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Biomedical subjects

N J Snell

Publications and source records attributed to N J Snell.

34 records · Page 2Linked to original sources
PubMed1982

A trial of prophylactic mexiletine in home coronary care.

A double blind randomised study was undertaken comparing the effects of oral mexiletine and placebo given by general practitioners at home in the early stages of suspected acute myocardial infarction, and continued for six weeks. The study comprised 216 patients. In 59 the diagnosis of acute myocardial infarction was not confirmed. Of the 72 patients with confirmed myocardial infarction treated with mexiletine, 11 (15.3%) died, compared with 19 (22.4%) of the 85 patients given the placebo, and significantly fewer of the former compared with the latter had frequent ventricular ectopics or ventricular tachycardia recorded on 24 hour electrocardiograms. Numbers of patients transferred to hospital or withdrawn from the trial because of arrhythmia or heart failure were similar in the two treated groups. Ten (13.9%) of the patients taking mexiletine had the drug withdrawn because of side effects attributed to it, compared with three (3.5%) of the group taking the placebo. A further five patients (all on mexiletine) also had treatment withdrawn because of side effects but infarction was not later confirmed. The results indicate that oral mexiletine can be given safely to patients with suspected myocardial infarction at home by their general practitioners in the absence of a positive electrocardiographic diagnosis. The frequency of ventricular tachycardia is significantly reduced; but there is no evidence of reduced mortality.

Aged↗
PubMed1981

A survey of deaths in Hong Kong attributed to tuberculosis.

Records obtained for 578 (96%) of the 602 patients certified as having died from tuberculosis in Hong Kong during a 1-year period were reviewed by an expert independent assessor in London, In his opinion 14 (2% of the 578) had never had tuberculosis, and in 28 (5%) it was not possible to decide whether or not the patient had ever had tuberculosis. Tuberculosis had been no more than a contributory factor in causing death in 44 (8%), in 29 (5%) it was irrelevant, and in 33 (6%) it was not possible to determine what role it had played. The remaining 430 (74%) patients were considered actually to have died from tuberculosis, 307 from active disease and 123 from the late effects of inactive disease. If all 578 patients had died from tuberculosis this would represent a death rate for the survey year of 13.1 per 100 000 of the population. The rate falls to 9.7 per 100 000 if based on the 430 patients considered by the assessor to have died from tuberculosis, a reduction of 26%. Since the annual death rate from active disease (6.9 per 100 000 in this survey) is a better index of the current efficiency of an antituberculosis programme than the total death rate, it is suggested that efforts should be made to obtain and publish separate annual rates for deaths from active and from inactive tuberculosis. An analysis of potentially avoidable delays and failures in diagnosis showed that these were mainly due to the patient's delay in seeking or accepting advice, or inadequate investigation, particularly failure to examine the sputum, by the unofficial (non-governmental) medical services. The majority of failures in management were attributable in whole or in part to the patient.

Adolescent↗
PubMed1979

A comparison of Mantoux and tuberculin Tine testing in a chest unit.

Simultaneous Mantoux (10 T.U.) and Tuberculin Tine tests were performed on 393 in-patients on a chest unit. The results were read by the same observer between 48 and 72 hours later. The overall agreement between the tests was 78%; this rose to 90% if patients categorised as 'doubtful' reactors were reclassified as positive. Where one test was 'doubtful' the other was more than 3 times as likely to be positive as negative. It is suggested that the 'doubtful' category by abandoned for both tests and readings in this range be reclassified as positive. In patients expected on clinical grounds to be positive reactors, over one-third were negative to both tests; in those expected to be negative over one-fifth were positive. The Tine test is convenient and gives results which seem to correlate well with the Mantoux test, although neither test appears to be highly specific.

Adult↗
PubMed1979

Tuberculin reactivity as a predictor of survival time in inoperable bronchial carcinoma.

One hundred and two patients with inoperable bronchial carcinoma who had tuberculin tests at the time of diagnosis were followed up to see if there was any correlation between their degree of tuberculin reactivity and their subsequent survival time. There was a significant difference in survival between positive and negative tuberculin reactors (Log Rank Test P less than 0.05), the former having a median survival time almost twice that of the latter. This did not appear to be related to clinical differences between the groups at the time of testing, and other possible explanations are discussed. Tuberculin testing may be useful in helping to assess prognosis in patients with inoperable bronchial tumours.

Aged↗
PubMedDate not supplied

Pediatric tuberculosis in immigrants to the United Kingdom from the Indian sub-continent.

Tuberculosis (TB) is now an uncommon disease in the United Kingdom (U.K.) and its overall incidence is declining. However, the incidence of TB in immigrants from India, Pakistan, and Bangladesh (the Indian sub-continent, ISC) is much higher than in the native white population or immigrant groups from other areas, and this is so even for children of ISC ethnic origin born in the U.K. The clinical pattern of the disease also differs, extrapulmonary involvement being commoner in ISC patients than white patients. The epidemiology and management of TB in pediatric patients of ISC origin is reviewed and reasons for differences from other ethnic groups in the U.K. are discussed.

Adolescent↗
PubMedDate not supplied

A survey of ventilatory capacity in Chinese subjects in Hong Kong.

A survey of three indices of ventilatory capacity (forced expiratory volume in one second, FEV1; forced vital capacity, FVC; and peak expiratory flow rate, PEFR) was carried out on 3490 Chinese inhabitants of Hong Kong aged between 5 and 97 years. The results are compared with those of previous surveys of ventilatory capacity in a variety of ethnic groups. Our results confirm previous findings that the indices FEV1 and FVC are proportional to the square of the height of the subject, but we have found that PEFR is proportional to height itself. Using the indices FEV1/height2, and PEFR/height we have derived regression equations which may be used to predict normal values of the ventilatory indices for both adults and children. An interesting observation in this cross-sectional survey was that although all ventilatory indices were adversely affected by smoking, the rates of decline of these indices with age were not accelerated in smokers compared with non-smokers, in contrast to the findings of previous surveys on European populations.

Adolescent↗