Search PubMed⌕ Search

Biomedical subjects

J Chambers

Publications and source records attributed to J Chambers.

At least 73 records · Page 4Linked to original sources
PubMed1998

Effect of omeprazole in patients with chest pain and normal coronary anatomy: initial experience.

Gastroesophageal reflux is frequently found in patients with chest pain despite normal coronary anatomy, but little data on the effect of specific medication exist. After performing 24 h ambulatory pH monitoring and the Bernstein test on 23 patients with normal coronary anatomy, we gave omeprazole, 40 mg nocte, for six weeks to these and to a control group of ten patients with coronary disease. Pain episodes per fortnight fell from 16.2 to 12.0 (P=0.02) in the patients with normal anatomy and from 19.6 to 17.1 (nonsignificant) in the patients with coronary disease. Improvement occurred in seven (30%) of the patients with normal coronary anatomy compared with one (10%) of those with coronary disease, while complete resolution occurred in four (17%) and none, respectively. Improvement or complete resolution were not predicted by the results of 24 h pH monitoring, although there was a trend towards the prediction of efficacy by the Bernstein test. Omeprazole shows promise as a treatment for patients with chest pain despite normal coronary anatomy and larger placebo-controlled trials should now be undertaken.

Adult↗
PubMed1998

Is it safe to cardiovert atrial fibrillation without anticoagulation if the transoesophageal echocardiogram is normal?

The risk of thromboembolism after unprotected DC cardioversion for chronic atrial fibrillation is 5%. The use of transoesophageal echocardiographic guidance probably reduces this risk to around 1.3%. However, after conventional courses of anticoagulation, the risk is only 0.3 to 0.8%. Until there is further information from large randomised trials, the routine use of transoesophageal echocardiography cannot be recommended. However it should be considered in acute onset atrial fibrillation of less than 2 days duration in the presence of underlying structural heart disease or in individual patients who have previously suffered an embolic event.

Anticoagulants↗
PubMed1998

Pulmonary response of normal human subjects to inhaled vasodilator substances.

1. Inhaled vasodilators such as nitric oxide and epoprostenol (prostaglandin I2) are now widely employed as supportive therapies to improve oxygenation and reduce pulmonary vascular resistance in patients with acute and chronic pulmonary hypertension. However, few data exist concerning their effects in normal individuals. The aim of this study was to characterize the response of the pulmonary circulation in normal individuals to inhaled nitric oxide and nebulized prostaglandin I2.2.Eight healthy volunteers were exposed to inhaled nitric oxide (0, 20 and 40 p.p.m.) and nebulized prostaglandin I2 (10 microgram/ml). Changes in effective pulmonary blood flow and diffusing capacity of the lung for carbon monoxide (TLCO) were measured using respiratory mass spectrometry. Bicycle ergometry was used to increase effective pulmonary blood flow as a positive control.3. Exercise produced significant increases in both effective pulmonary blood flow and TLCO, but neither nitric oxide nor prostaglandin I2 produced significant changes in either parameter.4.No significant change in pulmonary haemodynamics was demonstrated in response to inhaled nitric oxide or nebulized prostaglandin I2, using doses known to be effective in patients with acute and chronic pulmonary hypertension. These data suggest that the normal pulmonary vascular bed is not amenable to vasodilatation by inhaled drugs. The study further suggests that the normal pulmonary vasodilatation seen on exercise is not mediated pharmacologically, but is a secondary consequence to the mechanical effects of a rise in pulmonary blood flow. This study thus supports the view that there is no resting vasoconstrictor tone in the pulmonary vascular bed.

Administration, Inhalation↗
PubMed1998

Atypical chest pain: looking beyond the heart.

Chest pain is common, and tends to be overinvestigated. Patients with normal coronary anatomy have a low mortality, but remain significantly incapacitated. We discuss ways of improving the management of such patients. An early diagnosis of a non-cardiac cause of pain should be made, ideally by the general practitioner, taking account of risk factors for cardiac as well as psychological disorders, the quality of the pain, the patient's concerns and worries and the presence of stressful life events. The minimum of investigation should be performed. Cardiological referral should be considered for patients with a high a priori risk of ischaemic heart disease. Otherwise referral, if necessary, should be to a gastroenterologist, psychiatrist or clinical psychologist, as appropriate. Treatment options are medications with musculoskeletal or oesophageal activity, simple or repeated reassurance, cognitive therapy, psychiatric drugs, and respiratory retraining. We suggest that a multidisciplinary chest-pain clinic may improve the care of such patients.

Chest Pain↗
PubMed1998

The use of routine duplex scanning in the assessment of varicose veins.

BACKGROUND: Clinical assessment has been shown to compare poorly with results of hand-held Doppler examination or venography in the evaluation of varicose veins. Although the use of duplex scanning has been well described in the assessment of varicose veins, there are few data comparing clinical and Doppler assessment with results of duplex scans. METHODS: A total of 188 patients were referred with varicose veins to a sole specialist vascular surgeon over a 1-year period. After clinical and Doppler assessment, all patients were referred for a duplex scan which was performed by a trained vascular technician. The results of the duplex scan were compared retrospectively with the clinical and Doppler findings. RESULTS: A total of 315 legs were assessed over this period, with 38.7% having recurrent disease and 31.4% having trophic skin changes or ulceration. On duplex scanning, 198 legs (62.9%) had saphenofemoral junction incompetence, 61 legs (19.4%) had saphenopopliteal junction incompetence, 94 legs (29.8%) had perforator incompetence and 24 legs (7.6%) had deep venous incompetence. The respective sensitivity of clinical and Doppler assessment at these sites was 71.2, 36.1, 43.6 and 29.2%. If patients who were felt to have sole saphenofemoral junction incompetence clinically were treated by high ligation, stripping to the knee and stab avulsions, 28.9% would have had sites of reflux untreated. CONCLUSIONS: Clinical and Doppler assessment is unreliable. Routine duplex scanning is likely to reduce recurrence by identifying sites of reflux with greater accuracy.

Adult↗