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Biomedical subjects

A D Morgan

Publications and source records attributed to A D Morgan.

At least 19 recordsLinked to original sources
PubMed1989

An audit of doctor's management of patients with chest pain in the accident and emergency department.

In a series of 604 patients attending an accident and emergency department with chest pain, the decisions made by casualty officers about admission to the coronary care unit were compared with the retrospective opinions of experienced clinical assessors who knew the results of any subsequent investigations. Of the 119 patients whom the assessors judged should have been admitted to the coronary care unit, 14 (11.8 per cent) were judged to have been discharged in error. Of the 485 patients whom the assessors judged should not have been admitted to the coronary care unit, 32 (16 per cent) were judged to have been advised admission unnecessarily. Misinterpretation of the electrocardiographic results was apparently the reason for five of the 14 false negative errors and four of the 32 false positive errors. The median time that patients who were eventually admitted to the coronary care unit spent in the accident and emergency department was 78 min.

Chest Pain↗
PubMed1987

Role of computed tomography in diagnosis of bronchiectasis.

Bronchograms and computed tomograms were performed in 27 patients who presented consecutively for bronchography with chronic sputum production. The films were reported separately by three consultant radiologists, who had been asked to give a diagnostic interpretation of the films for each bronchopulmonary segment. The reporting of bronchiectasis on computed tomograms was compared with that on bronchograms. The sensitivity and specificity of computed tomography at segmental level compared with bronchography was 66% and 92%, respectively. We conclude that computed tomography alone is not yet suitable for accurate characterisation and localisation of disease in patients in whom surgery is contemplated. Computed tomography may be useful in patients in whom bronchography is contraindicated and for monitoring progression of disease after initial combined computed tomography and bronchography.

Bronchiectasis↗
PubMed1987

Interpretation of bronchograms and chest radiographs in patients with chronic sputum production.

Bronchograms and plain chest radiographs of 27 patients with chronic sputum production were reported separately in random order and independently by two pulmonary radiologists to establish the diagnostic rate of each investigation and to assess interobserver variation. Both radiologists agreed on the presence of bronchiectasis on bronchography in 19 of 27 (70%) patients and in 94 of 448 (21%) bronchopulmonary segments. One radiologist only interpreted the films as showing bronchiectasis in a further two (7%) patients and 26 (6%) segments. There was more disagreement about the presence or absence of individual bronchographic abnormalities. Two main groups of patients with bronchiectasis were identified by bronchography: 11 with bronchiectasis alone and eight with bronchiectasis and bronchographic features suggestive of "chronic bronchitis". There was no clinical difference between these two groups. Plain chest radiographs were insensitive, being diagnostic (both radiologists agreeing) of bronchiectasis in only nine of 19 (47%) patients with definite bronchiectasis on bronchography.

Adolescent↗
PubMed1987

Pneumococcal serotypes in sputum isolates during acute respiratory illness in Edinburgh.

During the years 1978-83 serotyping was carried out on all sputum isolates of pneumococci obtained from patients in the chest wards of the City Hospital, Edinburgh. In 402 patients with acute respiratory illness the peak isolation rates occurred from January to April, and the serotype distribution was similar to that seen in previous UK studies, the commonest types being 3, 6, 9, 19, 23, and 8. The overall mortality rate was 8.7%, the serotype distribution in fatal cases reflecting the distribution of the whole group. The presence of mixed infection, predominantly with Haemophilus influenzae, was associated with a lower mortality rate of 3.5%. Nearly all patients (92%) were either elderly or had a chronic underlying disease and only one death occurred in a patient under 70 years who had no pre-existing disease. Of the pneumococcal serotypes isolated from the 292 patients with chronic chest disease, 82% are included in the new 23 valent pneumococcal vaccine and the efficacy of this needs to be assessed further in high risk patients.

Aged↗
PubMed1987

Breathing patterns during sleep in patients with nocturnal asthma.

Breathing patterns early and late in the night, at the same sleep stage, were compared in six healthy subjects and 15 adults with nocturnal asthma, to try to identify changes of overnight bronchoconstriction, and breathing patterns at different sleep stages, to see whether there were changes related to sleep stages that were indicative of bronchoconstriction. Despite an average 31% fall in FEV1 overnight in the patients with asthma, neither breathing frequency nor expiratory time, which might be expected to change during bronchoconstriction, was different early in the night from late in the night, nor did they differ between sleep stages. There was no evidence of asynchronous movement of the chest and abdomen in any patient. This study did not identify any abnormality of breathing pattern that would indicate the development of nocturnal asthma without the need to awaken the patient.

Adolescent↗
PubMed1986

Sodium cromoglycate in nocturnal asthma.

To investigate whether mast cell degranulation was important in producing nocturnal asthma, the effect of a single high dose of nebulised sodium cromoglycate on overnight bronchoconstriction, oxygen saturation, and breathing patterns in eight patients with nocturnal wheeze was examined. The study took the form of a double blind placebo controlled crossover comparison. Treatment with cromoglycate did not reduce the overnight fall in FEV1 or FVC, although it was associated with improved nocturnal oxygenation. This study suggests that mast cell degranulation may not be important in the pathogenesis of nocturnal asthma.

Adolescent↗
PubMed1986

Quantitative assessment of the value of spirometry.

To determine the value of simple spirometric measurements in the diagnostic assessment of breathless patients, doctors requesting such tests were asked to predict the likely ventilatory abnormality, expressing these pretest predictions as probabilities. Comparison of these pretest predictions with the test results allowed an analysis of the doctors' ability to identify lung function abnormalities and an assessment of the diagnostic usefulness of the test. Predictions and spirometric measurements were made in 123 patients. Doctors expressed preference for a particular spirometric category in 112 cases, of which 13 were predicted to have a restrictive defect, 77 were predicted to have an obstructive defect, and 22 were predicted to be normal. Spirometry showed that nine patients had a restrictive defect, 79 had an obstructive defect, and 24 had normal indices. The study showed that 61% of the tests gave a result that doctors predicted as being unlikely. The study also showed that doctors had difficulty in identifying the reversibility of airflow obstruction in patients in whom they correctly predicted obstruction. Spirometry fulfils a useful role in the diagnosis of breathless patients.

Adolescent↗
PubMed1985

Right ventricular performance during exercise in chronic obstructive pulmonary disease. The effects of oxygen.

Radionuclide ventriculography allows non-invasive assessment of right ventricular performance. This study has confirmed that there is a modest reduction in right ventricular ejection fraction (RVEF) in patients with chronic obstructive pulmonary disease (COPD), as compared to normal subjects. However, occult right ventricular dysfunction also becomes apparent in these patients during exercise. The change in RVEF during exercise is related to the corresponding fall in arterial oxygen saturation in patients with COPD. Oxygen improves the response of the right ventricle to exercise, although the mechanism remains unclear. Long-term oxygen therapy, in patients with respiratory failure, does not appear to have any significant effect on RVEF.

Adult↗
PubMed1985

Almitrine improves oxygenation when both awake and asleep in patients with hypoxia and carbon dioxide retention caused by chronic bronchitis and emphysema.

Patients with chronic bronchitis and emphysema who are hypoxic when awake become more hypoxic during sleep, with a further rise in their preexisting pulmonary hypertension. Almitrine, a respiratory stimulant, improves arterial blood gas tensions in such patients when they are awake. We have used a double-blind, placebo-controlled, cross-over study to compare the effects of 50 mg almitrine given orally twice a day for 14 days on oxygen saturation (SaO2), respiratory movements, and sleep quality in 9 patients with hypoxic chronic bronchitis and emphysema (FEV1, 0.4 to 1.0 L; PaO2, 51 +/- (SEM) 2 mmHg; PaCO2, 49 +/- 1 mmHg). Almitrine improved arterial blood gas tensions when awake, mean PaO2 rising by 8 mmHg (p less than 0.001) and PaCO2 falling by 4 mmHg (p less than 0.01). Almitrine improved nocturnal oxygenation, mean SaO2 when awake rising from 83 +/- 4% to 89 +/- 3% (p less than 0.01), and the lowest SaO2 during sleep rising on average from 65 +/- 6% to 77 +/- 3% (p less than 0.02). The number of hypoxemic episodes (SaO2 falling by greater than or equal to 10% from the preceding stable baseline during sleep) and the time when SaO2 was below 80% (135 +/- 53 versus 46 +/- 35 min; p less than 0.01) also improved. Almitrine did not improve sleep quality. We conclude that almitrine improves arterial gas tensions when awake and reduces the frequency and severity of nocturnal hypoxemia without impairing sleep quality in patients with chronic bronchitis and emphysema who are both hypoxemic and hypercapnic when awake.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1975

Haemostasis and healing following median sternotomy.

Experiments in goats showed that the application of bone wax to the divided sternum retarded healing. An autologous red cell compound was an efficient haemostatic and lacked the obstructive effect of wax. A human autologous red cell compound has been applied to the sterna of 15 patients following median sternotomy with good effect.

Animals↗