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Biomedical subjects

E D Bateman

Publications and source records attributed to E D Bateman.

At least 55 records · Page 3Linked to original sources
PubMed1991

Silicosis among gemstone workers in South Africa: tiger's-eye pneumoconiosis.

Six cases of silicosis in workers involved in the processing of semiprecious gem stones have been seen in our clinic since 1976. They had been employed as stone sculptors in lapidaries where they processed tiger's-eye, rose quartz, amethyst, quartz crystal, and a variety of other locally occurring semiprecious stones. In five of the cases, exposure was in small and poorly regulated lapidaries without specific dust control measures. The sixth was detected during the course of a health and hygiene survey (including dust sampling) that was conducted in one of two lapidaries still operating in our area. Progressive massive fibrosis (PMF) or accelerated silicosis was noted in four of the six cases, three of whom had progression of their disease after cessation of exposure. With the development of PMF, the initial restrictive pulmonary function abnormalities were followed by steadily worsening airflow obstruction. Lung biopsies confirmed silicosis in three cases. Tuberculosis was confirmed in two cases and suspected and treated in a third. Workmen's Compensation was awarded in five cases. The survey confirmed that in semiprecious gem stone processing, the risk of silicosis appears to be confined to stone sculptors. Tried and proven techniques of general and local exhaust ventilation combined with water or oil to control dust at source were capable of effectively reducing dust emission to acceptable levels.

Adult↗
PubMed1991

Tuberculous pleural effusions: increased culture yield with bedside inoculation of pleural fluid and poor diagnostic value of adenosine deaminase.

A prospective study of 111 adult patients with a pleural effusion was carried out in an area with a high prevalence of tuberculosis to compare the yield of bedside with laboratory inoculation of pleural fluid, and the yield and speed of a radiometric mycobacterial culture system (BACTEC) with that of conventional culture. The use of adenosine deaminase activity in pleural fluid as a diagnostic test for tuberculosis was also evaluated. In the 62 cases of tuberculosis confirmed histologically or by culture, or both, the BACTEC system had the same culture yield as conventional mycobacterial culture (positive in 14 cases-23%), but was significantly faster (18 versus 33 days). Bedside inoculation had a culture yield significantly higher than laboratory inoculation in the 24 patients tested (11 versus four). The remaining three diagnostic categories were malignant (28), miscellaneous (10), and undiagnosed (11). Median adenosine deaminase activity was significantly higher in tuberculous effusions than in any of the other categories, but there was considerable overlap between the groups. It is concluded that the BACTEC system is significantly faster than conventional mycobacterial culture and that bedside inoculation of pleural fluid substantially increases culture yield. Adenosine deaminase does not provide as valuable a diagnostic test of pleural tuberculosis as has been suggested.

Adenosine Deaminase↗
PubMed1991

Hut lung: a domestically acquired pneumoconiosis of mixed aetiology in rural women.

A form of pneumoconiosis in rural African women termed "Transkei silicosis" has been thought to be due to silica particles inhaled while they are hand grinding maize between rocks. Twenty five women were studied who were considered to have this condition according to the following criteria: rural domicile, radiographic and lung biopsy evidence of pneumoconiosis, no exposure to mining or industry and no evidence of active tuberculosis. They were assessed for radiological, pathological, physiological and bronchoalveolar lavage fluid features. Potential aetiological factors were assessed by determining levels of exposure to respirable quartz and non-quartz containing dusts and smoke in rural dwellings during maize grinding and cooking. Most of the women were symptomless. Radiological findings ranged from a miliary pattern to extensive fibrosis resembling progressive massive fibrosis. Histological features included simple "anthracosis" in 12, anthracosis with macules in six, and mixed dust fibrosis in seven. Cell numbers and their proportions in lavage fluid were normal. More than 60% of macrophages were heavily laden with inorganic inclusions. Respirable quartz concentrations and calculated cumulative time weighted exposures were below those recommended for industry during grinding with sandstone (100% quartz) and they were even lower during grinding with dolerite containing no quartz despite the presence of an appreciable amount of quartz in the ground maize. Total respirable dust and smoke concentrations were greater than the recommended safe levels. Three women had no exposure to maize grinding. It is concluded that the inhalation of non-quartz containing dust and smoke from biomass fuelled fires is more important in the aetiology of this condition than exposure to quartz dust. The term "hut lung" may be more appropriate.

Bronchoalveolar Lavage Fluid↗
PubMed1990

Asthma and hyperthyroidism. A report of 4 cases.

For many years it has been known that thyrotoxicosis can worsen asthma, increasing both the frequency and severity of asthma attacks and increasing requirements for medication. Clinical recognition of this association may be difficult. Thyrotoxic asthmatics frequently experience side-effects from medications, particularly beta-receptor agonists and theophyllines. Four case reports of asthmatics in whom thyrotoxicosis was diagnosed are presented. All 4 patients improved on returning to euthyroid status. The mechanism responsible for the harmful interaction is not known.

Adult↗
PubMed1990

Experience with fibreoptic bronchoscopy in the diagnosis of pulmonary shadows in renal transplant recipients over a 12-year period.

Despite improvements in immunosuppressive therapy, pulmonary infections remain an important cause of morbidity and mortality in renal transplant recipients. Over a 12-year period (1 January 1977 to 31 December 1988) we prospectively assessed the value of fibreoptic bronchoscopy in diagnosing radiographic pulmonary shadows in this group of patients. Forty-eight bronchoscopies were performed on 46 patients. A definitive diagnosis was established in 28/48 (58%) procedures (and was partially definitive for one of two organisms ultimately identified in another). The procedure failed in 19/48 (40%), although in 15 of these, the radiographic shadows resolved on antibiotics (9) or spontaneously (3) or autopsy revealed acute pneumonia (3). In four instances a specific diagnosis was made by alternative means. Clinically useful information which led to changes in management was obtained in 17/48 (35%) procedures and bronchoscopy was thought to have favourably influenced survival in 16/48 (33%). Fibreoptic bronchoscopy is in our experience a safe (only one pneumothorax and no significant haemorrhage) and useful technique in evaluating pulmonary shadows in renal transplant recipients.

Adolescent↗
PubMed1990

Primary pulmonary hypertension and thromboembolic pulmonary hypertension--similarities and differences.

In a retrospective study of 36 patients with primary pulmonary hypertension (PPH) and 16 patients with chronic large vessel thromboembolic pulmonary hypertension (TPH) the diagnostic value of clinical features, chest radiographs, electrocardiographs, radionuclide lung scanning and cardiac catheterization was assessed. PPH patients were younger, had higher prevalence of Raynaud's phenomenon, right axis deviation, right ventricular hypertrophy on electrocardiograph and higher pulmonary artery pressures than TPH patients, but these features were not diagnostic. Although pulmonary angiography is considered by some to be necessary in distinguishing these two conditions, radionuclide lung scanning proved a safe and effective noninvasive method for this purpose.

Blood Pressure↗
PubMed1990

Prognostic and therapeutic considerations in clinical primary pulmonary hypertension.

Twenty-two patients with primary pulmonary hypertension were reviewed to assess the correlation of clinical and haemodynamic features with prognosis. A relationship between resting haemodynamic measurements and survival was sought in all 22 patients, and the effect of vasodilator therapy in 13 was reviewed. Those who survived 12 months or less (seven patients) or 40 months or more (seven patients) from catheterization were classified into short or long survival groups respectively. Clinical, haemodynamic and pulmonary angiographic features of patients in these groups were compared. In the whole group, mean pulmonary artery pressure and pulmonary vascular resistance were inversely related to survival. Multivariate analysis of mean pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), mean right atrial pressure (RAP), systemic vascular resistance (SVR) and cardiac index (CI) in the whole group identified RAP and PVR as the model which best predicted survival time. The short survival group had a higher prevalence of electrocardiographic evidence of right ventricular hypertrophy, higher mean pulmonary artery pressure and pulmonary vascular resistance than the long survival group. Our experience with vasodilator therapy was less encouraging than that described by other workers. Two of six patients on long-term treatment appeared to stabilize. Two other untreated patients showed spontaneous improvement. Prediction of prognosis in the individual patient is difficult.

Analysis of Variance↗
PubMed1989

Comparison of respiratory effects of two cardioselective beta-blockers, celiprolol and atenolol, in asthmatics with mild to moderate hypertension.

The effects of two cardioselective beta-adrenergic blocking agents--celiprolol (claimed to have bronchodilator properties) and atenolol (without such claims)--on respiratory function and control of asthma were studied in ten asthmatic patients with mild to moderate essential hypertension. Following a beta-2 agonist-free period of ten hours, administration of 100 mg of atenolol was associated with bronchoconstriction (p less than 0.05), whereas 400 mg of celiprolol was not. Responsiveness to beta-2 agonist therapy was retained with both agents (p less than 0.05). Day-to-day asthma control, interpreted from patient recordings of peak flow, inhaler use and symptom scores, were all no different on either agent from placebo. When given acutely, celiprolol appeared to have acute bronchosparing properties, possibly providing a greater margin of respiratory safety than atenolol.

Adrenergic beta-Antagonists↗
PubMed1988

Does nedocromil sodium have a steroid sparing effect in adult asthmatic patients requiring maintenance oral corticosteroids?

A randomised, double blind, placebo controlled trial of nedocromil sodium was undertaken to assess its corticosteroid sparing effect in 50 adults with asthma who had required an oral corticosteroid dose of (or equivalent to) at least 5 mg prednisolone a day continuously during the preceding year, in addition to inhaled beclomethasone dipropionate and bronchodilators. Patients having corticosteroids other than prednisolone were changed to prednisolone. A four week baseline period was followed by 20 weeks of inhaled nedocromil sodium (16 mg daily) or placebo. After four weeks of the treatment phase an attempt was made to reduce the oral prednisolone maintenance dose by 2.5 mg a fortnight until a dose of 5 mg daily was reached and thereafter by 1 mg a fortnight, provided that there was no significant clinical deterioration as judged by clinic assessments and daily diary cards. Of 50 patients recruited, 47 entered the treatment phase (age range 16-64 years), 24 receiving nedocromil sodium and 23 placebo. The total steroid reduction achieved was 2.5 mg in the nedocromil group and 3 mg in the placebo group, which did not differ significantly. There was no significant change in symptoms, lung function or inhaler use in either group during the study. The number of patient requiring short term upward adjustment of booster doses of oral prednisolone for exacerbations of asthma was similar in the two groups (26 with placebo, 28 with nedocromil). Thus nedocromil sodium does not appear to provide an oral corticosteroid sparing effect in chronic steroid dependent asthma.

Adolescent↗
PubMed1986

Rapid diagnosis of sputum negative miliary tuberculosis using the flexible fibreoptic bronchoscope.

Acid fast bacilli are seldom identified by direct staining of sputum smears in patients with miliary tuberculosis, so that delays in diagnosis are common. We report 41 patients with miliary tuberculosis who had negative sputum smears and who underwent bronchoscopy, bronchial brushing, and transbronchial biopsy. In two patients the procedure was repeated. A definitive diagnosis was obtained from bronchoscopy in 34 patients (83%). Bronchial brushings yielded Mycobacterium tuberculosis in 24 of 42 bronchoscopies (57%), 13 from direct smear and a further 11 from culture only. Transbronchial biopsies were diagnostic in 30 of 41 procedures (73%), 28 from histological appearances, one from direct smear of the biopsy specimen, and another exclusively from culture. A rapid diagnosis was established in most patients (27/34), either by direct smear of brushings or biopsy specimens only (5), by histological examination only (14), or by both direct smear of brushings and biopsy specimens only (5), by histological examination only (14), or by both direct smear of brushings and histological examination (8). The diagnosis was confirmed later in a further seven patients by culture of brushings or specimens; in five of these non-caseating granulomas were initially found by histological examination. Fibreoptic bronchoscopy is a valuable technique for rapidly establishing the diagnosis of miliary tuberculosis.

Adolescent↗
PubMed1984

Cryptogenic fibrosing alveolitis. Clinical spectrum and treatment.

Cryptogenic fibrosing alveolitis (CFA) is a relatively uncommon condition with a variable prognosis and a mean survival of less than 5 years. The prediction of responsiveness to corticosteroid treatment is difficult, but is highly desirable because of the range of beneficial and harmful effects encountered with this treatment. This review of the clinical details of 42 patients with CFA managed at the Respiratory Clinic at Groote Schuur Hospital over the past decade highlights this difficulty, and draws attention to features which may be helpful in predicting response and prognosis. Although 53% of patients experienced symptomatic improvement or had an initial objective response to treatment, only 28% showed sustained improvement on lung function tests. The outcome and pattern of disease of patients in this study are very similar to those reported from other centres.

Adult↗
PubMed1984

Serum type III procollagen peptide concentration in cryptogenic fibrosing alveolitis and its clinical relevance.

The serum concentrations of a metabolite produced during synthesis type III collagen, type III procollagen peptide (PCP), were measured in patients with cryptogenic fibrosing alveolitis, and the results were related to the course of the disease and its response to treatment. The mean PCP concentration was significantly higher for patients untreated at the time of sampling than for an age and sex matched control group (p less than 0.001). Seventeen of these patients subsequently started treatment and their response to treatment was assessed by measurement of changes in the transfer coefficient (KCO) and forced vital capacity (FVC) at six months and one year later. Those patients showing a response to treatment, indicated by an increase in the percentage predicted KCO or FVC of more than 10% one year after starting treatment, had a significantly higher mean PCP concentration (p less than 0.01 and p less than 0.001 respectively) than patients with stable or deteriorating physiological indices. When the PCP concentrations of these patients were compared with repeat measurements three to six months after the commencement of treatment 14 out of 17 showed a decrease in PCP levels. This percentage change in PCP concentrations correlated significantly with the change in the percentage predicted KCO and FVC at 12 months after the commencement of treatment (p less than 0.01). These results suggest that measurement of PCP concentrations in patients with cryptogenic fibrosing alveolitis may be useful in the assessment of response to treatment.

Adrenal Cortex Hormones↗