Multicentre, prospective, randomized trial of 4 vs. 6 French catheters in 410 patients undergoing coronary angiography.

The aim of this study was to assess the quality of angiograms obtained using 4 Fr catheters compared with 6 Fr catheters, the ease of use of the 4 Fr catheters, and the safety of patient mobilization 1 hr following 4 Fr angiography. Details of catheter performance and procedural details were recorded at the time of the angiogram. The angiographic images were scored on the quality and completeness of vessel opacification throughout systole and diastole. A total of 410 patients were recruited. There was no difference between 4 and 6 Fr for procedural variables. All angiograms were considered to be of diagnostic quality. The angiographic scores for the right coronary artery and left ventricular injections were no different between 4 and 6 Fr. However, the angiographic scores for the left anterior descending and circumflex arteries were lower with 4 than with 6 Fr (both P < 0.05). Patients who had 4 Fr angiography mobilized safely at 1 hr and reported significantly less discomfort and bruising than 6 Fr patients. Good-quality diagnostic coronary angiograms can be achieved using 4 Fr catheters with the advantage of earlier postprocedural mobilization and reduced discomfort and bruising for the patient.

Three-dimensional analysis techniques--Part 1: Three-dimensional soft-tissue analysis of 24 adult cleft palate patients following Le Fort I maxillary advancement: a preliminary report.

The three-dimensional, facial soft-tissue changes of 24 patients with various cleft types following transpalatal Le Fort I osteotomy were measured using laser scanning techniques, radial measurements, and a color millimetric scale. There was a varying degree of midface retrusion in the different cleft groups, and a very similar pattern of retrusion over the nasal complex. Each group of patients showed a varying degree of relapse postsurgically, but there was a failure in all the cleft groups to correct the lack of nasal projection.

Three-dimensional analysis techniques--Part 2: Laser scanning: a quantitative three-dimensional soft-tissue analysis using a color-coding system.

New methods for measuring and averaging three-dimensional soft-tissue morphology and change from laser scans using a color millimetric scale are described. The techniques were employed to measure facial differences between a group of Class I skeletal males and females. The surgical change in one patient following bimaxillary surgery is also illustrated. The combination of the laser scanning technique and the new color coding system probed to be a simple, noninvasive, effective, and easily interpreted method for measuring three-dimensional soft-tissue differences and change across the facial complex.

Three-dimensional analysis techniques--Part 3: Color-coded system for three-dimensional measurement of bone and ratio of soft tissue to bone: the analysis.

A new color-coded method of illustrating three-dimensional changes in the bone and the ratio of soft tissue to bone movement is described. The technique is illustrated by superimposing preoperative and 1-year postoperative CT scans of three patients following bimaxillary surgery. The method has proved to be a very simple, effective, and readily interpreted method of quantifying both bone and the ratio of movement of the overlying soft tissues across the face following surgery.

Three-dimensional analysis techniques--Part 4: Three-dimensional analysis of bone and soft tissue to bone ratio of movements in 24 cleft palate patients following Le Fort I osteotomy: a preliminary report.

The three-dimensional changes in the bone and the ratio of soft tissue to bone movement were investigated in a group of 24 cleft palate patients following Le Fort I osteotomy. CT scans were taken for each patient preoperatively and 1 year postoperatively. The scans were superimposed, radial measurements calculated, and the changes illustrated by two separate color scales. In all of the groups, there was a fairly consistent pattern of movement over the mandible. The soft tissues moved in a 1.25:1 ratio over the chin and canine regions, and reduced to 1:1 over the body. In the maxilla, there was a 1:1 movement in the midline increasing to 1.25:1 bilaterally over the alar bases for both the bilateral clefts and clefts of the secondary palate groups. In the unilateral cleft group, however, there was a greater degree of movement over the cleft than over the noncleft side.

Three-dimensional nasal changes following maxillary advancement in cleft patients.

Three-dimensional laser surface scanning of the face was performed before and after Le Fort I maxillary advancement in 24 patients with replaced clefts of the lip and palate. The surgery resulted in advancement of the upper lip and para-alar tissues and an increase in the relative prominence of the nose within the face. These changes were produced at the expense of an increase in nasal width and a reduction in nasal tip protrusion. The changes in nasal morphology showed significant variation among patients.

Normal coronary angiograms: financial victory from the brink of clinical defeat?

OBJECTIVE: To examine the hypothesis that, in patients undergoing coronary angiography for suspected ischaemic heart disease, a normal angiographic result is associated with a fall in consumption of health care resources following the angiogram. DESIGN: Retrospective cost-benefit analysis comparing the 12 month periods before and after coronary angiography. SETTING: Tertiary cardiac referral centre. SUBJECTS: 69 consecutive patients investigated in the financial year 1991-92 whose angiograms were normal. MAIN OUTCOME MEASURES: Drug and hospital admission costs in the 12 month periods before and after angiography; urgent and elective consultations with general practitioner in that time. RESULTS: The mean cost of care per patient in the year before investigation was 656.89 pounds. A highly significant fall in all indices of resource consumption was observed in the year following investigation, the mean resulting difference in the cost of care being 35.15 pounds per month. The cost of coronary angiography would, if this fall were maintained, be recouped in a mean time of 18 months. CONCLUSIONS: Patients suspected on clinical grounds to have coronary atherosclerosis who are found at angiography to have normal coronary arteries are heavy consumers of health care resources. Early investigation for these patients is safe and has beneficial resource consequences in the medium term.

A three-dimensional soft tissue analysis of fifteen patients with Class II, Division 1 malocclusions after bimaxillary surgery.

A three-dimensional soft tissue study of the results of surgery in a group of 15 women with Class II, Division I malocclusions after orthognathic surgery was performed with laser scans. A group of 30 women with Class I malocclusions ages between 19 and 25 years were used as controls. Laser scans were taken before surgery, 3 months after surgery, and at least 1 year after retention. The skeletal 2 patients were shown to have a narrowing of the face over the maxillary complex, checks, the nose, as well as around the alar bases, the so called "adenoid facies." There was also the expected mandibular deficiency. The effects of the bimaxillary surgery were not simply confined to the maxilla and the mandible, with soft tissue changes extending as far as the outer canthi of the eyes. There was very little relapse in the group as a whole from the third month to 1 year after surgery. This technique has proved to be a simple noninvasive method of measuring three dimensionally. It has proven to be a very useful tool in auditing surgical outcome and measuring surgical relapse.

A multicentre comparison of treatment regimens for unilateral cleft lip and palate using a multiple regression model.

The European Cleft Lip and Palate Research Group consists of specialists in orthodontics from six centres for the treatment of cleft palate in northern Europe. The purpose of this part of the multicentre study was to investigate whether differences in outcomes could be explained by specific treatment regimens. Three regimens that were assumed to influence the outcome of treatment were selected: Presurgical orthopaedics, closure of the palate, and primary bone grafting. The sample comprised 151 children with complete unilateral cleft lip and palate from the six centres. The result of multiple regression analysis showed that within that sample it was not possible to reach definite conclusions as to which factors exerted the most favourable influence on facial growth, but primary bone grafting was associated with reduced maxillary inclination and presurgical orthopedics with increased mandibular inclination.

Postmyocardial infarction ventricular septal rupture in the thrombolytic era: two-year experience at a regional centre.

We review the 2-year experience in one cardiology unit of postmyocardial infarction ventricular septal rupture. Between July 1990 and July 1992 there were 23 such patients for whom records were available, 20 of whom underwent surgical repair. The overall mortality was 48%, and the operative mortality was 40%. The mortality in patients who suffered septal rupture within 48 hours of acute myocardial infarction was 82%, while in those in whom rupture was delayed for more than 48 hours the mortality was 17% (P < 0.001). Despite a local thrombolytic rate of 75% in acute myocardial infarction, only 5 out of 23 had received thrombolytic therapy. In this centre, postinfarction septal rupture is a common reason for emergency referral. Survival in those presenting more than 48 hours after infarction is good; in those presenting earlier the prognosis remains poor, despite surgery.

Increased cardiac sympathetic nervous activity in patients with unstable coronary heart disease.

We have evaluated overall and cardiac sympathetic activity in 47 patients undergoing coronary angiography, 27 with stable angina of at least 3 months duration, and 20 with unstable ischaemic symptoms within this period. Cardiac and overall sympathetic activity were assessed using radiotracer noradrenaline kinetic techniques to measure cardiac and total noradrenaline spillover to plasma. Overall sympathetic activity (whole body noradrenaline spillover) was similar in the two groups, whereas cardiac sympathetic activity (cardiac noradrenaline spillover) was strikingly increased in the patients with unstable ischaemic symptoms (102 +/- 23 pmol.min-1 vs 34 +/- 4 pmol.min-1, P < 0.001), as was the cardiac to whole body noradrenaline spillover ratio (0.043 +/- 0.008 vs 0.021 +/- 0.005, P < 0.01). Coronary sinus bloodflow (50 +/- 4 ml.min-1 vs 38 +/- 4 ml.min-1, P < 0.05) and coronary sinus noradrenaline concentration (2.60 +/- 0.38 nmol.l-1 vs 1.41 +/- 0.17 nmol.l-1, P < 0.01) were also increased in the patients with unstable ischemic syndromes. Left ventricular ejection fraction was similar in the two groups (63 +/- 2% vs 62 +/- 2%). Patients with unstable ischaemic symptoms within the previous three months have increased cardiac sympathetic nervous activity compared to patients with stable angina. This may in part explain why patients with unstable ischaemic syndromes are at increased risk of sudden cardiac death.

A three-dimensional analysis of bone and soft tissue to bone ratio of movements in 17 Skeletal II patients following orthognathic surgery.

The three-dimensional changes in the bone and the ratio of soft tissue to bone movement were investigated in a group of 17 Skeletal II patients following orthognathic surgery. CT scans were taken for each patient pre-operatively and 1 year post-operatively. The scans were superimposed, radial measurements calculated, and the changes illustrated by two separate colour scales. There was a constant ratio of movement over the maxillae with the central part of the upper lip being moved in a 1:1 ratio, increasing to a 1.25:1 ratio over the canine regions and 1.5:1 ratio over the paranasal areas. In the mandible there was a constant ratio of 1.25:1 over the chin, mentalis, and canine regions bilaterally. The ratio reduced to 1:1 over the body of the mandible.

Noradrenaline kinetics and coronary haemodynamics during acute beta 1-adrenoceptor blockade in man.

1. To investigate the effects of acute beta 1-adrenoceptor blockade on sympathetic nervous activity, cardiac and whole-body noradrenaline kinetics were determined during intravenous infusions of saline placebo and of metoprolol (10-15 mg plus 150 micrograms min-1 kg-1) in 10 patients undergoing diagnostic cardiac catheterization, in whom beta-adrenoceptor antagonists had been discontinued for 7 days. 2. Coronary haemodynamics were measured in these 10 patients plus two others. Compared with saline placebo, metoprolol administration was associated with decreases in heart rate (68 +/- 2 to 59 +/- 3 beats/min, P < 0.001) and coronary sinus blood flow (86 +/- 8 to 68 +/- 6 ml/min, P < 0.001) and an increase in calculated coronary vascular resistance (1.42 +/- 0.19 to 1.75 +/- 0.22 mmHg min ml-1, P < 0.001). Arterial and femoral venous noradrenaline concentrations, whole-body noradrenaline clearance and whole-body noradrenaline spillover to arterial plasma did not change. In contrast, cardiac noradrenaline spillover (33.7 +/- 5.1 to 20.2 +/- 4.3 pmol/min, P < 0.05) and cardiac noradrenaline clearance (31 +/- 3 to 23 +/- 3 ml/min, P < 0.001) were significantly decreased during metoprolol administration. 3. These results may be explained by inhibition of pre-junctional facilitatory beta-adrenoceptors, which we hypothesize may be predominantly of the beta 1-subtype in the heart and of the beta 2-subtype in the periphery.

Sri Lankan cleft lip and palate study model analysis: clefts of the secondary palate.

The study models of a group of adult Sri Lankan patients with clefts of the secondary palate were investigated. Tooth-size and arch-dimension comparisons were made with a comparable control group. Significant differences were found between the cleft and control groups in tooth sizes, chord lengths, and arch widths. The cleft group dimensions were generally smaller than those of the control group. Overjets were larger in the cleft group.

Le Fort I maxillary osteotomy: is it possible to accurately produce planned pre-operative movements?

The planned preoperative maxillary movements for five groups of patients requiring orthognathic surgery were prospectively compared to the actual surgical movements achieved in the operating theatre. There was a very poor success rate in achieving predicted movements in all the patient groups. There is a need to test and implement a reliable method of assisting the surgeon in spatially orientating the jaws on the operating table.

Comparison of different methods for assessing sympathovagal balance in chronic congestive heart failure secondary to coronary artery disease.

Twenty-five patients (aged 62 +/- 2 years) with stable, moderate to severe ischemic congestive heart failure (CHF) (New York Heart Association class II/III: 15/10; ejection fraction 21.6 +/- 2%; and peak oxygen uptake 13.6 +/- 0.7 ml/kg/min) were studied to evaluate the ability of different methods to characterize autonomic tone in chronic CHF. Sympathovagal balance was assessed by: (1) heart rate variability in the time domain, assessed by the SD of RR intervals; (2) heart rate variability in the frequency domain, assessed by low- (0.03 to 0.14 Hz) and high- (0.18 to 0.40 Hz) frequency components of heart rate variability by autoregressive power spectral analysis; (3) 24-hour, daytime and nighttime heart rate; (4) submaximal heart rate during upright bicycle exercise, with respiratory gas analysis to obtain peak oxygen uptake; and (5) radiolabeled norepinephrine spillover. These methods did not correlate, with the exception of day and nighttime heart rate (r = 0.74; p < 0.001) and the expected inverse correlation between low and high frequency (r = -0.92; p < 0.001). No method correlated significantly with peak oxygen uptake, exercise tolerance or ejection fraction. After 8 weeks of physical training at home, all methods showed improvement in autonomic balance: increases in SD of RR intervals (+21%; p < 0.02) and high frequency (+41%; p < 0.007), and decreases in low frequency (-19%; p < 0.002), low-/high-frequency ratio (-48%; p < 0.03), norepinephrine spillover (-28.9%; p < 0.03), 24-hour heart rate (-2.7%; p < 0.005) and submaximal heart rate (-10.8%; p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

A three dimensional analysis of soft and hard tissue changes following bimaxillary orthognathic surgery in skeletal III patients.

The three dimensional changes in the bone and the ratio of soft tissue to bone movement were investigated in a group of 16 Skeletal III patients following orthognathic surgery. Computerised tomogram scans were taken for each patient pre-operatively and 1 year postoperatively. The scans were superimposed, radial measurements calculated, and the changes illustrated by two separate colour scales. There was no constant pattern of movement in the maxilla or mandible in these patients. However, following a Le Fort 1 osteotomy there was commonly a 1:1 ratio in the midline which increased to 1.25:1 at the alar bases and over the canine regions bilaterally. There was also a 1.25:1 ratio or greater over the chin and mentalis regions following mandibular set back.