Diastolic ventricular interaction: a possible mechanism for abnormal vascular responses during volume unloading in heart failure.

Background: Baroreflex dysfunction is common in chronic heart failure and contributes to the associated sympathoexcitation. Baroreceptor activity normally decreases during volume unloading, causing an increase in sympathetic outflow and resulting in forearm vasoconstriction. Some heart failure patients develop attenuated vasoconstriction or paradoxical vasodilation.

The effect of breakfast on minor anal complaints: a matched case-control study.

With the objective of exploring the association between breakfast and minor anal complaints, an age, sex and pregnancy matched case-control study was carried out in the out-patient clinics at Birmingham Heartlands Hospital. Patients were selected after personal interviews using a structured questionnaire in out-patient clinics. Information on age, sex, occupation and breakfast habits, as well as on haemorrhoids and anal fissure, was obtained.

Exercise vascular responses in health and disease.

In normal subjects during exercise, there is vasoconstriction of non-exercise resistance vessels and an increase in blood pressure. We have investigated patients with vasovagal syncope with structurally normal hearts and patients with hypertrophic cardiomyopathy compared with normal controls and found a failure of vasoconstriction in both patients with vasovagal syncope and hypertrophic cardiomyopathy compared with normals and this has been associated with exercise hypotension. An association between exercise hypotension and sudden death has previously been reported in hypertrophic cardiomyopathy.

Diastolic ventricular interaction in chronic heart failure.

Background: Diastolic ventricular interaction describes a situation in which the volume of one ventricle is directly influenced by the volume of the other ventricle. Such interaction is normally negligible, but it is accentuated in circumstances associated with pulmonary hypertension and volume overload. When this interaction occurs, acute volume unloading results in a reduction in right ventricular end-diastolic volume, as expected, but left ventricular end-diastolic volume paradoxically increases.

Baroreflex sensitivity in patients with vasovagal syncope.

Background: In the present study, we tested the hypothesis that baroreflex sensitivity is reduced in patients with vasovagal syncope compared with normal control subjects.

Methods And Results: We investigated 30 patients with vasovagal syncope (mean age, 43.6 +/- 16.

Is pharyngoplasty a risk in velocardiofacial syndrome? An assessment of medially displaced carotid arteries.

The association of medially positioned internal carotid arteries and velocardiofacial (Shprintzen) syndrome was first made in 1987. This is also the most common syndrome associated with facial clefting. The potentially dangerous implications in children with this syndrome requiring pharyngoplasty for velopharyngeal incompetence and stigmatized hypernasal speech involve potential damage to these vessels.

Electrical burns to the oral commissure: does splinting obviate the need for commissuroplasty?

Two groups of children who had sustained electrical burns to the oral commissure were compared. The first group (n = 20) underwent splinting of the commissure and the other group (n = 22) did not have splints as part of their treatment regimen. The mean age at the time of burn was 3 years in both groups.

Demonstration of late cardiotoxicity following bone marrow transplantation by assessment of exercise diastolic filling characteristics.

We evaluated the role of rest and exercise left ventricular diastolic filling parameters as a marker of cardiotoxicity in 25 consecutive patients 1 year following BMT. Ten age- and sex-matched subjects served as controls. Patients were evaluated in toto and in three sub-groups according to chemotherapy.

Failure of reflex venoconstriction during exercise in patients with vasovagal syncope.

Background: In this study, we tested two hypotheses. First, we tested the hypothesis that reflex constriction of the venous capacitance beds in patients with vasovagal syncope is impaired during both subhypotensive lower-body negative pressure. Second, we proposed that splenic venoconstriction may be impaired during exercise in patients with vasovagal syncope.

Specialist unit improves outcome after acute stroke.

Stroke rehabilitation units are associated with reduced mortality, morbidity and length of stay, in much the same way that coronary care units are known to improve the acute care of patients who have had a heart attack. Such units have facilitated the development of drugs that may improve the outcomes following a heart attack. The acute stroke unit at King's Healthcare, London, was set up to improve the early management of stroke and facilitate the development of new treatments.

Determinants of exercise capacity in patients with coronary artery disease and mild to moderate systolic dysfunction. Role of heart rate and diastolic filling abnormalities.

Background: To test the hypothesis that diastolic filling abnormalities are an important cause of exercise limitation in some patients with coronary artery disease we assessed the factors limiting exercise capacity in a group of patients with coronary artery disease in whom exercise limitation was greater than expected from the degree of resting left ventricular systolic dysfunction.

Methods And Results: We assessed the relationship between exercise capacity (maximal oxygen consumption) during erect cycle ergometry, heart rate, radionuclide indices of left ventricular systolic function (ejection fraction) and diastolic filling (peak filling rate, and time to peak filling) during semi-erect cycle ergometry in 20 patients (15 male, five female) who were aged 42-72 years (mean 61 years) and had angiographically proven coronary artery disease and evidence of reversible myocardial ischaemia on thallium scintigraphy. All patients exhibited marked exercise limitation (maximal oxygen consumption 8.

Carpal tunnel syndrome in children and adolescents with no history of trauma.

Four cases of carpal tunnel syndrome in children and adolescents with no history of trauma are discussed. The pertinent literature and a classification of the different causes of carpal tunnel syndrome in this age group is presented.

Non-emergency attenders at a district general hospital accident and emergency department.

Following concern about long waiting times, a survey was carried out in the Accident and Emergency (A&E) department of Monklands District General Hospital over 5 consecutive days to investigate factors related to the bypassing of general practitioners (GPs) by 'self-referred' patients and inappropriate use of the department. Two hundred and forty-five (90.7%) of 270 non-emergency patients who attended the department during GP surgery hours completed a self-administered questionnaire.

Exercise capacity in hypertrophic cardiomyopathy. Role of stroke volume limitation, heart rate, and diastolic filling characteristics.

Background: We previously showed that exercise capacity in patients with hypertrophic cardiomyopathy (HCM) is related to peak exercise cardiac output. Cardiac output augmentation during exercise is normally dependent on heart rate (HR) response and stroke volume (SV) augmentation by increased left ventricular end-diastolic volume and/or increased contractility. We hypothesized that in contrast to normal subjects, peak exercise capacity in patients with HCM is determined by the diastolic filling characteristics of the left ventricle during exercise, which would in turn determine the degree to which SV is augmented, and that HR is a relatively unimportant determinant of peak exercise capacity.

Abnormal forearm vascular responses during dynamic leg exercise in patients with vasovagal syncope.

Background: We have reported previously that in some patients with normal hearts who present with exercise syncope, abnormal forearm vasodilation is seen during leg exercise and tilt table tests are positive. This suggests that exercise syncope may be a variant of vasovagal syncope. In this study we tested the hypothesis that there is loss of the normal forearm vasoconstrictor response during dynamic leg exercise in an unselected population of patients with classic vasovagal syncope.

A long-term appraisal of the unilateral complete cleft lip repair: one surgeon's experience.

The authors reviewed 85 patients with unilateral complete cleft lip repaired with a low triangular flap technique. Clefts were classified into four categories, depending on the degree of deformity. The clinical results, as evidenced in standardized slides, were assessed by a professional panel using a weighted formula adapted from that devised by Williams.

Reversible ischaemia in hypertrophic cardiomyopathy.

Atypical and typical chest pains are common symptoms in patients with hypertrophic cardiomyopathy. Some of these chest pains seem to be caused by ischaemia. It is difficult to objectively demonstrate ischaemia in hypertrophic cardiomyopathy.

Residual problems in chest donor sites after microtia reconstruction: a long-term study.

The rib cartilage has been the most popular autogenous tissue for microtia reconstruction. In this study, 88 chest donor sites were evaluated in 80 patients examined in the outpatient clinic at least 1 year after tissue removal. Microtia reconstruction usually was initiated between the ages of 2 and 3 years (42 percent), at which time an axial half of the sixth rib was harvested along with all of the seventh and eighth rib cartilages with their attached perichondrium.