Biomedical subjects
Publications and source records attributed to D Chamberlain.
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Recent literature suggests that CMV pneumonia is an immunopathologic process. This case report summarizes the clinical course of a patient which supports this hypothesis. The patient is the recipient of an allogeneic BMT who recovered from an episode of CMV pneumonia that occurred about two months after the transplant. Despite recovery from the viral infection, follow-up BALs revealed persistent lymphocytosis in an apparent asymptomatic patient. He subsequently developed BOOP about four months after the initial CMV infection. These observations suggest that the viral infection may have resulted in the activation of the host's cell-mediated response and provides evidence to support the hypothesis that CMV pneumonia is an immune-mediated process.
This is the fifth survey of staffing (consultants and senior registrars) in cardiology in the United Kingdom. Data from previous years--including the fourth survey (1986) that was not published separately--are used to show the trends over the past decade. In 1988 there were less than six cardiologists per million population. The United Kingdom, with Ireland, has fewer cardiologists than all other European countries with reliable figures. The ratio for Europe as a whole is approximately 45 per million population; the recommended figure for the United States of America is 60 per million. The distribution of cardiologists in England and Wales is still very uneven. Seven million people--nearly 15% of the population--have no immediate access to special expertise in cardiology. Women are particularly poorly represented in the specialty. This survey indicates that the crisis in staffing for cardiology continues. It will worsen as the possibilities grow for effective management of heart disease and as needs increase with the greater average age of the population. Resolution of this crisis should be a major priority in policies aimed at countering the ravages of heart disease.
In a family with tuberous sclerosis affecting four generations a mother and daughter had the rare pulmonary manifestations of the disease. Pathologically the pulmonary disease may be the same as pulmonary lymphangioleiomyomatosis.
A consecutive series of 559 hospital survivors of acute myocardial infarction aged less than 66 years were studied; 93 were designated prospectively as low-risk because they were suitable for early submaximal exercise testing and had none of the following clinical or exercise test 'risk factors': (1) angina for at least one month prior to infarction; (2) symptomatic ventricular arrhythmias, or (3) recurrent ischaemic pain, both after the first 24 h of infarction; (4) cardiac failure; (5) cardiomegaly; and (6) an abnormal exercise test (angina, ST-depression or poor blood pressure response). Altogether 301 patients were exercised; their mortality over a median follow-up of 2.4 years was 10.2%, versus 24.6% in the 258 patients not exercised (P = 0.0005). Absence of clinical 'risk factors' alone, in the exercised patients, identified 156 with a mortality of 5.4% versus 15.6% in the 145 with at least one clinical 'risk factor' (P = 0.004). The fully defined low-risk group comprised 93 of the former patients who had neither clinical nor exercise test 'risk factors'. None of these patients died compared with 19 of those with at least one 'risk factor' (mortality = 14.7%; P = 0.002). Their respective rates of non-fatal reinfarction were similar and never exceeded 5% per annum. Therefore, simple clinical and exercise test criteria can positively identify low-risk patients after infarction in whom secondary prevention may be inappropriate.
Transcutaneous cardiac pacing using the Pace-Aid (Cardiac Resuscitator Corporation) was assessed in 32 emergency patients presenting with profound bradycardia or asystole who had failed to recover with advanced life support including the use of epinephrine. Pacing stimuli, pulse width 20 ms at 50, 100, or 200 mA, were delivered through two 8 cm gel-pad electrodes placed antero-posteriorly on the chest. By ECG criteria, definite electrical capture was achieved in a total of five patients and possible capture in a further 16. Of the 21 patients presenting in asystole 11 showed possible electrical capture only. No evidence of capture was seen in one third of the patients studied. Use of the Pace-Aid resulted in a palpable pulse in a total of seven patients. Four of the 11 patients with profound bradycardia survived to receive temporary transvenous pacing; two were eventually discharged. None in the asystolic group survived. Difficulties in using the Pace-Aid resulted from electrical overload by the pacing impulse that obscured the evidence for electrical capture, and intense muscle contraction that hindered reliable palpation of the arterial pulse. Transcutaneous pacing can occasionally be of value even at a late stage in the emergency treatment of profound bradycardia but is unlikely to be worthwhile in complete asystole.
A total of 25 proximal, intraosseous periodontal defects were treated in 21 adult patients. A 3-prong adjunctive, regenerative treatment approach was used. The treatment included (1) citric acid conditioning of the root surfaces, (2) grafting of particles of decalcified, freeze-dried homologous bone, and (3) placement of freeze-dried, homologous dura mater sheets between the replaced surgical flaps and the tooth surfaces. The results, as evaluated by probing attachment and probing bone level measurements, during 1 year of observation, demonstrated limited improvements of the treated defects. The limited results were similar to previous observations in our clinics following treatment of intraosseous defects using different treatment modalities. It appears that new treatment approaches need to be sought to accomplish clinically significant and predictable regeneration in proximal, intraosseous periodontal defects.
Vasculitis developed in six of 253 patients treated with intravenous anisoylated plasminogen streptokinase activator complex (APSAC) after acute myocardial infarction. All patients recovered spontaneously with no evidence of renal impairment and no long term sequelae. Although leucocytoclastic vasculitis and serum sickness have been reported after streptokinase treatment, such allergic reactions have not been described as a complication of other thrombolytic agents.
The thickness of the radiographic image of the maxillary sinus mucosa on intraoral radiographs was evaluated in 13 patients with advanced periodontal disease, prior to and 12 months following initial periodontal therapy. Before treatment, a relationship was observed between the thickness of the sinus mucosa and the mean probing depths of the teeth in the involved sextant. As many as 79% of the available sextants showed swelling of the mucosa prior to periodontal therapy, compared to only 17% after treatment. This report supports previous studies indicating that advanced periodontal disease may cause swelling of the maxillary sinus mucosa and that periodontal therapy will significantly reduce such swelling.
A controlled trial in 149 patients admitted to a district hospital with probable myocardial infarction tested the effect of 30 units of anisoylated plasminogen streptokinase activator complex (APSAC) on indices of infarct size. Patients were grouped prospectively according to whether they entered the trial within two and a half hours (early entry) or between two and a half and four hours (late entry) after onset of the symptoms. Sixty seven of 73 patients in the control group showed increased plasma activity of myocardial creatine kinase isoenzyme that was diagnostic of infarction compared with only 60 of 76 who received APSAC. The difference was significant overall but occurred predominantly in the early entry group. The patients who received APSAC had more early ventricular arrhythmias, compatible with reperfusion, and showed greater preservation of R waves during admission to hospital. Unwanted effects were generally minor and more common in the actively managed group than the control group (26% v 3%). After nine to 12 months of follow up 12 patients in the control group had died compared with seven in the actively managed group. The ease of administration and the apparent efficacy of APSAC suggest that it is suitable for use in a district hospital for patients with suspected acute myocardial infarction.
The hopeful phase: three shocks at 160J, 160J, 320J (200J, 200J, 400J). The struggling phase: three shocks at 320J (400J) after, respectively, lignocaine, adrenaline, bicarbonate. Patient intubated if possible. The desperate phase: three shocks at 320J (400J) with different electrode position or different defibrillator. While improvements will doubtless be made as skill in resuscitation increases, the guidelines can ensure that relatively few treated patients die in ventricular fibrillation and only those with irreversible myocardial damage are likely to be converted to intractible asystole.
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One hundred fifty-three patients with limited and 167 with extensive small cell carcinoma of the lung (SCCL) were evaluable for response to treatment with six courses of chemotherapy (cyclophosphamide, doxorubicin, and vincristine), irradiation to intrathoracic disease, and prophylactic cranial irradiation (PCI). No maintenance chemotherapy was given. Fifty-two percent of patients with limited disease (LD) and 10% of extensive disease patients (ED) achieved a complete response. The median survival times for LD and ED patients were 49 and 34 weeks, respectively. These results were compared to a previous experience with 147 patients who were treated with three courses of similar induction chemotherapy and thoracic irradiation, as well as one year of maintenance chemotherapy (CCNU, procarbazine, and methotrexate) but without PCI. Although the use of PCI was found to reduce the frequency of brain metastases as the site of first relapse, detailed comparisons of response rates and survival showed no significant differences between the two study populations. Prolonged maintenance chemotherapy of the type used in the first study does not favorably influence outcome after intensive induction therapy for SCCL.
Long-term bronchial anastomotic healing has been assessed in the canine lung transplant model with cyclosporin as the primary immunosuppressant. Early bronchial revascularization was achieved by wrapping an omental pedicle around the bronchial anastomosis. Ten dogs underwent left lung transplantation and six survived 100 days or more before being put to death. No significant bronchial complications occurred. Late bronchostenosis was not seen, despite four biopsy-proved rejection episodes in three of the dogs surviving past 100 days. Histologically, all anastomoses were well healed at autopsy. Cyclosporin was shown to be an effective immunosuppressant in this model and was associated with prolonged survival and low morbidity. Transplant lung function was assessed at 100 days by contralateral pulmonary artery ligation in five dogs and was satisfactory in the three animals that had not had rejection episodes. The findings support our belief that bronchial anastomotic complications after human lung transplantation are mainly related to the effects of immunosuppression with steroids and to the ischemia resulting from division of the bronchial circulation at the time of transplantation.
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This article describes a study of relationships between Type A coronary-prone behavior patterns, as measured by the Bortner and Rosenman scale, and stress levels, coping ability and psychological stress-related symptoms of a group of 148 senior female managers and administrators. The results indicate that the majority of the sample were categorized as Type A individuals, and that Type A behavior was related to age. A relationship was found between Type A behavior and subjects perceiving themselves as having higher stress levels compared to the female and male peers with whom they worked. Type A individuals perceived that their "ability to cope with stress" was worse compared to that of their female peers and female superiors, but saw themselves as better "copers" compared to their female subordinates. Type A individuals did not see themselves as a source of stress to their subordinates. A relationship was also found between Type A behavior and symptoms of anxiety, frustration and irritation. Results are compared to those of previous relevant research, and the implications of the findings are discussed.