Contemporary concepts in the diagnosis, treatment and natural history of pulmonary embolism are reviewed, and a practical rationale for investigation and therapy is outlined.

Acute Disease↗

PubMed1986

Rapid diagnosis of sputum negative miliary tuberculosis using the flexible fibreoptic bronchoscope.

Acid fast bacilli are seldom identified by direct staining of sputum smears in patients with miliary tuberculosis, so that delays in diagnosis are common. We report 41 patients with miliary tuberculosis who had negative sputum smears and who underwent bronchoscopy, bronchial brushing, and transbronchial biopsy. In two patients the procedure was repeated. A definitive diagnosis was obtained from bronchoscopy in 34 patients (83%). Bronchial brushings yielded Mycobacterium tuberculosis in 24 of 42 bronchoscopies (57%), 13 from direct smear and a further 11 from culture only. Transbronchial biopsies were diagnostic in 30 of 41 procedures (73%), 28 from histological appearances, one from direct smear of the biopsy specimen, and another exclusively from culture. A rapid diagnosis was established in most patients (27/34), either by direct smear of brushings or biopsy specimens only (5), by histological examination only (14), or by both direct smear of brushings and biopsy specimens only (5), by histological examination only (14), or by both direct smear of brushings and histological examination (8). The diagnosis was confirmed later in a further seven patients by culture of brushings or specimens; in five of these non-caseating granulomas were initially found by histological examination. Fibreoptic bronchoscopy is a valuable technique for rapidly establishing the diagnosis of miliary tuberculosis.

Adolescent↗

PubMed1985

Morbidity trends in the medical wards at Groote Schuur Hospital--1971 and 1982.

In 1971, 5 544 patients were admitted to the 261 Department of Medicine beds at Groote Schuur Hospital. During 1982 8 005 patients were admitted although the number of beds remained essentially unchanged. Whites constituted 54,7% of all admissions in 1971 and 39,3% in 1982. The overall mortality rate fell from 14,9% in 1971 to 9,6% in 1982, and the respective autopsy rates from 25,9% to 18,2%. Patterns of morbidity observed in the various population groups differed greatly and changed over the period studied. Comparisons between morbidity patterns in our patients and national mortality patterns showed close parallels within each population group and major differences between the different groups--those those in whites closely resemble patterns in industrialized countries, whereas for the patients of mixed race and black patients they more closely approximate those in developing countries. Attention is drawn to the inadequate growth of medical facilities in relation to population expansion, and to the urgent need for a far-sighted, ambitious, comprehensive, non-discriminatory preventive and curative health service.

Black or African American↗

PubMed1985

Comparison of impedance plethysmography with ascending venography for the diagnosis of proximal deep-vein thrombosis.

In a series of 56 patients with proximal lower-limb deep-vein thrombosis (DVT) diagnosed on ascending venography, impedance plethysmography (IPG) and Doppler ultrasound examinations were performed and the results compared. Both IPG and Doppler ultrasonography were highly sensitive for the diagnosis of proximal occlusive DVT, but considerably less sensitive for the potentially more dangerous proximal non-occlusive thrombosis. If, in the presence of clinically suspected DVT, these non-invasive investigations are both negative, ascending venography remains essential.

Evaluation Studies as Topic↗

PubMed1985

Immediate and long-term survival in patients admitted to a respiratory ICU.

Of 458 patients admitted to a respiratory ICU over a 1-yr period, 65% required positive-pressure ventilation and 10% received continuous positive airway pressure by face mask. The average ICU stay was 7 days. The overall mortality of 19% depended largely on the medical disease precipitating admission but also increased in patients over 60 yr of age. Of 359 patients discharged from the hospital, 226 were followed for at least 18 months. Of these, 65% made a full recovery, 21% partially recovered, and 13% died.

Adolescent↗

PubMed1985

A respiratory epidemiologic survey of grain mill workers in Cape Town, South Africa.

Exposure to grain dust may induce acute and chronic respiratory, nasal, and ocular symptoms. The prevalence of respiratory symptoms, atopic status, and lung function changes, as measured by pulmonary function tests (PFT) over the week in 582 grain mill workers and 153 control subjects not exposed to grain dust were studied in Cape Town. Atopic status, smoking habits, and baseline PFT did not differ significantly between grain workers and control subjects. Grain workers showed significant deterioration in lung function values over the week, with forced expiratory volume in one second declining on average by 4.8% compared with an increase of 3.3% in control subjects (p less than 0.001). Forced expiratory flow during the middle half of the forced vital capacity declined by 14.8% in grain workers and by 0.8% in control subjects (p less than 0.0001). Grain workers had significantly higher prevalences than did control subjects of regular cough (46 versus 30%), expectoration (35 versus 17%), wheeze (25 versus 11%), and watery eyes (25 versus 10%) (p less than 0.01 for all). These symptoms were not related to the duration of employment. A dose-response relationship, independent of smoking habits, was demonstrated between reported dust exposure and symptoms as well as between dust exposure and PFT. These results have important implications for the grain mill industry in South Africa where there is insufficient legislation and worker compensation.

Adult↗

PubMed1985

Serum angiotensin converting enzyme in sarcoidosis: sensitivity and specificity in diagnosis: correlations with disease activity, duration, extra-thoracic involvement, radiographic type and therapy.

Serum angiotensin converting enzyme (SACE), despite certain limitations, has been found to be a useful adjunct to the diagnosis, assessment of disease activity, and management of sarcoidosis. The spectrofluorimetric assay was used to measure SACE in 50 normal controls, 76 patients with tuberculosis (42 pulmonary, 16 lymphatic and 18 military cases), 20 patients with cryptogenic fibrosing alveolitis, 50 patients with silicosis, three patients with extrinsic allergic alveolitis, 10 patients with Crohn's disease, two patients with Gaucher's disease, and 128 patients with sarcoidosis on 303 occasions (144 during periods judged as clinically active and 189 inactive). Our results show a normal range (mean +/- 2SD) of 19-54 nmol/ml/min. The false positive rate is 2 per cent in normal controls, 9.2 per cent in tuberculosis (38.9 per cent in military but 0 per cent in the other forms), 48 per cent in silicosis, 100 per cent in Gaucher's disease, and 0 per cent in the other diseases. The sensitivity, specificity, positive and negative predictive values were 58.1, 83.8, 83.8 and 58.1 per cent respectively. The sensitivity rose to 85.9 per cent if only those samples taken from patients in whom sarcoidosis was suspected on initial presentation were included, and 92.1 per cent if only those with clinically active sarcoidosis were included. The sensitivity of SACE as a diagnostic test in sarcoidosis is thus influenced by the relative frequency of active and inactive sarcoidosis. The specificity is influenced by the prevalence of military tuberculosis and silicosis, but is uninfluenced by other common varieties of interstitial lung disease such as cryptogenic fibrosing alveolitis and extrinsic allergic alveolitis, or by other non-pulmonary granulomatous disease. There was no correlation of the SACE level with age, sex, population group, associated other illness or duration of sarcoidosis. Statistically, SACE levels were significantly higher in patients with Types II and III chest radiographs as compared to Type I and 0, and also in those with additional clinically evident extra-thoracic disease e.g. in lymph node, eye and especially multiple systems. SACE also reflected clinical activity with levels being statistically significantly greater in those patients assessed as having active disease, although 7.9 per cent of these had normal levels. Our observations indicate that SACE levels correlate well with disease activity longitudinally, both in relation to spontaneous remission and steroid therapy, and are thus helpful in patient management.

Adrenal Cortex Hormones↗

PubMed1984

Cryptogenic fibrosing alveolitis. Clinical spectrum and treatment.

Cryptogenic fibrosing alveolitis (CFA) is a relatively uncommon condition with a variable prognosis and a mean survival of less than 5 years. The prediction of responsiveness to corticosteroid treatment is difficult, but is highly desirable because of the range of beneficial and harmful effects encountered with this treatment. This review of the clinical details of 42 patients with CFA managed at the Respiratory Clinic at Groote Schuur Hospital over the past decade highlights this difficulty, and draws attention to features which may be helpful in predicting response and prognosis. Although 53% of patients experienced symptomatic improvement or had an initial objective response to treatment, only 28% showed sustained improvement on lung function tests. The outcome and pattern of disease of patients in this study are very similar to those reported from other centres.

Adult↗

PubMed1984

Pulmonary veno-occlusive disease associated with hypertrophic cardiomyopathy.

Explore the source record for details and available documents.

Adult↗

PubMed1984

Sarcoidosis with leg ulcers and annular facial lesions.

A patient with unusually severe sarcoid skin lesions illustrates the difficulty and therapeutic importance of differentiating these lesions from those of necrobiosis lipoidica diabeticorum.

Aged↗

PubMed1983

Some economic and philosophical dilemmas facing medicine in South Africa.

Growth of the population in South Africa is not being matched by appropriate expansion of our health care services. Inadequate development of primary health care and community hospitals is placing an increasing burden of clinical service on teaching hospitals, which in turn have not been allocated sufficient resources to cope with both these service demands and academic activities. The current policy, whereby a greater percentage of health care funding is being directed towards preventive medicine, is appropriate, but the coupling of this with a progressive reduction in the relative amount of total expenditure on health (as a percentage of the gross national product) is short-sighted and not in the best interests of academic medicine or health care services in the country. The public and the medical profession in South Africa should recognize these adverse trends and actively participate in reversing them. The profession also needs to re-evaluate its priorities and objectives in relation to economic and sociological developments and prospects. An enlightened approach with adequate financial backing is needed to prevent further erosion in medical standards, to protect academic teaching centres of excellence and to ensure an adequate health care service in the future. Social, economic and political advancement of all people in our country is necessary to allow achievement of these objectives.

Delivery of Health Care↗

PubMed1983

Occupational health and safety in South Africa.

Explore the source record for details and available documents.

Accident Prevention↗

PubMed1983

Ventilatory responses to carbon dioxide in asthmatics with previous carbon dioxide retention during severe asthma.

Ventilatory responses to carbon dioxide (Sco2) were measured in 15 asymptomatic asthmatic patients in whom CO2 retention had been documented during a previous attack of acute asthma. At the time when Sco2 was measured, the patients had normal or only mildly impaired ventilatory function (vital capacity (VC) 3,5 +/- 0,19 I, 98,7 +/- 4% of predicted (mean +/- SE); forced expiratory volume in 1 second (FEV1) 2,37 +/- 0,161, 83,8 +/- 5,2% of predicted; and FEV1/VC 68 +/- 2,5%). Fifteen control subjects without lung disease were also studied (VC 4,38 +/- 0,28 I, 103 +/- 2,6% of predicted; FEV1 3,76 +/- 0,23 I, 112 +/- 4,4% of predicted; FEV1/VC 86 +/- 7,8%). Sco2 in the patients (1,21 +/- 0,14 l/min/mmHg, range 0,62 - 2,81) was significantly different (P less than 0,001) from that in controls (2,13 +/- 0,17 l/min/mmHg, range 1,13 - 3,17). Sco2 in a subgroup of 5 patients with normal pulmonary function was also significantly different from that in controls. Correction for lung size (Sco2/VC) did not detract from the significance of the difference between patients and controls, suggesting that inherently low respiratory centre sensitivities to CO2 may have played a role in the development of hypercapnia during severe asthma in these patients.

Acute Disease↗

PubMed1983

Use of the flexible fibre-optic bronchoscope in the diagnosis of lung carcinoma.

Bronchoscopy carried out in 367 patients because of a chest radiograph suggestive of lung carcinoma confirmed this diagnosis in 194 cases and excluded it in 173. The diagnosis of carcinoma was made by fibre-optic bronchoscopy in 141 cases (73%), by examination of biopsy specimens and bronchial brushings in 125, and by visualization and follow-up in 16. Visible tumours accounted for 40% of the malignant lesions and 79% of these were diagnosed on examination of biopsy specimens or brushings, compared with 55% of non-visible tumours. Of the tumours 131 were radiographically peripheral, and 60% of these were diagnosed with the fibre-optic bronchoscope. The diagnostic yield in the 63 proximal tumours was 98%.

Bronchoscopy↗