Biomedical subjects
Publications and source records attributed to C M Jack.
We report a case of axillary lymphadenopathy thirty years after a decorative tattoo clinically mimicking metastatic melanoma. The importance of relying on histological confirmation of metastatic disease before altering extent of surgery is discussed. The importance of recording presence of decorative tattoos is stressed.
As the issue of equality of access to health-care services becomes more important, there is increasing concern that specialist palliative care services in the UK are under-used by minority ethnic groups (Haroon-Iqbal et al, 1995; Karim et al, 2000). Research into the provision of such services for black and minority ethnic communities identified a number of factors that contribute to a perceived low take-up of services (Hill and Penso, 1995). A strategy to promote ethnic and racial sensitivity in palliative care service delivery, and policies to improve access to, and take-up of, services was recommended. This article presents the important elements relating to equal access to specialist palliative care and the provision of culturally sensitive services, and examines the role of the Macmillan Ethnic Minorities Liaison Officer in the Bradford community palliative care team.
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An analysis of a micro-processor-based system to detect cardiac arrest rhythms was made in a series of 84 cardiac arrests in 78 patients. The ECG was sensed using 2 external ECG/defibrillator pads applied to the chest wall. In 5 arrests, the initial rhythm was continuous electrical pacing in addition to the cardiac arrest and these were not included in the analysis. Of the remaining 79 arrests there were 15 in which the initial rhythm was ventricular fibrillation and 14 were correctly detected by the system (sensitivity 93%). In the remaining 64 arrests the initial rhythm was not ventricular fibrillation and 62 were correctly identified (specificity 97%). A high specificity is required in any device employing automatic detection of ventricular fibrillation. Continuous electrocardiographic recordings of the cardiac arrests were analysed every 8 to 18 s: of 223 sections showing ventricular fibrillation, 165 were correctly determined by the system, i.e. sensitivity 74%, where the rhythm was not ventricular fibrillation, of the 5002 sections 4953 were correctly detected by the system, i.e. specificity 99%. The percentage accuracy of detection of ventricular fibrillation varied from 25-100% (mean 81%) and for detection of non-ventricular fibrillation from 57-100% (mean 99%) in every 8 to 18 s section of ECG tracing per cardiac arrest episode. Thus the automatic detection of cardiac arrest rhythms is feasible with a high degree of accuracy.
A case of left atrial rhabdomyosarcoma presenting in a patient with known mitral stenosis is described. Computed tomography of the left atrium, gated to the electrocardiogram cycle, was used to visualise the site and extension of the tumour.
The detection and correction of ventricular fibrillation at the earliest time after its onset is essential to ensure long-term survival. During successive cardiac arrests the rhythms occurring were sensed by using disposable pre-gelled ECG defibrillator pads placed in the anterior-anterior position. Simultaneously with the treatment, the arrest rhythms were analyzed continually every 8 to 18 seconds by a microprocessor system. This system sampled digitally the electrocardiogram, and the algorithm looked for absence of the isoelectric segment, irregular energy density spectrum, and irregular wave shape. The analysis was displayed visually as ventricular fibrillation (VF) or non-VF, and simultaneously the ECG and system's analysis were recorded on tape. Later, the system's interpretation of the rhythm was compared with the ECG record. There were 46 males and 32 females. Their ages ranged from 14 to 85 years, with a mean of 63 years. Twenty-nine patients had sustained an acute myocardial infarction. In the remaining 49 patients, there were a variety of causes for cardiac arrest, including heart failure, vasovagal syncope, cardiomyopathy, and postoperative cases. We report in detail the process and results.
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Pulmonary hypertension in systemic lupus erythematosus (SLE) in the absence of chronic parenchymal lung disease or pulmonary emboli is rare. We report such a case with an acute and rapidly progressive onset of symptoms in a patient who had started taking the contraceptive pill eight months previously.
We describe a 44-year-old woman with Group C haemolytic streptococcal endocarditis who developed tracheal stenosis as a result of endotracheal intubation. She recovered fully following valve replacement for continuing left ventricular failure due to mitral and aortic incompetence and subsequent resection of the stenosed tracheal segment with reanastomosis of the trachea.