Ticlopidine and severe aplastic anaemia.
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Biomedical subjects
Publications and source records attributed to P Mayo.
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As part of a series of investigations to determine the effect of sensitisation by environmental mycobacteria on the efficacy of BCG vaccination in India, this study was carried out in Ahmednagar in Maharashtra. A preliminary skin test survey showed that the rate of sensitisation with age was much lower than in Agra, the site of a previous study, and BCG vaccination scars were associated with considerable enhancement in sensitisation to Tuberculin and other reagents. It was possible to set up prospective BCG vaccination studies in pre-school and primary and secondary school children. Follow up with skin tests were carried out 1 and 2 years later. By the second year, results were obtained almost identical with those 10 years after BCG administration in the UK. On this basis it is proposed that the vaccine is likely to provide a considerable level of protection in Ahmednagar. The results of this study also resemble those obtained in the very youngest age group studied in Agra. The marked differences between Indian towns strongly suggest the influence of exposure to mycobacteria in the environment.
The present review deals with 63 adult patients having acute nontuberculous empyema treated by early thoracotomy and decortication, during the period from 1955 through 1979. Group I (38 patients) had postpneumonic empyema, but no underlying disease. Group II (25 patients) had acute empyema and one or more serious associated diseases. Positive cultures were present in 45 of 63 patients (71.4%). Most surgeons have customarily recommended conservative management, especially for patients in Group II, because of the supposedly "high risk" involved in decortication. Consequently, the mortality is extremely high. The empyema must be cured; a "well drained" or "controlled" empyema will not suffice. The severely ill patient can better withstand the ordeal of a major operation than the deleterious effects of a lingering empyema. The critically ill patient is best managed by the primary procedure of open thoracotomy and decortication. The author's experience confirms that such patients can expect an outlook (8% mortality) approaching the zero mortality of Group I patients.
Splenic rupture heralded by acute thoracic empyema is rare. A review of 420 cases of spontaneous and delayed splenic rupture failed to list a single such instance. I have reported two unusual cases of spontaneous rupture of the spleen presenting in each instance an acute thoracic empyema without history of trauma.
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In this retrospective study of 115 cases of histoplasmids, there were 66 male and 49 female patients ranging in age from 2 months to 79 years. The most common presenting symptoms were cough, chest pain, wheezing, weight loss, hemoptysis, and shortness of breath. Thirty-five patients (30%) were asymptomatic. Two patients had manifestations of obstruction of the superior vena cava. Radiologic findings simulated carcinoma, tuberculosis, pneumonia, and viral infections. Sixty-five patients had various operative proceudres, such as lung biopsy, wedge resection, lobectomy, pneumonectomy, resection of lymph node, and bypass of superior vena cava, for diagnosis and treatment. There were two deaths and two postoperative complications. A total of 15 patients received intravenous amphotericin B. Four patients with pneumonic infiltrates developed disseminated histoplasmosis.
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