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Biomedical subjects

M Ruttley

Publications and source records attributed to M Ruttley.

11 recordsLinked to original sources
PubMed2003

Post-sternotomy internal mammary arteriovenous fistula.

Arteriovenous fistula from the mammary artery is a rare complication following cardiac surgery. The fistula usually develops within the first 2 weeks after surgery and is initially asymptomatic. Typically, a continuous machinery murmur is heard along the parasternal border of the chest wall. A patient with an arteriovenous fistula between the right internal mammary artery and mammary vein following a combined aortic valve and coronary bypass operation is described. A transthoracic colour Doppler scan led to the diagnosis of the fistula. Because of potential late complications endovascular embolisation of the fistula was successfully performed.

Aged↗
PubMed1993

Apolipoprotein (a) concentrations and susceptibility to coronary artery disease in patients with peripheral vascular disease.

OBJECTIVE: To investigate the relation between apolipoprotein(a) concentrations and angiographically defined coronary artery disease in patients with atheromatous peripheral vascular disease. DESIGN: 40 consecutive patients were recruited at the time of admission for peripheral vascular surgery. All underwent clinical assessment and coronary arteriography. Apolipoprotein(a) concentrations were measured by an immunoradiometric assay. SETTING: Tertiary referral centre. SUBJECTS: Patients requiring surgical intervention for large vessel peripheral vascular disease. MAIN OUTCOME MEASURES: Presence or absence and severity and distribution of angiographically defined coronary artery disease. Measurement of circulating contractions of apolipoprotein(a) and other lipid indices. RESULTS: Coronary artery disease was absent in 11 patients (group 1), mild to moderate in 12 (group 2), and severe in 17 (group 3). The distribution of peripheral vascular disease and of standard lipid indices was similar in these three groups of patients. There was a significant difference in apolipoprotein(a) concentrations between the three groups, with concentrations progressively increasing with the severity of coronary artery disease (mean (95% confidence interval): group 1, 112 U/1 (52 to 242); group 2, 214 U/1 (129 to 355); group 3, 537 U/1 (271 to 1064) (analysis of variance p < 0.005). The prevalence of coronary artery disease was increased 7.4 fold in patients with apolipoprotein(a) concentrations that were greater than the cohort median (206 U/1) (p < 0.01). CONCLUSIONS: The results show an association between apolipoprotein(a) concentrations and angiographically defined coronary artery disease in patients with large vessel peripheral vascular disease. The findings imply differences in the pathogenesis of coronary and peripheral atheroma and suggest that the measurement of apolipoprotein(a) may prove a useful additional tool in the risk factor assessment of patients undergoing peripheral vascular surgery.

Aged↗
PubMed1992

The effect of iodixanol, a new isotonic contrast agent, on femoral blood flow in man.

Both ionic and non-ionic contrast media (CM) injected intra-arterially produce peripheral vasodilatation and a sensation of heat or even pain. This effect has been considered to be predominantly related to the osmolality of the CM used. Iodixanol is a non-ionic dimeric CM which can be made isotonic with blood at iodine concentrations up to 400 mg/ml. To assess the degree of peripheral vasodilatation following aortic injection of iodixanol, the change in femoral artery blood flow has been assessed non-invasively. Dupex ultrasound flow-velocity records were taken from the contralateral femoral artery in 10 patients undergoing transfemoral aortography. Volume flow, mean velocity, pulsatility index and peak systolic velocity were continuously recorded before and up to 2 min after injection of 60 ml of iodixanol at an iodine concentration of 320 mg/ml (iodixanol 320). Transient changes consistent with vasodilatation were observed in all patients. The greatest changes were observed during the time period 18-24 s after injection. Volume flow, mean velocity and pulsatility index all changed significantly from baseline (mean changes of 80.6%, 73% and -42.7% respectively). Peak systolic velocity did not change significantly. Intra-arterial injections of isotonic iodixanol 320 produces a significant increase in femoral blood flow in man. Factors other than hypertonicity must therefore be implicated in the vasodilatory effect of contrast media.

Adult↗
PubMed1981

Diagnosis and prognosis of chest pain with normal coronary arteriograms.

Ninety-eight patients previously investigated for suspected angina but shown to have normal coronary arteriograms were reviewed. The prognosis for like expectancy was excellent but 76% were still symptomatic after average follow up of three years. 41% of those re-evaluated were still thought to be describing cardiac-like pain. Full re-investigation showed coronary artery spasm or other causes of myocardial ischemia to be rare whereas oesophageal spasm was a common cause of the pain.

Adult↗
PubMed1978

Left cervical aortic arch associated with aortic aneurysm.

An aortic arch extending into the neck is a rare congenital anaomaly. Left-sided cervical aortic arch was thought to be much less common than right-sided, but they are now almost equal in incidence in the published reports. This paper describes a case of left-sided cervical aortic arch in an adult, with a previously undescribed association, aneurysm of the descending thoracic aorta. Cervical aortic arch must be considered in the differential diagnosis of pulsatile cervical swellings. The embryological development of the aortic arch is discussed. This is still controversial and it is not possible to be sure of the embryological explanation of this congenital anomaly of the aortic arch from a study of the adult anatomy.

Adult↗