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Biomedical subjects

R H Stables

Publications and source records attributed to R H Stables.

At least 19 recordsLinked to original sources
PubMed1996

An audit of lipid screening and management in patients undergoing diagnostic cardiac catheterization. Brompton House Officer Audit Group.

The aim of this study was to audit the management of hyperlipidaemia in a cohort of 206 consecutive patients, with known or suspected coronary artery disease, referred for diagnostic coronary angiography. The association of lipid subfraction values with the presence and extent of coronary artery disease was explored to identify the indices of greatest potential value to the hospital cardiologist, in the management of secondary prevention. Patients were questioned about previous lipid tests performed, advice received and treatment prescribed. Referral letters and hospital notes were reviewed to identify documentation of lipid results and treatment strategies. De novo fasting lipid estimations were obtained on 205 subjects at the time of catheterization. In only 46/206 (22%) cases was some form of lipid result recorded in the existing hospital notes or referral documentation. No patient was aware of the levels of the high or low density lipoprotein cholesterol subfractions (HDL, LDL) nor were these specifically recorded, or the subject of clinical comment, in any of the referral documentation. Patients who knew their total cholesterol (in mmol.1-1) result either as a value or as a "high' or "normal' categorization proved accurate witnesses. In keeping with other angiographic studies, we found that low values of HDL and high TC/HDL ratios were significantly associated with both disease presence and extent. Total cholesterol, calculated LDL and triglyceride levels had no such association. In the group as a whole and despite current therapy, 169/206 (82%) patients had a total cholesterol > 5.2 and 163/206 (79%) a TC/HDL ratio > 5. Only 22 (11%) patients were on drug therapy with a further 43 (21%) practising dietary modification. In the vast majority of subjects receiving some form of lipid intervention, target lipid levels had not been achieved. This study identifies the need for more intensive management of hyperlipidaemia in patients with coronary artery disease. Knowledge of HDL levels may be of value in guiding lipid secondary prevention management in the patient population evaluated at an angiographic centre.

Age Factors↗
PubMed1996

Post-stent management with a pneumatic groin compression device and self injected low molecular weight heparin.

BACKGROUND: The benefits of intracoronary stent implantation are offset by an increased risk of complications at the arterial puncture site and a prolonged hospital stay. Much of this morbidity can be attributed to the generally perceived need to achieve systemic anticoagulation after stent implantation. AIM: To test a simplified protocol for post-stent management using the Femostop pneumatic groin compression device and low molecular weight (fractionated) heparin (LMWH) administered by subcutaneous injection. PATIENTS: A case series of 100 consecutive patients, with stable angina pectoris, undergoing coronary stenting for a suboptimal result after conventional balloon angioplasty. METHODS: All patients were managed with a new post-stent protocol using the Femostop pneumatic groin compression device and LMWH. The incidence of complications and the length of hospital stay were recorded. RESULTS: The clinical course was uncomplicated in 92 patients and their discharge from hospital was achieved on the first post-procedural day for 44 patients and on the second for the remaining 48. The rate of vascular or bleeding complications was 6%. CONCLUSIONS: LMWH administered by subcutaneous injection may provide a practical and effective alternative to the use of intravenous heparin when systemic anticoagulation is used after stent implantation.

Angioplasty, Balloon, Coronary↗
PubMed1995

Doctor on a mountaineering expedition.

Doctors are welcome members on mountaineering expeditions to remote areas, but practical advice on how to prepare and what kit to take can be difficult to find. This article is a ragbag of useful advice on diverse topics. It explains the necessary preparation, provides tips for a healthy expedition, and summarises the common disorders encountered at high altitude. The comprehensive drug and equipment lists and first aid kit for climbers were used for the 1992 Everest in winter expedition. They are there to be sacrificed to personal preference and the experience and size of individual expeditions.

Altitude Sickness↗
PubMed1995

Coronary stenting in the management of myocardial ischaemia caused by muscle bridging.

A man of 64 was admitted for the investigation of post infarction angina. He was found to have angiographically normal coronary arteries, except for the presence of a muscle bridge in the left anterior descending coronary artery, believed to be subtending the ischaemic area. He had sustained a completed myocardial infarction in this territory 8 months before with identical findings at coronary angiography. A coronary stent was implanted in the intramyocardial segment and the patient made a good recovery with no adverse events at follow up 6 months later.

Coronary Angiography↗
PubMed1994

Computerized analysis of ambulatory monitoring in the quantification of sinoatrial disease.

A computer program was written to allow quantitative beat-by-beat analysis of 24-h tapes acquired during standard ambulatory monitoring. Compared with a control group, subjects with sinoatrial disease were found to have significantly more tachy-brady events, more heart rate variability, more beat-to-beat variability and had fewer beats within a normal heart rate range. This technique, complementary to conventional analysis of 24-h tapes, may be useful in detecting more frequent but less severe abnormalities of heart rhythm in sinoatrial disease, strengthening the diagnostic power of ambulatory monitoring and allowing quantification of a further range of heart rhythm abnormalities.

Adolescent↗
PubMed1994

Prospective assessment of the value of a chest radiograph in the performance of diagnostic cardiac catheterisation in adults.

OBJECTIVE: To assess the value of a chest radiograph in the performance of diagnostic cardiac catheterisation in adults. PATIENTS AND METHODS: 340 consecutive diagnostic cardiac catheter procedures in adults at one institution. It is normal practice for primary operators to report the results of catheterisation using a graphical user interface database system. Data entry screens were modified to present a study questionnaire to assess the use made of the chest radiograph in the performance of the catheter procedure. SETTING: Tertiary referral cardiac centre. RESULTS: The chest radiograph was judged of value in only 12/340 procedures (4%). The radiograph influenced catheter selection in six procedures, the volume of injected radiographic contrast medium in five, and showed an abnormality important to the planning or conduct of the procedure in six procedures. A dual benefit was reported in five procedures. Utility of the radiograph was related to the pre-catheter diagnosis. It proved of value in only 2/283 (0.7%) procedures with a working diagnosis of ischaemic heart disease, influencing only catheter selection. Its utility was greater in congenital heart disease, contributing in 3/4 (75%) procedures, dilated cardiomyopathy in 2/6 (33%) procedures, and valvar heart disease in 4/35 (11.5%) procedures. CONCLUSIONS: In the performance of diagnostic cardiac catheterisation in adults access to a recent chest radiograph contributes little to the conduct of investigations performed for suspected ischaemic heart disease, but may be of greater value in congenital disease, valve abnormalities, and dilated cardiomyopathy.

Adolescent↗
PubMed1989

Haemopericardium in rheumatoid arthritis.

We report two cases of haemopericardium presenting as tamponade in patients with rheumatoid arthritis. Pericardial aspiration produced a good clinical response with no reaccumulation. We suggest that, although rare, haemopericardium can be a feature of rheumatoid disease and may be associated with significant haemodynamic disturbance.

Aged↗
PubMed1989

Idiopathic familial atrial cardiomyopathy with diffuse conduction block.

Isolated atrial cardiomyopathy is rare and familial idiopathic atrial cardiomyopathy has only been described once. We describe a case characterized by severely reduced atrial contractile function, intermittent atrial electrical standstill, diffuse interatrial, intraventricular and atrioventricular block, complicated by systemic embolism. Whilst this condition is undoubtedly rare, other cases may be being mistaken for simple sinoatrial disease.

Adult↗
PubMedDate not supplied

Ward management: doing the off-duty by computer spreadsheet.

This article describes how the use of a computer spreadsheet system produced tangible benefits in terms of setting, maintaining and analysing a ward's off-duty patterns. The system, which proved easy to operate after initial instruction, is now being reviewed by other departments in the hospital.

Computers↗