Biomedical subjects
Publications and source records attributed to D Roomes.
Fibrinolytic enzymes, particularly streptokinase, are now widely used to treat empyema thoracis. Recent in vitro evidence suggests that streptokinase has no effect on pus viscosity but that deoxyribonuclease (DNase) reduces the viscosity of pus. We report the first use of human recombinant DNase given intrapleurally to treat an empyema which had not resolved after standard treatment with streptokinase.
Cyclical anaphylactoid reactions associated with menstruation are exceedingly rare. We report two sisters who were both affected, one severely and one mildly. Treatment involved suppression of menstruation and use of a cyclooxygenase-2 (COX-2) inhibitor. An abnormal reaction to prostaglandins, perhaps produced by COX-2 enzyme activity in the endometrium, is a possible mechanism.
STUDY OBJECTIVE: To investigate the effects of streptokinase and deoxyribonuclease (DNase) on the viscosity of pus to assess whether the DNase in the old preparation of streptokinase-streptodornase used intrapleurally to treat empyema was contributing to easier drainage of pus compared with purified streptokinase. DESIGN: In vitro measurement of pus viscosity. PATIENTS: Pus from three patients with surgically drained soft tissue abscesses and from six patients with empyema thoracis of varying etiology was studied. INTERVENTIONS: Pus samples were incubated with saline solution as control and with streptokinase, streptokinase-streptodornase, human recombinant DNase, and a mixture of streptokinase and DNase in concentrations approximating those achieved in clinical practice. RESULTS: Purified streptokinase had little effect on pus viscosity, with a mean reduction of 11.1% in the surgical specimens and 1.7% in the empyema samples. Streptokinase-streptodornase reduced viscosity by a mean of 52.8% in the surgical samples and 94.8% in the empyema samples. Human recombinant DNase reduced viscosity by a mean of 32. 79% in surgical samples and 93.4% in empyema samples. Adding streptokinase to human recombinant DNase produced no further reduction in viscosity. Final viscosities in samples treated with DNase were very similar whatever the starting viscosity. CONCLUSIONS: DNase significantly reduces pus viscosity, whereas streptokinase has little or no effect, and in empyema may work simply by breaking down loculations. Clinical studies should be undertaken to see if these in vitro changes produce clinical benefits. The simple viscometer devised for these experiments may also prove useful in other contexts.
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OBJECTIVE: To assess variability of opinion regarding fitness to dive among doctors currently doing diving medical examinations. DESIGN: Anonymous, reply-paid postal survey containing 15 clinical scenarios for which respondents were asked to declare the prospective scuba diver fit, unfit, fit after investigation or to offer specialist referral. PARTICIPANTS: All 81 doctors in Queensland, identified as members of the South Pacific Underwater Medical Society, who had completed approved training in underwater medicine, and who were doing diving medical examinations in June 1998. MAIN OUTCOME MEASURES: Variability in responses, and agreement with our interpretation of the action recommended by Australian Standard (AS) 4005.1-1992, the medical standard for fitness to scuba dive for recreational divers. RESULTS: 52 of the 81 questionnaires were returned (64% response rate). There was a wide variety of opinion about fitness to dive for all 15 hypothetical cases, with 70% consensus about unfitness in only four cases (one of which should have been referred according to AS guidelines) and fitness in only two cases (both of which should have been referred according to AS guidelines). No case was considered either fit or unfit by all respondents. Only 17.6% of responses recommended specialist referral, although the AS guidelines suggest that 10 of the 15 cases should be referred. One doctor failed 13 of the 15 potential divers outright and another passed seven outright and failed only four. For each case that the AS guidelines firmly indicate as unfit to dive, at least one respondent passed the hypothetical prospective diver as fit. CONCLUSIONS: There is no consensus among doctors who perform diving medical examinations as to what constitutes fitness to dive; current guidelines need to be improved.