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Code Number: is03081 ABSTRACT Objectives: The aims of the clinic were to offer suitable patients carotid endarterectomy with minimal delay, to discuss patients with unclear symptoms and to offer the [...]

Byline: M. Sintler, D. Rittoo, R. Patel, R. Vohra The Royal College of Surgeons Working Party recommends the Lichtenstein 'tension free' mesh repair, to be the treatment of choice for [...]

OBJECTIVES--To determine whether biplane transoesophageal imaging offers advantages in the evaluation of mitral prostheses when compared with standard single transverse plane imaging or the precordial approach in suspected prosthetic dysfunction. DESIGN--Prospective mitral valve prosthesis in situ using precordial and biplane transoesophageal ultrasonography. SETTING--Tertiary cardiac referral centre. SUBJECTS--67 consecutive patients with suspected dysfunction of a mitral valve prosthesis (16 had bioprostheses and 51 mechanical prostheses) who underwent precordial, transverse plane, and biplane transoesophageal echocardiography. Correlative invasive confirmation from surgery or angiography, or both, was available in 44 patients. MAIN OUTCOME MEASURES--Number, type, and site of leak according to the three means of scanning. RESULTS--Transverse plane transoesophageal imaging alone identified all 31 medial/lateral paravalvar leaks but only 24/30 of the anterior/posterior leaks. Combining the information from both imaging planes confirmed that biplane scanning identified all paravalvar leaks. Five of the six patients with prosthetic valve endocarditis, all three with valvar thrombus or obstruction, and all three with mitral annulus rupture were diagnosed from transverse plane imaging alone. Longitudinal plane imaging alone enabled diagnosis of the remaining case of prosthetic endocarditis and a further case of subvalvar pannus formation. CONCLUSIONS--Transverse plane transoesophageal imaging was superior to the longitudinal imaging in identifying medial and lateral lesions around the sewing ring of a mitral valve prosthesis. Longitudinal plane imaging was superior in identifying anterior and posterior lesions. Biplane imaging is therefore an important development in the study of mitral prosthesis function. [ABSTRACT FROM PUBLISHER]

The central pulmonary arteries and any thrombus within them can be imaged by transoesophageal echocardiography. Its use is reported in the diagnosis and subsequent management of a patient with acute pulmonary embolism, whose response to thrombolytic treatment was monitored by further transoesophageal studies. Transoesophageal echocardiography may be a valuable primary diagnostic procedure in patients who seem to have sustained a significant pulmonary embolus and require urgent intervention. [ABSTRACT FROM PUBLISHER]

Cardiac troponins have emerged over recent years as the "gold standard" serum biochemical marker for the diagnosis and management for patients with acute myocardial infarction (MI). The relationship between old (creatine kinase; CK) and new (troponin T; TT) markers of myocardial in jury were examined in this study of 392 consecutive patients admitted to a district hospital with a diagnosis of an acute MI. Significant correlation of serum TT and peak CK levels were seen (R= 0.58, < 0.000l) in all types of MI. A significant relationship was also seen according to type of MI (Q wave or non-Q wave MI) or peak CK level. The regression equation (TT (μg/l) =0.0027 (peak CK) + 1.1160 (IU/I)) may be used by clinicians to estimate TT release from a known peak CK result and thus provide some guidance on equivalence between the two tests. Our findings provide physicians with a benchmark reference range between the two cardiac markers, according to level of peak CK. [ABSTRACT FROM AUTHOR]

Presents an abstract of the study 'Temporal artery biopsy--an unnecessary investigation?,' by D. Rittoo, W. Speak et al, presented at the Symposium of Audit on Surgical Practice, March 3, 1999. Way to confirm the diagnosis of temporal arteritis.

Presents an abstract of the study 'Endoscopic Venous Surgery for Incompetent Perforators,' by D. Rittoo, H.S. Khaira, S. Odgwu and R.K. Vohra, which was presented at the Joint Meeting of the Royal College of Physicians of Edinburgh and the Royal College of Surgeons of Edinburgh, with the College of Medicine of South Africa.

Objectives: This study sought to determine the clinical and biological significance of elevated cardiac troponin T (cTnT) in patients with neuromuscular diseases., Background: Practice guidelines regard cTnT and cardiac troponin I (cTnI) as equally sensitive and specific for the diagnosis of myocardial injury. Although cTnI is unique to myocardium, cTnT can be re-expressed in skeletal muscle in response to injury. The commercial cTnT assay is claimed to be cardiac specific., Methods: Fifty-two patients with 20 different types of acquired and inherited neuromuscular diseases underwent full clinical assessment, cardiac investigations, and measurements of serum cTnT, cTnI, creatine kinase (CK), creatine kinase myocardial band (CK-MB), and N-terminal pro-B-type natriuretic peptide (NT-proBNP)., Results: Serial measurements (265 samples) in 25 initially hospitalized patients taken during a mean of 2.4 years showed persistent elevation of cTnT (median: 0.08 μg/l; interquartile range: 0.06 to 0.14 μg/l), CK (582 U/l; 303 to 3,662 U/l), and CK-MB (24 μg/l; 8 to 34 μg/l). In contrast, cTnI, measured using 2 sensitive assays, was persistently normal throughout the study in 22 patients. Electrocardiograms (ECGs) and echocardiograms were normal in 16 and 17 patients, respectively, and no serial changes were observed. Therapeutic interventions in patients with reversible myopathies normalized cTnT, CK, and CK-MB in unison. Single measurements in 27 ambulatory patients showed elevated CK (953 U/l; 562 to 1,320 U/l), CK-MB (18 μg/l; 11 to 28 μg/l), and cTnT (0.03 μg/l; 0.02 to 0.05 μg/l) in 21, 22, and 18 patients respectively. cTnI was abnormal in only 1 patient. NT-proBNP (41 pg/ml; 35 to 97 pg/ml) was normal in all but 2 patients. ECGs were normal in 15 patients. No patients with elevated cTnT, but with normal cTnI, had any cardiovascular events in either group during follow-up., Conclusions: Patients with a wide spectrum of neuromuscular diseases commonly have persistent elevation of cTnT and CK-MB in the absence of clinical and cTnI evidence of myocardial injury. Re-expressed cTnT in diseased skeletal muscle appears to be the source of the elevated cTnT detected in the circulation of these patients., (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)