You don't have to retrieve to relieve: how and when to trim a self-expanding metal biliary stent.
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Duodenum↗
Biomedical subjects
P Brady
Publications and source records attributed to P Brady.
Tracheo-oesophageal fistula following a fall.
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Accidental Falls↗
Patient scoring systems.
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Aortic Aneurysm, Abdominal↗
Parkinsonism: siblings share Helicobacter pylori seropositivity and facets of syndrome.
OBJECTIVE: Given a history of peptic ulcer is more frequent in parkinsonism, to investigate the role of Helicobacter pylori in its pathogenesis and of cross-infection in familial aggregation. METHODS: Facets of parkinsonism were quantified in 33 elderly subjects with idiopathic parkinsonism and in their 39 siblings with double the number of controls, all obeying inclusion/exclusion criteria. Specific-IgG antibody was assayed. RESULTS: Siblings, compared with controls, had brady/hypokinesia of gait (P< or =0.002), bradykinesia of hands (P = 0.01), abnormal posture (P = 0.001), rigidity (P < 0.001) and seborrhoea/seborrhoeic dermatitis (P = 0.02). Both parkinsonians and siblings differed from controls in the odds of being H. pylori seropositive [odds ratios 3.04 (95% C.I.: 1.22, 7.63) and 2.94 (1.26, 6.86) respectively, P < 0.02], seropositivity being found in 0.70 of sufferers. CONCLUSION: Familial transmission of chronic infection plus part of syndrome links Helicobacter with causality. Seropositivity not being universal throughout parkinsonism, consequent on gastric atrophy +/- sporadic antibiotic exposure, might explain less aggressive disease in older sufferers.
Adult↗
Thoracoscopic approach for biopsy of the latissimus dorsi cardiomyoplasty wrap.
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Animals↗
Surgical repair of type-A aortic dissection: early and late results in 32 consecutive patients.
BACKGROUND: Acute type-A aortic dissection is a surgical emergency. One unit's experience in the surgical repair of type-A aortic dissection is documented. METHODS: Surgical treatment was undertaken for type-A aortic dissection in 32 consecutive patients between January 1988 and August 1994 at Royal North Shore Hospital. Retrosternal chest pain was the commonest presenting symptom and in four of these cases it was initially misinterpreted as myocardial ischaemia. RESULTS: A total of 24 patients had signs of aortic incompetence on presentation. Computed tomography (CT) scanning was the commonest modality of definitive diagnosis, but trans-oesophageal echocardiography was used as confirmation wherever possible, and we now consider it the initial, best investigation whenever a diagnosis of dissection is considered. There were 15 supra-coronary ascending aortic replacements, and a further four with aortic valve re-suspension. There were 13 operations of the Bentall's type. The overall 30-day mortality was 19%. The late mortality was 19%, with 62% long-term survival at a mean follow-up of 4.8 years. CONCLUSION: Early diagnosis and surgical intervention can give excellent palliation and improved life expectancy in acute type-A aortic dissection.
Acute Disease↗
Maternal risk factors for childhood malnutrition in the Mazowe District of Zimbabwe.
OBJECTIVE: To determine the maternal risk factors associated with childhood malnutrition. DESIGN: An unmatched case control study of 327 children < 5 years of age. SETTING: Primary health care clinics on the communal lands and commercial farms in the Mazowe District of Zimbabwe. MAIN OUTCOME MEASURES: The relationship between maternal risk factors and childhood malnutrition was analysed. To correct for confounding variables a forward stepwise logistic regression was performed. RESULTS: Odds ratio (95pc confidence limits) for childhood malnutrition were a working mother 5.69 (2.37 to 3.66) and lack of decision making power 2.86 (1.1 to 7.45) on the communal lands, and lack of extra income generating projects 3.92 (1.64 to 9.54) and previous death of a child 2.17 (1.08 to 4.39) on the commercial farms. In both areas malnutrition was associated with < or = 1 acre of land 3.66 (1.4 to 9.53) and p < 0.01 (Fisher's exact test) for the communal lands and commercial farms respectively), and father's income < or = Z$150/month 12.5 (2.5 to 100) and 5.56 (1.4 to 25.0) for the communal lands and commercial farms respectively. CONCLUSIONS: To reduce childhood malnutrition in the rural areas reduced maternal work load and increased decision making power, better access to health care plus more access to land and higher income are all critical issues.
Case-Control Studies↗
The use of ultra-low-dose aprotinin to reduce blood loss in cardiac surgery.
One hundred patients due to undergo primary cardiac surgery were prospectively randomized to receive aprotinin or placebo. In the aprotinin group, 250,000 kallikrein inhibitory units (KIU) of aprotinin were added to the cardiopulmonary bypass prime solution. A further 250,000 KIU of aprotinin were infused intravenously over 30 minutes immediately before the start of cardiopulmonary bypass. The control group received 0.9% saline in equal volumes at identical times. The study was designed to have a 90% chance of demonstrating a 30% reduction in blood loss. No significant differences were found between the two groups. The median blood loss in the aprotinin group was 750 mL (interquartile range 556 to 1025 mL, 95% confidence interval 600 to 800 mL). In the control group, the median blood loss was also 750 mL (interquartile range 500 to 988 mL, 95% confidence interval 625 to 925 mL). In the aprotinin group, 12 patients received postoperative autotransfusion of shed mediastinal blood of median volume of 665 mL (interquartile range 500 to 925 mL, 95% confidence interval 450 to 1000 mL). In the control group, 14 patients received postoperative autotransfusion of mediastinal blood of median volume of 663 mL (interquartile range 600 to 800 mL, 95% confidence interval 600 to 700 mL). Five patients in the aprotinin group and seven patients in the control group required postoperative homologous blood transfusion. Reassessment of inclusion criteria showed a 19% reduction in blood loss in patients undergoing only aortocoronary bypass receiving aprotinin compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Aprotinin↗
The bizarreness effect: it's not surprising, it's complex.
Higher recall of bizarre images relative to common images (the bizarreness effect) is consistently found when bizarreness is varied as a within-subject (mixed-list) variable. In Experiment 1, mixed lists, rather than the smaller number of bizarre sentences typically used in such lists, determined the occurrence of the bizarreness effect. Contrary to predictions from expectation-violation theory, Experiments 2 and 3 showed that manipulations designed to augment or attenuate surprise reactions to bizarre sentences had little impact on the bizarreness effect. Experiments 4 and 5 indicated that mixing affected the degree to which participants differentially encoded order information for bizarre and common items. A new account of the bizarreness effect is presented that combines considerations of distinctiveness with the differential use of order information across bizarre and common items.
Adult↗
Giant double parathyroid adenoma presenting as a hypercalcaemic crisis.
The largest documented case of a double parathyroid adenoma is reported. The patient presented in hypercalcaemic crisis with a large intrathoracic mass. After removal of a massive cystic parathyroid adenoma from the right superior mediastinum, a second very large parathyroid adenoma was found on the contralateral side adjacent to the left thyroid lobe. This case illustrates the importance of the cervical approach, as well as routine bilateral neck exploration, for all cases of primary hyperparathyroidism.
Adenoma↗
Frequency and specificity of antiheart antibodies in patients with dilated cardiomyopathy detected using SDS-PAGE and western blotting.
OBJECTIVES: This study was designed to investigate the organ and disease specificity of antiheart antibodies in patients with dilated cardiomyopathy. BACKGROUND: Autoimmune disease is characterized by the presence of circulating autoantibodies, and autoimmune mechanisms may play a role in the pathogenesis of dilated cardiomyopathy. METHODS: An SDS-PAGE (sodium dodecylsulfate polyacrylamide gel electrophoresis) procedure followed by Western blotting was used to screen serum samples for antiheart antibodies of two immunoglobulin classes, IgM and IgG, from 52 patients with dilated cardiomyopathy and 48 patients with ischemic heart disease as control subjects. Use of two-dimensional gel electrophoresis followed by Western blotting and protein sequencing enabled us to identify the protein bands against which antiheart antibodies were produced in both groups of patients. RESULTS: Strong IgG antiheart antibodies against myocardial proteins, cross-reacting with skeletal muscle proteins, were detected in significantly more patients with dilated cardiomyopathy (n = 24 [46%]) than with ischemic heart disease (n = 8 [17%]) (p = 0.001). Patients with dilated cardiomyopathy showed a significantly greater frequency and reactivity of IgG antiheart antibodies against six myocardial proteins (molecular weight 30, 35, 40, 60, 85 and 200 kD) than did patients with ischemic heart disease. These were identified as myosin light chain 1, tropomyosin, actin, heat shock protein (HSP)-60, an unidentified protein and myosin heavy chain, respectively. CONCLUSIONS: We detected strong IgG antiheart antibodies in significantly more patients with dilated cardiomyopathy than with ischemic heart disease. The most immunogenic band was that corresponding to HSP-60. Antibodies against HSP-60 were found in 85% and 42% of patients with dilated cardiomyopathy and ischemic heart disease, respectively, confirming our hypothesis of an immune involvement in dilated cardiomyopathy.
Actins↗
Cytosolic Ca2+ spikes evoked by the thiol reagent thimerosal in both intact and internally perfused single pancreatic acinar cells.
Cytosolic calcium signals evoked by the sulphydryl-group-oxidising agent, thimerosal, have been investigated in acutely isolated pancreatic acinar cells. Two techniques were employed for the assessment of the cytosolic free-calcium concentration ([Ca2+]i): measurement of calcium-dependent chloride and non-specific cation currents (whole-cell patch-clamp recording) and microfluorimetry (fura-2). Thimerosal (0.5-100 microM) evoked repetitive spikes in both chloride and cation currents as seen by patch-clamp recording, and in [Ca2+]i as seen by microfluorimetry, with a latency of 1-3 min. The response increased in magnitude over time and was not reversed on removal of thimerosal. The thimerosal-induced spikes were reversibly blocked by 2 mM dithiothreitol and by 20 mM caffeine. Inclusion of heparin (200 micrograms/ml) in the pipette solution blocked the thimerosal-induced spikes. The calcium spikes continued after the removal of extracellular calcium; however, low concentrations of thimerosal (0.5-5 microM) were unable to initiate a current response in the absence of external calcium. High concentrations of thimerosal (50-100 microM) could initiate spikes without extracellular calcium. Thimerosal, at concentrations that failed to produce an independent effect, potentiated the acetylcholine-evoked oscillations in [Ca2+]i. We conclude that thimerosal is able to mobilise calcium from an intracellular store; the blockade by heparin may indicate that thimerosal exerts an action on the inositol trisphosphate pathway. The dependence on extracellular calcium for initiation, but not for continuation of the thimerosal-induced calcium spikes suggests that thimerosal may have the additional effect of inhibiting the plasma membrane calcium ATPase.
Action Potentials↗
Immunoquantitation of carnitine palmitoyl transferase in skeletal muscle of 31 patients.
We studied 31 patients suspected of having muscle carnitine palmitoyl transferase 2 (CPT2) deficiency. The catalytic activity of CPT2 was measured in muscle biopsies by the isotope exchange method and CPT2 immunoreactivity was quantitated by an enzyme-linked immunosorbent assay. Nine patients had normal enzyme activity and immunoreactivity. Eight patients had significant deficiencies in catalytic activity (> 3 S.D. below reference mean) of which six were also deficient in immunoreactivity. An additional nine patients were significantly deficient in immunoreactivity with normal catalytic activity and five patients had partial deficiencies in both. At least two categories of alterations in CPT may exist which lead to a deficiency based on the data presented: (1) a regulatory defect in CPT which only alters the enzyme active site; and (2) a structural defect due to altered synthesis, increased degradation, or changes in the immunoreactive site. It may prove to be of diagnostic importance to combine the analysis of enzyme activity and immunoreactivity in patients suspected of having a CPT deficiency and to further investigate the condition of partial CPT deficiency.
Adolescent↗
Time of onset of symptoms of acute myocardial infarction.
Several studies have observed an increased occurrence of acute myocardial infarction (AMI) in the morning based on subjective self-reports and objective confirmation. Evidence has also been collected to suggest a circadian variation in the onset of sudden cardiac death and silent myocardial ischemia. No published reports have examined the time of onset of AMI in relation to time after awakening. The present study examines the times of onset of AMI in relation to awakening in 137 patients with confirmed AMI. Information concerning time of awakening on the day of AMI revealed a marked increase in the onset of initial AMI symptoms within the first hour after awakening. Of the patients studied, approximately 23% reported onset of the initial symptoms of AMI within 1 hour after awakening. An increased onset of symptoms of AMI soon after awakening was also observed when patients in whom the acute cardiac symptoms were known to or may have caused awakening were excluded from consideration. This was also noted in subgroups of AMI patients classified according to age, order and location of AMI. These results extend previous observations of the circadian morning increase of AMI onset and assist in narrowing the search for potential triggers of the circadian variation of onset of AMI to physiologic changes that may occur soon after awakening.
Adult↗
Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community-wide perspective.
As part of an ongoing community-wide study examining changes over time in the incidence and survival rates of 4108 patients hospitalized with validated acute myocardial infarction (MI) in 16 hospitals in the Worcester, Massachusetts, metropolitan area during calendar years 1975, 1978, 1981, 1984, and 1986, we examined changes over time in the proportion of patients with acute MI developing atrial fibrillation (AF) and the impact of AF on in-hospital and long-term survival for up to a 10-year follow-up period. The overall percentage of patients with AF complicating acute MI was 16.0%; this proportion increased over time from 13.3% in 1975 to 14.8% in 1978, 14.9% in 1981, 20.3% in 1984, and to 17.7% in 1986. Patients with AF experienced consistently higher in-hospital case fatality rates than MI patients without AF overall (27.6% versus 16.6%), as well as during each of the 5 years under study. The independent effect of AF on in-hospital survival was not upheld, however, when a variety of potentially confounding prognostic factors were controlled for in a multivariate analysis resulting in an adjusted odds ratio (OR) of 1.18 (95% confidence interval 0.90, 1.52). Among discharged hospital patients, while the crude long-term survival rate for patients with AF was poorer than that of patients without AF for the combined as well as for individual study periods, similar to the in-hospital findings the independent effect of AF on long-term prognosis was not upheld after use of a multivariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
The impact of age on the incidence and prognosis of initial acute myocardial infarction: the Worcester Heart Attack Study.
As part of a community-wide study examining time trends in the incidence and case-fatality rates (CFR) of patients hospitalized with acute myocardial infarction (MI) in sixteen hospitals in the Worcester, Massachusetts metropolitan area, the association of age to the incidence rates of initial acute MI and to in-hospital and long-term survival among 2115 patients with validated acute MI was examined. After selected age-specific changes in the incidence rates of initial events of acute MI between 1975 and 1981, the incidence rates of acute MI markedly declined between 1981 and 1984, resulting in decreases in the age-specific incidence rates of initial acute MI between 1975 and 1984. For the combined study periods, the in-hospital CFR of acute MI increased from 5.0% in patients less than 55 years of age to 7.9% in those 55 to 64 years, to 16.1% in those 65 to 74 years and to 32.1% in patients 75 years of age and older. Among discharged hospital survivors, increasing age was related to poorer long-term survival over a 5-year follow-up period. The results of this population-based study reinforce the need for, and importance of, modification of coronary risk factors in both young and older individuals, and of focused therapeutic efforts to salvage jeopardized myocardium in elderly patients hospitalized with acute MI.
Adult↗
Growth potential of latissimus dorsi muscle flaps used in the cardiomyoplasty procedure.
Synchronously stimulated latissimus dorsi muscles have been used for cardiomyoplasty in adult patients with heart failure. This procedure has the potential of being used in pediatric patients to enlarge a hypoplastic ventricle or to reinforce the right atrium in the Fontan procedure. The growth potential of such a myograft was studied. Young piglets weighing 18 to 22 kg underwent right latissimus dorsi cardiomyoplasty while the latissimus dorsi weight and myoplasty area were measured. In half of the animals, the myograft was not stimulated and in the others it was continuously stimulated with an atrioventricular sequential pacemaker to contract in synchrony with the heart. Two months later, with doubling of body weight, the hearts were removed for study. In both groups, significant (p less than 0.05) increase in latissimus dorsi weight (+92% +/- 15% nonpaced versus +77% +/- 3% paced) and myoplasty area (+107% +/- 13% nonpaced versus +116% +/- 30% paced) were noted. The results in stimulated versus nonstimulated animals were not significantly different. Thus, not only does cardiomyoplasty offer a contractile tissue to repair or enlarge cardiac chambers, but this tissue can also grow in young patients and avoid subsequent size mismatch.
Animals↗
The legitimacy of rattlesnake bites in central Arizona.
Previous authors have classified poisonous snake bites as being legitimate or illegitimate, depending on whether the victim was taking unnecessary risks with a snake before being bitten. We reviewed medical records of 86 consecutive rattlesnake bite victims cared for at a single medical center to determine legitimacy of snake bites. A bite was considered illegitimate if, before being bitten, the victim recognized an encounter with a snake but did not attempt to move away from the snake. A legitimate bite was said to have occurred if a person was bitten before an encounter with a snake was recognized or was bitten while attempting to move away from a snake. The study group was made up of 75 male (87.2%) and 11 female (12.8%) victims. Seventy-four percent were 18 to 50 years old, and 15% had been bitten previously. Only 43.4% of all bites were considered legitimate, and pet (captive) snakes accounted for almost one third of all illegitimate bites. The ingestion of alcoholic beverages was associated with 56.5% of illegitimate bites versus 16.7% of legitimate bites (P less than .001). While 74.4% of bites were to upper extremities, only 27% of upper extremity bites were legitimate. All bites to the lower extremity were legitimate (P less than .001). Of 14 individuals bitten by pet snakes, all were men and 64.3% were under the influence of alcohol at the time of the bite.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗