DOCSLIB.ORG

Proceedings of the Association of Britishneurologists from the Joint

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Proceedings of the Association of Britishneurologists from the Joint 20424ournal ofNeurology, Neurosurgery, anid Psychiatry 1997;62:204-215 Proceedings of the Association of British Neurologists from the J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.62.2.204 on 1 February 1997. Downloaded from joint meeting with the British Society for Clinical Neurophysiology, Charing Cross Hospital, 18-20 September 1996 CRYPTIC COELIAC( D)ISlIASE PRESENTING VI''H intraperitoneal (1 mg/kg, twice daily) or each comprising 32 transverse optical NEUROMUSC'UIAR DYSFUNCTION subcutaneous (10 mg/kg, once daily) routes sections of the optic disc at a depth of 1 5 to A Gibson, M Hadjivassiliou, AK from the time of immunisation, it prevented 4-0. A topographic map is created. A Chattopadhyay, GAB Davies-Jones, Royal the development of the neurological deficits contour is drawn around the swollen disc to Hallamshire Hospital, Sheffield, UK and histological changes observed in vehicle enable comparison of subsequent images to treated controls. Subcutaneous treatment baseline. Eight patients are described who presented from either day 7, or from the onset of the Eight patients were examined regularly with neuromuscular abnormalities of disease, again reduced disease severity. over a six to 12 month period. Five patients obscure aetiology despite thorough BB1 101 did not inhibit the development of with symptomatic improvement on medical investigation. None had evidence of CNS an immune response, as measured by the treatment showed significant reduction in involvement at presentation. All patients had production of antimyelin antibodies. It is papilloedema (neuroretinal rim volume) and antigliadin antibodies in their serum. Distal concluded that MMP inhibitors may have nerve fibre layer thickness. Four of these had duodenal biopsies in all patients fulfilled the potential as therapeutic agents in peripheral resolution of visual field defects; one was histopathological criteria for coeliac disease demyelinating diseases such as GBS. unreliable at perimetry. Three patients with (CD). Patients ranged in age from 18-67 chronic disc swelling and mild field loss (median 62) years and there were five men MNEASURING SINGLE COGNIlIVE EVENTS WITH showed no improvement or worsening of and three women. Neuromuscular disease WHOLE BRAIN FUNCTIONAI. M%lAGNETIC papilloedema and nerve fibre layer had been present for 1-18 (median four) RESONANCE IMAGING thickness; disc changes were not evident years before the diagnosis of CD. M Humberstone, S Clare, J Hykin, PG clinically. Automated Humphrey 300 All patients had nerve conduction studies Morris, GV Sawle, University of perimetry was used. and EMG and two patients had muscle Nottingham, Nottingham, UK This technique is a sensitive measure of biopsy. Three patients had sensorimotor optic disc changes, quantifies swelling, and neuropathy, one had motor neuropathy, one A technique has been developed for is a useful adjunct to perimetry in monitor- had myositis and sensorimotor neuropathy, studying single cognitive events with ing idiopathic intracranial hypertension, and one had myositis and motor functional MRI. The technique uses echo- particularly if perimetry is unreliable. neuropathy. The neuropathic abnormalities planar imaging at a field strength of 3 Tesla Several methods of displaying images are in these six patients were distally and generates one functional image of the demonstrated. predominant and implied axonal pathology. whole brain every three seconds. A signal One other patient had mononeuritis averaging technique was used to create time MANAGING ID)IOPATHIC INTRACRANIAL. multiplex, and one patient had sweeps of functional signal change after a HYPERTENSION: COORDINATED FOLLOW UP IS neuromyotonia. single cognitive event. A t test is used to ESSENTIAI. Cryptic CD may initially present with identify areas and times of significant J Craig, D Mulholland, JM Gibson, Royal neuromuscular dysfunction. CD merits early activation without making any a priori Victoria Hospital, Belfast, UK consideration in patients with assumptions about the spatial or temporal neuromuscular abnormalities of obscure pattern of response; thus allowing both to be The optimum management of patients with http://jnnp.bmj.com/ aetiology, especially if introduction of a characterised. This technique was used to idiopathic intracranial hypertension (IIH) is gluten free diet results in symptomatic analyse functional activity during simple unclear and there is uncertainty on how and improvement. motor tasks in six normal subjects. Widely when to treat visual complications. A distributed patterns of functional activity casenote review was performed to examine appeared transiently 3-6 seconds after a management of patients with IIH (as per AN INHIBI'1'OR OF MAIRIX single externally cued press of a button with modified Dandy criteria), between 1991 and METALLOPROlEIINASE ACTIVITY ANI) T'NFa the right thumb. Activation was seen in 1995 at the Royal Victoria Hospital. Forty RELEASE IS AN lEFF} EC'TIVE I'REATMEN' IN primary and in premotor cortex in all three patients were identified corresponding EXl'ERIMENTAI. AU'TOIMMUNE NEURI'L'IS subjects. The time course of activation can to an average annual incidence rate per on September 27, 2021 by guest. Protected copyright. KJ Smith, EJ Redford, M Davies, N be examined in real time using video. This 100 000 of 0 6 for the total and 0 9 for the Gregson, P Hughes, AJH Gearing, K Miller, technique can be used to analyse and female population. Casenotes in full were RAC Hughes, Guy's Hospital, London, and compare the separate tasks which constitute available for 38 patients (88%). Almost two Neures Ltd, Abingdon, UK a cognitive paradigm. Comparison between thirds had presented to the ophthalmology decisions to move and decisions not to move department, the most commonly reported The factors involved in the genesis of the in a "go", "no-go" paradigm discloses symptoms being headache (81%), transient inflammatory autoimmune demyelinating hierarchical organisation of the mesial visual obscurations (65%), and sustained disease Guillain-Barre syndrome (GBS) premotor cortex and identifies "decision visual loss (34%). Analgesia regularly remain poorly understood, although there is making" and "motor execution" areas. prescribed in 63% of patients was effective evidence that the pro-inflammatory cytokine in none, acetazolamide produced tumour necrosis factor-a (TNFa) may be MONIT1'ORING PAPILLOEDEMA WITH symptomatic improvement in 44%, and involved. Because TNFa release is CONFOCAL. IASER TOMOGRAPHY IN CSF opening pressure improvement in 22%. dependent upon a metalloproteinase IDIOPA'I'HIC IN'I'RACRANIAI. HYPER'I'ENSION Repeated lumbar puncture, although (MMP)-like enzyme, and since the DA Mulholland, J Craig, JM Gibson, SJA offering acute symptomatic relief (58%), did extracellular degrading MMPs are also Rankin, Royal Victoria Hospital, Belfast, not prevent visual deterioration. Seven implicated in the pathogenesis of UK patients (18%) underwent thecoperitoneal autoimmune disease, it was examined shunting to preserve vision or to control whether an inhibitor (BB1 101) of this class This study measured the efficacy of confocal headache. Visual acuity deteriorated in two of enzymes is effective in the therapy of an laser tomography at assessing optic disc (5%), visual fields in seven (18%), and two animal model of GBS. Experimental allergic swelling in patients with idiopathic (5%) developed optic atrophy despite neuritis (EAN) was induced in 116 Lewis intracranial hypertension. Eight patients therapy. Almost two thirds were solely rats using bovine peripheral nerve myelin. with papilloedema were studied. At every followed up by neurologists, only 50% When BB 1 101 was administered bv examination three images were acquired, having more than one formal visual field Proceedings 205 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.62.2.204 on 1 February 1997. Downloaded from assessment in the year after diagnosis. Visual subsequent X was significantly impaired for in the forearm flexor muscles. Magnetic functioning as measured by visual fields and > 1600 ms afterwards. Age-matched control brain stimulation, somatosensory evoked visual acuity, rather than by repeated CSF subjects showed a normal attentional blink potentials, and stretch reflex studies did not pressure monitoring, should guide therapy. which was significantly less protracted and provide evidence for delayed conduction Until IIH is better understood and less profound than patients. within central pathways. Forearm stretch controlled, and trials analysing treatment This investigation demonstrates an reflexes were present but their latencies were options are available, coordinated impairment of temporal components of prolonged. Somatosensory evoked potentials neurological and ophthalmological follow up attention in visuospatial neglect. were obtained in most patients but were is mandatory. delayed. Wrist tremor could be modulated DIFFERENCES IN DECISION MAKING BETWEEN by mechanical perturbations or median INVASIVE MENINGOCOCCAL DISEASE IN UNITED KINGDOM AND UNITED STATES nerve electrical shocks. Simple voluntary PLYMOUTH NEUROLOGISTS wrist movements were of normal duration T Ahmed, AY Al-Memar, D Dance, R PJ Martin, B Vickrey, D Gifford, S and peak velocity, but the kinematic profile Hopkins, S Harrison, I Bray, DC Thrush, Delrahim, T Belin, D Smith, DW was asymmetric. Each movement was Derriford Hospital and University of Chadwick, Walton Centre for Neurology associated with a triphasic EMG
Load more

Recommended publications
  • Births, Marriages, and Deaths
    DEC. 31, 1955 MEDICAL NEWS MEDICALBRrsIJOURNAL. 1631 Lead Glazes.-For some years now the pottery industry British Journal of Ophthalmology.-The new issue (Vol. 19, has been forbidden to use any but leadless or "low- No. 12) is now available. The contents include: solubility" glazes, because of the risk of lead poisoning. EXPERIENCE IN CLINIcAL EXAMINATION OP CORNEAL SENsITiVrry. CORNEAL SENSITIVITY AND THE NASO-LACRIMAL REFLEX AFTER RETROBULBAR However, in some teaching establishments raw lead glazes or ANAES rHESIA. Jorn Boberg-Ans. glazes containing a high percentage of soluble lead are still UVEITIS. A CLINICAL AND STATISTICAL SURVEY. George Bennett. INVESTIGATION OF THE CARBONIC ANHYDRASE CONTENT OF THE CORNEA OF used. The Ministry of Education has now issued a memo- THE RABBIT. J. Gloster. randum to local education authorities and school governors HYALURONIDASE IN OCULAR TISSUES. I. SENSITIVE BIOLOGICAL ASSAY FOR SMALL CONCENTRATIONS OF HYALURONIDASE. CT. Mayer. (No. 517, dated November 9, 1955) with the object of INCLUSION BODIES IN TRACHOMA. A. J. Dark. restricting the use of raw lead glazes in such schools. The TETRACYCLINE IN TRACHOMA. L. P. Agarwal and S. R. K. Malik. APPL IANCES: SIMPLE PUPILLOMETER. A. Arnaud Reid. memorandum also includes a list of precautions to be ob- LARGE CONCAVE MIRROR FOR INDIRECT OPHTHALMOSCOPY. H. Neame. served when handling potentially dangerous glazes. Issued monthly; annual subscription £4 4s.; single copy Awards for Research on Ageing.-Candidates wishing to 8s. 6d.; obtainable from the Publishing Manager, B.M.A. House, enter for the 1955-6 Ciba Foundation Awards for research Tavistock Square, London, W.C.1.
    [Show full text]
  • Studies on the Breaking Pattern in Man at Rest and During Sleep
    STUDIES ON THE BREAKING PATTERN IN MAN AT REST AND DURING SLEEP by Steven Andrew Shea A thesis submitted to the Faculty of Science, University of London for the degree of Doctor of Philosophy 1988 Department of Medicine, Charing Cross and Westminster Medical School, London. 2 ABSTRACT . This thesis quantifies the breathing pattern and the extent of the reproducibility of this pattern within an individual at rest and during sleep. From breath-by-breath measurements of respiratory frequency, tidal volune and end-tidal POO2 made under standardised conditions of relaxed wakefulness - with a minimum of sensory stimulation - the results show that differences between individuals are highly significantly greater than differences seen on repeated measurements within an individual: people tend to breathe in a reproducible and characteristic fashion. The basic respiratory pattern is shown to have long-term reproducibility for periods of up to 5 years and may be, to some extent, inherited since it is shown to be similar between identical twins. The individual’s ’respiratory personality’ also persists during deep non-rapid eye movement (non- REM) sleep when any forebrain influences upon breathing are minimal. Further studies, using similar techniques, examine the effect upon this basic respiratory pattern of some behavioural, metabolic and pulmonary reflex control mechanisms. These studies reveal that visual, and auditory stimulation, and altered cognitive activity (performing mental arithmetic) affects the pattern of breathing; principally by increasing respiratory frequency. However, these changes in breathing which occur between the different ’states’ are not solely behavioural responses since they are also related to increases in cerebral and/or somatic metabolism.
    [Show full text]
  • Idiopathic Progressive Pulmonary Fibrosis
    Thorax: first published as 10.1136/thx.30.3.316 on 1 June 1975. Downloaded from Thorax (1975), 30, 316. Idiopathic progressive pulmonary fibrosis DEWI DAVIES, J. S. CROWTHER, and ANDREW MacFARLANE Ransom Hospital, Mansfield Davies, D, Crowther, J. S., and MacFarlane, A. (1975). Thorax, 30, 316-325. Idiopathic progressive pulmonary fibrosis. Five patients with progressive fibrotic lung disease are described. The dominant symptom was slowly increasing dyspnoea, and cough and sputum were not prominent. Marked weight loss was also a feature. There was severe restrictive impairment of ventilation with normal arterial gas tensions. The changes were confined to the upper parts of the lung in some but others had more generalized disease. The duration has varied so far from two to 17 years. The lung changes are considered to be due to dense progressive fibrosis. Necropsy in two confirmed this. Histologically there was monotonous fibrosis with lymphoid collections and secondary bronchiectasis, a picture similar to that found in association with ankylosing spondylitis. None of these patients had joint disease. Tuberculosis was excluded as a cause by exhaustive bacteriological tests and the failure of chemotherapy to stop deterioration. All other recognized types of infective and non-infective progressive lung fibrosis were also excluded, and this is not considered to be a variant of cryptogenic fibrosing alveolitis. Though these patients have many features in common they do not necessarily have the same pathogenesis. They are http://thorax.bmj.com/ presented as an encouragement to further study. Patients with lung fibrosis, especially in the upper by adequate bacteriological studies, and the only lobes, are readily assumed to have tuberculosis.
    [Show full text]
  • Proceedings Ofthe Thoracic Society
    Thorax: first published as 10.1136/thx.20.5.477 on 1 September 1965. Downloaded from Itorax (1965), 20, 477. Proceedings of the Thoracic Society The Summer Meeting of the Thoracic Society was held on 9 and 10 July in the Memorial Hall, the Town Hall, Sheffield. Summaries of the symposium and papers follow. SYMPOSIUM ON COMPUTERS IN MEDICINE IN A RENAL FUNCTION SURVEY DURING OPEN-HEART SURGERY PRINCIPLES J. C. A. RAISON said that some data of renal function L. C. PAYNE said that management, whether of a during extracorporeal circulation were used in a pilot hospital, the health and welfare of a community, or study to illustrate the possible use of a hospital board of patients, involves information regarding the hos- computer which had been installed originally for pital, the community, and the patients. It involves finance control. The subject and material provided reference information about disease, its incidence and examples of the theoretical advantages of a computer manifestations, about drugs, their doses, toxicities, system for clinical research, incorporating multiple and interactions, about the multiplicity of medical procedures, complex tabulation, multiple calcula- measurements and their interpretations, about the tions, correlation of accumulating data from different aetiology and epidemiology, and so on. It involves sources, and prediction as 'off-line' features, while current information of what is going on while it is 'on-line' facilities might allow ultimately for thera- going on, for no manager will respond to any element peutic control. The acknowledged difficulty of in a developing situation of which he is unaware, and communicating with a machine was heightened by moreover not do so with all the confidence of not that of communication with a non-scientific pro- even knowing he does not know.
    [Show full text]
  • Proceedings of the British Thoracic Society
    Thorax: first published as 10.1136/thx.43.3.219P on 1 March 1988. Downloaded from Thorax 1988;43:219P-264P Proceedings of the British Thoracic Society The 1987 winter meeting ofthe British Thoracic Society was held on 8 and 9 December at Kensington Town Hall, London. Influence of starting airway calibre on slope of the concen- at intervals during day I and day 14 of treatment and on the tration-response curve to methacholine assessed by partial day following cessation of treatment, day 15, to determine flow-volume loops whether a rebound increase in reactivity occurs after cessa- tion of regular inhaled ,B agonist therapy. Eight subjects aged RW HEATON, MK GILLE-r, PD SNASHALL Department Of 18-45 years with mild asthma received placebo or 750 ug Medicine, Charing Cross and Westminster Medical School, terbutaline via a Nebuhaler at 10, 16 and 22 h for two weeks London In assessment of bronchial responsiveness to in a randomised double blind crossover design with a one inhaled pharmacological agents it is customary to "normal- week run in/washout period preceding each phase. Histamine ise" the concentration-response curve (CRC) so that the PD20 FEV, was measured at 09, 12, 15, 18 and 21 h on days 1, baseline measurement ofairway calibre is expressed as 100% 14 and 15; ALFEV, and AIPD20 following terbutaline were and responsiveness given as the concentration of agonist assessed as change from 09 to 12 h and from 15 to 18 h. On causing a given percentage change. This is valid only if the both days 1 and 14 terbutaline produced an increase in FEV, slope of the CRC relates to starting airway calibre in a and an increase in PD.
    [Show full text]
  • Clinical Investigations in Gastroenterology Third Edition Clinical Investigations in Gastroenterology Malcolm C
    Malcolm C. Bateson Ian A.D. Bouchier Clinical Investigations in Gastroenterology Third Edition Clinical Investigations in Gastroenterology Malcolm C. Bateson • Ian A.D. Bouchier Clinical Investigations in Gastroenterology Third Edition Malcolm C. Bateson Ian A.D. Bouchier Bishop Auckland Edinburgh, Midlothian United Kingdom United Kingdom ISBN 978-3-319-53785-6 ISBN 978-3-319-53786-3 (eBook) DOI 10.1007/978-3-319-53786-3 Library of Congress Control Number: 2017939629 © Springer International Publishing AG 1988, 1997, 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
    [Show full text]
  • Pathology Course
    Pathology Course Kindly Sponsored by: Edited by: Michelle Kunc, Jhia Teh, Sally Barker and Yvonne Tsitsiou 1 Introduction The Medical Education Society (MedED) was established in 2004 by three students who were keen to develop schemes whereby senior students tutor younger ones - ‘peer-to- peer’ learning. It was decided that teaching would be outside the formal curriculum and the topics covered would reflect learning needs identified by members of the society and student body. This year we have coordinated PACES and Pathology revision courses, which are being delivered by past ICSM students. We hope you enjoy our Year 5 events and find their content useful for your revision. We would like to thank all the doctors involved in the production of this guide for their support and for taking time out of the schedules to come back and teach us. We would also like to thank the previous MedED guide editors: • 2016-2017: Daniel Campioni-Norman, Rhys Smith, Helen-Cara Younan and Rebekah Judge • 2017-2018: Charlie Caird, Stephanie EzeKwe, Mohammad Fallaha, Samyukta Sundar • 2018-2019: Sophia von Widekind, Lasith Ranasinghe, Daniel Huddart, Alex Huddart If you have any questions please contact us at [email protected]. Please note: MedED does not represent the ICSM Faculty or Student Union. This guide has been produced by students and the Pathology Course lecturers. We have made every effort to ensure that the following information is accurate and reliable. However, this guide should not be used to replace formal ICSM teaching and education
    [Show full text]
  • Pathology Mcqs by Dr Asif Khan
    B. Cells which are not able to express MHC1 C. MHC cells which express MHC2 D. Cells which are not able to express MHC Pathology mcqs Key: B 1. Function of CD4 is all except: 7. The following interleukin is characteristically A. Memory produced in a TH1 response: B. Immunoglobin production A. IL-2 C. Activation of macrophages B. IL-4 D. Cytotoxicity C. IL-5 D. IL-10 Key: B Key: A 2. A super-antigen is a bacterial product that A. Binds to B7 and CD28 co-stimulatory molecules 8. CD-95 has a major role in: B. Binds to the beta chain of TCR and MHC class II A. Apoptosis molecules of APC stimulating T cell activation B. Cell necrosis C. Binds to the CD4 + molecule causing T cell C. Interferon activation activation D. Proteolysis D. Is presented by macrophages to a larger-than- normal number of helper CD4 + lymphocytes Key: A Key: B 9. The complement is fixed best by which of the following immunoglobulins: 3. All of the following statements about NK cells are A. IgG true except: B. IgM A. They are derived from large granular cells C. IgA B. They comprise about 5% of human peripheral D. IgD lymphoid cells C. They are MHC restricted cytotoxic cells Key: B D. They express IgG Fc receptors 10. Antigen presenting cells are which of the following: Key: C A. Astrocytes B. Endothelial cells 4. The following feature is common to both cytotoxic T- C. Epithelial cells cells and NK cells: D. Langerhan’s cells A.
    [Show full text]
  • Unmet Medical Device Needs for Patients with Rare Diseases
    Contents Page i CONTENTS Executive Summary ...................................................................................................................... ii Background ................................................................................................................................. ii Methods ....................................................................................................................................... ii Survey Respondents ................................................................................................................... iii Findings ...................................................................................................................................... iii Introduction ................................................................................................................................... 1 Unmet Device Needs in Rare Diseases ....................................................................................... 1 Purpose of This Needs Assessment ............................................................................................. 2 Methods .......................................................................................................................................... 4 Stakeholder Consultations ........................................................................................................... 4 Survey Methodology ..................................................................................................................
    [Show full text]
  • Farmer's Lung: a Review J
    Br J Ind Med: first published as 10.1136/oem.23.1.16 on 1 January 1966. Downloaded from Brit. J. industr. Med., I965, 23, i6 Farmer's Lung: A Review J. WATKINS-PITCHFORD Chief Medical Officer, Ministry of Pensions and National Insurance Pulmonary disability among agricultural workers traced the responsible organism to thermophilic handling mouldy hay has been known for genera- actinomycetes which developed in damp hay as it tions and it seems probable that Ramazzini's became overheated due to moulding. Characteristic description in 17I3 of the Diseases of Sifters and precipitin reactions were obtained only from the Measurers of Grain included the condition now serum of subjects exposed to mouldy hay and from known as farmer's lung. However, it was first a high percentage of patients with the clinical described as a clinical entity by Campbell in 1932 features of farmer's lung. and by Fawcitt in I936. Both these authors col- lected their material from the North-west of Incidence England, an area of high rainfall, but it exists in other areas as well. In 1953 Fuller reported on 32 cases from the Devonshire area and Williams and The true incidence of farmer's lung must be Mulhall (I956) collected io cases in Radnor and largely conjectural. However, it is certainly not a Breconshire. In I96I Staines and Forman reported- rare condition in some parts of the country. A con- the results of a survey conducted on behalf of the sultant dealing with a Welsh rural population of copyright. College of General Practitioners; 444 cases had been 9o,ooo saw I95 cases in eight years.
    [Show full text]
  • Essential Respiratory Medicine Essential Respiratory Medicine
    Essential Respiratory Medicine Essential Respiratory Medicine Shanthi Paramothayan Consultant Respiratory Physician UK This edition first published 2019 © 2019 by John Wiley & Sons Ltd All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions. The right of Shanthi Paramothayan to be identified as the author of editorial in this work has been asserted in accordance with law. Registered Office(s) John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Office 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com. Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats. Limit of Liability/Disclaimer of Warranty The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions.
    [Show full text]
  • The Respiratory System
    17 The Respiratory System Jonathan E. Rodnick and James K. Gude Core Problems Role of the Family Physician Bronchitis Chronic Obstructive Pulmonary Disease The fact that pulmonary diseases are common and widespread Pneumonia has many implications for family physicians. Below are some Cough of the important philosophical considerations the family phy­ sician should keep in mind during the work-up and manage­ Core Procedures ment of patients with respiratory diseases. Chest Roentgenogram Interpretation Tuberculin Skin Test I. A thorough occupational history is obtained, and expo­ Pulmonary Function Testing sures to fumes, gases, and dusts in the environment are noted. Thoracentesis and Chest Intubation Silicosis from mining, manufacturing, or sandblasting, coal Gram's Stain of Infected Material miners' pneumoconiosis, and asbestosis can be prevented. Pulmonary fibrosis can be caused from long-term exposure to Because of the frequency of respiratory problems, family phy­ irritant gases such as cadmium, chlorine, mercury, or nitrous sicians must be knowledgeable in their diagnosis and treat­ fumes. Organic dust from spores, fungal antigens, and avian ment. In the now classic Virginia study, 1 diseases of the respi­ sources can cause an interstitial pneumonitis. ratory system constituted the greatest number of problems 2. A careful family history is obtained in regard to pulmo­ seen compared to other diagnostic categories. In a review of 3 nary diseases with a genetic predisposition. A type of emphy­ years of data and more than 120,000 visits to our Family Prac­ sema related to a 1-antitrypsin deficiency can be inherited. tice Center at the Community Hospital of Sonoma County Neurofibromatosis and tuberous sclerosis often have pulmo­ (California), we found that 13.0% of the encounters were for nary components.
    [Show full text]