Biomedical subjects
Publications and source records attributed to R Marshall.
Streamlining of air flow in the upper airways and trachea has been investigated by inhaling 81m krypton through each side of the nose separately and counting over the lung fields with a gamma camera. 81m Kr inhaled through one nostril was uniformly mixed in the air stream by the time the carina was reached. Gas mixing occurs probably by a combination of diffusion and turbulent flow.
Tax credits will help reimburse employers for the added costs of hiring and training disadvantaged workers from seven target groups with especially high rates of unemployment.
A nasal mask consisting of a frame covered with a thin latex membrane allows one nostril to be closed by the application of light pressure with a finger. When the mask is connected to a pneumotachograph it is possible to measure the resistance of each side of the nose separately by posterior rhinometry.
Children not initially admitted to the hospital accounted for 42 of 94 episodes of bacteremia due to Haemophilus influenzae. Antibiotics were prescribed for 22 of the 42 children who were initially sent home; at second visit, 17 were improved, including all 13 with pneumonia. No antibiotics were prescribed for 20 children; at second visit, 15 had persistent fever or new focal infection and five had resolution of symptoms. New diagnoses of focal infection were made at second visit in three of the 22 treated and in 11 of the 20 untreated children, including three who had a new diagnosis of meningitis (one treated with antibiotics initially; two not treated). Cultures of blood positive for H. influenzae were obtained at second visit in ten children who were not treated initially; no child who was treated initially had a second positive culture. These findings indicate that although young children with bacteremia due to H. influenzae may be mildly ill at first visit, many are at risk for development of serious focal infection, including meningitis.
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One year's experience with MAS in a neonatal intensive-care unit is analyzed with follow-up information. Seventeen patients or 3.7% of all admissions had MAS. Four patients (23.5%) died of acute respiratory failure. Two patients with MAS and persistence of the fetal circulation required cardiac catheterization to exclude cyanotic congenital heart disease. No survivors had persistent chronic lung disease. However, two of three patients with MAS and seizures had significant psychomotor retardation at follow-up examination.
A questionnaire survey of 1005 consecutive attenders at four outpatient clinics yielded 117 (12%) budgerigar fanciers (exposed to budgerigars- known in North America as parakeets-for at least three months) and 296 (29%) former fanciers. Twnety had precipitins to budgerigar serum or droppings or both, and 10 of these together with 39 precipitin-negative patients reported undue breathlessness on exertion during exposure to buderigars. These 59 patients were investigated further, seven completing a series of inhalation provocation tests with budgerigar antigens designed to confirm or exclude budgerigar-fancier's lung (BrFL). Typical positive responses were obtained from four current and one former fancier. The prevalence of confirmed BrFL among the 11n current budgerigar fanciers was 3.4% (four cases). This was biased, however, by the inclusion of one patient whose attendance at the surveyed clinic was attributable to the disease. With the exclusion of this patient, confidence limits suggested that the true prevalence of BrFL among current budgerigar fanciers in the general population lies between 0.5% and 7.5%, which is similar to the prevalence of farmer's lung in farm workers. In view of the enormous population at risk, however, this implies that BrFL rather than farmer's lung is by far the commonest type of allergic alveolitis in Britain.
A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically, including parenteral and gavage aminoglycoside antibiotic, and Stage III patients require operation. All Stage I patients survived, and 32 of 38 Stage II and III patients (85%) survived the acute episode of NEC. Bacteriologic evaluation of the gastrointestinal microflora in these neonates has revealed a wide range of enteric organisms including anaerobes. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.
This study is of the results of surgical management of bleeding chronic peptic ulceration at Prince Henry's Hospital, retrospective for the periods 1951 to 1960 and 1961 to 1970 and prospective for 1972 to 1977. During the latter five years all patients were admitted from the community to a haematemesis and melaena unit with a defined policy of management and prospective data recording for computer analysis. There was a continuing improvement in mortality over this 25-year period, especially with duodenal ulcer. No clear distinction could be made between conservative surgery and partial gastrectomy in terms of reduced surgical mortality in duodenal ulcer. Bleeding gastric ulcer remains a difficult problem, with a current surgical mortality of 21%.
Precipitin responses to different avian serum antigens occur in bird fancier's lung (BFL) and coeliac disease. Failure to distinguish between them could encourage an erroneous diagnosis of BFL in patients with coeliac disease, and the recent suggestion that these two disorders are strongly associated may be questioned, partly for this reason. In the present study small bowel biopsy specimens were obtained from 12 of a series of 14 patients proved to have BFL by inhalation provocation tests. None was suggestive of coeliac disease. Of a further 61 patients with biopsy-proved coeliac disease, seven were found to be exposed currently and 33 formerly to birds. As a result of clinical evaluation, BFL was considered a possible cause of undue breathlessness reported by three of the current bird fanciers only, and all underwent inhalation provocation tests. One alone gave positive results. We conclude that if a real association does exist between these two disorders, its clinical importance has been greatly exaggerated.
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A rebreathing method for measuring carbon monoxide diffusing capacity is described. The method can be used in patients whose vital capacity is too small, or whose cooperation is inadequate, for the single-breath method. The apparatus is simple and the same gas mixtures are used as for the single-breath method. The results obtained by the rebreathing method are similar to those by the single-breath method (80% of the results by the rebreathing method lie within 20% of the value by the single-breath method). The rebreathing method also provides a measurement of the functional residual capacity.
A case of single coronary artery from the right sinus of Valsalva with a connecting branch passing between the aorta and right ventricular infundibulum is described. The anomaly was demonstrated at coronary arteriography and verified at surgery. This type of single coronary artery has been associated with sudden exertional death in young persons. The case prompted a review of the classification of single coronary artery with emphasis on clinical significance of the various subtypes and angiographic findings.
Twelve patients with recent weight loss to less than 85% of standard weight-height ratio and a serum albumin level of at least 3 gm/100 ml were considered to have the adult equivalent to marasmus. Cellular immune function was assessed by delayed hypersensitivity skin testing to Monilia and streptokinase-streptodornase, peripheral lymphocyte count, proportion of T and B cells, whole blood and isolated lymphocyte transformation to phytohemagglutinin, pokeweed mitogen, concanavalin A, Monilia, and streptokinase-streptodornase. Significant impairment of skin test reactivity while in vitro responsiveness remained intact was noted in the marasmic patients. No impairment was found in 12 individuals with recent weight loss who remained at a weight greater than the 85% weight-height ratio. In four marasmic individuals in whom weight loss was arrested by nutritional repletion, skin reactivity returned without substantial change in weight. In this type of marasmus, both depleted nutritional status and weight loss must be present for impairement of skin test responsiveness. These findings confirm relative sparing of more vital functions dependent on protein metabolism in adult marasmus compared to the kwashiorkor-like syndromes of hypoalbuminemic malnutrition seen in adults.
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