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Biomedical subjects

M J Elliott

Publications and source records attributed to M J Elliott.

152 records · Page 9Linked to original sources
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Massive cardiac chondroma presenting with heart failure and superior vena cava obstruction in a teenage boy.

Histologically benign soft-tissue chondromas have been reported at many anatomical sites but are an uncommon cause of soft tissue mass lesions in childhood, accounting for less than 1% of cases. The most frequent sites for extraosseous soft-tissue chondromas are the hands and feet. For the extremely rare visceral chondromas, the site can be lung, where they may represent a component of Carney's syndrome of extra-adrenal paraganglioma, pulmonary chondroma, and epithelioid leiomyosarcoma of the gastrointestinal tract. Primary cardiac chondromas are exceptionally rare in patients of any age although cardiac chondrosarcoma, both primary and metastatic, is well reported. We present a case of a teenage boy with a fatal cardiac chondroma

Adolescent↗
PubMedDate not supplied

Avascular necrosis of the talus after McKay clubfoot release for idiopathic congenital clubfoot.

Avascular necrosis of the talus is a serious potential complication of clubfoot surgery. In the few cases described in the literature, the necrosis has involved the entire talus and resulted in progressive fragmentation and collapse. Serial postoperative radiographs of 96 idiopathic clubfeet in 70 patients are reviewed here to determine the incidence of avascular necrosis after McKay soft tissue release. Based on criteria in the literature for making the diagnosis, no cases of avascular necrosis were seen. Growth lines were observed in the cuboids and calcanei of all the feet during the follow-up period. Eight feet failed to develop growth lines in the talus during follow-up. Five of these feet showed flattening of the dome of the talus and three hypoplasia of the talar head and neck at the most recent follow-up. Absence of normal growth lines in the talus after operation seems to predict talar abnormalities.

Adolescent↗
PubMedDate not supplied

Pseudoaneurysm of the aorta after heart-lung transplantation: diagnosis by color flow Doppler mapping.

Five months after heart-lung transplantation for treatment of end-stage cystic fibrosis, a 14-year-old girl had a swelling over the manubrium that was identified as a pseudoaneurysm at the aortic anastomotic site by means of cross-sectional echocardiography with color flow Doppler mapping. The diagnosis was confirmed at operation, despite which she died. Biopsy material taken during the operation revealed chronic sternal osteomyelitis caused by Pseudomonas aeruginosa. Disruption of the aortic anastomosis by infection may be a major complication of heart-lung transplantation for treatment of cystic fibrosis.

Adolescent↗
PubMedDate not supplied

Surgery for congenital abnormalities of the mitral valve at the Hospital for Sick Children, London from 1969-1983.

The surgical management of congenital mitral valve (MV) anomalies remains controversial and complex. Valve repair has been said to be preferable to valve replacement. To assess the validity of this suggestion we have reviewed our experience of these procedures at The Hospital for Sick Children, Great Ormond Street, London from 1969-1983. In that time 48 patients have undergone surgery; in 23 repair was practicable (Group A) and in 25 replacement of the MV was required (Group B). Group A patients were slightly older than group B patients (5.9 +/- 1.0 years (SEM) vs 3.6 +/- 0.5 years). Björk Shiley valves were the predominant prosthesis used. Overall mortality was 33%, with 17% in Group A and 48% in Group B. Hospital mortality was 4.5% in Group A and 28% in Group B. Actuarial survival for Group A was 90% at 1 year, and 75% at 2 and 5 years; for Group B it was 52% at 1 and 2 years and 42% at 5 years. Mortality was significantly higher in those aged less than 5 years. Four patients in Group A have required re-operation, in 3 valve replacement was required; 2 of these died in hospital. One patient in Group B has required reoperation for valve-related thromboembolism. Three patients are awaiting replacement of calcified bioprostheses. These data support the concept that repair of MV should be performed where possible. The severity of the anomalies was greater in Group B and a rethink as to whether valve replacement is the best option for severe mitral stenosis in those aged less than 5 years seems indicated, in view of the very high mortality.

Actuarial Analysis↗
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Insulin delivery during surgery in the diabetic patient.

The usual treatment of diabetic patients during surgery with general anesthesia owes little to logic, common sense, or knowledge of requirements, and mortality and morbidity remain high in many centers. In the nondiabetic patient, surgery is accompanied by a rise in secretion of catabolic hormones, insulin-resistance and loss of protein. Therapy of the diabetic patient should be designed to account for these changes and to avoid hypoglycemia, hyperglycemia, and hyperketonemia. It is suggested that for major operations for well-controlled non-insulin-dependent diabetic (NIDDM) persons and for all minor and major operations for insulin-dependent diabetic (IDDM) persons and poorly controlled NIDDM, a combined insulin (3.2 U/h), glucose (10 g 10% dextrose/h), and potassium infusion should be used until oral feeding recommences. The insulin dose should be modified periodically according to bedside glucose monitoring. Fluids should be used as in nondiabetic patients, except that lactate-containing solutions should be avoided. Insulin requirements will be increased (1) by infection, (2) in patients with hepatic disease, (3) in obese patients, (4) in steroid-treated patients, and (5) during cardiovascular surgery. A diabetes-care team should preferably be responsible for the care of the diabetic pre-, per-, and postoperatively.

Anesthesia↗
PubMedDate not supplied

Cytokine expression and networks in rheumatoid arthritis: rationale for anti-TNF alpha antibody therapy and its mechanism of action.

The cloning of cytokine cDNAs has permitted the analysis of cytokine expression in diseased sites such as rheumatoid joints. A very wide range of cytokines were detected, mostly with proinflammatory activities. From the analysis of cytokine regulation in rheumatoid joint cell cultures using neutralizing anti-cytokine antibodies, it was found that blockade of TNF alpha reduced the production of other proinflammatory cytokines. Hence TNF alpha was a potential therapeutic target. This concept was tested successfully in collagen induced arthritis in mice and led to clinical trials of anti-TNF alpha antibody in rheumatoid arthritis (RA) in humans. The mechanism of action of anti-TNF alpha will be discussed.

Animals↗
PubMedDate not supplied

Anterior tibial compartment syndrome associated with ergotamine ingestion.

This is the first reported case of acute anterior tibial compartment syndrome following ergotamine tartrate overdosage. A 25-year-old man developed signs and symptoms of ergotism after ingestion of 72 mg of ergotamine tartrate over the 12 days prior to his hospital admission. On the fourth hospital day, the patient developed bilateral anterior tibial compartment syndrome. The development of this syndrome is postulated to have been due to the progressive edema and tissue pressure in the anterior tibial compartments, worsened by the gradual improvement of the peripheral circulation which followed the diminished vasopastic effect of the ergotamine.

Adult↗