Biomedical subjects
Publications and source records attributed to P Mitchell-Heggs.
The abdominal radiographs of a forty-year-old patient with Fournier gangrene suggest that gas can spread from the scrotum along expected defined anatomical planes. Comparison is made with other previously described cases and with the radiological appearances associated with perforation of the rectum.
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Diazepam, in moderate doses, has been used in a placebo controlled, single blind study to treat dyspnoea in four patients severely disabled from chronic airflow obstruction. The subjects had the 'pink puffer syndrome', usually associated with emphysema and were not hypercapnoeic nor severely hypoxic at rest. With diazepam, they experienced a striking reduction in dyspnoea, and an improvement in effort tolerance; in addition the slope of the ventilation/CO2 response curve was reduced. There were no changes in resting blood gases. Psychiatric examination at the end of the study did not reveal prominent anxiety, although three patients were depressed. The use of diazepam to treat dyspnoea in this syndrome is safe in the absence of any acute infection
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The case of a patient with lymphoma associated with atrial arrhythmias and atrioventricular conduction defects resulting in heart failure is presented. Management included temporary cardiac pacing. Cytotoxic treatment was associated with resolution of the conduction abnormalities. Aetiology and management are discussed.
Six patients in sinus rhythm with congestive heart failure due to either myocardial infarction or cardiomyopathy, were given oral frusemide to eliminate oedema. Symptomatic relief occurred as body weight was reduced, and after a 'dry' basal weight had been achieved, progressive-load exercise testing was done to examine any benefit that derived from adding oral digoxin to the diuretic. Three pairs of sub-maximal exercise tests were done at intervals over three months, and the responses of each patient when using digoxin and diuretics were compared with those when using diuretics alone. One patient did not complete this study, because more frequent premature beats and increased angina followed the withdrawal of digoxin. For the five patients who completed three pairs of tests, there was no significant change in symptoms, in workload achieved, or in heart rate, respiratory rate, ventilation and respiratory quotient, whether digoxin was added or removed. It is concluded that in these patients where salt and water retention was controlled with diuretics, digoxin did not improve the capacity for exercise, and it is suggested that for such patients with myocardial disease in sinus rhythm, treatment should begin with diuretics.
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Forty-five patients (25 male and 20 female) over 12 years of age with cystic fibrosis have been studied clinically, radiologically and physiologically. Their mean age at the first visit was 17 years; they were followed for a mean period of 4 years and attended at least every six months. The first symptom which developed before the age of five in 42 of the 45 patients was respiratory. Thirty-two of the 45 patients had severe lung disease (Group III) at the start of the study of the seven patients died during the study. Cough and sputum were almost universal, 23 had haemoptyses and eight pneumothoraces. Staphylococcus pyogenes, Haemophilus influenzae and Pseudomonas aeruginosa were the common pathogens isolated from sputum and the increasing prevalence of the latter was again confirmed. Acquisition of the mucoid strain of pseudomonas signified poor prognosis. Established infection was never eradicated. Forty-three patients had evidence of pancreatic insufficiency; in all but one patient the symptoms were mild and five patients abandoned dietary restriction and pancreatin without ill effect. Seven patients had symptoms of partial bowel obstruction (meconium ileus equivalent) but only one required surgical relief. The liver was enlarged in seven patients and the spleen was felt in three. Three patients had diabetes mellitus. The influence of cystic fibrosis on growth and development is reported--the growth spurt is late in the majority but growth failure is not confined to those with severe lung infection or malabsorption and in these circumstances remains unexplained. Mean weight was low in relation to height and puberty was delayed in both sexes.
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