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Biomedical subjects

P J Quigley

Publications and source records attributed to P J Quigley.

At least 19 recordsLinked to original sources
PubMed1996

Plasma atrial natriuretic peptide is elevated in patients with hypertrophic cardiomyopathy.

STUDY OBJECTIVES: To determine if plasma levels of atrial natriuretic peptide are elevated in patients with hypertrophic cardiomyopathy and to determine the relationship of atrial natriuretic peptide to symptoms and echocardiographic indices of left ventricular structure and diastolic function in these patients. DESIGN: A prospective study in which atrial natriuretic peptide was measured in peripheral venous plasma in 14 patients (age 44 +/- 14 years) with hypertrophic cardiomyopathy and 17 healthy controls. Echocardiography was performed in all cases and 30 controls to examine indices of left heart structure and function. All patients underwent clinical evaluation. RESULTS: The concentration of atrial natriuretic peptide was significantly higher in patients with hypertrophic cardiomyopathy than controls, (17.86 +/- 8.72 vs. 6.22 +/- 3.26 pmol/l, P = 0.0001). Diastolic dysfunction was observed in 11 of 14 patients with hypertrophic cardiomyopathy. No correlation was demonstrated between atrial natriuretic peptide levels and the degree of diastolic dysfunction, septal or free wall thickness, left atrial size, degree of mitral regurgitation or New York Heart Association functional class. CONCLUSIONS: Plasma levels of atrial natriuretic peptide are elevated in patients with hypertrophic cardiomyopathy but do not correlate with symptoms or echocardiographically-derived indices of left ventricular structure or diastolic function.

Adult↗
PubMed1996

Doppler echocardiographic detection of left ventricular diastolic dysfunction in patients with pulmonary sarcoidosis.

STUDY OBJECTIVE: To determine the prevalence of left ventricular diastolic dysfunction in patients with biopsy specimen-proved pulmonary sarcoidosis without clinical evidence of cardiac disease. DESIGN: A cross-sectional study. SETTING: A large tertiary care university teaching hospital. PATIENTS AND CONTROL SUBJECTS: Fifty consecutive subjects had biopsy specimen-proved pulmonary sarcoidosis without suspected cardiac involvement. Those with other conditions known to affect diastolic function were excluded. The control group comprised 30 healthy hospital workers. INTERVENTIONS: Clinical examination, 12-lead ECG, and combined echocardiographic/phonocardiographic examination. MEASUREMENTS: Indexes of left ventricular diastolic function, including isovolumic relaxation time, peak velocity of early (E) and late (A) ventricular filling, deceleration rate of early diastolic flow, and the sum of the time velocity integrals of E and A were obtained in each patient and control subject. Systolic function was determined using a modification of Simpson's rule. RESULTS: Diastolic dysfunction was present in 7 (14%) patients, 6 of whom had normal systolic function and normal two-dimensional echocardiographic examination. Those with diastolic dysfunction had a longer duration of illness (15 +/- 7 vs 6 +/- 5 years; p = 0.0004), were significantly older (52 +/- 11 vs 38 +/- 9 years; p = 0.0009), and had higher systolic BP (130 +/- 13 vs 117 +/- 12 mm Hg; p = 0.01) than the sarcoid patients with normal diastolic function. CONCLUSIONS: These results demonstrate a significant prevalence of left ventricular diastolic dysfunction in patients with pulmonary sarcoidosis. The cause of this abnormality may be a subclinical sarcoid cardiomyopathy.

Adult↗
PubMed1994

Squamous cell carcinoma of the feline thymus with widespread apoptosis.

The present report documents a case of squamous cell carcinoma originating from the thymus of a 12-year-old short-haired male cat. The tumour had metastasised to the sternal lymphoid tissue and to the left lung. To the authors' knowledge, thymic carcinoma has not been reported in domestic animals. Furthermore, extensive apoptosis was observed in the tumour mass.

Animals↗
PubMed1993

Doppler echocardiographic evidence of left ventricular diastolic dysfunction in ankylosing spondylitis.

Although cardiac involvement in the form of conduction abnormalities or aortic regurgitation occurs in 5 to 10% of patients with ankylosing spondylitis, few studies have assessed left ventricular (LV) function. This study assesses the prevalence of both systolic and diastolic LV dysfunction and other cardiac abnormalities in patients with ankylosing spondylitis who have no clinical cardiac manifestations. Fifty-nine patients (49 men and 10 women, mean age 42 +/- 10 years) underwent full clinical examination, electrocardiography, 24-hour Holter monitoring and 2-dimensional, M-mode and Doppler echocardiography. Mean disease duration was 17 +/- 9 years (range 1 to 42). Seventeen patients had evidence of noncardiac extraarticular manifestations. Precordial examination was normal in all. An age- and sex-matched control group of 44 healthy subjects was also studied. On echocardiography, abnormal LV diastolic function was detected in 12 patients (20%). Prolonged isovolumic relaxation time, prolonged deceleration time, reduced rate of descent of flow velocity in early diastole (EF slope) and reversal of the early and late peak transmitral diastolic flow velocities (E/A ratio) were noted in 9 patients. In 3 patients there was an increased E/A ratio, reduced deceleration time and increased EF slope. Mild aortic regurgitation and mitral regurgitation was seen in 1 and 3 patients, respectively. No abnormalities of left atrial size, LV systolic or diastolic dimensions or wall thicknesses were noted. There was no correlation between the presence of LV diastolic dysfunction and age, disease severity, disease duration, or the presence of extraarticular manifestations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Coronary angioplasty performed with gradual and prolonged inflation using a perfusion balloon catheter: procedural success and restenosis rate.

The results of routine coronary angioplasty using gradual and prolonged balloon inflation with a perfusion balloon catheter were evaluated. One hundred forty patients were treated with inflation of the balloon to 6 atm over 3 minutes, with a median inflation time of 15 minutes. The procedural success rate (residual stenosis less than or equal to 50%) was 99%. In-hospital major complications occurred in five patients (3.6%), with one patient experiencing a periprocedural infarction, three patients requiring bypass surgery for abrupt closure, and one patient dying after elective bypass surgery following previous successful angioplasty of a culprit lesion. The restenosis rate in the 117 patients with angiographic follow-up (87% of those eligible) was 42%. Thus gradual and prolonged inflation using a perfusion balloon catheter resulted in a high procedural success rate and a restenosis rate similar to that reported in large studies of patients treated with standard angioplasty. These results warrant further study using a prospective randomized trial design.

Aged↗
PubMed1992

Early and late outcome following deployment of a new flexible tantalum intracoronary stent in dogs.

A new radiopaque, highly flexible balloon-expandable tantalum stent was tested. Thirty-six of 40 stents were successfully deployed percutaneously in the coronary arteries of 31 dogs. The dogs were given aspirin before, intravenous heparin during, and aspirin alone after the procedure. One dog died at 24 hours because of coronary occlusion following traumatic implantation. Four dogs were put to death early, revealing re-endothelialization by 9 days. Eleven dogs were put to death from 2 weeks to 9 months during long-term follow-up, showing all vessels widely patent with the stent uniformly embedded within a stable neointimal layer. Follow-up arteriography showed patency in all remaining stents up to 1 year, with no perforation or aneurysm formation. Four stents were placed into canine peripheral arteries and were removed percutaneously after deployment. Pathology revealed no significant trauma to involved vessels. This tantalum stent exhibits feasibility of percutaneous deployment, early neointimal formation, low thrombogenicity on long-term aspirin therapy alone, and patency up to 1 year in this canine model.

Animals↗
PubMed1992

Prospective analysis of possible myocardial damage or hemolysis occurring as a result of prolonged autoperfusion angioplasty in humans.

OBJECTIVES: The purpose of this study was to further explore the procedural safety of prolonged (15-min) dilation using an autoperfusion coronary angioplasty balloon by assessing the degree of myocardial damage or hemolysis, if any, occurring as a result of the procedure. BACKGROUND: Prolonged balloon inflation periods may be beneficial during percutaneous transluminal coronary angioplasty. The duration of standard balloon angioplasty is often limited by the occurrence of myocardial ischemia due to loss of anterograde blood flow. Autoperfusion angioplasty allows continued myocardial perfusion during balloon inflation and has previously been shown to reduce but not totally eliminate acute myocardial ischemia during prolonged (up to 15 min) balloon inflation. The risk of intravascular hemolysis as a result of autoperfusion angioplasty has not yet been fully delineated. METHODS: Sixty-two consecutive patients (76% men; mean age 58 years) undergoing elective percutaneous transluminal coronary angioplasty of a single lesion were studied. Serial electrocardiographic and creatine kinase MB isoenzyme data were examined to detect evidence of myocardial damage. Tests for hemolysis (plasma free hemoglobin, serum haptoglobin and serum lactate dehydrogenase) were obtained in the 1st 24 consecutive patients. RESULTS: Inflation time was 14 +/- 4 min (mean +/- SD) and the procedure was successful (less than or equal to 50% residual lesion stenosis) in 59 patients (95%). Electrocardiographic evidence of myocardial infarction (greater than 1 mm persistent ST segment depression, greater than 1 mm ST segment elevation or new Q waves) was not observed in any patient. Cardiac enzyme assays were within the normal range in all patients. No evidence of hemolysis was found in the 24 consecutive patients studied. CONCLUSIONS: We conclude that prolonged autoperfusion angioplasty can be performed in patients without clinical evidence of myocardial damage or hemolysis.

Aged↗
PubMed1991

The use of intraaortic balloon pumping as an adjunct to reperfusion therapy in acute myocardial infarction. The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group.

To assess the risk and possible benefits of use of the percutaneous IABP in patients given thrombolytic therapy as treatment for acute myocardial infarction, we prospectively evaluated 810 consecutive patients entered into the TAMI trials. During hospitalization the 85 patients treated with the IABP had more cardiac risk factors, were slightly older (58 vs 56 years), and more often had anterior infarction (62% vs 38%). At acute cardiac catheterization, patients treated with the IABP also had more multivessel coronary disease (67% vs 43%), more frequent TIMI grade 0 or 1 flow (44% vs 28%), lower global ejection fraction (40% vs 52%), and worse regional infarct (-3.2 vs -2.5 SD/chord) and noninfarct (-0.67 vs +0.36 SD/chord) zone function. Although mortality rates (32% vs 4%) and in-hospital complications were greater in patients treated with the IABP, a greater improvement in global (delta ejection fraction: +1.9% vs +0.7%) and noninfarct zone (delta SD/chord: +0.11 vs -0.09) left ventricular function was observed in patients treated with the IABP at 1-week follow-up angiography. In addition, no reinfarction or reocclusion of the infarct-related artery occurred while patients were being treated with the IABP. These results suggest that the IABP may have a specific role after thrombolytic therapy in treating patients at high risk for reocclusion or at high risk for hemodynamic deterioration because of large infarction or critical stenoses in coronary vessels supplying the noninfarct zone.

Angioplasty, Balloon, Coronary↗
PubMed1989

Repeat percutaneous transluminal coronary angioplasty and predictors of recurrent restenosis.

One hundred seventeen consecutive patients undergoing repeat percutaneous transluminal coronary angioplasty (PTCA) were studied to assess procedural success and recurrent restenosis rates. Clinical, anatomic and procedural variables were examined as predictors of recurrent restenosis using stepwise logistic regression analysis. Primary success was achieved in 114 patients (97.5%). One patient (0.8%) died after acute occlusion. No other in-hospital complications were encountered. After a mean follow-up interval of 218 +/- 160 days, 72 of 114 successfully dilated patients (63%) remained angina free. There were no late deaths. Three patients (2.6%) experienced a late myocardial infarction. Follow-up arteriography was performed in 100 patients (88%), of whom 32% had recurrent restenosis (greater than 50% luminal diameter narrowing). On univariate analysis, the presence of 3 clinical variables at repeat PTCA was associated with significantly higher recurrent restenosis rates compared with their absence, that is, unstable angina (48 vs 20%, p = 0.003), diabetes (61 vs 26%, p = 0.003) and hypertension (46 vs 18%, p = 0.003). Patients with recurrent restenosis had a shorter interval between first and second PTCA compared with those who remained patent (136 +/- 116 vs 214 +/- 163 days, p = 0.018). Multivariate analysis confirmed unstable angina, diabetes and hypertension as independent predictors of recurrent restenosis. Repeat PTCA may be performed for restenosis with a high likelihood of success and low incidence of complications. The rate of recurrent restenosis is similar to that reported for initial angioplasty. Patients with unstable angina, diabetes and hypertension appear to be at higher risk for recurrent restenosis.

Aged↗
PubMed1988

Perfusion balloon catheter.

An autoperfusion balloon catheter was developed to allow passive myocardial perfusion during balloon inflation, through a central lumen and multiple side holes in the shaft proximal and distal to the balloon. This report reviews preliminary experimental animal data and initial human clinical experience with this device. In our first study with this device, the duration of inflation in dogs was compared with the maximal duration of inflation using a standard angioplasty catheter. Coronary arteriography was performed to demonstrate distal coronary blood flow through the perfusion balloon catheter. Electrocardiographic recordings and repeated left ventriculograms were performed to detect evidence of ischemia during standard and perfusion and balloon catheter inflations. The average inflation time was 3 +/- 1 minute for the standard catheter and 37 +/- 10 minutes for the perfusion catheter. Each dog had evidence of severe myocardial ischemia during standard inflation, yet none of the animals had ST-segment elevation, ventricular arrhythmia or wall motion abnormality during dilatation with the perfusion catheter. In a second experiment, the effect of prolonged balloon inflations (30 minutes) on intimal hyperplasia was evaluated in the rabbit model. Results of this study showed reduction of intimal and medial hyperplasia after 4 weeks in iliac arteries in rabbits treated with prolonged inflations compared with the contralateral vessel in rabbits treated with standard angioplasty. Initial clinical results from patients treated with this new catheter are presented. The availability of an effective autoperfusion catheter should allow for testing the hypothesis that prolonged inflations could alter the acute angioplasty success rate and long-term restenosis rate.

Angioplasty, Balloon↗
PubMed1988

Digital subtraction contrast echocardiography: a new method for the evaluation of regional myocardial perfusion.

The potential of contrast enhanced digital subtraction echocardiography to demonstrate and quantitate myocardial perfusion was evaluated in 36 patients undergoing routine coronary arteriography or angioplasty. In 24 technically successful studies, multiple cross sectional echocardiographic images, obtained before and after intracoronary (sonicated contrast) injection, were stored by high speed, real time data transfer to an on line minicomputer. Subsequent digital subtraction processing of the stored image data provided composite images in which the distribution of myocardial perfusion was easily seen. Quantitative analysis of peak enhanced myocardial grey level and washout half time successfully differentiated between myocardial segments in which angiography had suggested normal, reduced, and grossly impaired or absent perfusion. The results suggest that this new method of digital image capture and quantitative processing has substantial advantages over previous off line qualitative techniques. It is likely to be of considerable value for routine coronary arteriography, angioplasty, and coronary thrombolysis.

Adult↗
PubMed1988

Myocardial protection during coronary angioplasty with an autoperfusion balloon catheter in humans.

An autoperfusion balloon catheter was developed to allow passive myocardial perfusion during inflation through a central lumen and multiple side holes in the shaft proximal and distal to the balloon. We report its safety and efficacy in 11 patients undergoing elective angioplasty to a single coronary lesion. Each lesion was dilated three times with the autoperfusion inflation bracketed between two inflations by standard angioplasty catheters. Chest pain score, 12-lead electrocardiogram, heart rate, and mean aortic pressure were recorded before each inflation and at 1-minute intervals after inflation. Inflation duration during autoperfusion angioplasty (513 +/- 303 seconds) was longer than for the pre- (107 +/- 55 seconds, p = 0.0004) and post- (139 +/- 71 seconds, p = 0.0006) standard dilatations. The maximum ST-segment elevation and depression in any lead during autoperfusion angioplasty (0.3 +/- 0.5 and 0.6 +/- 0.8 mm) was significantly less than for the pre- (2.4 +/- 1.7 mm, p = 0.002 and 2.2 +/- 1.3 mm, p = 0.0004) or post- (1.9 +/- 1.3 mm, p = 0.002 and 1.6 +/- 1.3 mm, p = 0.018) standard dilatations at the same point in time. Maximal chest pain score during autoperfusion (3.2 +/- 3.5) was lower than for the pre- (6.1 +/- 2.1, p = 0.003) but not the post- (5.2 +/- 3.1, p = 0.07) standard angioplasty. All 11 patients underwent successful, uncomplicated procedures. We conclude that this autoperfusion catheter significantly reduces ischemic symptoms and signs during coronary angioplasty, allowing prolonged periods of balloon inflation.

Angioplasty, Balloon↗
PubMed1987

Morphometric parameters of Purkinje dendritic networks after ethanol treatment during aging.

Spine densities on terminal branches of Purkinje cell dendrites of Fischer 344 rats were significantly altered by ethanol treatment and aging processes. An effect of the control liquid diet on the lengths of terminal branches and an interaction effect of this diet with age on the numbers of terminal branches/cell also occurred, but there were no detectable interaction effects of ethanol with age on dendritic parameters. Changes in spine density on terminal branches, which accounted for 63-67% of the total dendritic length/cell, represented a major quantitative modulation of synaptic input to these neurons during age and following ethanol treatment.

Aging↗
PubMed1986

Percutaneous transluminal coronary angioplasty in unstable angina: comparison with stable angina.

Percutaneous transluminal coronary angioplasty was performed in 25 patients with unstable angina and in a similar group of 25 patients with stable angina. The frequency of single, double, and triple vessel disease was identical in each group. Technical success was achieved in 22 (81%) out of 27 attempts in those with unstable angina and in 14 (52%) out of 27 attempts in those with stable angina. Vessel occlusion occurred in nine patients, necessitating emergency bypass surgery in four. There was evidence of myocardial infarction in three patients in each group and one patient in the unstable group subsequently died. Twenty eight of 32 successfully treated patients were followed up by means of repeat coronary arteriography, exercise electrocardiography, and clinical assessment after a mean (SD) interval of 14 (7) months. There was angiographic evidence of restenosis in 32% (seven of 22) of lesions in the unstable group and 44% (four of nine) of lesions in the stable group. There were no late infarctions or deaths during the follow up period. These results support the growing evidence that angioplasty can be carried out safely and effectively in patients with unstable angina.

Angina Pectoris↗