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Biomedical subjects

D McGivern

Publications and source records attributed to D McGivern.

15 recordsLinked to original sources
PubMed1988

Diagnostic imaging of post-irradiation changes in the chest.

Thirty-nine patients were studied with regard to post-irradiation changes in the chest. Twenty of these were reviewed retrospectively and 19 studied prospectively. All patients had chest radiographs and computed tomography (CT) of the chest following radiotherapy. Nineteen also had ventilation and perfusion studies of the lung, including single photon emission computed tomography (SPECT) and these were correlated with the chest radiographs and computed tomography. The majority showed abnormalities on computed tomography, the commonest being areas of lung opacification and evidence of volume loss. Several patients also showed a reduction in the size of pulmonary vessels. In most but not all, the changes were also seen on the chest radiographs. Abnormalities were not confined to the radiation fields, the vascular changes being present in large areas of lung which had not been directly irradiated. The structural and functional abnormalities correlated well as shown by ventilation and perfusion scintigraphy. However, single photon emission computed tomography was more sensitive than planar scintigraphy in showing perfusion defects, and it also showed some defects in areas of lung which appeared normal on computed tomography and the chest film. Computed and photon emission tomography were considerably more sensitive than chest radiography in showing the changes due to irradiation. The chest radiograph is clearly an insensitive indicator of post-irradiation change in the lung. Functional abnormalities are more profound and extensive than the chest film suggests, even when it is positive. There are clear implications for the planning of radiotherapy fields affecting the chest in patients who have good prospects of long-term survival. The maximum damage is related to irradiation of the hilum or mediastinum and this should be avoided wherever possible.

Adult↗
PubMed1987

Factors influencing mortality from infective endocarditis in two district general hospitals.

Factors influencing mortality were studied in 92 consecutive cases of infective endocarditis admitted to two district general hospitals between January 1975 and April 1982. Thirty two patients died, an overall mortality of 35%, 13 patients died before diagnosis and 19 despite aggressive antimicrobial therapy. Bactericidal antibiotic levels were monitored in 39 cases but these did not appear to influence outcome. Mortality was lowest for Streptococcus viridans infection (15%) but rose to 50% for infections with S. faecalis and other less common organisms. Most deaths were in patients over 50. Cardiac failure on admission was a poor predictor of mortality, although this was the principal cause of death during treatment (14 cases). Eight patients had emergency valve replacement and 3 died post-operatively. When the diagnosis was missed during life (13 cases) arterial embolus was a common presenting feature (46%). Classical signs of endocarditis, other than pyrexia, were absent. A cardiac murmur (always mitral incompetence) was noted in only 6 cases and considered to be insignificant.

Age Factors↗
PubMed1986

Maintenance chemotherapy for anaplastic small cell carcinoma of the bronchus: a randomised, controlled trial.

Since March 1980, 309 patients with anaplastic small cell carcinoma of the bronchus (ASCB) have received remission induction therapy prior to randomisation to maintenance (M) or no maintenance (NM) chemotherapy. Induction therapy consisted of six courses of vincristine, doxorubicin and cyclophosphamide (VAC) given IV every 3 weeks. Those with limited disease also received mediastinal irradiation. Consenting patients with no unequivocal residual disease were randomised to have no further treatment until relapse or a further eight courses of VAC, at a lower dosage, every 4 weeks. Patients failing to achieve randomisation status received palliative treatment only. The median survival for all patients with limited disease (LD) is 363 days and that for patients with extensive disease (ED) is 272 days (P less than 0.00001). Sixty-one patients with ED were randomised. Those having maintenance chemotherapy lived significantly longer (median 372 days) than those who did not continue therapy (median 259 days) (P = 0.006). An imbalance in the proportion of 'complete remitters' randomised to maintenance therapy does not account for this difference. There is no significant difference between the M and NM groups in the 32 randomised LD patients. Continuing treatment during remission with agents used to induce the remission can prolong survival in patients with extensive stage ASCB.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Allergy to gerbils.

Pet gerbils were identified as the cause of asthma or rhinitis in three out-patients seen over a period of eighteen months. Allergy to gerbils was confirmed by skin tests, RAST and the clinical course. Gerbils are popular household pets and allergy to gerbils may be commoner than recognized.

Adolescent↗
PubMed1979

Modification of the normal postural changes in plasma renin activity by the application of positive pressure to the legs.

In six normal male subjects plasma renin activity (PRA) rose progressively on standing over a 2 hour period. PRA fell to basal levels after a further 2 hours of recumbency. The rate of rise of PRA on standing was largely abolised following the application of an anti-gravity ('G') suit. Continuous monitoring of blood pressure (BP) heart rate (HR) and packed cell volume (PCV) suggest that it is the fall in effective blood volume which elicits the stimuli to renin release during changes in posture.

Adult↗