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Biomedical subjects

M A Spiteri

Publications and source records attributed to M A Spiteri.

50 records · Page 3Linked to original sources
PubMed1988

Reliability of eliciting physical signs in examination of the chest.

Agreement between 24 physicians on the presence or absence of respiratory signs was investigated. The physicians were divided into six sets of 4; each set examined 4 patients with well-defined chest signs. There was generally poor agreement about particular signs. Overall, the 4 physicians in a set were in complete agreement only 55% of the time. Some signs such as wheezing seemed to be more reliably elicited than others such as whispering pectoriloquy. Comparison of diagnoses based on the clinical findings with the correct diagnoses supported by investigations showed that 28% of physicians' diagnoses were incorrect. The more often the examiners differed from the majority on the presence or absence of a sign, the more likely they were to make an incorrect diagnosis. A ranked order of the reliability with which chest signs are elicited would improve the teaching of chest medicine.

Clinical Competence↗
PubMed1988

Subcutaneous adrenaline versus terbutaline in the treatment of acute severe asthma.

Subcutaneous adrenaline and terbutaline have been compared in a double blind study of 20 patients with acute severe asthma presenting to an accident and emergency department. Ten patients received adrenaline 0.5 mg (0.5 ml) and 10 terbutaline 0.5 mg (0.5 ml) subcutaneously. Further treatment with nebulised salbutamol (5 mg), hydrocortisone (200 mg), and aminophylline (0.9 mg/kg/hour) was started 15 minutes later. All patients reported a reduction in chest tightness within three minutes of receiving both adrenaline and terbutaline and reported no adverse effects. Mean baseline values of peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1) did not differ significantly between the adrenaline group (130 1 min-1 and 0.83 l) and the terbutaline group (111 1 min-1 and 0.63 l). After administration of adrenaline PEF had increased by 21% and FEV1 by 40% five minutes after the injection, and by 35% and 64% at 15 minutes. Terbutaline caused a 23% increase in PEF and a 37% increase in FEV1 at five minutes, and a 40% and 58% increase at 15 minutes. There was no significant difference in PEF, FEV1, heart rate, blood pressure, or pulsus paradoxus between the two groups at any time. Continuous electrocardiographic recording showed no abnormalities in either group. Thus in this study subcutaneous adrenaline (0.5 mg) and terbutaline (0.5 mg) produced effective rapid bronchodilatation without serious side effects.

Acute Disease↗
PubMed1988

Apparent pulmonary mycetoma following invasive aspergillosis in neutropenic patients.

After the death from massive haemoptysis of two neutropenic patients who had developed apparent pulmonary mycetomas, two subsequent patients underwent successful resection of similar lesions. Histological examination of these lesions confirmed that these so called mycetomas were masses of devitalized lung tissue infiltrated with fungus. The term mycotic lung sequestrum is therefore proposed to distinguish this condition from a fungus ball arising in a previously formed cavity. A review of 34 similar cases reported previously showed that haemoptysis occurred in about half of the cases and was fatal in just over half of these. Medical treatment appears to have little impact on survival and early consideration of surgical intervention is important.

Adolescent↗
PubMed1988

Phenotypic and functional changes in alveolar macrophages contribute to the pathogenesis of pulmonary sarcoidosis.

Bronchoalveolar lavage (BAL) was performed on 10 patients with sarcoidosis and 10 normal volunteers. In each case aliquots of the lavage were used to prepare cytospins on which differential cell counts were performed. Immunocytological methods using monoclonal antibodies RFD1 and RFD7 (identifying dendritic cells and mature macrophages in normal tissues) were performed to identify macrophage subsets. Sarcoid BAL contained a significantly higher proportion of RFD1+ cells (mean 44.7 +/- 10.32% compared to 12.3 +/- 4.0% in normals). Much of this increase was accounted for by a highly significant rise in the proportion of cells with the double phenotype RFD1+/RFD7+ (27.2 +/- 6.1% in sarcoid compared to 7.3 +/- 2.0% in normal). Suspensions of sarcoid and normal BAL were also studied in autologous mixed lymphocyte reactions (AMLR) using peripheral blood mononuclear cells (PBM) as a responder population. AMLRs were therefore set up using BAL, PBM, and BAL with PBM. In each case reactivity was compared to mitomycin treated controls. These studies revealed that sarcoid PBM expressed markedly reduced AMLR reactivity when compared to normal but both sarcoid and normal BAL were relatively unreactive. BAL admixed with PBM suppressed peripheral blood AMLR reactivity in the normals. In sarcoid patients BAL admixed with PBM abolished AMLR completely. We suggest that changes within the BAL macrophage populations in sarcoid patients may significantly influence the pathogenesis of this disease.

Adult↗
PubMed1987

Necrotizing sarcoid granulomatosis.

We report a patient with necrotizing sarcoid granulomatosis (NSG) and point out that while the latter may have certain histological and radiological features distinct from sarcoidosis, sophisticated immunological tests show that the two disorders have essentially similar underlying immune mechanisms. We also stress that although the clinical course of NSG has been repeatedly described as benign and responsive to steroid therapy, the young patient may initially be critically ill with symptoms suggestive of an infective process rather than a granulomatous cause.

Adult↗
PubMed1985

Lupus pernio: a clinico-radiological study of thirty-five cases.

Thirty-five patients with lupus pernio were observed in a series of 818 patients with clinical and histological evidence of sarcoidosis. This analysis provides the natural history of lupus pernio and its associated clinico-radiographic features. There was intrathoracic involvement in 74% of patients, upper respiratory tract disease in 54%, reticulo-endothelial involvement in 54%, bone cysts in 43% and ocular lesions in 37%. It predominated in West Indies-born women. Histological confirmation was easily obtained by nasal mucosal biopsy and this could be repeated serially to evaluate the response to various treatments. Nasal bone radiographs showed destruction of the nasal bones, porosis and alteration in bone texture. Peripheral bone cysts were evident in 50% of patients who were radiographed, and in about 50% of these patients, the cysts were found in both hands and feet.

Adult↗
PubMed1983

Adverse ocular reactions to drugs.

Drugs acting on various parts of the body may also affect the eye insidiously. Increased awareness of such drug toxicity by the prescribing doctor should encourage him to consider effects on the cornea, lens, retina, optic nerve and elsewhere when checking the patient's progress. The following review concerns adverse ocular effects of systemic drug administration.

Eye Diseases↗
PubMedDate not supplied

Virus-induced asthma.

Clinical and experimental investigations indicate that respiratory viral infections are important triggers for asthma attacks. Viral upper respiratory infections have been associated with 80% of asthma exacerbations in children and 50% of all asthma episodes in adults. Human Rhinovirus (HRV) has been implicated as the most common virus associated with asthma episodes. The observation that the great majority of wheezing lower respiratory tract illnesses in early life are associated with acute viral infections suggests that viruses may also alter the development of the lungs or of the immune system, acting as co-factors for the inception of asthma. Whilst there is no doubt that viruses are important asthma exacerbation factors, the role of viral infections in the development of asthma still remains controversial.

Asthma↗