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Biomedical subjects

I S Petheram

Publications and source records attributed to I S Petheram.

16 recordsLinked to original sources
PubMed2005

Anomalous unilateral single pulmonary vein: two cases mimicking arteriovenous malformations and a review of the literature.

Total anomalous pulmonary venous drainage is a rare congenital anomaly. It usually involves a pulmonary to systemic venous shunt and most cases have a septal defect in order to survive. Anomalous pulmonary venous drainage with pulmonary venous shunting is an extremely rare and entirely benign entity. We present two such cases, in which there was atresia of the left superior pulmonary vein and drainage via a tortuous collateral vein to the left inferior pulmonary vein. This collateral was mistaken on plain film and CT for a pulmonary arteriovenous malformation. Awareness of this anomalous unilateral single pulmonary vein and its radiological appearances may help in avoiding unnecessary pulmonary angiography.

Adult↗
PubMed1991

Audit of tuberculosis contact tracing procedures in south Gwent.

A survey of part of the work of the tuberculosis contact clinic over a 5-yr period (1984-1988 inclusive) is presented. There were 106 notified index cases and 781 contacts were screened. Following chest radiography, Mantoux tests and BCG vaccinations, only four contacts who were tuberculin-positive required chemoprophylaxis. One asymptomatic adult casual contact was treated as an active case because of shadowing on a chest radiograph. Two other cases of active tuberculosis came to light but not through the routine contact tracing procedures. All cases given treatment were contacts of a single index case and the family case history is described. Because of experience with this family the contact tracing procedures will continue locally but will be monitored prospectively. In view of different findings in other centres it is suggested a further national survey is indicated with special attention to regional variations.

Adult↗
PubMed1981

Value of chest radiographs in severe acute asthma.

Chest radiographs were obtained in 117 adults admitted with severe acute asthma. In 10 (9%) patients abnormalities were seen that affected management and in nine the presence of pulmonary collapse or consolidation was shown which was not detected by clinical examinations. Over-inflation was common and correlated significantly with tachycardia, pulsus paradoxus and decrease in FEV1. Bronchial wall thickening was common and prominence of hilar vessels was also noted in a few patients. Chest radiography is strongly recommended in severe exacerbation of asthma and antero-posterior views are adequate for interpretation.

Acute Disease↗
PubMed1981

Reproducibility of flow rates measured with low density gas mixtures in exercise-induced bronchospasm.

We have studied the reproducibility of the change in maximum expiratory flow rates after breathing helium/oxygen (He/O2) mixtures in 12 asthmatics at rest and after exercise. Each subject performed four identical exercise tests which caused a similar degree of exercise-induced bronchospasm (EIB) on each occasion. We compared flow rates at 50% of the vital capacity (V50) breathing He/O2 to those breathing air at rest, and with the lowest V50 on air after exercise. Those subjects showing an increase of greater than 20% in V50 with He/O2 compared to the corresponding air value were termed "responders". At rest the responder status after He/O2 was more consistent than during EIB. Six subjects were non-responders consistently on up to 12 separate measurements at rest while the other five subjects were non-responders on all but one occasion and the remaining subject a responder on seven of eight measurements. During EIB all but one subject showed a He/O2 response. A response was seen consistently in six subjects but the actual percentage change in V50 with helium varied greatly. One subject remained a non-responder after exercise and the other five were He/O2 responders after only two or three of the four test runs, and non-responders on the remainder. The lack of consistency of our data, particularly during EIB makes the interpretation of the He/O2 breathing test less useful than originally claimed.

Adult↗
PubMed1981

Ketotifen in atopic asthma and exercise-induced asthma.

The efficacy of ketotifen, a tricyclic benzocycloheptathiophene derivative, was assessed in an outpatient clinical trial and in a group of 12 asthmatic subjects with exercise-induced asthma. Subjects in the outpatient trial had mild asthma and consisted of two groups: a group of 24 atopic asthmatics with at least one positive skin test reaction and with an associated history of bronchial reactivity to at least one allergen; and a group of eight asthmatics with one or more positive skin prick tests but not bronchial reactivity to an allergen. Both groups took four weeks medication of ketotifen 1 mg bd and placebo in a randomised double-blind crossover study. There was no difference between ketotifen and placebo for any measurement made during the study and consequently no evidence of drug efficacy. The exercise study followed a standardised protocol and each subject took in random double-blind order, placebo, 1 mg, 2 mg, and 4 mg ketotifen two hours before exercise. There was no difference in the mean decreases in lung function from pre-exercise baseline values after three doses of ketotifen than with placebo. Drug levels suggested ketotifen was well absorbed. It would appear that if given for a period of only four weeks ketotifen had no beneficial effects in the management of mild asthma, and that a single dose before exercise does not modify exercise-induced asthma.

Adolescent↗
PubMed1980

Mechanical ventilation for pulmonary disease. A six year survey.

Between 1972 and 1977, 91 patients received mechanical ventilation for pulmonary disorders. Forty-nine (53.8%) left hospital and 35 of these survived for at least 1 year. Nineteen of 23 asthmatic patients survived. Cerebral damage following cardiorespiratory arrest precluded successful outcome in three of the four who died. In those with chronic lung diseases, patients with chronic bronchitis fared best; outcome was poor in those with emphysema, bronchiectasis and pulmonary fibrosis often despite trivial precipitating causes of respiratory failure. Mortality was high in patients with pneumonia even if immunologically normal.

Acute Disease↗
PubMed1979

Patterns of recovery of airflow obstruction in severe acute asthma.

The speed and patterns of recovery of airflow obstruction were analysed in 209 patients receiving a standard therapeutic regime for severe acute asthma. Initial rates of recovery were rapid. Three-quarters of the patients had achieved 50% of their total improvement in peak expiratory flow rate (PEFR) within 24 hr. The time taken to reach eventual maximum PEFR was very much longer, 50% of the patients taking one week or more. Diurnal variation of moderate or severe degree was seen in 78% of patients. Length of history of asthma, time of deterioration and other measures of the severity of attack on admission did not differ in faster and slower responders. The rise of PEFR within 4 hr of starting treatment was highly significantly correlated with a higher PEFR at 24 hr and a shorter time to full recovery. Although the mean arterial PCO2 was higher (P less than 0.01) in the slower responding group and they were slightly older (P less than 0.05) and had lower mean FEV1 (P less than 0.02) and FVC (P less than 0.05) these differences were less helpful in predicting which patients responded fastest.

Acute Disease↗
PubMed1979

Unique massive pulmonary hamartoma. Case report with review of hamartomata treated at Brompton Hospital in 27 years.

A 30-cm tumor was removed from a 32-year-old man. It consisted of a collection of multiple small tumors, each histologically typical of a chondromatous hamartoma. Sixteen years earlier, identical histologic findings were noted in "cysts" in the right lower lobe. A review of other cases of cartilaginous hamartoma treated at Brompton Hospital since 1950 and a study of the literature suggest that this tumor is unique.

Adolescent↗
PubMed1978

Familial combined cellular and humoral immune defect with multisystem granulomata.

A brother and sister presented with recurrent respiratory infections. Investigations showed combined cellular and humoral immune defects and non-caseating granulomata in lungs, liver, lymph nodes, and skin. Despite antimycobacterial chemotherapy and corticosteroids in the brother and the additional treatment of human immunoglobulin injections in the sister both patients deteriorated with pulmonary and hepatic involvement.

Adolescent↗
PubMed1976

Aspergillus prosthetic valve endocarditis.

The clinical, laboratory, and histopathological features of seven cases of Aspergillus fumigatus prosthetic valve endocarditis are presented. The exact nature of the lesion, a combination of infective fungal endocarditis and thrombosis on the prosthetic valve, is discussed and the difficulties in clinical diagnosis are emphasized. Helpful indications were sudden unexplained heart failure with the appearance of new murmurs, and emboli to large or medium-sized systemic arteries. Fever and anaemia were inconstant, and in no case was blood culture or precipitin investigation helpful. Spore contamination of operating theatre air was the likely source of infection, and measures taken to overcome this and other predisposing factors are discussed. Since medical diagnosis is usually late and the few reported cures in this condition have included replacement of the prosthesis, early surgical intervention combined with antifungal chemotherapy is advised.

Adult↗