James Wilkinson - Academia.edu (original) (raw)

Papers by James Wilkinson

Journal of the Royal Society of Medicine, 1979

Three hearts are described in which a fibrous membrane was interposed between the right atrium an... more Three hearts are described in which a fibrous membrane was interposed between the right atrium and a formed but hypoplastic right ventricle, which possessed recognisable inlet, trabecular, and infundibular components. In these hearts the distribution of the conducting tissue was as expected for concordant atrioventricular connections, and contrasts with that seen in the classical type of 'tricuspid atresia'. The distinctive morphological and histological features of these specimens lnd further support to our view that the majority of cases of atresia of the right atrioventricular orifice should be regarded as coming within the designation of 'the univentricular heart'.

Four patients are described with a recently recognized variant of double outlet right ventricle. ... more Four patients are described with a recently recognized variant of double outlet right ventricle. Clinical examination favoured tetralogy of Fallot, but the chest x-ray suggested corrected transposition. Catheterization and angiocardiography showed that the aorta was to the left of the main pulmonary artery, and both arose from a normally positioned morphological right ventricle. Egress of bloodfrom the left ven-tricle was through a subaortic ventricular septal defect. In allpatients severe pulmonary stenosis was present and the right coronary artery ran an anomalous course anterior to the pulmonary valve ring. Two children had successful total correction, and one a palliative Blalock-Taussig shunt. Necropsy material from the fourth patient allowed confirmation of the ventricular morphology and the conducting tissue was examined. In corrective surgery, bloodfrom the left ventricle was rerouted into the aorta by an intraventricular baffle. Pulmonary stenosis was relieved by infundibul...

Cardiology in the Young, 2017

David Hamilton was born in Stockton on Tees. His father was brought up as a Quaker and became a c... more David Hamilton was born in Stockton on Tees. His father was brought up as a Quaker and became a civil engineer, specialising in bridge building. David grew up with the teaching that "if a job is worth doing it is worth doing well", from his father who was a skilled handyman. At the age of 12, David decided that he wanted to become a surgeon because it would allow him to use the manual skills, learned from his father, with the pursuit of medicine. He was a keen and talented rugby player at school, during National Service in 1949-1951 and during his years as a student at The Middlesex Hospital. He played for the English School's XV against a French school's team in April 1949. He was also a regular player of tennis and cricketbeing a member of his school first XI for 4 years. While still at school, he started meeting and "going out with" the daughter of the minister at the Presbyterian Church, which the family attended in London. Their relationship blossomed and lasted for the next 69 years, though he and Myra were not married until he finished his medical student days, at the Middlesex Hospital, in 1957. They would have celebrated their Diamond Wedding in November this yearthough Myra pre-deceased David by a few months, in June, 2017. After graduating and completing his pre-registration year at The Middlesex Hospital, he became an anatomy demonstrator and proceeded to pass the primary FRCS exam at the first attempt before going on to complete the final examagain at the first attemptin 1961. His early surgical training included a period of orthopaedic surgery, which he greatly enjoyed, but soon after finishing his FRCS a surgical rotation at The Middlesex saw him doing cardiothoracic surgery with Sir Thomas Holmes Sellors. Sir Thomas tempted him to continue in that area of surgery and he went on to a term at Harefield Hospital, before applying for a senior registrar position in Liverpool, which started in 1965.

Journal of Neurology, Neurosurgery & Psychiatry, 1986

European Respiratory Journal, 1996

This study applied bronchoalveolar lavage (BAL) to children with congenital heart disease (CHD) p... more This study applied bronchoalveolar lavage (BAL) to children with congenital heart disease (CHD) prior to elective cardiac catheterization (n=48), to determine the influence of pulmonary blood flow and viral infection on the alveolar epithelial lining fluid (ELF) concentration of leucocytes, protein and endothelin-1 (ET-1). Lower respiratory tract (LRT) viral infection was defined as either a positive immunofluorescence for virus, or a virus cultured from the bronchoalveolar lavage fluid (BALF). Haemodynamic status was determined at cardiac catheterization. Normative data for BALF, but not ELF parameters, were obtained from 26 asymptomatic, noninfected normal children undergoing elective surgery. In the absence of LRT infection, the BALF macrophage, lymphocyte and neutrophil differential in CHD was not significantly different from the normal controls. In CHD, both increased pulmonary-to-systemic flow ratio (Q'p/Q's) and increased pulmonary artery-to-left ventricular pressure ratio PAP/LVP were associated with a decrease in ELF protein (r s =-0.59; p<0.0001; and r s =-0.50; p<0.0001 respectively). A respiratory virus was isolated from the BALF in 8 (17%) of CHD children. Virus isolation was associated with an increased ELF total protein (p<0.05 vs no infection), a decreased alveolar macrophage differential count (p<0.01), and an increased neutrophil differential count (p<0.05). ET-1 was detected in the BALF of 83% of the noninfected CHD children compared to only 23% of the controls (p<0.001). ELF ET-1 concentrations did not correlate with haemodynamic status in CHD, but were up to 100 times higher than paired plasma levels. We conclude that, in congenital heart disease, both lower respiratory tract viral infection and increased pulmonary blood flow and/or pulmonary vascular pressure influence the alveolar milieu. High alveolar epithelial lining fluid concentrations of endothelin-1 occur in congenital heart disease, but the stimulus for pulmonary endothelin-1 production is unclear.

Archives of Disease in Childhood, 1986

Heart, 2003

Objective: To compare actual with predicted long term growth after early repair of tetralogy of F... more Objective: To compare actual with predicted long term growth after early repair of tetralogy of Fallot (TOF). Design: Serial preoperative and postoperative anthropometric data were converted with z scores. The presence of restrictive physiology was assessed by echocardiography. Patients: 45 otherwise healthy patients who underwent repair at median age 1.6 years (range 0.2-4.9) were studied. Predicted height was determined from mid-parental height corrected for sex. Results: Mean (SD) weight and height z scores at the time of surgery were significantly depressed (21.04 (0.82) and 20.93 (0.95), respectively; p , 0.0001 for both). At latest follow up at a median age of 14.2 years (range 11-20.5), mean weight and height z scores were 0.16 (1.1) and 20.05 (0.81) (p = 0.32 and p = 0.41, respectively). The improvement between surgical and late weight and height z scores was significant (p , 0.0001 for each comparison). Catch up growth was largely complete within two years. Age at correction, duration of follow up, and prior surgical procedures were unrelated to growth. Mean current height z scores were similar to those predicted by mid-parental height. Patients with restrictive right ventricular physiology (n = 24) had a significantly greater late z score for weight (0.49 v 20.34; p = 0.01), with a similar trend for height. Low birth weight patients experienced comparable catch up growth but remained shorter than patients with normal birth weight (mean height z score 20.64 v 0.06; p = 0.03). Conclusions: Early repair of TOF results in significant acceleration of weight and height, with normalisation of long term growth and fulfilment of genetic growth potential.

The atrioventricular conduction tissues in 14 hearts with absence of the right atrioventricular c... more The atrioventricular conduction tissues in 14 hearts with absence of the right atrioventricular connection ('tricuspid atresia') were studied by serial sectioning. In all cases, the atrioventricular node lay in the floor of the right atrium, posterior to the tendon of Todaro, but in all but one case it extended anteriorly either medial or lateral to the insertion of the tendon in a way not seen in the normal heart. The common bundle frequently arose from the anterior or lateral extensions of the node and, after penetration of the central fibrous body, came to lie on the right wall of the main ventricular chamber at the point of junction with the septum separating this chamber from the outlet chamber. In all but 3 cases, branching of the bundle occurred posterior to the outlet foramen. The distribution of the left bundle characteristically favoured the posterior part of the main chamber and the right bundle passed inferior to the outlet foramen to ramify in the trabecular zone of the outlet chamber. Although these findings differ in some respects from those previously described in univentricular hearts with an outlet chamber and 2 atrioventricular valves, we believe that they are consistent with our view that the majority of hearts with absence of the right atrioventricular connection come within the category of the univentricular heart.

Heart, 1975

Circulation, 1976

We have studied the disposition of the cardiac conducting tissues in four hearts from situs solit... more We have studied the disposition of the cardiac conducting tissues in four hearts from situs solitus individuals possessing primitive ventricles without outlet chambers. These hearts correspond to the type of univentricular heart defined as common ventricle by Lev. All the hearts studied possessed normally positioned great arteries. Two groups, each consisting of two hearts, could be distinguished. The first type possessed a small posterior ridge which divided the posterior portion of the primitive ventricle into right and left ventricular sinuses. The papillary muscles to the atrioventricular valves were separate structures and arose on each side of this posterior ridge. The conducting tissues in these hearts arose from an atrioventricular node situated in the atrial septum but deviated posteriorly. The atrioventricular bundle pierced the fibrous annulus posteriorly and descended on the posterior ridge, lying to its left side. A bifurcation was not identified, and bundle branches we...

Cardiology in the Young, 2009

We report the occurrence of non-obstructive totally anomalous pulmonary venous connection to the ... more We report the occurrence of non-obstructive totally anomalous pulmonary venous connection to the superior caval vein in a child conceived by intracytoplasmic injection of sperm, a type of assisted reproductive technology. Totally anomalous pulmonary venous connection is an uncommon congenital anomaly, in which all the pulmonary veins connect to the morphologically right atrium, or one of its tributaries. To our knowledge, this malformation has not been previously described in a child conceived on the basis of assisted reproductive technology.

British Medical …

Patients and design: 10 children, aged 1.5–12 years, with PMVSDs underwent transcatheter closure ... more Patients and design: 10 children, aged 1.5–12 years, with PMVSDs underwent transcatheter closure with the AAVSDO. The device consists of two low profile disks made of Nitinol wire mesh with a 1.5 mm connecting waist. The left disk is 5 mm towards the apex and only 0.5 mm ...

The American Journal of Cardiology, 1980

The sequential chamber analysis and angiographic, hemodynamic and clinical features, including th... more The sequential chamber analysis and angiographic, hemodynamic and clinical features, including those seen on electrocardiography, are presented in 18 patients with a univentricular heart of right ventricular type. In all cases a main chamber with a right ventricular trabecular pattern received both (or the sole) atrioventricular (A-V) connections, and a rudimentary chamber with a left ventricular trabecular pattern receiving no A-V connection was also present. The 18 patients were seen between 1971 and 1979; 6 died and the diagnosis was confirmed at autopsy. Twelve patients had double inlet, four absent right and two absent left A-V connections. Electrocardiography revealed right ventricular hypertrophy in all, and 11 had a superior mean frontal QRS axis. Chest roentgenography disclosed dextrocardia in 7 and levocardia in 11. Of 12 infants presenting with a marked decrease in pulmonary flow, 10 presented as ill neonates with hypoxia and acidosis. Four infants with increased pulmonary flow presented before 8 weeks with heart failure and mild cyanosis. Two with moderate pulmonary stenosis had mild cyanosis, but were asymptomatic. All had associated cardiac anomalies, pulmonary stenosis and persistent ductus arteriosus being the most common. For accurate diagnosis, angiographic demonstration of a posterior rudimentary chamber in addition to the main chamber of right ventricular trabecular pattern is mandatory.

Embryology and Teratology of the Heart and the Great Arteries

Journal of Thoracic and Cardiovascular Surgery

ABSTRACT

International Journal of Cardiology

Heart (British Cardiac Society)