Richard J. Kennedy

The vectorcardiogram of left ventricular hypertrophy. Analysis and criteria (Frank Lead system).

Direct spatial vectorcardiograms were made by using the Frank lead system on 50 patients with known left ventricular hypertrophy of both systolic and diastolic overload types. Three distinctive loop patterns were demonstrated in the horizontal plane. In addition important quantitative measurements are described for the three planar projections. From these data, five criteria are proposed for the definitive vectorcardiographic diagnosis of left ventricular hypertrophy.

Right bundle branch block and left posterior fascicular block: Vectorcardiographic and clinical features

Abstract The clinical and vectorcardiographic features were studied in 12 patients, aged 64 to 85 years (mean 74 years), with right bundle branch block and left posterior fascicular block. The blocks had been present for 1 to 9 years (mean 2.7 years). Five patients had coronary artery disease of whom 4 had vectorcardiographic criteria of inferior wall infarction. In 5 patients the cause was undetermined (probably Lenegres disease), and 2 patients had aortic valve sclerosis. Other causes simulating this type of bilateral bundle branch block were excluded. In 7 patients the horizontal QRS loop was predominantly anterior with variable direction of inscription, and was termed type I. In 5 patients the loop was normal in position, predominantly counterclockwise and was termed type II. The frontal QRS loop was clockwise with the maximal or half area vector inferior (mean 102.1 °). Two patients died of causes not related to disturbed atrioventricular conduction; complete heart block developed in none.

Single coronary artery: Antemortem diagnosis in a patient with congestive heart failure☆

Abstract The case of a 27 year old woman is reported in whom the diagnosis of single coronary artery was established ante mortem. This is probably the first such report. The patient had progressive heart failure, and no other process could be found during life or at autopsy to account for her heart disease. It is proposed that occasionally a single coronary artery can produce fatal myocardial ischemia.

Meningococcic pericarditis: A case report and review of the literature☆

Abstract An unusual case of meningococcic meningitis and pericarditis with a large pericardial effusion and cardiac tamponade is presented. Improvement followed antibiotic therapy and pericardiocentesis, but complete recovery necessitated pericardiotomy and pericardiectomy. The diagnosis, exclusion of toxic or allergic pericarditis, review of the literature and treatment are discussed.

Use of the permanent subcutaneous transvenous pacemaker in Adams-Stokes syndrome

Abstract The technic and results of long term endocardial pacing with a subcutaneous power supply are discussed. Among 15 patients so treated during a 10 month period, 11 patients were discharged from the hospital with satisfactorily functioning transvenous units. One patient died suddenly one month after discharge. The other 10 have done well. Of the original group, 2 died suddenly in the hospital, and 2 had transthoracic epicardial pacemakers installed when transvenous units failed to function. The incidence of late failure of equipment has been small, and the ease and safety of installation under local anesthesia make it a satisfactory method for permanent pacemaking.

Factors associated with anxiety and depression in the management of acoustic neuroma patients

The objectives of this study were to describe anxiety and depression levels among acoustic neuroma patients; examine differences in anxiety and depression across the acoustic neuroma management options of microsurgery, radiation and observation; and to investigate management, medical and demographic factors that might predict anxiety and depression in this patient group. A cross-sectional questionnaire was completed by 205 adults diagnosed with, or treated for, a unilateral acoustic neuroma within five years of questionnaire distribution. Median age of participants was 57.0 years, and 120 (58.5%) were female. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Clinically significant anxiety was reported by 29.8% of participants and 10.2% were depressed. Mean anxiety and depression scores did not differ from general population norms. No significant differences in anxiety and depression were found across management options. Time since management, number of symptoms and comorbid medical conditions predicted anxiety, while depression was predicted by number of symptoms. This appears to be the first study among acoustic neuroma patients in which anxiety and depression were compared across management options. Treating physicians should be aware that as the number of acoustic neuroma symptoms increases, so may the likelihood of clinically significant anxiety and depression.

Factors associated with symptom-specific psychological and functional impact among acoustic neuroma patients

INTRODUCTION The main purpose of this study was to investigate the psychological and functional impact attributed to acoustic neuroma symptoms. MATERIALS AND METHODS A sample of 207 acoustic neuroma patients completed a study-specific questionnaire about the severity, frequency, and psychological and functional impact of 9 acoustic neuroma symptoms. RESULTS The survey response rate was 56.4 per cent. All symptoms had some degree of psychological impact for the majority of participants; hearing loss was the symptom most often reported to have a severe psychological impact. The majority of respondents reported functional impact attributed to hearing loss, balance disturbance, dizziness, eye problems, headache and fatigue; balance disturbance was the symptom most often reported to have a severe functional impact. For most symptoms, psychological and functional impact were related to severity and frequency. CONCLUSION Of the acoustic neuroma symptoms investigated, hearing loss and balance disturbance were the most likely to have a severe psychological and functional impact, respectively.

The simultaneous occurrence of ventricular pre-excitation, left bundle branch block, and delayed A-V conduction

Abstract A case demonstrating coexistent ipsilateral ventricular pre-excitation and left bundle branch block with delayed atrioventricular conduction is presented. The VCG and ECG features are discussed.

A rare case of tension pneumocephalus post-cochlear implantation: Images for surgeons

tory of infection of the band including the port tubing and port. Although 2 weeks prior to presentation, her band had been deflated because of a leak. On examination, she had a fever to 38 C and a soft abdomen with epigastric tenderness. A chest X-ray revealed an appropriately positioned gastric band. A computed tomography scan revealed oral contrast passing through to the duodenum but that the gastric band tubing appeared to traverse the ascending colon – as shown in Figure 1. At laparoscopy, there were dense adhesions along the length of the band tubing that were released and the original length of tubing was found to enter the ascending colon. The operation was converted to laparotomy with the LAGB being removed and the colon defect being repaired. The patient made an unremarkable recovery and was discharged home 4 days post surgery. LAGB surgery has been performed in Australia since 1994 and has been the most common form of bariatric surgery in Australia. Recently, there has been a trend away from LAGB. In an Australian study by Bardsley and Hopkins, greater than 13% of patients undergoing LAGB surgery required re-operation because of complications. The more common reasons for re-operation being band slippage, tubing or balloon leakage, failure of weight loss, band erosion and port revision. LAGB port tubing is considered to be inert and there are very few cases of complications arising from erosion of the tubing. The most likely mechanism leading to tubing erosion is bacterial colonization of the tubing as previously proposed by Sneijder et al. Of the few cases of tubing erosion reported in the literature, all were associated with port infection. Although the number of LAGBs being inserted in Australia is decreasing, there is still a significant number of patients with bands in situ that will continue to develop complications in the future and it is important to keep this in mind when these patients present in the acute setting. This case demonstrates that although complications from LAGB tubing erosion are extremely rare, they are possible in the setting of tubing infection, and should be kept in mind.

A rare case of tension pneumocephalus post-cochlear implantation.

tory of infection of the band including the port tubing and port. Although 2 weeks prior to presentation, her band had been deflated because of a leak. On examination, she had a fever to 38 C and a soft abdomen with epigastric tenderness. A chest X-ray revealed an appropriately positioned gastric band. A computed tomography scan revealed oral contrast passing through to the duodenum but that the gastric band tubing appeared to traverse the ascending colon – as shown in Figure 1. At laparoscopy, there were dense adhesions along the length of the band tubing that were released and the original length of tubing was found to enter the ascending colon. The operation was converted to laparotomy with the LAGB being removed and the colon defect being repaired. The patient made an unremarkable recovery and was discharged home 4 days post surgery. LAGB surgery has been performed in Australia since 1994 and has been the most common form of bariatric surgery in Australia. Recently, there has been a trend away from LAGB. In an Australian study by Bardsley and Hopkins, greater than 13% of patients undergoing LAGB surgery required re-operation because of complications. The more common reasons for re-operation being band slippage, tubing or balloon leakage, failure of weight loss, band erosion and port revision. LAGB port tubing is considered to be inert and there are very few cases of complications arising from erosion of the tubing. The most likely mechanism leading to tubing erosion is bacterial colonization of the tubing as previously proposed by Sneijder et al. Of the few cases of tubing erosion reported in the literature, all were associated with port infection. Although the number of LAGBs being inserted in Australia is decreasing, there is still a significant number of patients with bands in situ that will continue to develop complications in the future and it is important to keep this in mind when these patients present in the acute setting. This case demonstrates that although complications from LAGB tubing erosion are extremely rare, they are possible in the setting of tubing infection, and should be kept in mind.