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Biomedical subjects

C W Clarke

Publications and source records attributed to C W Clarke.

At least 19 recordsLinked to original sources
PubMed2001

Evaluation of a new percutaneous dilatational tracheostomy set apparatus.

Percutaneous tracheostomy is a well established technique used primarily to assist weaning from mechanical ventilation on many intensive care units. We report our experiences of a total of 36 procedures performed with the new Blue Rhino Percutaneous Tracheostomy Introducer Set developed by Ciaglia. The technique was successful in all cases and was simpler and quicker to perform than with the earlier Ciaglia percutaneous tracheostomy set. Difficulties were encountered when using Shiley tracheostomy tubes. Significant complications included one posterior wall tear and one tracheal cartilage ring fracture.

Adult↗
PubMed2000

Lung cancer in New South Wales: current trends and the influence of age and sex.

OBJECTIVE: To examine the effects of time, sex and age at diagnosis on lung cancer incidence rates and the distribution of the histological types of lung cancer in New South Wales. DESIGN AND SETTING: Retrospective analysis of data from the NSW Cancer Registry and Australian Bureau of Statistics population data for NSW for 1985-1995. MAIN OUTCOME MEASURES: Trends in lung cancer incidence rates between 1985 and 1995 for men and women aged over 30 years; changes in incidence rates within age groups; and incidence rates of histological subtypes relative to sex and age. RESULTS: The incidence of lung cancer in men aged 40-80 years fell, while that in women aged over 65 rose. Rates were stable in younger women and older men. Incidence rates in men aged 40-60 years fell by 40%-60%. Were it not for the reduction in incidence rates in men between 1985 and 1995, the number of male lung cancer cases in 1995 would have been greater by 389 (95% CI, 362-415). In women, increasing incidence rates were responsible for an extra 242 cases (95% CI, 232-253) in 1995. Adenocarcinoma comprised a greater percentage of lung cancer cases in younger people, while squamous-cell carcinoma increases steadily with age in both men and women. Women with lung cancer are less likely to have squamous-cell carcinoma (25% for women v. 40% for men) and therefore more likely than men to have adenocarcinoma (35% of new female cases v. 26% for men) or small-cell lung cancer (24% v. 19%). CONCLUSIONS: Increased smoking cessation has seen a halving of lung cancer rates in middle-aged men. Whether this represents delayed or prevented cases is uncertain. The distribution of histological subtypes of lung cancer in women is different from that in men, and it is not clear whether this difference is hormone-dependent or related to historical patterns of smoking.

Adenocarcinoma↗
PubMed1993

Care of diabetic patients in hospital clinics and general practice clinics: a study in Dudley.

A five year retrospective casenote review was undertaken of 452 patients attending 11 different general practice diabetic clinics, and 506 patients attending a diabetic clinic at hospital A and 210 patients attending a diabetic clinic at hospital B. The populations attending the clinics, the degree of glycaemic control achieved and the monitoring for the development of diabetic complications were investigated. Insulin dependent patients comprised 57.9% of patients attending the diabetic clinic at hospital A, 35.7% at hospital B and 25.0% of patients attending the diabetic clinics at general practices. Of these 55.6%, 37.3% and 30.1% respectively received multiple daily insulin injections. Hospital A had a higher proportion of patients under 40 years old than hospital B or the general practice clinics. The ages of diabetic patients attending the general practice diabetic clinics were broadly similar to those attending hospital B. Significantly more general practice patients, both insulin and non-insulin dependent, had a mean blood glucose level of less than 11 mmol l-1 compared with patients attending clinics at hospitals A and B (P < 0.001). Glycosylated haemoglobin levels did not differ between patients attending hospital A and the general practice clinics. More non-insulin dependent and insulin dependent diabetic patients attending the general practice clinics and hospital A had been monitored satisfactorily for diabetic retinopathy (general practice clinic 68.8% and 39.7% respectively, hospital A 61.7% and 43.5%) than at hospital B (43.0% and 19.4%). Referral rates among all groups for ophthalmological assessment were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Sub-clinical systemic lupus erythematosus presenting with acute myocarditis.

A 46 year old woman presented with fever and normochromic anaemia followed rapidly by severe myocardial failure, unresponsive to maximum inotropic support and broad spectrum antibiotics. There were no classical clinical stigmata of systemic lupus erythematosus (SLE) but a possible immunological cause was looked for, and on the basis of her immuno-serology a diagnosis of SLE-like disease was made. She responded rapidly to high dose steroids. The importance of considering the possibility of SLE or 'lupus overlap' in an acutely ill 'undiagnosed' patient is emphasized. The relevance of instigating appropriate immuno-serological tests in the course of such an illness is discussed.

Acute Disease↗
PubMed1991

Nifedipine and nisoldipine in hypertensive diabetics.

The effects of nisoldipine and slow release nifedipine on mild to moderate hypertension and glycaemic control were studied in 28 diabetic hypertensives, all except one of whom were non-insulin dependent. After two weeks placebo treatment patients were randomised to receive either nisoldipine 5 mg twice daily or nifedipine 10 mg twice daily. If, after four weeks of treatment, diastolic blood pressures (DBP) were 95 mmHg or more, the doses were doubled. On the 'optimum' dose patients were reviewed at weeks 4, 8, 12 and 24. At each visit blood was taken for haematology, biochemistry, glucose and glycosylated haemoglobin (GHb). Twenty-four hour home blood glucose (HBG) profiles were done at the end of the placebo period, and at weeks 8, 12, and 24, when on 'optimum' treatment. Mean sitting blood pressure fell from 173/99 to 161/92 (nisoldipine) and 158/86 mmHg (nifedipine) on the lower doses. Responses to higher doses were less marked. Changes in post breakfast blood glucose and GHb were not statistically significant. There were no significant changes in 24 hr HBG profiles on nisoldipine 5 mg and only minor decreases on 10 mg. On nifedipine 10 mg there was a similar change but on 20 mg an increase in HBG was seen at all points.

Adult↗
PubMed1989

Lymphocytic lymphoma and acquired C1 esterase inhibitor deficiency.

We report a 59-year-old woman who had progressive symptoms of angioedema for 3 years, culminating in an attack of laryngeal stridor. C1 esterase inhibitor deficiency was confirmed and treatment with tranexamic acid produced considerable clinical benefit and improvement in complement levels. Two years later she developed clinical evidence of lymphocytic lymphoma. Splenectomy resulted in rapid correction of complement abnormalities. The patient received 6 months of chemotherapy after surgery and remained asymptomatic with normal complement levels 4 years later.

Angioedema↗
PubMed1985

Confusion and paranoia associated with oral tocainide.

Two middle aged female patients developed hallucinations and severe confusion with paranoid features during oral tocainide administration at recommended dosage levels. Both patients had evidence of impaired renal function. Symptoms were provoked on re-challenge in the first patient. In the second patient the tocainide blood level was higher than the recommended therapeutic range. Both patients reverted to their normal mental state on withdrawal of the drug.

Administration, Oral↗
PubMed1982

Reproducibility of prick skin tests to five allergens.

Thirty-five patients had prick skin tests to the common allergens Candida albicans. Aspergillus fumigatus, grass pollen, horse dander and Dermatophagoides pteronyssinus performed on a regular basis from Autumn 1973 to Autumn 1975. Specific IgE to the same allergens (except C. albicans) was determined at the time of skin testing for the first five seasons. It was found that the position on the volar aspect of the forearm on which the test was performed did not affect the reaction. There was a significant variation in the percentage of patients with positive skin tests to A. fumigatus, grass pollen and horse dander with the latter showing as significant decrease with time. There was evidence of variation in weal size for all but C. albicans, and for grass pollen, horse dander and D. pteronyssinus there were reduction in weal size with time. Significant differences were found for results of Log specific IgE for grass pollen and D. pteronyssinus over the study, but there was no trend. A good correlation between weal size and Log specific IgE for grass pollens and D. pteronyssinus was observed. For the four allergens, the coefficient of concordance between IgE levels within patients for the five seasons was highly significant.

Allergens↗
PubMed1981

Positive immediate skin tests in cystic fibrosis: a possible role for Pseudomonas infection.

A review was made of the medical records of 49 patients from whose sputum mucoid Pseudomonas aeruginosa had been isolated over a 20-month period. This showed that 31 of 42 had positive immediate skin prick tests to common antigens. 21 had positive reactions to Aspergillus fumigatus antigens and 23 had precipitins to A. fumigatus antigen. 36 patients had had frequent courses of antibiotics and airway obstruction was present in 47. These results have prompted the hypothesis that the positive skin test reactions in patients with cystic fibrosis may in part be explained by the abundance of fungal and bacterial antigens that occur in the respiratory tract of these patients. The former antigens sensitize the immunoglobulin E producing cells whilst the latter exert an adjuvant action and facilitate this.

Antigens, Bacterial↗
PubMed1981

Antigen of Haemophilus influenzae in bronchial tissue.

Haemophilus influenzae antigen was detected in five of seven bronchial biopsies obtained from patients undergoing diagnostic bronchoscopy. Antibody against H influenzae antigens was obtained from a patient with bronchiectasis. Immunofluorescent techniques were used. This provides further evidence to support the pathogenicity of H influenzae in lower respiratory tract disorders.

Adult↗
PubMed1981

Isophorone diisocyanate induced respiratory disease (IPDI).

A 50-year-old male spray painter developed severe asthma soon after the introduction of a new paint containing isophorone diisocyanate (IPDI). His asthma was associated with an abnormal chest X-ray, blood eosinophilia, normal IgE level, negative skin prick tests and no precipitins to A. fumigatus. A bronchial challenge test, performed when he was well, with the paint containing the additive gave a positive response. It was considered that IPDI was the cause of his illness. He is now well on maintenance therapy and he no longer works in the industry.

Asthma↗