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Biomedical subjects

N Brooks

Publications and source records attributed to N Brooks.

8 recordsLinked to original sources

Psychosocial assessment after traumatic brain injury.

Psychosocial outcome has been difficult to define, but nevertheless widely reported. More recent studies have demonstrated not only that the long term emotional costs of head injury are enormous for survivor and family members, but the functional consequences in terms of changes in family life, recreational and vocational activities, are great and prolonged. These consequences have more recently become the focus of rehabilitation, with studies demonstrating dramatic improvements in many aspects of productive living, and consequent lifetime cost savings of an enormous amount. The psychosocial deficits matter, they can be the focus of treatment, and the treatment can be successful and cost effective.

Activities of Daily Living

Complete right bundle-branch block: echophonocardiographic study of first heart sound and right ventricular contraction times.

High speed enchocardiograms of the mitral, tricuspid, and pulmonary valves were recorded with a simultaneous electrocardiogram and phonocardiogram in 20 patients with complete right bundle-branch block and in 67 normal subjects. Late opening of the pulmonary valve indicating late right ventricular ejection was found in all patients. In 8 patients with wide splitting of the first heart sound the late ejection was related mainly to delay in tricuspid valve closure, suggesting a late onset of the right ventricular pressure pulse. In 10 patients with a single first heart sound the delayed ejection was associated with a long interval between tricuspid valve closure and pulmonary valve opening, suggesting a slow rising right ventricular pressure pulse; 3 of these patients also had late tricuspid valve closure but the tricuspid component of the first sound was absent. Late onset of pressure rise is thought to result from block in the main right bundle-branch, and a slow rising pulse from block in the distal Purkinje network. These findings explain the conflicting results in previous studies of the first heart sound and right ventricular pressure pulse in patients with right bundle-branch block, and may have prognostic significance.

Adolescent

Reoperation for recurrent angina.

Forty patients with persistent or recurrent angina after an aortocoronary bypass procedure underwent a second operation. The cause of recurrent angina, defined by angiography, was thought to be isolated graft failure in 13 patients, progression of disease in ungrafted vessels in 4, incomplete revascularisation in 2, and stenoses distal to patent grafts in 1. More than one factor was responsible in 20 patients. There was 1 early postoperative death and 3 perioperative myocardial infarctions. Thirty-four patients have been followed for more than 3 months (4 to 63 months). Of these, 17 had previously bypassed vessels regrafted and 5 are sympton free, 4 have mild angina, and 8 have severe angina. Ten patients had previously ungrafted vessels grafted and 4 are sympton free, 3 have mild angina, 2 have severe angina, and 1 is limited by breathlessness. Seven patients had a combined procedure and 4 are sympton free, 1 has mild angina, and 2 have severe angina. Reoperation can be carried out safely but the results are less satisfactory than for a primary procedure.

Adult