Biomedical subjects

P Clarkson

Publications and source records attributed to P Clarkson.

46 records · Page 3Linked to original sources

PubMed1994

Doppler echocardiography and the early diagnosis of carditis in acute rheumatic fever.

BACKGROUND: The incidence of acute rheumatic fever in New Zealand remains relatively high. Reliable early diagnosis of carditis is difficult and important in management. AIM: To determine if Doppler echocardiography contributed to the early diagnosis of carditis in acute rheumatic fever. METHODS: Forty-seven patients admitted to hospital with suspected acute rheumatic fever and 19 control patients, with a febrile illness due to a documented non-cardiac bacterial infection, were assessed two days and two weeks following admission. Presence or absence of clinical carditis was determined by a cardiologist unaware of the suspected diagnosis, from clinical examination, chest radiograph, electrocardiogram (ECG) and two dimensional echocardiogram. Doppler echocardiography was then performed and interpreted by a second cardiologist unaware of the diagnosis. After completion of the study the Jones criteria were applied, to categorise the patients with suspected acute rheumatic fever into four groups for the final diagnosis: no acute rheumatic fever, possible acute rheumatic fever, definite acute rheumatic fever without carditis, and definite acute rheumatic fever with carditis. RESULTS: In 19 patients with a final diagnosis of acute rheumatic fever and carditis at the baseline assessment carditis was detected by clinical assessment in 15 patients, compared with 19 patients with evidence of significant valve regurgitation by Doppler echocardiography. Following the two week assessment, all 19 patients had both clinical and Doppler evidence of carditis. Five patients with a final clinical diagnosis of possible acute rheumatic fever or definite acute rheumatic fever without carditis, had a Doppler abnormality detected. There was no clinical or Doppler abnormality in the febrile controls. CONCLUSIONS: Doppler echocardiography is more sensitive than clinical assessment in the detection of carditis in acute rheumatic fever, and can contribute to earlier diagnosis.

Acute Disease↗

PubMed1994

Effect of ethnic origin of mother on fetal outcome.

The outcome of 11046 infants, from 20 weeks' gestation, born to mothers of different ethnic origins within one London borough has been analysed. There was no difference in perinatal death rates between the Asian and white infants. Among those with mothers from Africa and the West Indies there were overall significantly more intrauterine deaths (26.8/1000 and 20.0/1000) and neonatal deaths (8.6/1000 and 9.6/1000) than for the white mothers (intrauterine deaths 8.3/1000; neonatal deaths 3.7/1000). At less than 28 weeks', gestation specific death rates were similar in all groups and the overall higher death rates were due to an increase in the proportion of preterm deliveries among the black mothers. From 28 to 36 weeks' gestation, black infants born alive had lower neonatal death rates (7.7/1000) than the white infants (19/1000). The cause of the increased incidence of preterm labour among the black mothers is uncertain, though differences in intrauterine infection rates may be an important factor.

Adult↗

PubMed1994

Left ventricular hypertrophy in hypertension--general and local trends in diagnosis and therapy.

LVH is a frequent echocardiographic finding in the general population but it should be regarded as an ominous predictor of future cardiovascular events rather than an innocent compensatory phenomenon. Echocardiography is the most sensitive and specific method for its detection but the ECG should not be regarded as superfluous since additional prognostic information and information about coexisting myocardial damage is present. The decreasing prevalence of LVH suggests that LVH can be prevented by control of hypertension and prevention of weight gain. Once LVH is present then antihypertensive drugs, weight reduction or salt restriction may promote its reversal, with early studies demonstrating associated improvement in mortality and morbidity.

Adult↗

PubMed1994

Left ventricular diastolic dysfunction.

Diastolic heart failure is common, particularly in patients with coronary artery disease and hypertension. Although it does not contribute to heart failure mortality to the same degree as systolic dysfunction, it is responsible for significant morbidity. Clinical suspicion is a prerequisite to the diagnosis, which should be considered in all patients with exercise intolerance due to dyspnoea, particularly if associated with a history of ischaemic heart disease or hypertension. Although invasive haemodynamic studies are the gold standard investigation, this method of assessment is limited to a very small proportion of these patients, and echocardiography remains the single most useful investigation. It is important to realize that the management of diastolic heart disease depends to a large extent on the aetiology, which contrasts with the treatment of systolic dysfunction. As indicated, a wide variety of different drugs may potentially be of benefit, although considerable further research will be needed to more clearly define this heterogenous condition and its optimal treatment.

Diastole↗

PubMed1985