonary artery stenosis in 9 case (8.4%), major aortopulmonary collaterals in 15 cases (14%), right atrial pressure was more than 10 mmHg in 10 cases (11%) and right ventricular end diastolic pressure more than 9 mmHg in 73 cases (68%). The left ventricular end diastolic pressure was above 13 mmHg in 58 cases (54%).

Adolescent↗
PubMed1994

End-systolic volume and long-term survival after coronary artery bypass graft surgery in patients with impaired left ventricular function.

BACKGROUND: Left ventricular function is the main predictor of long-term survival in patients with coronary artery disease. In patients with impaired left ventricular function after myocardial infarction, end-systolic volume is a better predictor than the global ejection fraction. We analyzed long-term follow-up of patients with impaired left ventricular function undergoing coronary artery bypass graft surgery to evaluate preoperative predictors of survival. METHODS AND RESULTS: Consecutive patients with ejection fractions < or = 40% (n = 193) who had undergone surgical revascularization were followed to assess the predictive value of preoperative baseline characteristics and catheterization findings for long-term survival. Patients were followed for 133 +/- 30.7 months. At the time of surgery, patient age was 56 +/- 7.9 years and 169 patients (87.6%) had a history of previous myocardial infarction. Thirty-one patients (16%) were female. The ejection fraction was 32 +/- 7%, and the end-systolic volume was 147.4 +/- 52.6 mL. One hundred sixty-four patients (84.9%) had three-vessel disease, and 44 (22.8%) had a left main stenosis with > 50% diameter loss. Follow-up was complete in 99%. Fourteen patients died (7.3%) within the first 30 days after surgery. Twelve-month actuarial survival was 86%, 4-year survival was 80%, and 10-year survival was 40%. Predictors of poor long-term survival on multivariate analysis were end-systolic volume index (chi 2 = 14.02, P = .002), number of previous myocardial infarctions (chi 2 = 6.47, P = .001), preoperative stenosis score (chi 2 = 4.97, P = .02), and age at the time of surgery (chi 2 = 4.45, P = .03). CONCLUSIONS: End-systolic volume index is the major predictor of survival after coronary artery bypass graft surgery in patients with impaired left ventricular function. Strategies to prevent ventricular dilatation, such as angiotensin-converting enzyme inhibitors, may improve the long-term outcome in these patients.

Adult↗
PubMed1994

Lipoma of hypopharynx.

The histologically benign hypopharyngeal lipoma is a potentially fatal tumour because of the risk of upper airway obstruction. It may be asymptomatic or present with symptoms ranging from vague foreign-body sensation to sore throat, dysphagia or dysphonia. The diagnosis may be suggested by indirect or fibreoptic laryngoscopy. Lateral neck soft tissue X-ray and barium swallow may help but CT imaging of the pharynx enables a more precise preoperative diagnosis. Treatment is by surgical excision of the lesion either perorally, endoscopically or via a lateral pharyngotomy. Long-term follow-up is recommended due to the possibility of recurrence and metachronous lesions.

Adult↗
PubMed1990

The prevalence and outcome of ventricular arrhythmias in acute myocardial infarction.

One hundred and seventy-two consecutive cases of acute myocardial infarction (MI) admitted to a coronary care unit were studied with regard to ventricular arrhythmias--pre-mature ventricular contractions (PVC), ventricular tachycardia (VT) and ventricular fibrillation (VF). Sixty-seven (39%) patients had ventricular arrhythmias (PCC-VT-VF), of whom 17 (9.8%) had VT and 11 (6.4%) VF. VT and VF, but not total arrhythmias, were more common in anterior infarctions. Fifty-six out of 67 (83.5%) of these patients arrived at Accident & Emergency (A&E) within the first six hours of onset of chest pain. Ten out of 11 (91%) patients who had VF did so in the first six hours. PVCs were poor predictors of the occurrence of VF (positive predictive value 5.9%). Forty-three patients (84%) who had PVCs did not develop any further arrhythmias. Spontaneous heart rate had no influence on the occurrence of ventricular arrhythmias. Frequent PVCs were more commonly associated with progression to VT and VF. In 30 cases (88%) lignocaine was effective. There was no death due to VT/VF and all responded to drugs and/or cardioversion.

Adult↗