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Biomedical subjects

G Jackson

Publications and source records attributed to G Jackson.

At least 253 records · Page 14Linked to original sources
PubMed1989

An integrated team approach to the management of patients with oropharyngeal dysphagia.

This paper describes a team approach to the assessment and management of patients with oropharyngeal dysphagia of neurologic origin. The team's major focus was to determine the need for adjustments to the patient's diet to maintain or restore the safety of oral feeding. This involved the development of a detailed radiographic examination and a series of dysphagia diets, in addition to comprehensive evaluations by an occupational therapist, physiotherapist, and speech pathologist. The effects of deteriorating swallowing ability on the physical, cognitive, and emotional status of the patient are discussed in the context of a multidisciplinary approach.

Aged↗
PubMed1989

Ambulatory electrocardiography: an open-access service for general practitioners.

Access to ambulatory electrocardiography would enable general practitioners to investigate certain patients with cardiac symptoms without the need for hospital referral. An analysis has been made of the results in 200 consecutive patients referred to a pilot open-access service based at three health centres. Twenty-two GPs used the service, although there was a wide range (1-48) in the number of patients each referred. In 72 patients aged under 50 years, abnormalities other than extrasystoles were detected in only six; major significant arrhythmias were found in three patients, although treatment was required in only one case. Arrhythmias were frequent in patients aged over 50 years but were usually minor; 16/128 (13 per cent) showed major significant arrhythmias. Pacemakers were implanted in two patients. Palpitation and/or dizziness were reported during the period of monitoring by 39 per cent of patients (and were equally common in both age groups), but in neither age group did these symptoms correlate with the occurrence of a significant arrhythmia. In primary care, palpitation and dizziness are rarely due to significant arrhythmias. To increase the cost-effectiveness of the service, ambulatory monitoring could be restricted to patients over 50 years of age, except when there is other evidence of heart disease.

Adolescent↗
PubMed1988

Echocardiography.

Imaging echocardiography is an important extension of the clinical examination and will answer most questions in an emergency-for example, whether an enlarged cardiac shadow on the chest radiograph represents ventricular dilatation or an effusion. Doppler ultrasonography is essential for hospitals with an interest in cardiology because it provides direct haemodynamic data that are complementary to imaging. It requires more skill than imaging and may also be time consuming. Colour flow Doppler mapping is speedy and simple to use and aids the interpretation of continuous wave Doppler. It is therefore a natural companion to conventional Doppler, but there would have to be a high clinical load to justify its purchase.

Cardiomyopathies↗
PubMed1988

Balloon dilatation of the aortic valve for inoperable aortic stenosis.

The place of balloon dilatation of the aortic valve in the treatment of calcific aortic stenosis is controversial. Thirty two patients (mean age 76) in whom valve replacement was contraindicated were followed up for three to 24 months (mean 8); 25 were in functional class III or IV according to the New York Heart Association's classification. Major complications of the procedure occurred in four patients. Echocardiography and Doppler studies were performed before operation and before discharge in 28 patients, and the area of the valve was measured again six to 50 (mean 23) weeks after operation in 11 patients. The peak to peak aortic pressure gradient fell from a mean of 65 (SD 24) to 46 (20) mm Hg, but the area of the aortic valve, measured by Doppler echocardiography, in 18 patients showed a modest but significant increase, from 0.61 (0.16) to 0.74 (0.23) cm2. One month after dilatation, 29 patients were alive, of whom 17 had improved symptoms. Only two had lasting clinical benefit. Sixteen patients died, 12 of a cardiac cause. The estimated one year survival rate was 49%. Six patients underwent or required valve replacement because of persisting symptoms. In view of its limited long term efficacy balloon dilatation of the aortic valve should be used only for patients with severe symptoms whose life expectancy is limited by other disease or who are considered to be unsuitable for valve replacement. It may have a role in improving the condition of patients who present with cardiogenic shock or pulmonary oedema before valve replacement is undertaken.

Aged↗
PubMed1988

Value of measuring end tidal partial pressure of carbon dioxide as an adjunct to treadmill exercise testing.

The end tidal partial pressure of carbon dioxide (PCO2) was measured during treadmill exercise in 30 normal controls and 113 patients referred for assessment of chest pain. Among the 92 patients without significant ST depression hypocapnia occurred more often in those reporting "typical" than "atypical" chest pain (17 of 22 patients compared with 29 of 70; p less than 0.01). Hypocapnia was uncommon in patients with significant ST depression whether reporting typical or atypical chest pain (one of 10 patients and two of 11, respectively). Hypocapnia at rest (PCO2 less than 4 kPa) occurred in 16 (14%) patients but in only one control. Hypocapnia occurred during or after exercise in only one control and three of the 21 patients with significant ST depression on exercise (group 1). The remaining 92 patients were divided into those with a history suggestive of hyperventilation (group 2; n = 30) and those without (group 3; n = 62). Hypocapnia developed significantly more often in both these groups (21 and 25 patients respectively) than in controls or patients with significant ST depression. An abnormal response of the PCO2 to exercise provided objective data to support a clinical suspicion of chest pain induced by hyperventilation in 24 cases, suggested a cause for equivocal ST depression other than coronary stenosis in five patients, and led to the diagnosis of previously unsuspected respiratory disease in 14 patients. Measurement of end tidal PCO2 gives additional valuable diagnostic information during the conventional treadmill exercise test in patients with both typical and atypical chest pain.

Carbon Dioxide↗
PubMed1988

24-hour control of blood pressure by once daily doxazosin: a multicentre double-blind comparison with placebo.

The antihypertensive efficacy of the new, once daily, alpha 1-adrenoceptor inhibitor, doxazosin, was compared with placebo in 40 patients with mild to moderate hypertension. Following a dose titration the mean final daily doxazosin dose in 20 patients was 13.1 mg. Through-the-day blood pressure control was assessed by frequent measurements during 24 h hospitalisation in the 9 th week of double-blind treatment compared with similar measurements made during a 2 week single-blind placebo run-in. Mean reductions in standing and supine systolic and diastolic blood pressure during doxazosin treatment were statistically significantly greater than during placebo treatment at most hourly time points during the 24 h post-dose period. Twenty-four post-dose the mean falls in standing and supine diastolic blood pressure during doxazosin treatment were statistically significant when compared with placebo. Adverse effects during doxazosin treatment were generally minor and were tolerated or disappeared with continued therapy. No patients were withdrawn from the study due to adverse effects. We conclude that once daily doxazosin provides smooth and effective blood pressure control throughout a 24 h post-dose period.

Adult↗
PubMed1988

Effect of changes in heart rate on pressure half time in normally functioning mitral valve prostheses.

To test the validity of a relation between the pressure half time and the diastolic time interval, previously shown in a pulse duplication system, eight patients with prosthetic mitral valves and permanent pacemaker systems were studied. Recordings were made from the apex by continuous wave or pulsed Doppler echocardiography at heart rates between 75 and 150 beats/min. The pressure half time was found to be closely correlated with the diastolic time interval although there was individual variation and in three prostheses the pressure half time attained a plateau when the diastolic time interval was more than 300 ms. It is likely that the orifice area is the main controller of pressure half time where there is stenosis of the prosthesis, but that other factors such as ventricular or atrial compliance and the diastolic time interval may modify or obscure the effect of orifice area in normally functioning prosthetic valves.

Blood Pressure↗
PubMed1988

Common cardiac drugs and rehabilitation.

Cardiac patients are often on drugs. They invariably benefit from a rehabilitation programme where they may be seen more frequently than in a routine follow-up clinic. Rehabilitation units must keep alert for drug-induced adverse effects or symptomatic deterioration, as well as the more usual psychological and physical benefits they induce.

Adrenergic beta-Antagonists↗
PubMed1988

Breaking the cycle.

Explore the source record for details and available documents.

Burnout, Professional↗
PubMed1987

Chronic cardiac toxicity after inhalation of 1,1,1-trichloroethane.

Two patients showed evidence of chronic cardiac toxicity after repeated exposure to 1,1,1-trichloroethane. In both cases there was circumstantial evidence of a deterioration after routine anaesthetic use of the related compound halothane. An adolescent boy who sniffed trichloroethane presented with multiple ventricular arrhythmias during tonsillectomy. Follow up showed mild chronic left ventricular impairment. A 54 year old man had repeated industrial exposure to trichloroethane and deteriorated from mild stable cardiac failure to end stage cardiac failure after halothane anaesthesia for herniorrhaphy. Chronic cardiac toxicity is a previously unreported feature of this type of solvent exposure. Related compounds such as halothane may have a toxic interaction after exposure to trichloroethane.

Adolescent↗
PubMed1987

Inoperable aortic stenosis in the elderly: benefit from percutaneous transluminal valvuloplasty.

Eight patients with severe symptomatic calcific aortic stenosis were considered to be unsuitable for valve replacement. Four were admitted with pulmonary oedema and three in cardiogenic shock and one had angina at rest. With the use of echocardiographic and radiographic guidance percutaneous transluminal aortic valvuloplasty was carried out. Aortic gradients were reduced by an average of 40%. All four patients who presented with cardiac failure improved immediately and remained well six months later. The patient with angina was symptom free at nine months. Two of the three patients who presented in cardiogenic shock improved immediately and were well nine and three months later. The other patient died four hours after the procedure. Doppler echocardiographic studies showed a slight initial increase in aortic incompetence, but this did not worsen and valvar gradients remained improved three and six months later. Percutaneous valvuloplasty of the aortic valve is an effective therapeutic option in patients with severe calcific aortic stenosis who are unfit for surgery. Its role as an alternative to surgery has not been considered and should be investigated in a controlled clinical trial.

Aged↗
PubMed1987

Does atenolol improve physical and psychological function after coronary artery bypass surgery: a controlled study.

A double-blind prospective randomized trial of atenolol (100 mg once daily) was carried out on 88 patients (78 men) awaiting coronary artery bypass graft surgery. Standardized ratings of both psychiatric morbidity and functional capacity were made before, 3 months (n = 82) and 12 months (n = 81) after surgery. One year after surgery men in the atenolol group had a significantly shorter treadmill exercise time than those on placebo (7.21 +/- 0.28 min vs 8.32 +/- 0.40 min; p less than 0.05), but the frequency of reported anginal attacks during the year was similar in both drug groups. Improvement in functional capacity (measured in exercise time) in the 71 men following surgery was related to both physical and psychological variables assessed before the operation. Men with more severe occlusive disease, lower neuroticism and higher extraversion scores pre-operatively showed greater percentage improvement in exercise time after surgery. Women had significantly levels of psychiatric morbidity and shorter treadmill exercise time than men both before and after surgery. Of the psychiatric and psychological variables, only ratings of Type A behaviour fell significantly in the atenolol group (170.9 +/- 5.3 vs 163.0 +/- 5.2; p less than 0.05). This change, which is probably not clinically important, occurred independently of any reduction in either overall psychiatric morbidity score or ratings of somatic symptoms mediated by beta-adrenergic receptors. The atenolol group reported more side-effects of both psychological and physical symptoms than the placebo group. We do not recommend the routine use of atenolol after bypass graft surgery. Our findings failed to support the suggestion that Type A characteristics may reflect an underlying sympathetic nervous system reactivity.

Angina Pectoris↗
PubMed1987

Plasma flecainide concentrations following acute myocardial infarction.

Plasma flecainide concentrations were measured in 10 patients with acute myocardial infarction. Following an oral loading dose of 300 mg plasma concentrations were highly variable and unpredictable. Subsequently, doses of 150 mg twice daily produced mean plasma flecainide concentrations consistently above 400 micrograms/1 within 48 hours. Oral flecainide is, therefore, subject to the same problems of varying oral bioavailability as other antiarrhythmic drugs tested following acute myocardial infarction and, initially, an intravenous regime remains preferable. Mild pulmonary oedema occurred in six patients and, although it responded to one dose of frusemide and did not recur, flecainide must be used with caution when significant left ventricular dysfunction is suspected.

Administration, Oral↗