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Biomedical subjects

P H Kidner

Publications and source records attributed to P H Kidner.

At least 19 recordsLinked to original sources
PubMed1989

Body surface potential mapping to monitor the effects of thrombolytic therapy following acute myocardial infarction.

The authors demonstrate the value of body surface potential mapping (BSPM) and a limited lead system in monitoring complete ECG evolution following myocardial infarction (MI) and the effects of thrombolytic therapy. They produced ST-segment isopotential maps, which indicate the site and extent of myocardial injury. Pathological Q wave maps were also produced, which intimate the extent of myocardial necrosis. Analysis of a sequence of maps recorded during the acute phase of MI revealed sudden changes attributed to reperfusion, reinfarction or "silent" events.

Adult↗
PubMed1985

Preregistration rotation including general practice at St Mary's Hospital Medical School.

A rotation for the preregistration year which included medicine, surgery, and general practice started at St Mary's Hospital Medical School in August 1981. Initially approved by London University for an experimental period of three years, in 1984 it became an established rotation subject to normal review. Special arrangements were made for clinical work, supervision, prescribing, teaching, and other aspects of the general practice component. Data relating to the general practice consultations of the nine participating house officers show that they obtained wide experience, and their comments on the post itself were generally favourable. The four months spent in general practice were needed to allow time for the house officers to adapt to the new setting but did not seem to have an important effect on their experience in medicine and surgery.

Attitude of Health Personnel↗
PubMed1985

The value of exercise-induced U-wave inversion on ECG chest wall mapping in the identification of individual coronary arterial lesions.

Exercise-induced U-wave inversion on chest wall mapping was compared with coronary arteriographic findings in 160 consecutive patients who presented with chest pain suggestive of ischaemic heart disease. ECG recordings were made from 16 points on the chest wall before, during and after exercise. None of the 27 patients with normal coronary arteriograms developed U-wave inversion during or after exercise (specificity = 100%). In 21 (all males) of the 133 patients (15.8%) with significant coronary arterial lesions, U-wave inversion on exercise was noticed on different coronary artery territories on the chest wall map, and its localization was correlated with angiographic evidence of individual coronary arterial lesions (100% projection rate). In 9 patients (6.8%) this sign was observed in the absence of any ST segment changes or Q waves. Exercise-induced U-wave inversion was the sole ECG criterion reflecting a lesion of the left anterior descending artery in 12 cases (9%), of the circumflex in 6 cases (4.5%), and in only one case of right coronary artery disease. This sign was not detectable in the conventional V5 site in 9 cases (7.1%) with significant disease of the left anterior descending coronary artery. These nine patients showed U-wave inversion on other areas of the left anterior descending coronary artery territory on exercise. Exercise-induced U-wave inversion disappeared in all the ten patients who underwent coronary artery bypass graft surgery. It is suggested that exercise-induced U-wave inversion shown on chest wall mapping is a reliable indicator of coronary artery disease, which disappears after myocardial revascularization, and in addition, aids identification of individual coronary arterial lesions.

Adult↗
PubMed1983

Electrocardiographic chest wall mapping in the diagnosis of coronary artery disease.

Chest wall mapping of ST segment changes, inverted U waves, and Q waves using 16 electrocardiographic electrodes was performed at rest and during and after bicycle ergometry in 150 patients presenting with chest pain suggestive of angina. All patients underwent coronary angiography. The presence or absence of appreciable coronary artery disease (greater than or equal to 50% stenosis) was detected with a sensitivity of 98% and a specificity of 88%. The identification of lesions in individual coronary arteries was also possible with a sensitivity and specificity of 87% and 85% respectively for the territory of the left anterior descending and diagonal artery, 71% and 85% respectively for the right coronary artery, and 85% and 80% respectively for the circumflex artery. This test appears to be a reliable non-invasive screening method for selecting patients for angiography.

Coronary Disease↗
PubMed1983

Initial assessment of meptazinol in the treatment of the pain of myocardial infarction/unstable angina.

Meptazinol, a new analgesic agent, was used to treat chest pain in patients admitted to a coronary care unit with suspected myocardial infarction or unstable angina. A pilot study showed that meptazinol was effective in relieving pain in 15 out of 22 subjects. There were no adverse haemodynamic effects nor respiratory depression. Nausea and/or vomiting occurred with administration of the drug but as these symptoms may occur in patients with myocardial infarction who have not received any analgesia (Ingram et al., 1980), a cause and effect relationship cannot be inferred in this respect. The incidence of other side effects ascribed to meptazinol was low.

Angina Pectoris↗
PubMed1981

Angina pectoris: effects of lidoflazine on exercise tolerance and chest pain.

In a double-blind study involving 24 patients, treatment with lidoflazine in comparison with placebo was associated with a significant improvement in exercise tolerance; the median increase in work performed was 62 percent. This increase was significant at the 6th week of assessment. Ten patients were followed up for a further 2 years. Lidoflazine therapy was associated with a significant improvement in work done over that period. Lidoflazine was well tolerated and apparent adverse effects were minor.

Adult↗
PubMed1981

Audit of an inner city coronary unit.

The performance of the St Mary's Hospital London W2 coronary care unit was studied in each of 2 years, 1969 and 1975, results of which could be compared with each other and with national figures from the annual reports of the Hospital In-patient Enquiry. In 1975 the admissions were 42% more than in 1969; the increase was confined to mild cases over 45 years of age, and was out of proportion to national trends. The hospital fatality rate was unchanged and when age-standardized was 69% and 78% of contemporaneous national rates. In both years, 50% of the patients admitted came from outside the health district and 10% of local admissions were visitors from abroad. In 1975 there was an increased proportion of ex-smokers among the patients and more gave a history of previous myocardial infarction. The value and limitations of this kind of surveillance of a clinical unit are argued.

Adult↗
PubMed1981

Myocardial infarction - a rare complication in Henoch-Schönlein purpura.

A 29-year-old man with previous Henoch-Schönlein disease presented with multiple systemic emboli and a myocardial infarction. Subsequent investigation by angiography showed normal coronary arteries. This appears to be the first reported case of Henoch-Schönlein disease and myocardial infarction probably due to coronary vasculitis.

Adult↗
PubMed1980

Effect of nifedipine on exercise tolerance in angina pectoris.

Nifedipine is a new antianginal drug, the calcium-antagonistic inhibitory action on excitation-contraction coupling apparently being so pronounced that, in therapeutic dosage, all other pharmacological properties are negligible. Its effect on exercise tolerance in angina was assessed by an exercise study involving 14 patients: single-stage exercise tests were chosen and the advantages of this are given. Our results suggest that the onset of action occurs after about 20 minutes, reaches a peak of activity at approximately one-half to two hours, and some effect may still be present at three hours. There was a significant improvement in exercise times with a mean rise of 50 per cent over placebo.

Adult↗
PubMed1979

A biochemical and clinical comparison of two commercially available creatine kinase iso-enzyme MB assay kits suitable for use in the routine medical laboratory.

Two methods for the measurement of plasma creatine kinase MB (CK-MB) activity were compared for analytical performance, cost, practicality, and diagnostic correlation with clinical and electrocardiographic findings in patients admitted to the coronary care unit of a district general hospital. The methods were column chromatography and immunoinhibition. Both methods were found acceptable, and the method to be adopted would depend on the staff arrangements and resources available in the laboratory.

Chromatography↗
PubMed1977

Blood viscosity, red-cell flexibility, haematocrit, and plasma-fibrinogen in patients with angina.

Whole-blood viscosity, haematocrit and plasma-fibrinogen concentration were measured in 22 patients with angina and 22 controls. All four variables were significantly higher in patients with angina. When the viscosity was corrected to a standard haematocrit (45%), however, there was no significant difference in the mean viscosity of the two groups, indicating that the higher viscosity in patients with angina is the result of the higher haematocrit. Increased red-cell flexibility tends to counteract the effect of increased plasma-fibrinogen concentration, which tends to increase blood-viscosity.

Adult↗
PubMed1977

Oral disopyramide for the prevention of arrhythmias in patients with acute myocardial infarction admitted to open wards.

Patients with acute myocardial infarction admitted to open wards of three hospitals were given either oral disopyramide (100 mg four times daily) or matching placebo, prophylactically, for seven days. The drug was associated with a significant reduction in mortality (p = 0-0025) and in incidence of extension of infarction (p = 0-01), ventricular fibrillation (p = 0-05), and ventricular tachycardia (p = 0-01). Disopyramide was not associated with any particular complication or side-effect. Unitl information is available to the contrary, oral disopyramide should be given for the first seven days after myocardial infarction to all patients not managed in an intensive-care unit.

Acute Disease↗