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D E Stableforth

Publications and source records attributed to D E Stableforth.

66 records · Page 4Linked to original sources
PubMed1981

Transbronchial lung biopsy with the fibreoptic bronchoscope: analysis of results in 433 patients.

Transbronchial lung biopsy was performed via the fibreoptic bronchoscope in 433 patients. In 183 patients, whose chest radiographs showed bilateral diffuse shadows a histologic diagnosis was established by transbronchial biopsy in 61%, including sarcoidosis (58), fibrosing alveolitis (18) and carcinoma (14). Histologically normal lung or inadequate pulmonary tissue for diagnosis was obtained from 71 patients in this group. In 225 patients with solitary chest radiography opacity, a diagnosis of bronchial carcinoma was finally made in 130, of whom 82 (63%) had a histological diagnosis established by transbronchial biopsy. In 84 patients finally shown to have sarcoidosis, 65 (77%) had positive histology by transbronchial biopsy whereas only 19 (40%) of 48 patients with fibrosing alveolitis yielded histology compatible with the diagnosis. Pneumothorax developed in three patients after the procedure but only one required intercostal drainage. Haemorrhage of 50-100 ml occurred in seven patients and bleeding ceased spontaneously in all cases. There were no fatalities.

Adolescent↗
PubMed1980

Asthma mortality in Birmingham 1975-7: 53 deaths.

Out of 83 patients studied 72 were certified as dying from asthma, and 11 aged under 45 as dying from chronic bronchitis and pneumonia. Fifty-three deaths were thought to be due to asthma. There were avoidable factors associated with several of these deaths from asthma. Recent discharge from hospital (16%), non-availability of aerosol bronchodilators (45%), underuse of corticosteroids (66%), and lack of objective measurements of airflow obstruction (100%) were found in deaths outside hospital. Inadequate initial assessment including baseline spirometry and blood gases (50%), significant underusage of corticosteroids (93%) and intravenous and nebulised bronchodilators (100%), and failure to monitor treatment objectively (100%) were found in deaths in hospital. "False-positive" and "false-negative" certifications of asthma were studied, and the findings suggest that these may lead to appreciable inaccuracy in the reporting of deaths from asthma.

Adolescent↗
PubMed1980

Reversible airway obstruction in cystic fibrosis.

Fourteen (29%) of 48 children with cystic fibrosis had a greater than 15% improvement in forced expiratory volume in one second, or in forced vital capacity after inhalation of salbutamol. All these children were atopic (one or more positive prick tests) and had a significantly higher mean serum IgE than either non-atopic subjects or those atopic subjects without airways reversibility (p less than 0.02). Half of those with airways reversibility had or subsequently developed the clinical picture of allergic bronchopulmonary aspergillosis. Of the whole group 81% were atopic, of whom 77% had a positive reaction to A fumigatus, 64% to housedust, and 56% each to grass pollen and cat hair. Children who were not atopic had significantly better spirometry (p greater than 0.05) than those who were. Children with skin hypersensitivity to A fumigatus had identical spirometry to those who were atopic without reactivity to A fumigatus. Serum precipitins to A fumigatus were present in 48%. Serum precipitins to pancreatin were present in 71%, but the presence of these precipitins did not correlate with atopy, airways reversibility, or serum IgE.

Adolescent↗
PubMed1980

Spontaneous pneumothorax in Hodgkin's disease.

Three cases of intrathoracic Hodgkin's disease are reported, in which spontaneous pneumothorax complicated the course of the disease. Factors related to this unusual complication are discussed.

Adult↗
PubMed1978

Transbronchial lung biopsy through the fibreoptic bronchoscope.

Fifty-five patients were investigated using transbronchial lung biopsy through the flexible fibreoptic bronchoscope under fluoroscopic guidance, 51 by the transnasal route under local anaesthesia, two via an endotracheal tube whilst undergoing assisted ventilation and two by the same route under general anaesthesia. Multiple specimens of lung tissue subjects with diffuse pulmonary disease and in 16 of 32 (50%) with localized lesions, giving a positive yield of 64% of all cases. The only complication was an haemoptysis of 50 ml in one patient. Our results suggest that transbronchial lung biopsy is a relatively safe procedure which gives results comparable with other lung biopsy techniques.

Adolescent↗
PubMed1978

Lung function in alpha-1-antitrypsin deficient sisters.

Two sisters were found to homozygous for alpha-1-antitrypsin deficiency. One was disabled by breathlessness and had advanced clinical and radiological emphysema which was confirmed on lung function testing. The other, of similar age and smoking history, was symptom-free with a normal chest radiograph. She had a slightly increased airways resistance, a reduced gas transfer, a bilaterally reduced apex--base perfusion gradient and a small but generalized increase in physiological dead space in all zones. The minor pulmonary and vascular abnormalities present in the younger sibling suggest that we are witnessing early changes in the evolution of the panacinar emphysema characteristic of alpha-1-antitrypsin deficiency. The reason for the different rates of progress of the disease in these two sisters is not understood.

Adult↗
PubMedDate not supplied

Asthma deaths in the United Kingdom.

Mortality due to asthma was recognised by Thomas Willis in 1671 though it was not until the early 1960s that an epidemic of death raised major concern in the United Kingdom. Initially over-treatment with beta agonist aerosols was blamed as the cause both here and in Australia and New Zealand. Further studies in London, Cardiff and Birmingham suggested this was not the case, rather than under diagnosis, under appreciation and under treatment were a more common cause of asthma mortality. The British Thoracic Society's confidential survey in 1979 confirmed these findings and further suggested that wrong certification was a potential source of inaccuracy in older age groups. More recently the New Zealand Asthma Task Force have reported the results of a two year national survey of deaths, revealing similar results to the UK studies, also finding little evidence of beta agonist over usage, little effect of nebulized drug administration and no significant theophylline drug over usage. An examination of trends in Asthma Mortality in the United Kingdom by Stewart and Nunn shows that the changes in the World Health Organisation I.C.D. coding of 1967 and 1978 had little overall effect on asthma death certification in the 15-44 year old age group. When this is taken into account they found that asthma mortality has declined from 1958 to 1982 in females but that there has been no change in males despite therapeutic advances over the period. Asthma mortality date derived since; however, does suggest a small but significant annual incremental rise in the 15 to 44 year age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Management of adults with cystic fibrosis.

Many patients with cystic fibrosis now survive into adulthood seeking continuation of their care from adult physicians rather than paediatricians. Attention to detail is the key to successful management of this complex multisystem disorder; care is best provided in the context of a multidisciplinary, team-oriented approach.

Adult↗