Biomedical subjects
Publications and source records attributed to R J Chambers.
Computed tomography (CT) and ultrasonography (US) have been shown to be effective, noninvasive methods for the detection of established mycotic aortic aneurysms. We report a patient in whom CT and US were performed immediately before and after the development of a large mycotic abdominal aortic aneurysm, providing a unique opportunity to observe its rapid evolution.
Seventy-nine patients with moderate to severe left ventricular dysfunction who underwent aortocoronary bypass grafting between 1971 and 1977 had follow-up heart catheterization at a mean interval of 3 years. Thirty-three patients (42%) had angiographic improvement in left ventricular function at follow-up and 18 (25%) had a decrease in left ventricular end-diastolic pressure. Fifty-eight patients (73%) had improvement in angina of at least one New York Heart Association class at follow-up. There was no correlation between late improvement in left ventricular function and improvement in angina. Improvement in left ventricular function did not correlate with preoperative indices of severity of coronary disease or with indices of completeness of surgical repair.
A patient who developed an acute anterior myocardial infarction after completion of a marathon is presented. Coronary angiography performed 5 hours after the onset of symptoms showed occlusion of the left anterior descending coronary artery and nonocclusive thrombus in the proximal right coronary artery. Repeat angiography 10 days later showed complete resolution of thrombosis in both arteries. The relation between marathon running and coronary thrombosis is discussed.
Five of our first 20 candidates for PTCA had unanticipated occlusion of the relevant coronary artery between the time of coronary angiography and PTCA. None had a change in symptoms or ECG to suggest coronary occlusion. We currently schedule PTCA within a month to help avoid this occurrence.
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In 16 patients who underwent endarterectomy of the left anterior descending (LAD) coronary artery combined with saphenous vein bypass grafting between Aug. 1, 1976 and July 31, 1978, the results of preoperative and postoperative angiography were comparable. Most patients had obstruction or severe stenosis of the proximal LAD coronary artery together with a poor runoff as demonstrated angiographically. Eighteen vein grafts were placed in the LAD artery and 15 (83%) were satisfactorily patent. Six of 18 grafted arterial segments became occluded distal to the site of graft insertion, but in most cases there was sufficient proximal runoff to maintain graft patency. In this study intraoperative measurements of graft flow were predictive of graft or distal vessel patency, or both. Careful postoperative assessment of the results of this technique seems warranted.
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Diazepam did not alter the rate or rhythm in III patients with atrial fibrillation. In 3 out of 38 patients with atrial flutter the use of diazepam was followed by an increase in atrioventricular block. Diazepam restored sinus rhythm in I patient with atrial tachycardia (total 7 patients) and in I patient with ventricular tachycardia (total 8 patients). Experimentally in the dog diazepam raised the electrically-induced ventricular tachycardia threshold significantly. Pretreatment with diazepam did not alter significantly the dose of strophanthidin K required to induce ventricular tachycardia in the dog. The value of diazepam as a cardiac anti-arrhythmic agent should be further assessed in a controlled clinical trial, especially in patients with acute myocardial infarction.
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