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R J Chisholm

Publications and source records attributed to R J Chisholm.

36 records · Page 2Linked to original sources
PubMed1992

Aggressive clinical pattern of angina at restenosis following coronary angioplasty in unstable angina.

The frequency, clinical pattern, and timing of recurrent angina following successful single-lesion percutaneous transluminal coronary angioplasty (PTCA) was assessed in a consecutive group of 104 patients with stable angina and in 85 with unstable angina. In addition, the relationship between lesion morphology and angiographic features and the pattern of recurrent angina was determined. Restenosis, defined as recurrence of symptoms with > 50% stenosis at the site of PTCA, occurred in 25 (24%) of the stable group and in 23 (27%) of the unstable group (p = NS). The pattern of angina at repeat presentation was aggressive in nature in 8% of the stable group and in 48% of the unstable group (p = 0.002). The time interval between the recurrence of symptoms and repeat coronary angiogram or PTCA was longer in the nonaggressive group than in the aggressive group, 16 +/- 12.1 and 5 +/- 6.8 weeks, respectively (p < 0.003). The key factors predicting the recurrent angina pattern identified by multiple logistic regression analysis were the angina status pre-PTCA (p = 0.001) and the presence of double-vessel disease (p = 0.01). An aggressive pattern of angina at the time of restenosis is frequent in patients with unstable angina at the time of PTCA, and close post-PTCA surveillance is necessary in these patients.

Aged↗
PubMed1992

Effect of valve deformity on results and mitral regurgitation after Inoue balloon commissurotomy.

BACKGROUND: The effect of valve deformity and patient age adversely affect the results of percutaneous transvenous mitral commissurotomy (PTMC) with conventional balloons. METHODS AND RESULTS: These factors were characterized after PTMC with the Inoue balloon. The increases in mitral valve area and mitral regurgitation after the procedure were evaluated comparing echocardiographic score of 8 or less versus more than 8, age of less than 60 versus age of 60 years or more, and age of less than 70 versus age of 70 years or more. One hundred sixty-two patients (mean age, 52 +/- 14 years) were studied. For the entire group, mitral valve area increased from 1.0 to 1.8 cm2 (p less than 0.001). Valve area increased from 1.0 +/- 0.3 to 1.8 +/- 0.6 cm2 in patients with echocardiographic score of 8 or less (n = 102) and from 1.0 +/- 0.3 to 1.7 +/- 0.5 cm2 with echocardiographic score of more than 8 (n = 44). Patients less than 60 years old (n = 104) had increases in valve area from 1.0 +/- 0.3 to 1.8 +/- 0.6 cm2 versus 1.0 +/- 0.4 to 1.8 +/- 0.6 cm2 for those 60 years old or older (n = 50) (p = NS). There was no significant difference in resultant valve area when the age division was increased to less than 70 versus 70 years or more. Similarly, the percentage of patients with 2+ or greater increase in mitral regurgitation was not different for those with higher than for those with lower echocardiographic scores (4% versus 12%, p = NS), age of less than 60 versus age of 60 years or more (10% versus 10%, p = NS), or age of less than 70 versus age of 70 or more years (9% versus 18%, p = NS). Valve replacement for mitral regurgitation was performed in four patients (one emergency), all with echocardiographic scores of less than 8. CONCLUSIONS: Age and extent of valve deformity do not have significant effects on acute results of PTMC using the Inoue balloon. Unique balloon geometry or the controlled, stepwise balloon sizing may explain these acceptable acute results in patients with more-deformed valves.

Adult↗
PubMed1991

Effects of hemoperfusion during percutaneous transluminal coronary angioplasty on left ventricular function.

The effect of autologous blood perfusion, delivered through an angiographic power injector, on alleviating left ventricular (LV) hemodynamic deterioration during percutaneous transluminal coronary angioplasty (PTCA) was examined. LV systolic and diastolic pressures, LV peak positive and peak negative first derivative of LV pressure (dP/dt), and ST-segment shift were recorded in 9 patients with and without hemoperfusion. Hemoperfusion resulted in an improved LV hemodynamic profile during balloon occlusion, as reflected in LV systolic pressure (127 +/- 14 vs 120 +/- 15 mm Hg, p = 0.01), LV end-diastolic pressure (17 +/- 14 vs 25 +/- 6 mm Hg, p less than 0.001), peak positive (1,237 +/- 240 vs 1,149 +/- 225 mm Hg/s, p less than 0.05) and peak negative (1,666 +/- 357 vs 1,485 +/- 385 mm Hg/s, p = 0.003) dP/dt. Hemoperfusion provides substantial protection for significant LV dysfunction induced by conventional PTCA in 1-vessel angioplasty and is a feasible option to protect against potential cardiovascular collapse in high-risk PTCA.

Adult↗
PubMed1991

Elevated left atrial pressure does not cause left-to-right shunting after mitral balloon valvuloplasty.

To assess the hemodynamic factors affecting left-to-right shunting following balloon mitral valvuloplasty we studied 10 patients at 3 points during the procedure: pre-septal dilation, post-septal dilation pre-valvuloplasty, and post-valvuloplasty. Hemodynamic parameters were recorded and an oximetry run was obtained at each stage. Mitral valvuloplasty was successful in 8 and unsuccessful in 2 patients. No patient had a significant oxygen step-up at any stage, including the 2 patients with unsuccessful valvuloplasty. Significant left-to-right shunting through the atrial septal puncture in mitral valvuloplasty is infrequent, even before successful balloon valvuloplasty when left atrial pressure is maximally elevated.

Adult↗
PubMed1991

Hemodynamic response to balloon occlusion of the left main coronary artery during balloon angioplasty supported by cardiopulmonary bypass: a case report.

Four coronary lesions, including a severe left main stenosis, were successfully dilated in a patient with poor left ventricular function; the procedure was supported by percutaneous cardiopulmonary bypass. During left main occlusion there was a loss of phasic systemic arterial pressure, while pulmonary arterial pressure was maintained. The ischemic myocardial depression occurring during left main occlusion was not prevented by percutaneous cardiopulmonary bypass, indicating inadequate myocardial protection.

Aged↗
PubMed1989

Role of resting thallium201 perfusion in predicting coronary anatomy, left ventricular wall motion, and hospital outcome in unstable angina pectoris.

We performed quantitative thallium scintigraphy in 66 unstable angina patients, 5.6 +/- 5.1 hours after rest pain, to predict coronary anatomy, left ventricular wall motion, and hospital outcome. Thallium defects and/or washout abnormalities were present in 5 of 10 (50%) patients with coronary stenoses less than 50%, 27 of 33 (82%) patients with coronary stenosis greater than or equal to 50% and no history of previous myocardial infarction, and in 23 of 23 patients (100%) with histories of previous infarction. Defects were uncommon in the territory of vessels with less than 50% (13 of 61, 21%), but significantly more common in the territory of vessels with greater than or equal to 50% stenosis (57 of 137, 42%), p less than 0.005. With the addition of washout abnormalities to defect analysis, sensitivity for detection of coronary stenoses improved to 67% (92 of 137), p less than or equal to 0.005, but specificity fell to 59% (36 of 61), p less than 0.01. Segmental wall motion abnormalities were less common in segments with normal perfusion (21%) or in those with washout abnormalities alone (19%), than in segments with thallium defects (45%, p less than 0.005). Defects in patients with previous infarction were common in both segments, with normal (26 of 66, 40%) or abnormal (24 of 45, 53%) wall motion. Eleven of 18 patients with in-hospital cardiac events, but no history of myocardial infarction, had resting thallium defects, whereas only 8 of 25 patients without cardiac event had thallium defect (p = 0.056).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Mammography and breast pain.

Two hundred and three consecutive patients underwent mammography at both public and private facilities. Their patients were asked to complete a questionnaire which recorded their assessments of pain. There was a very low incidence of significant pain (4%). The rate was highest (10.9%) in those with pre-existing breast pain. This compared with a rate of 1.4% in those without pre-existing breast pain. A larger number of premenopausal women suffered from breast pain (69%). Breast pain was particularly common in the week prior to onset of menstruation. Therefore, routine mammography should be scheduled in a pain-free interval and, if possible, the week prior to onset of menstruation should be avoided.

Breast↗
PubMed1989

Intracoronary thrombus and complex morphology in unstable angina. Relation to timing of angiography and in-hospital cardiac events.

In 78 consecutive patients with unstable angina, we performed coronary angiography randomized to either the first day of presentation or later during the hospital admission to assess the frequency of intracoronary thrombus and complex coronary morphology relative to the time of symptomatic presentation and the impact of these angiographic features on outcome. Early angiography (17 +/- 6 hours) was performed in 42 patients and late angiography in 36 patients (5.7 +/- 2.1 days). Twelve patients randomized to late angiography required urgent cardiac catheterization 3.9 +/- 2.2 days after admission. Coronary thrombi were present in 43% (18 of 42) of early angiography patients and in 38% (14 of 36) of late angiography patients (p = NS). Only 21% (five of 24) late elective angiography patients had coronary thrombi, but 75% (nine of 12) of late urgent angiography patients had thrombi (p less than 0.05 vs. both early and late elective angiography patients). There was no difference in the frequency of complex coronary morphology among patients randomized to early angiography (42%, or 15 of 36), late urgent angiography (42%, or five of 12), and late elective angiography (38%, or nine of 24). Cardiac events (death, myocardial infarction, and urgent revascularization) were more frequent in the patients with coronary thrombus (73%, or 23 of 32), complex coronary morphology (55%, or 16 of 29), and multiple-vessel disease (58%, or 29 of 50) than in the patients without these angiographic features (17%, or eight of 46; 31%, or 15 of 49; and 7%, or two of 28, respectively; all p less than 0.05). Multiple regression analysis demonstrated that coronary thrombus was the best angiographic predictor of cardiac events. Thus, angiographic detection of intracoronary thrombi varies according to the temporal relation between angiography and chest pain at rest.

Angina Pectoris↗
PubMed1988

Usefulness of exercise electrocardiography and thallium scintigraphy in unstable angina pectoris in predicting the extent and severity of coronary artery disease.

The safety and efficacy of exercise electrocardiography and thallium scintigraphy early in the course of unstable angina pectoris were assessed 4.6 +/- 1.6 days after admission in 67 patients with unstable angina that stabilized after medical therapy. Coronary arteriography was performed in all patients 5.4 +/- 2.4 days after admission. There was no difference in clinical, exercise or scintigraphic variables between patients with stenoses less than 50% and patients with 1-vessel coronary artery disease (CAD) defined as a diameter stenosis greater than or equal to 50%. Patients with 3-vessel CAD had a significantly shorter exercise duration than patients with less than 50%-diameter narrowing (5.5 +/- 2.2 vs 8.3 +/- 3.3 minutes, respectively), lower exercise heart rate (119 +/- 20 vs 149 +/- 22 beats/min) and systolic blood pressure (156 +/- 29 vs 166 +/- 33 mm Hg), more frequent chest pain (76 vs 20%) and more pronounced ST depression (-1.48 +/- 1.37 vs -0.33 +/- 0.72 mm). In addition, thallium defect size on exercise was greater in the patients with 2-vessel CAD (159 +/- 132 degrees) and 3-vessel CAD (255 +/- 132 degrees) than in patients with no CAD (28 +/- 319 degrees) or 1-vessel CAD (73 +/- 78 degrees), p greater than or equal to 0.05. Multiple regression analysis demonstrated that thallium defect size was the best predictor of extent of CAD, with exercise heart rate and presence of chest pain during exercise also predictive of extent of CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Angiographic morphology in unstable angina pectoris.

Complex morphology occurs frequently in unstable angina; however, its relation to symptomatic presentation, timing of angiography and hospital outcome has not been investigated. Accordingly, coronary angiography was performed 5 +/- 2 days after qualifying rest pain in 101 consecutive patients presenting with acute coronary insufficiency (n = 67) or crescendo angina (n = 34). Significant coronary artery disease was defined as any greater than or equal to 50% stenosis, and complex morphology as any stenosis with irregularity, overhang or thrombus. Eight of the 67 patients presenting with acute coronary insufficiency later proved to have a myocardial infarction as the qualifying event (creatine kinase twice normal with elevation of MB fraction). There were no myocardial infarctions in the crescendo angina group. Complex morphology occurred in 61% of patients. Thrombus alone occurred in 27% of patients with unstable angina without myocardial infarction, with similar frequencies between the 2 clinical groups. In contrast, intraluminal thrombi were identified in 78% of patients with acute coronary insufficiency who later proved to have a myocardial infarction as the qualifying event. The need for urgent catheterization (less than 48 hours) prompted by recurrent symptoms was associated with the angiographic findings of intraluminal thrombus (46%) and complex morphology (83%). The presence of complex morphology and intracoronary thrombus was associated with a higher incidence of in-hospital cardiac events, i.e., revascularization, myocardial infarction and death, independent of the incidence of multivessel disease.

Angina Pectoris↗
PubMed1986

Radiologic dilatation preceding palliative surgical tube placement for esophageal cancer.

A new two-stage technique is reported for tube placement in the palliative treatment of esophageal cancer. The first step consists of radiologic intervention with balloon dilatation of the stricture. The patient is then transferred to the operating room, where the permanent esophageal tube placement is performed. A comparison of technique-related complications in a group of 34 patients with esophageal malignancies who had a permanent tube inserted by either the two-stage technique or by a standard endoscopic operative method show the new technique to have fewer complications and markedly decreased operative time.

Adenocarcinoma↗
PubMed1984

Prostatic hyperplasia: radiological intervention. Work in progress.

Benign prostatic hypertrophy is the most common cause for urethral obstruction in males over 50 years of age. Interventional radiologic dilatation under fluoroscopic control offers a nonoperative alternative for treatment of prostatic hyperplasia. Cadaver studies with the use of arteriographic balloon catheters indicated that manual injection pressure provides effective dilatation of the prostatic urethra. Evaluation of symptom relief will have to await patient studies.

Cadaver↗
PubMed1983

Narcotics and spasm of the sphincter of Oddi. A retrospective study of operative cholangiograms.

The operative cholangiograms of 112 patients undergoing elective cholecystectomy were reviewed independently and retrospectively by two radiologists who were not aware of the anaesthetic technique used. Fifty four patients who received opioid drugs either pre- and/or intra-operatively comprised one study group whilst 58 patients who received no opioids comprised the other. Spasm of the sphincter of Oddi was observed in two patients in the opioid group and in one patient in the non-opioid group. The use of opioid drugs as part of the anaesthetic management for cholecystectomy did not appear to interfere with the radiological interpretation of operative cholangiography nor to increase the low incidence of spasm of the sphincter of Oddi.

Adolescent↗
PubMed1978

The prognostic implications of acute myocardial infarct scintigraphy with 99mTc-pyrophosphate.

The predictive value of the myocardial scintigraphy with 99mTc-pyrophosphate was studied in 100 patients admitted to the coronary care unit with suspected acute myocardial infarction. None of the 21 patients with normal scintigrams had acute myocardial infraction by other criteria. Fifty-five percent of patients with diffuse uptake (pattern B), 73% of patients with focal uptake (pattern C) and all patients with intense focal uptake (pattern D) and massive uptake (pattern E) had acute infarction. The complication rate in the hospital and after discharge (mean followup: 6.1 months) for patients with pattern E was 88% compared to 42% for D, 30% for C, 36% for B and 10% for patients with normal scintigrams (A). For patients with acute infarction with patterns C, D and E, the complication rate rose with increasing size of the myocardial uptake of 99mTc-pyrophosphate. In addition to its diagnostic potential, scintigraphy provides prognostic information which is useful for patient triage and for therapeutic decisions early in the evolution of the infarct.

Angina Pectoris↗