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Biomedical subjects

L R Bagg

Publications and source records attributed to L R Bagg.

At least 19 recordsLinked to original sources
PubMed1987

Significance of tomographic signs in the diagnosis of bronchial carcinoma.

In a previous study the value of conventional tomography was assessed in the diagnosis of 100 potentially malignant opacities on the chest radiograph. To determine which of the radiological signs were most useful the radiologists reviewed 82 of the original 100 radiographs independently, searching for the presence or absence of 36 signs. The five commonest signs of bronchial carcinoma were a mass, coarse linear shadows contiguous to a mass, unilateral hilar enlargement, linear shadows from mass to periphery, and an irregular margin to a mass. The combination of either two or three of these signs was highly sensitive, 95% and 89% respectively, in detecting carcinoma. The most useful specific signs were lobulation of the mass and cavitation with thick or irregular walls.

Bronchography↗
PubMed1984

Assessment of conventional tomography and fibreoptic bronchoscopy in the diagnosis of potentially malignant chest opacities.

Conventional chest tomography and fibreoptic bronchoscopy were performed in 100 patients with a localised chest abnormality on their chest radiographs who had been referred with a possible diagnosis of bronchial carcinoma. Carcinoma was eventually confirmed in 74 cases and in 26 the lesion proved to be benign. The accuracy of tomography in the overall series was 83%, with a sensitivity of 92% and a specificity of 58%. These figures compare favourably with the results of other imaging techniques used in the diagnosis of bronchial carcinoma. In 50 patients bronchoscopy did not suggest carcinoma and in this group of patients 24 had a carcinoma and 26 a benign lesion. The accuracy of tomography in the bronchoscopy negative patients was 74%, the major source of error being the false positive category. The lesion eventually proved to be benign in 33% of the cases where tomography suggested malignancy, but when the tomograms suggested that the lesion was benign a tumour was found to be present in only 12% of cases.

Aged↗
PubMed1984

The 12-min walking distance; its use in the pre-operative assessment of patients with bronchial carcinoma before lung resection.

The 12-min walking distance was measured as part of the pre-operative evaluation of 30 patients with carcinoma of the bronchus consecutively admitted to hospital for lung resection. Of the 22 who had a resection, 7 suffered post-operative ventilatory complications. There was no significant difference in distance walked, both in absolute terms and when standardised for effort, between these patients and the 15 who did not suffer post-operative complications. The empirically derived level of maximum separation between the complication and non-complication groups was in the region of 1,100 m. This approach also failed to provide significant separation between the two groups. Significant separation was achieved by discriminant analysis of simple pulmonary function tests but this separation was not enhanced by entry of values from the 12-min walk into the analysis. These results suggest that there is little to be gained from adding exercise testing to routine pulmonary function tests in pre-operative assessment before lung resection, and that the use of exercise tolerance as a final arbiter of fitness for operation should be viewed with caution.

Carcinoma, Bronchogenic↗
PubMed1984

Relationship of radiologic position to the diagnostic yield of fiberoptic bronchoscopy in bronchial carcinoma.

The radiologic position of tumors in 100 patients with bronchial carcinoma was compared with the diagnostic yield from fiberoptic bronchoscopy. A new method for dividing the chest x-ray film into three areas (hilar, perihilar, and peripheral) was based upon the expected range of vision of the fiberoptic bronchoscope. At bronchoscopy without fluoroscopy, only eight (36 percent) of 22 radiologically peripheral tumors were diagnosed, compared with 31 (94 percent) out of 33 hilar tumors (p less than 0.001) and 34 (76 percent) out of 45 perihilar tumors (p less than 0.01). The results show that in hilar and perihilar tumors, fiberoptic bronchoscopy gives a high diagnostic yield, whereas in peripheral tumors the yield is poor. This method allows the clinician to judge from the chest x-ray film whether a tumor is likely to be visible bronchoscopically. Thus, in radiologically peripheral tumors, as defined by our method, fluoroscopy at the time of fiberoptic bronchoscopy should be available to the clinician, or alternative diagnostic methods should be considered.

Bronchoscopy↗
PubMed1983

Clinical assessment of a rebreathing method for measuring pulmonary gas transfer.

A rebreathing method for measuring carbon monoxide transfer factor (TLCO) and transfer coefficient (KCO) is evaluated. The test was performed on 42 subjects. Seventeen of these had normal lung function while the remainder suffered from various conditions, most having fibrosing alveolitis. No patients with severe airways obstruction were included in the group. The results were compared with single-breath measurements and close correlations were found between single-breath KCO and rebreathing KCO (r = 0.78, p less than 0.001) and between single-breath TLCO and rebreathing TLCO (r = 0.97, p less than 0.001). The reasons for discrepancies between single-breath and rebreathing values are discussed. It is concluded that measurement of rebreathing gas transfer is a useful supplement to routine tests of lung function, particularly in breathless patients with a small vital capacity.

Adult↗
PubMed1982

Lung function in young adults with cystic fibrosis.

Pulmonary function tests have been carried out on eight adults with cystic fibrosis. There were statistically significant correlations between the severity of the patient's clinical state as assessed by the Shwachman score and TLco, TLC and VC. In addition the RV/TLC ratio increased with increasing clinical severity. There were no significant correlations between clinical severity and other measurements of lung function such as FEV1, PEFR, RV or PCO2. Serial studies indicated that the TLCO falls with increasing clinical severity of the disease. It is suggested that the objective measurements of pulmonary function should be included in any future 'scoring' system used to assess the severity of cystic fibrosis and that measurements of the single-breath TLCO might be one of the more discriminant tests.

Adolescent↗
PubMed1981

Analysis of simple pulmonary function screening tests in preoperative assessment before lung resection for bronchogenic carcinoma.

Simple pulmonary function screening tests were performed prospectively in a group of patients with carcinoma of the bronchus being evaluated for lung resection. Of the 22 who subsequently had a resection performed, 7 suffered post-operative ventilatory difficulties unrelated to technical surgical complications. By analysis of combinations of variables, it was possible to separate significantly the complication group from the non-complication group. This was not possible using one variable alone. The method of empiric determination of values which produce maximum separation is described and contrasted with the more statistically acceptable technique of discriminant analysis. With the latter it is possible to incorporate information from any number of variables and to achieve greater definition of the two groups. It is proposed that such an analysis might provide the means for more valid scientific assessment of simple pre-operative screening tests than is usually employed.

Carcinoma, Bronchogenic↗
PubMed1980

Dose-response study of the nasal decongestant and cardiovascular effects of pseudoephedrine.

1 The effects of different doses of orally administered pseudoephedrine on nasal airway resistance (NAR) were studied in a group of eighteen healthy subjects using double-blind conditions with drugs administered in a series of cross-over experiments according to a Latin-square design. 2 Challenge with 1% histamine diphosphate to one nostril 1 h after administration of the drugs produced increases in NAR. 3 The effects of pre-treatment with both placebo and increasing doses of pseudoephedrine on this histamine-induced increase in NAR were examined. Pseudoephedrine 60 mg, 120 mg and 180 mg significantly (P less than 0.05) reduced the effect of histamine on NAR compared with the placebo, and the protective effects of these doses did not differ significantly from each other. Pseudoephedrine 15 mg and 30 mg did not differ from placebo in their effects on NAR. 4 Small, but statistically significant increases in pulse and systolic blood pressure occurred after pseudoephedrine 120 mg and 180 mg, but not after pseudoephedrine 60 mg, 30 mg or 15 mg. No significant effects were produced by any of the doses of pseudephedrine with regard to diastolic blood pressure. Similarly no dose of pseudoephedrine altered mood or produced any excess of unwanted effects compared with placebo. 5 We conclude that pseudoephedrine 60 mg is the optimal single adult dose since this achieves maximal nasal decongestion without cardiovascular or other unwanted effects.

Adult↗
PubMed1980

Diurnal variation in peak expiratory flow in asthmatics.

Diurnal variation of peak expiratory flow was assessed over 10 days in 40 asthmatic outpatients judged clinically to be stable. Thirty patients showed a morning dip in their peak expiratory flow and the frequency with which this occurred appeared to be linked with the amplitude of the dip. The percentages showing large, moderate and insignificant dips were similar to those described in asthmatics hospitalised with an exacerbation. Ten patients were admitted with an exacerbation of their asthma in the preceding 2 years. Two of the three non-dippers assumed a dipping pattern during this admission. Without a continuous peak expiratory flow record it would not have been thought that many of our apparently stable patients were showing high amplitude dips such as have been associated with sudden unexpected death. The place of a continuous diurnal peak expiratory flow record in relation to asthma mortality is discussed.

Adult↗
PubMed1979

Rheumatoid arthritis in Kenya. I. Clinical observations.

76 Kenyan Africans with classical or definite rheumatoid arthritis are described. Their age, sex ratio, and pattern of joint involvement closely resembled that seen in Europe and the USA and differed from that described in West Africa and rural South Africa. However, they showed a marked lack of systemic nonarticular complications, with relatively little functional incapacity. Radiological grading was carried out on 58 cases, and the changes were found to resemble more closely those seen in an English series than in a Nigerian series.

Adult↗
PubMed1979

Rheumatoid arthritis in Kenya. II. Serological observations.

Sera from 48 Kenyan Africans with rheumatoid arthritis, 43 patients with other diseases, and 98 blood donors were tested for the presence of rheumatoid factor by latex fixation tests using human European, human African, and rabbit immunoglobulin, and a sheep cell haemagglutination test. In the patients with rheumatoid arthritis the frequency of rheumatoid factor was comparable to that reported in series from Europe and the USA, thus differing from the findings in West Africa. In the control patients and blood donors a high frequency of positive tests for rheumatoid factor was found; a similar result has been obtained from population studies in other African countries. Broadly similar results were obtained with each of the latex tests, and these were found to be less specific for rheumatoid arthritis than the sheep cell haemagglutination test.

Adolescent↗
PubMed1979

Serial pulmonary function tests in progressive systemic sclerosis.

Serial pulmonary function tests were performed on nine patients with progressive systemic sclerosis over a mean period of ten years. Abnormality was seen to develop both early and late in the course of the disease, and the earliest abnormality observed was impairment of the transfer factor. Deterioration of some aspect of pulmonary function was noted in each case, evidence of restriction or air trapping being seen with equal frequency. Two patients died, both of causes unrelated to their pulmonary involvement, and even pronounced early involvement of the lungs did not necessarily imply a bad prognosis.

Adult↗
PubMed1978

Medical care in a tropical national reference and teaching hospital: outline study of cost-effectivenees.

During a 28-day prospective audit the cost-effectiveness of treatment in three types of medical wards in a large tropical teaching hospital was assessed. Patients with chronic diseases such as rheumatic heart disease were more expensive to treat than those with acute, curable illnesses such as malaria. It was concluded that the cost of providing treatment could not be reduced without affecting standards of medical care. The expense of running such a hospital might also be justified by its importnat function as a teaching hospital.

Cost-Benefit Analysis↗
PubMed1978

New and old agents in diarrhea: a prospective study of an indigenous adult African population.

We conducted a prospective study 77 indigenous African adults with acute diarrhea seeking care at the major hospital in Nairobi, Kenya, to determine the major pathogens responsible for this syndrome in adults. Fecal and blood specimens were collected and examined for enteric bacterial pathogens, viruses, and parasites. In 13 (26%) inpatients and 11 (49%) outpatients Shigella was found, and heat-labile and heat-stable forms of enterotoxigenic Escherichia coli were found in 9 (18%) inpatients and 1 (4%) outpatient. Human revirus-like agent titers rose significantly in another 3 (6%). Amebic dysentery was not seen although hemagglutination-inhibition tests for invasive Entamoeba histolytica were positive in 4 inpatients. An etiologic agent was found in 65% of patients.

Adolescent↗