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Biomedical subjects

K M Citron

Publications and source records attributed to K M Citron.

At least 19 recordsLinked to original sources
PubMed1987

Intrathoracic aspergilloma: role of CT in diagnosis and treatment.

The authors describe the computed tomographic (CT) appearances of aspergilloma in 26 patients. With narrow (3-mm) sections, a bone algorithm, and wide window settings, CT scans enabled accurate identification of both the forming aspergilloma as well as the mature fungus ball in 25 cases. The diagnostic accuracy of CT was confirmed histologically in nine cases. The radiologic concept of the aspergilloma as a solid mass partially surrounded by a crescent of air is no longer tenable as the only definite criterion for diagnosis. In cases in which this classic appearance is seen on CT scans, mobility is easily demonstrated with use of prone and supine positions. In other cases, the aspergilloma appears as an irregular spongework containing air spaces and filling the cavity, obliterating the air crescent sign. The fungus ball is therefore fixed and immobile. Forming aspergillomas can also be identified by the fungal strands that fall into the cavity lumen, trapping air and initiating the sponge-work appearance. The CT appearance in patients with positive precipitins is characteristic and allows earlier diagnosis than does conventional tomography.

Adult↗
PubMed1986

Large lung bullae in sarcoidosis.

Large lung bullae are a rare manifestation of pulmonary sarcoidosis. Of three patients with this complication, all had pulmonary infiltrates at presentation and two had bilateral hilar adenopathy. Hypercalcaemia developed during the course of the illness in all three patients. In each case the bullae had developed within four years of the diagnosis of sarcoidosis. In one woman a bulla resolved almost completely after it had become infected.

Adult↗
PubMed1984

Pulmonary disease in patients with Marfan syndrome.

Hospital case notes and chest radiographs of 100 patients with Marfan syndrome were investigated for evidence of pulmonary disease. The criteria for inclusion of details of a given patient in the study were the occurrence of Marfan abnormalities in at least two separate body systems (skeletal, cardiovascular, ocular) or in one body system where there was a family history of a classically affected first degree relative. Selection of cases was biased towards those with cardiorespiratory problems by virtue of the hospitals from which the patients were drawn. Forty eight patients underwent cardiac surgery. Eleven patients had a history of spontaneous pneumothorax, which had been recurrent in 10 cases and bilateral in six. Eight had had pneumonia or excessively frequent respiratory infections and two had bronchiectasis. Chest radiographs showed emphysematous bullae in five, upper lobe fibrosis in four, and aspergilloma in two. The cases reviewed together with other published evidence suggest that spontaneous pneumothorax and bullae are causally related to Marfan syndrome. The presence of idiopathic upper lobe fibrosis in four Marfan patients is interesting but provides insufficient evidence to assess possible causality.

Adult↗
PubMed1984

Generalised allergic reactions to aminophylline.

Details of three patients who developed allergic responses to aminophylline are presented, together with data on such reactions compiled from reports submitted to the Committee on Safety of Medicines. Two of the patients developed generalised rashes within one day of starting treatment with oral aminophylline. Other symptoms included malaise and confusion. A third patient had severe generalised symptoms and a high fever, which was reproduced on challenge testing. Forty five of 147 reactions to aminophylline reported to the Committee on Safety of Medicines referred to dermatological or allergic reactions and in two instances exfoliative dermatitis was described. In contrast, only seven of 61 reported reactions to theophylline described skin or allergic responses and in none of these was dermatitis or a specified rash mentioned. The available evidence suggests that ethylenediamine rather than the xanthine component of aminophylline may be the principal cause of the reactions.

Adolescent↗
PubMed1984

Bone and joint tuberculosis. A survey of notifications in England and Wales.

Of the 4172 patients in a survey of all cases of tuberculosis notified in a six-month period in England and Wales in 1978-79, 198 had a bone or joint lesion; 79 were white and 108 were of Indian subcontinent (Indian, Pakistani or Bangladeshi) ethnic origin. The estimated annual notification rates for orthopaedic tuberculosis were 29 per 100 000 for the Indian subcontinent group and 0.34 per 100 000 in the white group, a ratio of 85 to 1. Rates increased with age in both groups. The spine was the most common site, and was affected in 30% of the white patients and 43% of the Indian subcontinent patients; the distribution of other sites was similar in both groups. Positive culture from a bone or joint lesion was obtained in 99 (50%) of the 198 patients (58% of white patients and 47% of the Indian subcontinent patients). Bacteriological or histological confirmation of tuberculosis either from a bone or joint lesion or from another site was obtained in 68% of the patients. Mycobacterium tuberculosis was isolated from the orthopaedic lesions in 79 of the 82 patients with identification test results and M. bovis in the 3 remaining patients. Of the 61 patients with M. tuberculosis and with no history of previous chemotherapy, 5 had resistant strains compared with 1 of the 18 patients who had previously received chemotherapy. All 6 patients with resistant strains were of Indian subcontinent ethnic origin.

Adolescent↗
PubMed1984

Deaths occurring in newly notified patients with pulmonary tuberculosis in England and Wales.

In a survey of the chemotherapy prescribed for 1312 adult patients of white or Indian subcontinent ethnic origin with pulmonary tuberculosis only, notified in the 6 months from October 1978 to March 1979, it was found that 163 (12%) patients died before they had completed chemotherapy. Of the 163 patients who died 96% were of white ethnic origin; 15% of the 1022 white patients died compared with 2% of the 290 Indian subcontinent patients. According to the death certificate, approximately half the white patients died from tuberculosis, and in a further 31% tuberculosis was a contributory factor. Death from tuberculosis most frequently occurred in the older age groups, accounting in part for the different findings in these two ethnic groups, because of the excess of older white patients. In a step-wise multivariate discriminant analysis death from tuberculosis was found to be significantly associated in the white patients with the radiographic extent of disease before treatment, and with age, extent of cavitation and a positive sputum smear result, but not sex. Most of the deaths from tuberculosis occurred early, 38% before the end of the first week of chemotherapy and 69% by the end of 4 weeks. There was a further group of 51 adult patients with pulmonary tuberculosis notified in the same 6-month period in whom the diagnosis was not made until after death, 25 of them dying from tuberculosis. It is concluded that there is still a substantial risk of death from tuberculosis in patients with extensive disease in the older age groups.

Adolescent↗
PubMed1983

Effect of naloxone on circadian rhythms in lung function.

To determine whether the endogenous opioid peptides play a part in the pathogenesis of asthmatic morning dipping, six patients with chronic asthma with a reproducible peak flow pattern of morning dipping were investigated in a double blind, randomised, crossover study of naloxone versus placebo. Naloxone was given as a loading dose of 8 mg followed by a continuous infusion of 5.6 mg/h from midnight until 10 am on two consecutive nights. Naloxone had no significant effect on PEFR, FEV1, or FVC at 6 am. There was, however, an improvement over placebo values in all these indices between the hours of 8 am and 8 pm on the day after the first naloxone infusion in all six patients. This effect was not observed after the second naloxone infusion.

Adolescent↗
PubMed1983

Clinical review of pulmonary disease caused by Mycobacterium xenopi.

Mycobacterium xenopi comprised 56% of all non-tuberculous mycobacteria isolated in the Brompton Hospital laboratory during six years. M xenopi alone was cultured from the sputum of 23 patients, whose clinical and bacteriological features are reviewed. Pulmonary disease was considered to be due to the organism present in 15 of these patients on the basis of strict criteria for a causal relationship. Radiographs of all these patients were consistent with mycobacterial disease, showing pulmonary cavitation in 11, apical shadowing in three, and upper lobe fibrosis in one. In nine patients the disease was chronic, progressing very slowly with longstanding respiratory symptoms and extensive radiographic abnormalities developing over many years (mean 19 years). In six patients the disease was subacute, being of recent onset with radiographic shadowing of limited extent. M xenopi was isolated as a saprophyte from four patients who had lung disease of known cause and single isolates were obtained from four patients who had no lung disease attributable to this organism. In vitro drug sensitivity tests showed the sputum cultures of 17 of 22 patients to be sensitive to two or more of the drugs rifampicin, isoniazid, and ethambutol. Response to chemotherapy was unpredictable and did not always correlate with the results of sensitivity tests. Of 11 patients treated with at least two drugs to which their organisms were sensitive, two remained sputum positive, one relapsed after 18 months of chemotherapy, and eight have remained sputum negative during a minimum of three years' follow-up.

Adult↗
PubMed1983

Pulmonary aspergilloma: analysis of prognosis in relation to haemoptysis and survey of treatment.

From 1956 to 1980 85 patients were admitted to the Brompton Hospital, London, with pulmonary aspergilloma. The mean follow-up period was 8.7 years and 85% of patients were followed for five years or until death if this was earlier. There were 41 deaths, 27 from respiratory causes: 11 from pneumonia, six from chronic respiratory failure, seven after surgery for aspergilloma, and three from haemoptysis. Medical treatment alone was given to 36 patients, of whom three died of haemoptysis. Systemic antifungal treatment was given to 18 patients without benefit. Intracavitary antifungals were helpful in three out of 10 patients. Surgical resection was performed in 41 patients, of whom three (7%) died after operation and a further six (15%) developed major complications. Cavernostomy was performed in nine patients considered unfit for resection; four died after operation. Haemoptysis was absent or minor in 40 patients, of whom 19 were treated medically and 18 by resection, with similar five-year survival rates of 65% and 75%. Frank or major haemoptysis occurred in 45 patients, of whom 17 were treated medically and 23 by resection, with five-year survivals of 41% and 84% (p less than 0.02). The better survival of the surgical group in this retrospective survey may have been due to the selection of patients with better lung function and more localised pulmonary disease. Our observations suggest that surgical resection for aspergilloma should be restricted to patients with severe haemoptysis and adequate pulmonary function. In patients unfit for resection cavernostomy is hazardous.

Adolescent↗