WEMJ Volume 117 No. 1 March/April 2018

Welcome to the first issue of WEMJ for 2018. There are two articles in this issue. First an excellent article from a medical student on the subject of Fever in the neutropenic patient and the methods of distinguishing between infective and malignant causes. This is followed by a blockbuster review article from Dr. Nabil Jarad in which he describes the history and treatment of emphysema. There are exciting developments in the treatment of pulmonary emphysema and this article, based on a paper that Dr. Jarad gave to the Bristol Medico-Historical Society, provides a fascinating insight on the subject.

1. Fever and Malignancy:  Can procalcitonin differentiate between neoplastic and infective causes of fever in the neutropenic patient?     WEMJ Volume 117 No 1  Article 1 March/April 2018; Lauren Jackson BA (Hons), Medical Student University of Bristol.

Neutropenia is a common and anticipated side effect of antineoplastic chemotherapy used in the management of both solid and haematological malignancy leaving them susceptible to opportunist infection(3-6).Procalcitonin has demonstrated high specificity in differentiating between infective and non-infective causes of fever in this population. Ambiguity persists reagrding the cause of low sensitivity.

 

2. The History and Future Treatment of Emphysema: Emphysema Valves, Emphysema Coils and Volume Reduction Surgery, Vol 117 No 1 Article 2 Dr Nabil Jarad PhD FRCP, Consultant Respiratory Physician, Bristol Royal Infirmary, Bristol BS2 8HW

Emphysema is one component of the spectrum of Chronic Obstructive Pulmonary Disease (COPD) a condition that affects at least one million persons in the UK.  Emphysema is a lung tissue damage induced mainly by cigarette smoking. For that reason, the condition has been treated with nihilism by health care workers. Breathlessness, weight loss and fatigue are the main manifestations.  Up to recently only symptomatic treatment including inhaled bronchodilators, oxygen therapy, anxiolytic agents and opioids were provided to treat breathlessness.  However, over the past ten years, new interventional modalities of treatment have been introduced which revolutionised the outlook to this condition.  This article looks back at the history of emphysema management and examines the exciting future of emphysema management. The evening lecture on this subject was delivered by the author on Monday 19 October 2016 at the Create Centre – Bristol during the 2016 Annual General Meeting for the Bristol Medico-Historical Society.