Traumatic paramediastinal air cysts--a continuing source of confusion.
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Biomedical subjects
Publications and source records attributed to W H Perks.
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The case is presented as an unusual example of the benefit of tracheostomy during pregnancy in a patient with obstructive sleep apnoea syndrome.
Examination of the records of employees leaving an electronics factory over three-and-a-half years showed that a significantly greater proportion left the shop floor (where soldering took place) because of ill health than left the stores and office areas. This difference was largely due to work-related respiratory disease in those whose job was soldering. Shop floor workers leaving for health reasons also had increased sickness certification due to respiratory illness compared to stores and office workers. These findings suggest that work-related respiratory illness is a significant cause of morbidity and loss of employment in solderers working at the factory and that this has been a longstanding problem with its onset before the first recorded cases of occupational asthma caused by solder flux containing colophony.
The mini-Wright peak flow meter (MPFM) has been evaluated, and the results obtained from it show a strong positive correlation (r=0.970) with the Wright's peak flow meter (PFM). MPFM measurements, however, were biased to be about 38 1/min higher than PFM measurements (95% confidence limits 31.01/min to 45.01/min). Between instrument variation was found (F--ratio 3.67 with 9 and 81 degrees of freedom: P less than 0.001). In practice this did not appreciably affect individual measurements greatly as 95% confidence limits on any individual measurements were increased from +/-24 1/min to +/-27 1/min. There was no significant day-to-day variability in measurements obtained with individual instruments. The MPFM is a pocket-sized, simple, cheap, and robust instrument for following changes in ventilatory function. In clinical trails and surveys, however, both the bias in favour of the MPFM compared to the PFM and inter-machine variation must be taken into account. As the manufacturers have altered the scale to remove the bias since this study was performed, it will be important to know whether the original or the modified meter is being used in future studies.
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Fourteen patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) have been treated with demethylchlortetracycline (demeclocycline) 1200 mg daily. In 12 patients the underlying lesion was malignant. The serum sodium returned to normal (greater than 135 mmol/l) in all patients after a mean of 8.6 days (SD +/- 5.3 days). Blood urea rose significantly from the pretreatment level of 4.2 +/- 2.3 mmol/l to 10.1 +/- 5.1 mmol/l at ten days (P less than 0.001). The average maximum blood urea was 13.4 +/- 6.8 mmol/l. In four patients the urea rose above 20 mmol/l, and in two of these demecyocycline was discontinued because of thie rise. The azotaemia could be attributed to a combination of increased urea producation and a mild specific drug-induced nephrotoxicity. Discontinuation of demeclocycline in six patients led to a fall in serum sodium, in one case precipitously, and return of the urea towards normal levels. Demeclocycline appears therefore to be an effective maintenance treatment of SIADH, and the azotaemia that occurs is reversible and probably dose dependent.
Hyponatraemia was found in 18 (62%) of 29 patients with histologically proven mesothelioma. The mechanism for the development of the hyponatraemia is discussed. It is suggested that patients with mesothelioma should be monitored for electrolyte abnormalities. If hyponatraemia is found the syndrome of inappropriate secretion of antidiuretic hormone should be suspected as treatment with demethylchlortetracycline may improve the quality of life in an otherwise fatal illness.
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1 The effects of atenolol (50 mg and 100 mg) and oxprenolol (80 mg) on respiratory function were studied in ten patients with angina pectoris or hypertension complicated by chronic airways obstruction. 2 In patients with "fixed" airways obstruction, neither atenolol nor exprenolol significantly affected airways resistance. 3 In patients with "labile" airways obstruction, atenolol did not produce a significant increase in airways obstruction, whereas oxprenolol did. 4 Following isoprenaline challenge (1500 microgram by inhalation), atenolol permitted full bronchodilatation, whereas oxprenolol almost completely blocked the action of isoprenaline. 5 Partial agonist activity appears to be of less clinical importance than cardioselectivity.
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.
A patient with a malignant mesothelioma developed the syndrome of inappropriate secretion of antidiuretic hormone. The electrolyte abnormalities were corrected by treatment with demethylchlortetracycline. Arginine vasopressin concentrations were increased in serum and urine. It is suggested that the syndrome might have been mediated by secretion of antidiuretic hormone from the posterior pituitary, because arginine vasopressin was not detected in the patient's tumor using a sensitive radioimmunoassay.
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A case is reported of a 21 year old man with polycythaemia and a vascular frontal lobe tumour that was histologically compatible with the diagnosis of haemangioblastoma. On review of the English literature no case could be found of polycythaemia associated with supratentorial haemangioblastoma.