Biomedical subjects

J Pilcher

Publications and source records attributed to J Pilcher.

At least 19 recordsLinked to original sources

PubMed1996

Schistosomiasis in Lake Malawi.

BACKGROUND: In 1992 two US Peace Corps volunteers (PCVs) developed central nervous system schistosomiasis due to infection with Schistosoma haematobium following recreational water exposure at Cape Maclear on Lake Malawi, an African lake considered by many to be free of schistosomiasis. To determine the transmission potential and risk for aquiring schistosomiasis in Lake Malawi, a cross-sectional survey of resident expatriates and visitors to Malawi was done during March and April, 1993. METHODS: A volunteer cohort of expatriates and visitors representing a cross-section of Malawi's foregn population answered detailed questions about freshwater contact and provided blood specimens to determine the seroprevalence of S haematobium and S mansoni by ELISA and immunoblot analyses. A survey for vector snails was conducted along Lake Malawi's southwestern shore. FINDINGS: The study population of 955 included 305 US citizens and 650 non-US foreign nationals. 303 of the study population had serological evidence of current or past schistosome infection. Seroprevalence was 32% (141/440) among expatriates whose freshwater exposure was limited to Lake Malawi; S haematobium antibodies were found in 135 of 141 (96%) seropositive specimens. Risk of seropositivity increased with the number of freshwater exposures at Lake Malawi resorts. Although many resort areas in the southwestern lake region posed a significant risk, Cape Maclear was the location most strongly associated with seropositivity (OR 2.9, 95% Cl 1.6-5.1). Schistosome-infected Bulinus globosus, the snail vector of S haematobium in Malawi, were found at Cape Maclear and other locations along the lakeshore. INTERPRETATION: S haematobium infection is highly prevalent among expatriates and tourists in Malawi. Recreational water contact at popular resorts on Lake Malawi is the most likely source of infection. Transmission of schistosomiasis is occurring in Lake Malawi, a previously under-recognised site of transmission.

Adult↗

PubMed1989

Diagnosis of coronary artery disease using thallium imaging: tomographic versus planar imaging.

Coronary artery disease was evaluated with tomographic and planar thallium imaging in 31 subjects who had undergone coronary angiography for assessment of chest pain syndrome. Coronary arteriography revealed significant coronary artery disease in 17; and 14 had normal coronary arteries. The sensitivity and specificity for planar imaging was 71% and 79%, and that for tomography, 94% and 79% respectively. The sensitivity and specificity figures for individual coronary artery lesion detection for planar imaging were 87/83 for LAD, 33/100 for LCX and 50/86 for RCA respectively, and for tomography the figures were 87/87 for LAD, 33/95 for LCX and 90/76 for RCA respectively. The use of coronary arteriography as a gold standard was considered by assessing its interobserver variability, which was 16%. The interobserver variability for thallium imaging was 8% and 3% respectively for tomographic and planar acquisitions.

Adult↗

PubMed1987

Long-term treatment with oral enoximone for chronic congestive heart failure: the European experience.

The long-term safety and efficacy of the inotropic/vasodilatory agent enoximone (50 to 100 mg 3 times daily) were evaluated in 30 patients with chronic congestive heart failure (New York Heart Association classes II to IV). Nineteen patients had idiopathic dilated cardiomyopathy and 11 had ischemic heart disease. Patients were receiving maintenance therapy of digitalis and diuretics. Cardiac function was assessed at 12 week intervals (physical examination, exercise testing, chest x ray, echocardiography, radionuclide angiography, 24-hour Holter monitoring and blood chemistry). During a mean follow-up of 40 weeks, 6 patients died, due to noncardiac (n = 1) and sudden death (n = 1) and to cardiac failure (n = 4) within 36 weeks of drug treatment. In the remaining patients New York Heart Association class improved in 18, was stationary in 5 and deteriorated in 1. Exercise capacity increased during the first 26 weeks and was maintained improved thereafter. Clinical improvement appeared not to wane with time. No change in heart rate, blood pressure and cardiothoracic ratio was observed. Echocardiographic left ventricular dimensions did not change significantly; however, the fractional shortening increased from baseline (14%) to 19% after 12 weeks, 17% after 26 weeks and 21% after 52 weeks (p less than 0.05). The preejection period/left ventricular ejection time ratio decreased from 0.74 to 0.35, 0.44 and 0.43 (p less than 0.05), respectively. There was an increase in radionuclide ejection fraction from 23% to 27% (difference not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

Double-blind crossover comparison of enoximone and placebo in patients with congestive heart failure.

The efficacy of oral enoximone, a new positive inotropic and vasodilator agent, was assessed in 12 patients with chronic congestive heart failure (New York Heart Association [NYHA] class II or III) in a double-blind randomized crossover comparison with placebo. Duration of each treatment was 6 weeks and the dose of enoximone was 150 mg tid. Efficacy was assessed by exercise tolerance, symptoms, radionuclide angiography for ejection fraction at rest and during exercise, and Holter monitoring. Two patients were withdrawn before completion of the study, one with pulmonary edema after 1 week on placebo and the other for noncompliance with enoximone therapy. Symptom-limited exercise capacity improved with enoximone by 30% and 43% (p less than .01) compared with baseline after 2 and 6 weeks treatment, respectively. Ejection fraction improved at rest (p less than .02) with enoximone but not with placebo. No change was found during exercise. Heart rate and blood pressure remained unaltered. During treatment with enoximone symptoms of exertional dyspnea and fatigue were improved and NYHA class decreased by at least one class for every patient. Holter monitoring revealed an overall increase (NS) in ectopic activity during enoximone therapy. There were no serious adverse effects and laboratory values did not change significantly. The addition of enoximone to the existing therapy of patients with moderately severe congestive heart failure provided clear and sustained subjective and objective benefit when compared with placebo.

Aged↗

PubMed1986

Automatic analysis overcomes limitations of sleep stage scoring.

A computer programme for the automatic analysis of the sleep EEG and EMG is presented. An EEG parameter is derived which is based on the joint frequency-amplitude distribution of the EEG activity. This newly developed parameter stresses the dynamic development of sleep, composed of alternating phases of EEG synchronization and desynchronization. While synchronization develops slowly, the opposite phase of EEG activity, desynchronization, is more rapid. A particular advantage of the EEG parameter is its continuous scale which results in high resolution. Thus, the parameter reflects gradual EEG changes which a visual analyser would have to classify into the same sleep stage. In addition to the EEG, the EMG is analysed and two parameters are extracted, representing the mean muscle tone and transient EMG activation, respectively. There is a close temporal relationship between the EEG and the EMG with a maximum of transient EMG activity during the phase of EEG desynchronization. The properties of the automatic analysis were compared to the visual analysis on a sample of 12 all-night sleep records. The results show that the EEG parameter also agrees sufficiently with the traditional sleep scoring method and therefore is a valid descriptor of the time course of sleep.

Electroencephalography↗

PubMed1986

Nuclear cardiology: a comparison of equilibrium gated blood pool and gamma camera first-pass measurements for the assessment of left-ventricular regional wall motion.

There are two major problems remaining for the successful assessment of left-ventricular regional wall motion (RWM) using nuclear cardiology. These are as follows. Which technique should be used: first pass or equilibrium? Secondly, which views should be used to give full information about the RWM of the left ventricle? This paper specifically considers each of these questions and concludes that equilibrium blood pool imaging in both the right anterior oblique and left anterior oblique projections is currently the best option.

Heart↗

PubMed1985

Investigations of long-term treatment with perhexiline maleate using therapeutic monitoring and electromyography.

Experience is reported with 41 patients taking perhexiline maleate for angina pectoris for periods of up to 70 months, while serum concentrations of the drug were monitored, and liver function tests and electromyographic tests were made before and during treatment. Severe side effects did not occur unless serum perhexiline levels were greater than 1.5 mg/L. The drug seems effective for prolonged dosage, and the monitoring of weight, liver function test results, and serum concentrations should prevent or reduce toxicity. A starting dose of 100 mg daily is recommended. The drug is not recommended for routine use in angina pectoris.

Adult↗

PubMed1985

Therapeutic monitoring of the anti-anginal drug perhexiline maleate.

Patients taking oral doses of perhexiline maleate have been examined. Measurement of serum perhexiline concentrations established that different dose requirements between patients were necessary due to the different doses at which drug saturation was achieved. Measurement of serum perhexiline concentrations are essential if side-effects from the drug are to be avoided.

Angina Pectoris↗

PubMed1985

Thallium-201 scintigraphy for ischaemic heart disease and infarct detection: comparison of rotating slant-hole tomography and planar imaging.

A trial was undertaken to compare the diagnostic capabilities of rotating slant-hole tomography and raw scintigraphic planar images for the assessment of ischaemic heart disease and for infarct detection. Twenty patients with coronary artery disease established by arteriography and 29 patients who had suffered acute myocardial infarction as established by ECG and enzyme criteria were imaged, along with ten normal volunteers. Overall sensitivity and specificity figures, as well as Receiver Operating Characteristics (ROC) curves, were obtained. For infarct detection there was a sensitivity of 93% for tomography and 96% for planar imaging while the specificity was 80% for tomography and 95% for planar imaging. This loss of sensitivity and specificity was also apparent in the ROC curves and showed that there was no advantage from the use of rotating slant-hole tomography. For ischaemic heart disease the sensitivities for tomography and planar imaging were 83% and 91% respectively, while the specificities were 83% and 90% respectively. The ROC analysis again showed this reduction in the diagnostic capability of the test. It was concluded that rotating slant-hole tomography was no advantage in the assessment of ischaemic heart disease. Inter-and intra-observer variability was good with consistent responses in more than 90% of cases. No significant improvement was demonstrated in the poor ability of thallium scanning to specify the diseased vessels, and the phenomenon of false defects in the rotating slant-hole tomographic scans of some normal subjects was shown to affect the response of observers significantly.

Aged↗

PubMed1980

Diazepam in immediate post-myocardial infarct period. A double blind trial.

One hundred and thirty-one male patients admitted to a coronary care unit with myocardial infarction, later confirmed, were randomly allocated to receive either 10 mg diazepam every six hours, or a matched placebo, for 48 hours. During this period, no differences were found between the treatment groups in the incidence of fatal or non-fatal tachyarrhythmias even when account was taken of differences in the severity of the initial infarct. Monitored blood pressure and heart rate data were comparable as were the patients' self-assessed anxiety levels and symptoms, except that drowsiness was more common in the patients treated with diazepam.

Adult↗

PubMed1978

Comparative trial of perhexiline maleate and oxprenolol in patients with angina pectoris.

A random single-blind study of oxprenolol against perhexiline has been undertaken in angina pectoris. Both drugs were effective in treatment (P less than 0.01) but perhexiline was better than oxprenolol (P less than 0.05), 12 of the 14 patients preferring perhexiline. Offset against this was the greater incidence of side effects with perhexiline, including one patient who later developed peripheral neuropathy. Despite the greater efficacy of perhexiline, it is suggested that side effects should preclude its routine prescription as a drug of first choice in angina pectoris. It should remain of value in the special situations of resistant angina and angina with heart failure or bronchospasm, when its use should be carefully monitored for these side effects.

Adult↗

PubMed1975