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Biomedical subjects

P R Bream

Publications and source records attributed to P R Bream.

17 recordsLinked to original sources
PubMed1993

Status epilepticus and pseudostatus epilepticus.

Status epilepticus is a life-threatening disorder whose early recognition is essential. Non-epileptic seizures (pseudoseizures, hysterical seizures) may be confused with true epileptic seizures presenting a diagnostic dilemma which can result in inappropriate, expensive and potentially harmful treatment. We describe a male patient with no prior history of epilepsy who presented with status epilepticus and developed multiple types of non-epileptic seizures during his hospital stay.

Adult↗
PubMed1988

Cinefluoroscopic evaluation of periprosthetic cardiac valve regurgitation.

The results of cinefluoroscopic evaluation in 509 patients in whom there was no evidence of prosthetic mitral or aortic valve regurgitation were compared with those in 41 patients who had perivalvular aortic or mitral regurgitation. Rotational motion of the base ring of each prosthesis (base-ring tilt) was measured in at least two views. A base-ring tilt of 7 degrees or more for aortic prostheses or 11 degrees or more for mitral prostheses was associated with an increased incidence of significant perivalvular regurgitation. Likewise, in patients who had multiple studies, a change between studies in base-ring tilt of 4 degrees or more for aortic prostheses or 5 degrees or more for mitral prostheses was associated with significant perivalvular regurgitation. These data suggest that the presence of either an abnormal base-ring tilt or an abnormal increase in base-ring tilt is strong, supportive evidence of partial prosthetic valve dehiscence.

Aortic Valve Insufficiency↗
PubMed1982

Quantitative axial oblique contrast left ventriculography: validation of the method by demonstrating improved visualization of regional wall motion and mitral valve function with accurate volume determinations.

To compare the relative merits of conventional and axial RAO/LAO angiography, we performed biplane left ventricular (LV) cineangiograms in 36 patients in both the conventional 30-degree RAO/60-degree LAO projection and in the axial 45-degree RAO/60-degree LAO/25-degree cranial projection, in random sequence. LV volumes were calculated by a computerized system utilizing modification of the area-length method. Eng-diastolic volume, end-systolic volume, and ejection fraction correlated closely between the two projections (r = 0.93, 0.95, and 0.86, respectively). The axial 60-degree LAO view projected the LV apex inferiorly, the LV outflow tract superiorly, reduced LV foreshortening, and "uncovered" the LV outflow tract in all cases. Segmental wall motion abnormalities of the ventricular septum, apex, and posterior wall were better evaluated by the axial 60-degree LAO view in patients with regional asynergy in these zones. The 45-degree RAO, compared to the 30-degree RAO view, allowed a true tangential view of the mitral valve and provided a large "clear area" between the mitral valve and descending aorta, which improved the ability to quantify mitral regurgitation. Thus, axial oblique LV angiography improves evaluation of LV regional wall motion and mitral valve function without compromising LV volume quantitation.

Angiocardiography↗
PubMed1981

The anomalous septal perforating artery. Its origin from the first diagonal, first marginal, or circumflex artery.

Origin of a septal perforating artery from a proximal portion of the left coronary system other than the left anterior descending artery was seen on coronary angiography in 18 out of 800 patients over a 14-month period. It arose from the first diagonal artery in 12 patients, the proximal circumflex artery in 2, and the first marginal artery in 4. The angiographic appearance and clinical significance of this finding are described.

Coronary Disease↗
PubMed1981

Significance of the caudal left-anterior-oblique view in analyzing the left main coronary artery and its major branches.

The authors describe the value of the caudal left-anterior-oblique view in visualizing the following arteries: left main coronary, proximal circumflex, early-arising first marginal, proximal left anterior descending, first diagonal, and anomalous septal perforators from the circumflex system. The technique involves movement of the parallelogram (x-ray tube--image intensifier combination) to the left 55-65 degrees and caudal angulation of 15-20 degrees. To promote additional profiling of the left coronary system, imaging is performed after full expiration. In our series of 100 patients, this view is indispensable in determining significant pathology in the arteries of the proximal left coronary system.

Angiocardiography↗
PubMed1980

Axial cineangiography in congenital heart disease.

Many congenital heart conditions that were previously considered to be inoperable are now able to be corrected surgically. As a result, a more accurate and refined "surgical diagnosis" than that offered by conventional angiography has been sought. Axial cineangiography is invaluable in establishing a specific diagnosis in such cases.

Aortic Stenosis, Subvalvular↗
PubMed1979

Angiographic study of univentricular heart of right ventricular type.

An angiographic analysis of 10 cases of univentricular heart of the right ventricular type is reported. This congenital malformation is characterized by a large chamber with right ventricular morphology that receives both atrioventricular valves, and a second, smaller chamber, a trabecular pouch, with left ventricular morphology. These chambers are separated by a posterior septum but are connected by an inlet septal defect. The angiographic studies were done using the angled angiographic techniques in three patients and the standard frontal and lateral angiographic views in seven cases. The atrial situs in seven patients was solitus, in one inversus, and in two it was ambiguus with left isomerism. In seven patients the usually large right ventricular chamber received two atrioventricular valves and in four patients, one atrioventricular valve was straddling. Three patients had atresia of one atrioventricular valve. The trabecular pouch was small in seven patients but relatively large in three. In six patients the trabecular pouch was located posterior and to the left of the right ventricular chamber and in four anterior and to the right. Double outlet right ventricle was present in all cases. The aorta arose anteriorly to the pulmonary artery in nine patients and posteriorly in one. An autopsy was performed in one case and its correlation with the angiographic findings was remarkable. The angiographic demonstration of the anatomicaly details of this entity and its associated anomalies was facilitated by angled angiography.

Adult↗
PubMed1978

Plain film findings of anatomically corrected malposition: its association with juxtaposition of the atrial appendages and right aortic arch.

Three cases of anatomically corrected malposition of the great arteries (ACM) are presented. The association of ACM with juxtaposition of the atrial appendages and right aortic arch is emphasized. The unique plain film findings of anatomically corrected malposition include: (a) 1-position of the ascending aorta; (b) discrete convexity of the mid-left heart border in association with findings of an abnormal right atrial border (left juxtaposition of the atrial appendages); and (c) right aortic arch. This unusual combination of findings on the postero-anterior chest should lead to a high degree of suspicion in regard to the diagnosis of anatomically corrected malposition.

Adolescent↗
PubMed1978

Chest film detection of coronary artery calcification. The value of the CAC triangle.

Eighty-six adult patients were studied by PA chest film and fluoroscopy for coronary artery calcification (CAC). A triangular area (CAC triangle) along the left mid-heart border of the PA chest film was used in identifying CAC. Of 57 patients, 24 (42%) with CAC observed fluoroscopically had a strongly suspected or positive CAC triangle. The CAC triangle in the PA chest film has proved useful in identifying coronary artery calcification on the plain film.

Adult↗
PubMed1977

Axial cineangiography in congenital heart disease. Section II. Specific lesions.

The value of axial cineangiography in several forms of congenital heart disease serves as an illustrated supplement to Section I. These techniques visualize defects in the entire ventricular and atrial septum. In persistent atrioventricular (A-V) canal, it is possible to visualize all parts of both septa, status of the A-V valves (two valves versus a common A-V valve), and if a common A-V valve, its degree of override. In tetralogy of Fallot, the bifurcation of the pulmonary trunk, entire ventricular septum and coronary arteries are vividly shown. The presence of true and confluent pulmonary arteries versus systemic or bronchial arteries in pseudotruncus is clearcut. In double outlet right ventricle or in transpositions with or without double outlet right ventricle, the mitral valve-semilunar valve relationships, the left ventricular outflow tract, subpulmonary region and a straddling tricuspid valve are well demonstrated. In asymmetric septal hypertrophy, biventricular angiography may be circumvented.

Cardiomyopathy, Hypertrophic↗
PubMed1977

Axial cineangiography in congenital heart disease. Section I. Concept, technical and anatomic considerations.

Cineangiographic axial techniques were designed to overcome the limitations of conventional angiography in the diagnosis of congenital heart disease. Two basic patient (or equipment) maneuvers are involved; 1) long axis of the heart is aligned perpendicular to the X-ray beam, and 2) rotation of patient results in the heart being radiographically sectioned at 30 degree angles. To accomplish this with fixed vertical and horizontal X-ray tubes, three positions were developed: 1) "hepato-clavicular," "4 chamber," 2) "long axial oblique," 3) "anterior-posterior axial." A fourth, the "sitting-up" projection is discussed. The hepato-clavicular position profiles the posterior ventricular septum and atrial septum, separates the A-V valves, places the four cardiac chambers en face, and clarifies mitral valve-semilunar valve and outflow tract relationships. The long axial oblique profiles the anterior ventricular septum, left ventricular outflow tract, aortic valve-anterior mitral valve leaflet. The sitting-up view visualizes the bifurcation of the pulmonary trunk and separates true pulmonary arteries from systemic collaterals.

Cineangiography↗
PubMed1977

Detection of a temporary cardiac pacing catheter in the left ventricle by chest X-ray.

This is the first reported case of detection by chest radiograph of a temporary cardiac pacing catheter inadvertently placed in the left ventricle. The unusual catheter position seen in the first chest radiograph was confirmed by a second film following reinsertion of the catheter into the right ventricle. The importance of roentgenographic confirmation of temporary cardiac pacing catheters, especially those inserted without fluoroscopy, is reemphasized.

Adult↗
PubMed1976

The frontal chest film as a method of suspecting transposition complexes.

The frontal chest film as a means of suspecting transposition complexes is discussed. The first step is recognizing the normal relationships formed by the ascending aorta, an aortic knob-descending aorta, and pulmonary trunk. The concept of which ventricle is connected to which atrium is developed--the terms ventricular noninversion and inversion being utilized. Frontal chest film signs of transposition are summarized as follows: 1) in the majority of transposition complexes, absence of the pulmonary trunk is the premier sign; 2) patients with ventricular noninversion tend to show the ascending aorta and aortic knob-descending aorta in normal position. Patients with ventricular inversion usually show absence of all three great artery relationships. 3) In ventricular inversion, the left heart border shows a septal notch or a diffuse convex bulge (two ventricles), or a discrete bulge high up on the left border (single ventricle).

Aorta, Thoracic↗
PubMedDate not supplied

Does memory loss occur after MR imaging?

In four separate studies, the existence of specific memory loss after magnetic resonance (MR) imaging at 1.5 T was assessed by means of recognition and recall tests for faces, common objects, lexical items, and by digit span, in a pre-post paradigm. Although specific memory loss was demonstrated, it was shown that the loss was not due to the main magnetic field of the imager or to radio-frequency pulse sequences, but rather to probable psychological (not physical) factors. No gross or subtle memory changes could be attributed to MR imaging, because control groups showed similar patterns of memory loss.

Adolescent↗