PubMed Health⌕ Search

Biomedical subjects

M Joy

Publications and source records attributed to M Joy.

At least 19 recordsLinked to original sources
PubMed1992

Need for invasive cardiological assessment and intervention: a ten year review.

The uptake of invasive cardiological investigation and cardiopulmonary bypass procedures by the North West Surrey Health District was audited over the years 1979-88. Growth was almost continuous throughout the ten year period. The need within the district each year for coronary angiography seemed to be between 111 and 171 and for surgical revascularisation of the myocardium between 63 and 96 procedures; the first figure is the mean of the second quinquennial period (1984-88) and the second figure the total for 1988. After correction for the standardised mortality ratio and catchment area, the national requirement should lie between 690 and 1070 coronary angiograms and 390 and 600 coronary artery bypass graft operations per million population each year. There is a further national requirement for 70 valvar heart operations and 30 miscellaneous procedures per million population each year. Owing to delays in the provision of services, 20 patients died of a cardiovascular cause while they were on the waiting list for investigation or surgery. In the United Kingdom the annual target to be achieved by 1990 was 300 coronary artery bypass procedures per million population.

Adult↗
PubMed1991

Delay to invasive investigation and revascularisation for coronary heart disease in south west Thames region: a two tier system?

OBJECTIVES: To assess the accessibility of invasive investigation and revascularisation procedures in the management of coronary heart disease in a defined population in the South West Thames region over 10 years, and to audit the performance of both the NHS and the private sector. DESIGN: Analysis of all patient referrals to the regional cardiothoracic centres for coronary heart disease during 1979-88. SETTING: North West Surrey District Health Authority, which had a mean catchment population of 205,000 during the study period. The health district is one of the 13 in the South West Thames region. PATIENTS: 823 patients aged 34-80 years with suspected coronary heart disease, 204 of whom were referred for private investigation and 619 were referred within the NHS. The NHS referrals were mainly to St Thomas's Hospital during 1979-83 and to St George's Hospital during 1984-8. MAIN OUTCOME MEASURES: Difference in time to investigation and intervention between the NHS and the private patients. RESULTS: After some variation in earlier years the mean (SD, range) waiting times from referral to cardiac catheterisation and then revascularisation increased progressively in NHS patients, to 115.8 (126.5, 22-482) days and 305.9 (164.4, 22-620) days respectively in 1988. There was no significant change over the 10 years in waiting times within the private sector, with a mean of 17.2 (18.2, 1-62) days to angiography and 22.8 (14.5, 2-152) days to surgery. Fifteen people on the NHS waiting list died of probable cardiac causes. No people on the private waiting list died. CONCLUSIONS: The performance of the NHS system in South West Thames region in response to emergency referral is adequate. The waiting time to routine investigation and revascularisation is prolonged and seems to be worsening despite increased investigative and surgical activity by the regional centre. The delays may subject NHS patients to unnecessary risk, which is not shared by private patients.

Adult↗
PubMed1991

Computer- and robot-assisted resection of thalamic astrocytomas in children.

Six children ranging in age from 2 to 10 years who harbored deep benign astrocytomas were operated upon using a computer- and robot-assisted system. A radical excision was achieved in all cases with no significant morbidity nor any mortality. The system consists of an interactive, three-dimensional display of computed tomographic image contours and digitized cerebral angiograms taken using the Brown-Roberts-Wells stereotactic frame. The surgical retractor is held and manipulated using a PUMA 200 robot. The position and orientation of the surgical retractor is displayed on the three-dimensional display. Preoperative planning and simulation are important features of this system. Movement of the brain after removal of the tumor and cerebrospinal fluid is substantial, so the tumor removal is based on visually defined margins. Enhanced computer graphics and robotic devices are important adjuncts to neurosurgical procedures and will find increasing use in the future.

Astrocytoma↗
PubMed1991

Is the non-pharmacological treatment of hypertension neglected?

Non-pharmacological techniques in the management of hypertension have been shown to be beneficial. This pilot study was set up to examine how often routine advice was given with respect to weight reduction and/or lifestyle adjustments, and whether it was needed. Three-quarters of the 69 patients in the study smoked or were overweight but only half of the smokers recalled advice to stop. One-fifth of the patients were apparently not told to lose weight. Only one-third recalled being told to reduce alcohol intake. Lifestyle counselling and the management of hypertension in this small study appeared to be not completely effective for various reasons. It is likely to be cheaper and more satisfactory than medication alone or as an adjunct and its application deserves further study.

Body Weight↗
PubMed1988

Acute myocardial infarction after a wasp sting.

A 56 year old man with ischaemic heart disease and known allergy to wasp venom was stung in the mouth by a wasp and within four hours sustained an acute myocardial infarction. This complication has been described on only three previous occasions. Possible pathogenic mechanisms include the anaphylactic reaction itself, the action of wasp venom constituents, and therapeutic intervention with adrenaline.

Animals↗
PubMed1987

Long term use of enalapril in the treatment of patients with congestive heart failure.

Fifty-five patients of both sexes, aged 39-72, suffering from congestive heart failure of varying aetiology were admitted to a double blind study in which enalapril given in a dose of 5-10 mg twice daily or placebo was added to existing medication. A significant increase in exercise performance (P less than 0.004) was seen in the group treated with enalapril, an improvement which was still evident after 24 weeks of therapy. No significant difference was seen between the mean ejection fractions but subjective assessment suggested improvement in the enalapril-treated group.

Adult↗
PubMed1987

Observations on the warm up phenomenon in angina pectoris.

Adaptation to exercise was investigated in 14 men aged 34-69 years (mean 51) with stable exertional angina caused by occlusive coronary artery disease. All underwent exercise electrocardiography to symptom limitation according to the Bruce protocol (first effort), and exercise to the onset of angina (warm up) followed by four minutes' rest, followed by exercise to symptom limitation (second effort). This protocol was repeated after sequential treatment for one month each with nifedipine 10 mg three times a day and with timolol 10 mg twice a day. Warm up significantly increased walking time to the onset of angina by 34.5% and to maximal exercise by 29.5%. The heart rate and rate-pressure product were significantly higher on second effort both at the onset of angina (by 7.0% and 11.1% respectively) and at maximal exercise (by 10.5% and 15.4% respectively). ST segment displacement was not significantly different after warm up. The effect of warm up on walking time to the onset of angina was markedly reduced after treatment with nifedipine but little influenced by timolol. Mean (SE) walking time after warm up on no treatment was 10.1 (0.7) min; after treatment with nifedipine it was 10.0 (0.6) min and after treatment with timolol it was 9.7 (0.4) min. These data demonstrate a substantial improvement in exercise performance after warm up and are consistent with the hypothesis that submaximal exercise in angina pectoris facilitates myocardial oxygen uptake by coronary vasodilatation.

Adaptation, Physiological↗
PubMed1986

Effect of BW12C on oxygen affinity of haemoglobin in sickle-cell disease.

Eight subjects with sickle-cell disease in the symptom-free steady-state received a single one-hour infusion of the new anti-sickling agent BW12C on a total of eleven occasions. A dose-dependent increase in wholeblood oxygen affinity was observed, resulting from the action of BW12C in stabilising the oxy-conformation of haemoglobin and causing a left shift of the oxygen saturation curve. At the highest dose given (20 mg/kg bodyweight), up to 23% of haemoglobin was modified to a BW12C-reacted high-affinity form without evidence of tissue hypoxia. There was biochemical and rheological evidence for a transient decrease in haemolytic rate.

Adult↗
PubMed1986

Aortic root abscess in Actinobacillus actinomycetemcomitans endocarditis: non invasive diagnosis and successful outcome following early surgery.

The case described is the first in which Actinobacillus actinomycetemcomitans endocarditis affecting the aortic valve was complicated by aortic root abscess formation. The diagnosis was supported by the development of complete left bundle branch block, the presence of pericarditis and the two-dimensional echocardiographic appearance. Early surgery was performed and the diagnosis confirmed. The patient made a full recovery.

Abscess↗
PubMed1986

The need for invasive cardiological assessment and operation: viewpoint of a district general hospital.

The uptake of cardiac catheterisation and operation and of permanent pacemaker implantation in a district hospital in Surrey from 1979 to 1984 was studied prospectively. The 1982-84 figures for coronary artery operation indicated that 362 procedures/million population/annum were needed in the district. If patients with greater than or equal to New York Heart Association grade II angina only received operation the corresponding figure would have been 325. The national need for these procedures (464/million population/year) was estimated by correcting for the low standardised mortality ratio for ischaemic heart disease in the health district that was studied. Valvular heart disease accounted for 79 operations/million population/annum and permanent pacemaker insertion for 87 procedures/million population/annum. These figures underline the substantial shortfall in modern cardiac care in the United Kingdom.

Cardiovascular Diseases↗
PubMed1986

Why are the angiotensin converting enzyme inhibitors rational in the treatment of congestive heart failure?

In chronic congestive heart failure, there is stimulation of the renin-angiotensin-aldosterone system, in addition to other homeostatic mechanisms. In addition to increased tone in the arteriolar and venous beds, there is salt and water retention by the kidney and excitation of the central nervous system by angiotensin. Interference with the generation of angiotensin reduces preload and afterload without a reflex tachycardia as the effects of angiotensin on the central nervous system are reduced. ACE inhibition is, therefore, a logical approach to the management of chronic congestive heart failure.

Angiotensin-Converting Enzyme Inhibitors↗