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Biomedical subjects

M Webb-Peploe

Publications and source records attributed to M Webb-Peploe.

17 recordsLinked to original sources
PubMed1998

Randomized multicenter comparison of conventional anticoagulation versus antiplatelet therapy in unplanned and elective coronary stenting. The full anticoagulation versus aspirin and ticlopidine (fantastic) study.

BACKGROUND: Dual therapy with ticlopidine and aspirin has been shown to be as effective as or more effective than conventional anticoagulation in patients with an optimal result after implantation of intracoronary metallic stents. However, the safety and efficacy of antiplatelet therapy alone in an unselected population has not been evaluated. METHODS: Patients were randomized to conventional anticoagulation or to treatment with antiplatelet therapy alone. Indications for stenting were classified as elective (decided before the procedure) or unplanned (to salvage failed angioplasty or to optimize the results of balloon angioplasty). After stenting, patients received aspirin and either ticlopidine or conventional anticoagulation (heparin or oral anticoagulant). The primary end point was the occurrence of bleeding or peripheral vascular complications; secondary end points were cardiac events (death, infarction, or stent occlusion) and duration of hospitalization. RESULTS: In 13 centers, 236 patients were randomized to anticoagulation and 249 to antiplatelet therapy. Stenting was elective in 58% of patients and unplanned in 42%. Stent implantation was successfully achieved in 99% of patients. A primary end point occurred in 33 patients (13.5%) in the antiplatelet group and 48 patients (21%) in the anticoagulation group (odds ratio=0.6 [95% CI 0.36 to 0.98], P=0.03). Major cardiac-related events in electively stented patients were less common (odds ratio=0.23 [95% CI 0.05 to 0.91], P=0.01) in the antiplatelet group (3 of 123, 2.4%) than the anticoagulation group (11 of 111, 9.9%). Hospital stay was significantly shorter in the antiplatelet group (4.3+/-3.6 versus 6. 4+/-3.7 days, P=0.0001). CONCLUSIONS: Antiplatelet therapy after coronary stenting significantly reduced rates of bleeding and subacute stent occlusion compared with conventional anticoagulation.

Administration, Oral↗
PubMed1995

Serum sickness-like illness following streptokinase therapy. A case report.

We report a patient who developed a serum sickness-like illness characterized by fever, arthritis, haematuria and a purpuric eruption 7 days following streptokinase therapy for myocardial infarction. Blood tests demonstrated increased circulating immune complexes. The skin involvement resulted in extensive, painful cutaneous infarction with secondary bacterial infection. Serum sickness is an uncommon but recognized complication of streptokinase therapy.

Humans↗
PubMed1994

Eighth survey of staffing in cardiology in the United Kingdom 1992.

The Eighth Survey of Staffing in Cardiology was conducted with an index date of 30 September 1992. The total number of cardiologists in England and Wales, defined as individuals trained in the specialty and spending at least 40% of their professional time working in it, was 358. Of these 11 were part time, defined as six sessions or less, giving a number in whole time (or near whole time) equivalents of 352.5. The number of individuals increased from 1991 by 18 (5.3%). There were 71 cardiologists in Scotland and Northern Ireland, making a total for the United Kingdom of 429 individuals (423.5 whole time equivalents), which is 7.3 per million population. A total of 44 Districts serving 8.8 million people have no resident cardiologist. There has been little improvement since the 1991 survey. An additional 34 Districts with populations greater than 250,000 have only one cardiologist: we have clear evidence of inadequate provision of care in most of these, a situation that is inevitable within the resources provided. A wider threat to the provision of a satisfactory level of cardiological care throughout the United Kingdom will follow from changes in the organisation of the National Health Service and in the new requirements for training of future cardiologists because these changes will make major new demands on consultant time which cannot be met within existing resources. A crisis will be averted only if a rapid and major expansion of the consultant grade can be achieved.

Cardiology↗
PubMed1991

Limitations of coronary angiography: an underestimated problem?

Angiographic imaging suffers from many limitations which may distort the diagnostic information obtained from coronary arteriograms. Radiographic features limiting precise coronary stenosis measurement are caused by the x-ray source, the image intensifier, and the chemical properties of the cinefilm. Biologic variations are introduced by fluctuations in angiographic contrast concentration and flow- or contrast-dependent coronary dilation. Random errors are also introduced by the selection of the radiographic projection and frame to be analyzed and the digitization of cineangiograms. These limitations and their significance in distorting quantitative information obtained from coronary angiograms are discussed in this review.

Angiography↗
PubMed1991

201Tl scintigraphy in the assessment of patients with multi-vessel coronary disease undergoing angioplasty who have previously had a coronary bypass graft operation.

Percutaneous transluminal coronary angioplasty (PTCA) has an important therapeutic role in the treatment of coronary artery disease. The purpose of this study was to investigate the role of 201Tl scintigraphy in symptomatic patients with multi-vessel coronary artery disease undergoing angioplasty who had previously undergone coronary graft operations. 201Tl imaging was carried out in 12 patients prior to PTCA, 6 weeks and 6 months to 1 year post-PTCA. Prior to PTCA, 201Tl imaging correctly identified the site of the dominant lesion in all patients in correlation with the catheter results. Six weeks post-PTCA, seven cases who had angiographically successful angioplasty showed persistent defects on 201Tl imaging. In five of these cases, follow-up catheter showed that re-stenosis had occurred. Six months to 1 year post-PTCA, 201Tl imaging was found to have good correlation (11 out of 12 patients) with the catheter results. The results suggest that 201Tl imaging is useful in the management of patients with multi-vessel disease undergoing angioplasty.

Aged↗
PubMed1989

Role of angioplasty in patients with previous coronary artery bypass surgery.

Fifty-nine patients with previous coronary artery bypass surgery (CABG) underwent coronary artery or vein graft angioplasty following a recurrence of symptoms, 141 lesions were attempted in 70 procedures. The overall angiographic success rate was 77%. Some angiographic success was achieved in 83% of patients. Complications included myocardial infarction in three (4.3%), death in one (1.4%), and iliac artery thrombosis in one (1.4%). No patients were referred for urgent surgery. Twenty-eight patients have undergone repeat coronary arteriography after 7.5 +/- 2.6 months (mean +/- SD), and 31% of lesions have recurred. Fifty-eight percent of patients without recurrence at follow-up continue to have improved symptoms. Treadmill exercise time was significantly prolonged in patients in whom all attempted lesions had been successfully dilated and in those in whom only some lesions were dilated. Our experience suggests that approximately 29% of patients with recurrence of angina following CABG may be suitable for angioplasty.

Adult↗
PubMed1984

Dilated cardiomyopathy.

On account of the rapidly progressive nature of the disease, the high incidence of systemic embolism and arrhythmias, and the risk of sudden death, dilated cardiomyopathy is inconsistent with aircrew duties. In the small proportion of subjects who apparently make a satisfactory recovery , re-licensing may be considered once there is no requirement for medication and chest X-ray, electrocardiogram, echocardiogram, exercise electrocardiogram, 24 h ambulatory electrocardiogram and left ventricular ejection fraction are all normal. These tests should initially be repeated annually and be associated with cardiological review.

Aerospace Medicine↗
PubMed1976

Late results of valvoplasty for mitral regurgitation due to rupture of chordae of the posterior (mural) cusp.

Nine patients with rupture of chordae tendinea of the posterior cusp of the mitral valve are presented. All have been treated by plication of the posterior cusp and atrial wall. The presenting postoperative features have been described: 89 per cent are markedly improved; two patients have normal heart sounds with no murmurs; 6 patients have only a Grade 1 pansystolic apical murmur. The advantages of this procedure compared with mitral valve replacement for the same condition have been presented.

Aged↗
PubMed1970

Therapeutic defibrination and heparin therapy in the prevention and resolution of experimental venous thrombosis.

The application of phenol to the femoral veins of anesthetized dogs resulted in an occluding thrombus in 24 of 25 veins at 1 week. Serial venography and eventual histology showed that these veins remained occluded over a 5-week observation period, the thrombi undergoing organization. Therapeutic defibrination was achieved with administration of an enzyme from venom of the pit viper (Arvin). Arvin, administered for 1 week immediately following phenol application and before thrombus formation had occurred, prevented thrombosis in all 10 such veins, and serial venography for a further 4 weeks showed that the veins remained patent. Administration of Arvin was begun 24 hours postoperatively, when venography had demonstrated an occluding thrombus and failed to clear any of 11 veins after 3 weeks of treatment. Intravenous administration of heparin, 10,000 units, at 6, 6, and 12-hour intervals in a 24-hour period, was begun immediately after phenol application and continued for 1 week; 10 of 12 veins were blocked at 1 week. Following the same dose of heparin every 6 hours four of eight veins were blocked at 1 week. The results indicate that when the vascular endothelium is damaged, therapeutic defibrination is more effective than heparin therapy in preventing venous thrombosis. Arvin therapy has no significant thrombolytic effect even if the thrombus is less than 24 hours old.

Ancrod↗