Sodium cromoglycate for ACE inhibitor cough.
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Biomedical subjects
Publications and source records attributed to D J Barnes.
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This is a case report of multiple septic complications of a peripheral intravenous cannula as a direct result of proximal embolization of a fragment of the cannula to the heart and major vessels.
Salmonella empyema occurred in a patient with non-Hodgkin's lymphoma. He was successfully managed with a combination of antibiotics and surgery.
The role of viruses and atypical organisms in pneumonia is well known in western populations, yet very little documentation is available about their role in pneumonia in developing countries. In a study of 175 adults with community-acquired pneumonia in Papua New Guinea, serological methods were used to assess this issue. Five patients had high influenza A titres suggestive of recent infection. Adenovirus titres rose significantly in one patient with Haemophilus influenzae pneumonia, whilst no evidence of past or recent infection was found in the remainder of patients when tested for all pathogens. Bacterial cultures revealed the continued predominance of Streptococcus pneumoniae in the pathogenesis of pneumonia in this population. We conclude that viruses and atypical organisms (including Mycoplasma and Legionella) play a very limited role in this setting.
A case of obstructive sleep apnoea is reported that was caused by a dermoid cyst of the floor of the mouth and cured by surgery.
Obstructive sleep apnoea is a common disorder in western societies and has a strong association with obesity and alcohol use. The condition has not previously been recorded in Papua New Guinea. The clinical details of 2 patients from Papua New Guinea with obstructive sleep apnoea are described, and the principles of treatment of this condition are outlined. Sleep apnoea is likely to become an increasing problem in Papua New Guinea.
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We describe the first case report of community-acquired Acinetobacter pneumonia in Australia. Well recognised risk factors for this entity (alcoholism, diabetes mellitus and chronic lung disease) were present in our patient. His pneumonia ran a fulminant course, with death occurring within 24 hours of presentation to hospital. Whilst rare, this infection is being described with increasing frequency, particularly in developing countries including Papua New Guinea.
Although tuberculosis is a recognised cause of adrenal insufficiency, little is known about adrenal function in patients with active tuberculosis. Ninety Melanesian adults with active tuberculosis (30 pulmonary, 30 miliary, 30 extrapulmonary) had adrenal function assessed prospectively before and three to four weeks after starting antituberculous chemotherapy. Basal serum cortisol concentrations were normal in 55 (61%) and raised in 35 (39%) of the subjects. No patient had a low basal cortisol concentration. After Synacthen stimulation, cortisol responses were normal in 81 (92%) of the patients and subnormal in seven (8%). After antituberculous chemotherapy the response to Synacthen stimulation was normal in all but one patient. It is concluded that adrenal dysfunction is an uncommon problem in patients with active tuberculosis, and that, contrary to recent reports, antituberculous chemotherapy regimens that include rifampicin do not have an adverse effect on adrenal function.
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In a prospective study of 175 adults with acute pneumonia, percutaneous lung aspiration (PLA) was performed in 144 in an attempt to obtain a bacteriological diagnosis. Positive cultures were obtained from PLA in 90/144 cases (62.5%). The most common organisms isolated were Streptococcus pneumoniae (60%) gram-negative bacilli including Hemophilus influenzae (26%) and Staphylococcus aureus (11%). In 39% of those patients with positive PLA cultures, the same organism was isolated on blood cultures. Complications of PLA were uncommon, with hemoptysis in 4% and chest wall hematoma in 0.7% of patients. The incidence of post-aspirate pneumothorax was not determined in this study. PLA was found to be a safe and effective method of obtaining a bacteriological diagnosis in adult patients with pneumonia.
In a prospective study of 170 adult patients with acute pneumonia, Haemophilus influenzae was found to be the aetiological agent in 15 cases (8.8%). The diagnosis in all cases was based on positive cultures of blood or percutaneous lung aspirate, or both. Chronic lung disease was significantly more common in patients with H influenzae pneumonia than in patients with pneumonia due to other organisms but age, sex, and smoking history did not differ significantly. Lobar consolidation was the most common radiological pattern, being present in 10 of the 15 cases. Type b was the commonest serotype isolated, but three cases were due to non-typable (non-capsulate) strains. All patients survived, responding well to treatment with penicillin, ampicillin, or chloramphenicol. Haemophilus influenzae should be considered as a possible cause of pneumonia in adults, particularly those with underlying chronic lung disease.
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