Search PubMed⌕ Search

Biomedical subjects

M G Pearson

Publications and source records attributed to M G Pearson.

68 records · Page 4Linked to original sources
PubMed1985

Rearrangements of chromosome 3 involving bands 3q21 and 3q26 are associated with normal or elevated platelet counts in acute nonlymphocytic leukemia.

Fourteen patients with acute nonlymphocytic leukemia (ANLL) or dysmyelopoietic syndromes were found to have abnormalities involving the long arm of chromosome 3. In eight patients, the structural rearrangements involved both bands 3q21 and 3q26 and included t(3;3) (four patients), inv(3) (three patients), and ins(5;3) (one patient). Before treatment, seven of these eight patients had platelet counts above 100,000 per microliter, five had normal or elevated platelet counts, and four had significantly elevated platelet counts (600,000 to 1,731,000 per microliter). In each of the eight cases, normal or elevated platelet counts were associated with marked abnormalities of megakaryocytopoiesis, including increased numbers of megakaryocytes and numerous micromegakaryocytes. Classification within the French-American-British system was difficult in most of these cases; however, the leukemia in five of the eight patients with abnormalities of chromosome 3 that involved both bands 3q21 and 3q26 was classified as M4. The remaining six of the 14 patients had translocations between chromosome 3 and another chromosome. None involved both bands 3q21 and 3q26, and a break in either q21 or q26 was noted in only two patients. One of the six, who had ANLL (M4) with a normal platelet count, had a 3;5 translocation which involved band 3q25. These data suggest that in patients with ANLL, abnormalities of chromosome 3 which simultaneously involve bands 3q21 and 3q26 are associated with unusually high platelet counts.

Adult↗
PubMed1984

Hypoxia in patients with acute hemiplegia.

Sixteen patients with an early dense hemiplegia due to cerebrovascular accidents were shown to have a greater degree of hypoxia than 16 matched control patients. The patients with hemiplegia had a reflex compensatory fall in arterial carbon dioxide tensions (PaCO2) with possible reduction in cerebral blood flow. Oxygen treatment led to an increase in PaCO2 in the patients with hemiplegia, but the increase in oxygen tensions in these patients was significantly less than that in the control group, suggesting increased pulmonary shunting as the cause for the hypoxia. Oxygen treatment may improve cerebral blood flow and oxygenation and have a useful role in the early management of patients with a dense hemiplegia.

Aged↗
PubMed1984

The effect of exercise on the deposition of an inhaled aerosol.

We investigated the regional deposition in the lungs, of an inhaled submicron aerosol at rest and during exercise in 13 normal volunteers of whom 5 were cigarette smokers. The degree of exercise (VO2 approximately 2 L/min) was chosen to simulate moderately heavy physical labour. Tracheobronchial and alveolar components of deposition were measured by comparing images immediately after inhalation of aerosol and 24 h later when mucociliary clearance was complete. At rest almost all deposition was alveolar (97%). The increase in total deposition on exercise was of similar order to the increase in ventilation. On exercise regional alveolar deposition became more even, although basal still exceeded apical deposition. Tracheobronchial deposition on exercise was increased in all zones but particularly in the upper zones, thereby contrasting with the base to apex gradient of parenchymal deposition. These changes were exaggerated in the smokers. The increased upper zone tracheobronchial deposition may have implications in regard to the pathogenesis of diseases caused by the inhalation of dusts and fumes.

Adult↗
PubMed1984

Kaolin dust concentrations and pneumoconiosis at a kaolin mine.

Kaolin is removed from underground seams in the mining area to a processing area, where it is sliced, dried, and pulverised to make the finished product. A study was undertaken to determine the dust concentrations in various work areas and to assess the prevalence of radiographic and pulmonary function abnormalities in 65 workers at a Georgia kaolin mine. Respirable dust concentrations were higher in the processing area than in the mine or maintenance areas for all determinations from 1977 to 1981. The mean respirable dust level in the processing area in 1981 was 1.74 mg/m3 and 0.14 mg/m3 in the mine area. Five workers, all of whom had worked at the processing area, had radiographic evidence of kaolin pneumoconiosis. The mean values of forced vital capacity (FVC) and FEV1 of the entire group were within the normal range. When the spirometric values were expressed as a percentage of the predicted values, the FVC and FEV1 were significantly lower in the workers with kaolinosis than in other workers in the processing area. The FVC and FEV1 also declined significantly with increasing years of work in the processing area. The FEV1/FVC%, however, was not significantly altered either by the presence of kaolinosis or by an increasing number of years of work, indicating that the impairment was restrictive and hence likely to be a consequence of dust inhalation rather than smoking. In this study the highest dust concentrations occurred in the processing area, and kaolin pneumoconiosis was limited to those who had worked there. Kaolin exposure appeared to have a small but significant effect on ventilatory capacity in those with kaolin pneumoconiosis and in workers with a longer exposure. There was no association between the radiographic appearances of kaolinosis and cigarette smoking or between the presence of radiographic abnormalities and reduced arterial blood gas tensions.

Adult↗
PubMed1983

Surgical treatment of emphysematous bullae: late outcome.

From 1967 to 1972 12 patients were operated on for emphysematous bullae in the Liverpool regional cardiothoracic centre. The patient with the poorest lung function died in the immediate postoperative period but the remainder survived for more than five years. All but one of the survivors showed evidence of benefit three to six months after surgery and all those not retired returned to full-time employment for at least five years. Nine patients were reviewed 5-10 years after surgery. These all reported a gradual return of dyspnoea, which was matched by a falling one-second forced expiratory volume (FEV1) (mean fall 82 ml a year); but five were still maintaining some of their postoperative improvement. When mean preoperative lung function values were compared with the values obtained 5-10 years later there was still a significant improvement in forced vital capacity; but FEV1, residual volume, transfer coefficient, and arterial oxygen and carbon dioxide tensions were unchanged. Chest radiographs showed no new bullae or (except in one case) any increase in size of pre-existing bullae. We conclude that the removal of large emphysematous bullae did not hasten the progress of the underlying emphysema and that in most patients some benefit lasted for more than five years after the operation. Patients treated by lobectomy fared at least as well as those treated by bullectomy alone. It may be relevant to the relatively good progress of patients in this series that only three had suffered from chronic bronchitis before operation or smoked after operation, all but two had bullae occupying half or more of one hemithorax, and none had hypercapnia.

Adult↗
PubMed1982

The inspiratory "squawk" in extrinsic allergic alveolitis and other pulmonary fibroses.

An inspiratory musical sound ("squawk") was recorded in 14 patients with diffuse pulmonary fibrosis. These were divided into two groups: nine patients suffering from extrinsic allergic alveolitis (seven with bird fancier's lung and two with farmer's lung) and five patients with pulmonary fibrosis due to other causes, including rheumatoid disease, Wegener's granulomatosis, systemic sclerosis, and sarcoidosis. Clinical studies and phonopneumographic analysis of 10 consecutive squawks in each patient showed that the sound in the group with extrinsic allergic alveolitis was of shorter duration, occurred later in inspiration, and tended to be of higher frequency than the sound heard in the other group. Inspiratory crackles were present in all patients and in eight a single loud crackle preceded the squawk. We suggest that squawks, like crackles, result from the opening of airways and that the differences between the squawks in the two groups may reflect the size of the affected airways.

Adult↗
PubMed1981

Pleural mesothelioma presenting as apparent recurrent pulmonary embolism.

Three patients with malignant mesothelioma of the pleura presented with unilateral pleural effusion and recurrent horizontal linear opacities on the chest radiograph. Although an initial diagnosis of pulmonary embolism was made in all three patients and two received anticoagulants, it is more likely that the opacities represented plate atelectases due to restriction of basal lung expansion by severe chest pain. It is suggested that the early manifestations of malignant mesothelioma of pleura may be confused with recurrent pulmonary embolism.

Adult↗
PubMedDate not supplied

A confidential study of deaths after emergency medical admission: issues relating to quality of care.

In this retrospective pilot study we examine the feasibility of establishing a confidential enquiry into why some patients die after emergency admission to hospital. After excluding those who died in the first hour or who were admitted for palliative care, pairs of physicians were able to collect quantitative and qualitative data on 200 consecutive deaths. Both physicians reported shortfalls of care in 14 patients and one of the pair in 25 patients whose deaths would not have been the expected outcome. In 25, the shortfalls of care may have contributed to their deaths. Major problems were delays in seeing doctors, inaccurate diagnoses, delays in investigations and initiation of treatment. They occurred mostly in those admitted at night. It is possible that establishing the correct diagnosis and starting appropriate treatment may have been delayed in 64% of the 200 patients. The headline figures appear worse than some previous external assessment studies but this study did concentrate on those in whom problems were more likely. Nevertheless, the frequency is too high to be overlooked. In this feasibility study we have demonstrated that it is practicable for local staff to collect and assess data in hospitals and that the types of problems identified are relevant to anyone planning how to organise emergency care. A larger definitive study should be performed.

Aged↗
PubMedDate not supplied

The national sentinel audit for stroke: a tool for raising standards of care.

STUDY OBJECTIVE: To assess the quality of inpatient care and follow-up for stroke in England, Wales and Northern Ireland. DESIGN: Retrospective audit of case notes and service organisation. SETTING: 197 trust (80% of eligible trusts in England, Wales and Northern Ireland). PATIENTS: 6,894 consecutive stroke patients admitted between 1 January 1998 and 31 March 1998 (up to 40 per trust). AUDIT TOOL: The Intercollegiate Stroke Audit. RESULTS: Most patients were admitted to acute hospitals with access to the appropriate acute investigations and treatments. Only 64% of trusts had a physician with responsibility for stroke and only 50% had a stroke team. Involvement of different members of the multidisciplinary team within appropriate time-frames varied from 37% to 61%. Assessment of impairments specific to stroke was inadequate (screening for swallowing disorders in only 55%, cognitive function tests in 23% and visual field examination in 44%). Rehabilitation goals were agreed by the multidisciplinary team in only 55% of eligible cases. 41% of patients were contacted by their GP within 3 days of discharge. The best compliance with standards was achieved for the 18% of patients who spent at least 50% of their time in a stroke unit. CONCLUSIONS: This national audit demonstrates that care is suboptimal in many areas, and that there is wide variation in standards for the management of stroke across the country. This may have implications for clinical governance.

Aftercare↗
PubMedDate not supplied

National benchmarking as a support system for clinical governance.

Audit of the management of acute asthma in hospital has developed in tandem with guidelines produced and updated by the British Thoracic Society (BTS), on the principle that agreed guidelines combined with systematic review of practice by periodic audit are more likely to result in improvements in practice than guidelines alone. A short audit data set was distilled from previous experience with more elaborate tools and made available nationally to audit departments and through letters to consultant members of the BTS. Hospitals have been able to contribute since 1990. The data set reflects key items of the process of care: peak flow measured on admission and twice daily during the hospital stay; blood gases on admission; systemic corticosteroids as an inpatient; discharged with inhaled and oral corticosteroids; written self-management plans; follow-up arrangements. Data from 4,741 admissions over a seven year period are presented. The proportion of patients nationally receiving these items of asthma care is given. The median values for hospital performance improved significantly over the seven years, although there is potential for further improvement. If these data represent the national picture, they could form the basis upon which to set national standards for the care of patients with acute asthma in hospital. A further result of the developing audit has been the recognition of the value of external benchmarking in providing a context for the interpretation of local audit results. This audit system provides hospitals with a quick and easy method of obtaining an overview of local performance, with comparative national data for the same year. This has potential as a tool for clinical governance with much wider applicability, providing the data are handled carefully, particularly as the variability between hospitals diminishes over time.

Asthma↗
PubMedDate not supplied

An analysis of medical workload--evidence of patient to specialist mismatch.

The National Health Service has employed physicians since its inception, yet 46 years later there are few data on the day-to-day work done by physicians. This paper describes the case mix of general medicine in one region using data for general medical admissions to one specialty (respiratory medicine) as a working example. The pattern of general medical inpatient admissions is consistent across the 10 districts in the Mersey region: 26% have a respiratory diagnosis, 22% cardiac, and 15% gastrointestinal. For medical day cases, 60% are gastrointestinal. The average length of stay for particular conditions varies little between hospitals, and the average consultant 'cares' for 949 consultant inpatient episodes per year. In only half the Mersey districts is the respiratory consultant provision appropriate for the case mix admitted to the hospital. A simple algorithm applied to data collected routinely by regional health authorities can yield much information upon which to plan medical manpower. Applied to a specialty, it has identified mismatches between workload and consultant type. For respiratory medicine, at least six more respiratory physicians (a 30% increase) are needed to correct the underprovision in Mersey region.

Diagnosis-Related Groups↗