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Biomedical subjects

S Revill

Publications and source records attributed to S Revill.

7 recordsLinked to original sources
PubMed2003

Clinical predictors of acute coronary syndromes in patients with undifferentiated chest pain.

BACKGROUND: Patients with acute, undifferentiated chest pain present a frequent diagnostic challenge to clinicians. Clinical features are often used to determine which patients may have acute coronary syndrome (ACS). AIM: To identify clinical features that independently predict ACS in patients with acute, undifferentiated chest pain. DESIGN: Prospective study of patients enrolled in a randomized controlled trial. METHODS: The presenting characteristics of participants in the ESCAPE randomized trial of chest pain unit vs. routine care were recorded in a standardized manner. Follow-up consisted of troponin T measurement at 2 days, postal questionnaire at 1 month, and telephone contact at 6 months. ACS was defined as elevated troponin T at 2 days or major adverse cardiac event within 30 days of presentation. Multivariate analysis identified independent clinical predictors of ACS. RESULTS: ACS was diagnosed in 77 (7.9%) of the 972 patients recruited. The following characteristics were independent predictors of ACS (odds ratio, p): age (1.09, p < 0.001), male gender (8.6, p < 0.001), indigestion or burning-type pain (3.0, p = 0.034), pain radiating to the left (2.4, p = 0.013) or right (5.7, p < 0.001) arm, vomiting (3.5, p = 0.007), and previous (5.1, p < 0.001) or current (3.7, p < 0.001) smoking. DISCUSSION: In addition to previously recognized predictors of ACS, it appears that indigestion or burning type pain predicts ACS in patients attending the emergency department with acute, undifferentiated chest pain. Diagnosis of acute 'gastro-oesophageal' chest pain should be avoided in this setting.

Chest Pain↗
PubMed1987

Serological study of rubella-like illnesses.

We investigated 627 patients who within a period of 2 1/2 years had had a rubelliform rash and/or symptoms of arthritis and arthralgia. Sera from these patients were investigated for evidence of rubella, human parvovirus B19 (HPV), and measles infection with methods to detect specific IgM and IgG antibodies. Complement fixation tests were used to screen for a wide range of other infectious agents. We detected 229 cases of rubella, 43 cases of HPV infection, 7 cases of measles, and 9 cases of infection by various other aetiological agents. This left a large proportion of rubelliform rashes, 54% (339 cases), whose aetiology was unknown. This study confirmed that the diagnosis of rubella on clinical grounds alone is unreliable. Many (6.8%) of the rashes in the study were due to HPV infection, and the seasonal incidence was the same as for rubella. There was considerable overlap between the features of rubella and HPV infections, although in adults arthralgia occurred more frequently in HPV infections than in rubella. In all cases HPV infection was self-limiting, although, as in rubella, symptoms can be prolonged and one adult's disease lasted almost 9 months. Purpura was noted in only one patient with HPV infection. In this study three patients had HPV infection during pregnancy. Two patients spontaneously aborted one month later. The third patient progressed to full term and delivered a healthy baby.

Adolescent↗
PubMed1984

Home nebulizers in severe chronic asthma.

Twenty-four outpatients who continued to have severe chronic asthma despite attending a chest clinic were studied. All were already using inhaled beta-agonists from a pressurized aerosol and regular inhaled corticosteroids. Nineteen were on long-term oral corticosteroids. Comparison was made between their symptoms and peak expiratory flow rate (PEFR) during 4 weeks on their usual treatment and the following month when they were also given 5 mg terbutaline night and morning by nebulizer. During the second month the symptom score for nocturnal asthma improved by 30% (P less than 0.01), for daytime wheeze by 23% (P less than 0.025) and shortness of breath by 15% (P less than 0.01). The prebronchodilator morning and evening PEFR increased by 8% (P less than 0.025) and 10% (P less than 0.01) respectively. A dose-response study with inhaled terbutaline in six patients before and after 4 weeks of nebulizer treatment showed no evidence of a decline in response. Home nebulizers produced considerable overall improvement. Because of variations in individual responses a monitored trial of the type which we have used is desirable before a decision is made on long-term treatment.

Adult↗