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S V Cox

Publications and source records attributed to S V Cox.

8 recordsLinked to original sources
PubMed2000

Effect of renal artery stenting on renal function and size in patients with atherosclerotic renovascular disease.

BACKGROUND: Renal artery stenting is widely performed, but little is known about its effectiveness in preserving renal function and size in patients with renovascular disease and chronic renal insufficiency. We studied the effect of renal artery stenting on renal function and size in patients with obstructive renovascular disease and chronic renal insufficiency. METHODS AND RESULTS: Stent deployment was performed in patients with chronic renal insufficiency (creatinine >1.5 mg. dL(-1)) and global renovascular obstruction (bilateral renal artery stenosis or unilateral stenosis in the presence of a solitary or single functional kidney). The effect of renal artery stenting on renal function was assessed by comparing the slopes of the regression lines derived from the reciprocal of serum creatinine versus time plotted before and after stent deployment. Renal size was assessed by serial ultrasound of pole-to-pole kidney length. Stenting was successful in all 61 vessels in 33 patients. Twenty-five patients had complete follow-up (mean 20+/-11 months). Before stent deployment, all patients exhibited a negative slope, indicating progressive renal insufficiency. After stent deployment, the slopes were positive in 18 and less negative in 7 patients. Thus, the mean slope increased from -0.0079 to 0.0043 dL. mg(-1). mo(-1) (P:<0.001). Ultrasonography on 41 kidneys revealed preservation of size, with the kidney length measuring 10.4+/-1.4 cm at baseline and 10.4+/-1.1 cm at last follow-up (P:=NS). Patient survival at 20+/-11 months was 90%. CONCLUSIONS: In patients with chronic renal insufficiency and global obstructive atherosclerotic renovascular disease, renal artery stenting improves or stabilizes renal function and preserves kidney size.

Aged↗
PubMed1999

Angiographic and clinical outcomes following acute infarct angioplasty on saphenous vein grafts.

Acute infarct angioplasty on aortocoronary saphenous vein grafts (SVGs) poses significant challenges because of their degenerate morphology and presence of significant thrombus. Of 370 acute, primary, or rescue myocardial infarct angioplasties performed over 3 years, 21 (5.7%) were on SVGs in patients who had undergone previous coronary artery bypass grafting a mean of 7.2 years earlier. Mean duration of chest pain to start of intervention was 3.9 +/- 3.2 hours; 6 (29%) patients presented with cardiac shock and 4 had failed treatment with thrombolytic drugs. At intervention, 11 (52%) of the culprit SVGs were totally occluded. Flow was reestablished or improved in 18 (86%), but classified as Thrombolysis In Myocardial Infarction trial grade 3 in only 10 patients (48%). Distal embolization and "no reflow" occurred with a frequency of 57% and 71%, respectively. In-hospital mortality was 19%. At 6 months, freedom from death, repeat target vessel revascularization, or recurrent myocardial infarction was 55%. In 349 patients undergoing native vessel intervention, success and Thrombolysis In Myocardial Infarction trial 3 flow rates were seen in 95% and 73% of patients, respectively, and in-hospital mortality was 7.9%. This present study demonstrates that infarct angioplasty on culprit SVGs can be successful but is associated with higher rates of embolic complications and worse acute and long-term clinical outcomes compared with a parallel experience of acute infarct angioplasty on native coronary arteries.

Aged↗
PubMed1993

Rhythm changes during resuscitation from ventricular fibrillation.

Defibrillation of patients with primary ventricular fibrillation (VF) results in a variety of rhythm changes. We analysed these changes in rhythm in 200 patients, using the American Heart Association's recommendation of two defibrillations prior to drug therapy. Sixty-three (31.5%) patients were immediate survivors with 38 (19%) being discharged from hospital alive. There was no difference between the age of immediate survivors (66.5 years, S.D. = 11.2) and non-survivors (68.3 years, S.D. = 13.7, P = 0.37). Immediate survivors were significantly more likely to be discharged alive from hospital if they were younger (70.0 years, S.D. 8.5 vs. 62.1 years, S.D. 15.8, P = 0.014). Increasing delays to the initiation of basic life support (CPR) and to defibrillation were associated with significantly less likelihood of cardioversion to sinus rhythm (P < 0.005 and P < 0.002, respectively). Those patients who stayed in VF were not more likely to be defibrillated into asystole or electro-mechanical dissociation. Seventeen percent (34) of patients were defibrillated to sinus rhythm after the first defibrillation and 14% (19) after the second, with similar hospital discharge rates (62% and 58%, respectively). Sixty percent (32) of patients in sinus rhythm, after two defibrillations, were discharged alive, compared to only 4% (6) of those patients not in sinus rhythm after two defibrillations. Our data provide new information on rhythm changes during resuscitation and supports the need for the earliest possible initiation of basic life support and defibrillation to improve survival from cardiac arrest due to ventricular fibrillation.

Age Factors↗
PubMed1992

Sclerosing peritonitis with gross peritoneal calcification: a case report.

We report the case of a patient on dialysis for 13 years, including continuous ambulatory peritoneal dialysis (CAPD) for 11 years, who developed sclerosing peritonitis with gross peritoneal calcification. The patient first presented with abdominal pain in January 1990, when peritoneal calcification was detected for the first time. Her symptoms settled spontaneously and 1 year later she presented with acute peritonitis and adynamic ileus. The peritonitis settled with antibiotics and Tenchkoff catheter removal, but the ileus persisted. She was commenced on long-term parenteral nutrition, but never recovered useful bowel function. After 8 weeks of hemodialysis and total parenteral nutrition, a further laparotomy for an acute abdomen showed what appeared to be extensive bowel infarction and peritoneal calcification. She died several days later. Of significance, peritoneal calcification was first noted on x-ray and computed tomography (CT) scan while the patient was still largely asymptomatic and before peritoneal ultrafiltration capacity was significantly impaired. Unlike other reported cases of calcifying peritonitis, sclerosing peritonitis was present and calcification was far more extensive. It was not associated with factors such as frequent infective peritonitis or acetate dialysate. Calciphylaxis was not present nor was there any abnormality of calcium-phosphate metabolism. The outcome of this case suggests that patients with recurrent or persistent bowel symptoms on long-term CAPD should have early abdominal x-ray or CT scanning to exclude sclerosing peritonitis or bowel calcification. If present, consideration should be given to transferring the patient to another therapeutic dialysis modality if possible.

Adult↗
PubMed1991

Physician response to screening for hypercholesterolaemia in a coronary care unit.

Hypercholesterolaemia is a known risk factor for coronary artery disease. This study describes a retrospective analysis of 176 patients admitted to the Coronary Care Unit (CCU) in a six month period with an admission fasting serum cholesterol of greater than 5.5 millimoles per litre (mmols/L). The patient records were examined at least six months after hospital discharge to determine what action, if any, was instituted in response to their hypercholesterolaemia. One hundred and thirty-four (76%) patients had a discharge diagnosis of myocardial ischaemia or infarction. Of the 176 patients, 73 were referred to a dietitian, 31 were given dietary advice by a medical officer, 13 were commenced on lipid-lowering drugs with nine continuing lipid-lowering drugs and only 13 patients were referred to this hospital's lipid clinic. Sixty-nine (39%) received no response to their hypercholesterolaemia. It is likely that our experience is not unique and greater attention to CCU measured lipid results and risk factor modification should be instituted by physicians.

Adult↗