The clinician's guide to the cardiovascular examination

A detailed examination of the cardiovascular system is indispensable to the full appreciation of the cardiac status. Yet, because this fundamental aspect of cardiology is so inadequately presented by many of the major texts, students often fail to grasp the essentials. The author not only brings a rich knowledge of the subject to his task, but also a wide experience of teaching and a firm conviction that the prime purpose of the undergraduate pre-clinical curriculum is to provide information on which the student may build. The student who masters this information will be well prepared for the clinical years and suitably equipped for more advanced studies

The lipoid pneumonia of blackfat tobacco smokers in Guyana

In Guyana, a large number of patients have been diagnosed as having a diffuse pulmonary fibrosis of unknown aetiology, characterized by typical radiological appearances, dyspnoea, cough, weight loss, and eventually pulmonary heart disease. Investigation of 56 patients showed that all had smoked a tobaco known as 'blackfat' or 'black tobacco'. In a community survey 20.4 per cent of the population aged 55 years and over smoked this tobbaco. 19.6 per cent of the blackfat smokers but no non-blackfat smokers showed definite radiological evidence of pulmonary fibrosis. Smokers with, but not those without fibrosis, had severe airway obstruction. Immunological studies made it unlikely that an extrinsic allergic aveolitis had caused the radiological changes. Three post-mortem open-lung specimens were obtained and in each case the histology showed a diffuse interstitial fibrosis and vasculitis associated with large deposits of lipid surrounded by black amorphous material. Blackfat is a tobacco leaf to which mineral oil and vaseline is added for flavouring and as humectants. The presence of oil in the tobacco, and the post-mortem findings of oil in the lungs, indicate that the diffuse pulmonary fibrosis can be more accurately described as a lipoid pneumonia caused by the inhalation of mineral oils when blackfat is smoked. The potential health hazards of many tobacco additives, particularly oils, employed by the tobacco industry should be recognized. A similar type of disease as that found in Guyana may be present in other parts of the world where blackfat, or related tobacco, are smoked.(Summary)

Diffuse pulmonary fibrosis and blackfat tobacco smoking in Guyana - abstract

Over the past year epidemiological, immunopathological and morbid anatomical studies have been in progress in an attempt to define the aetiology of an obscure form of diffues pulmonary fibrosis in Guyana. Dr. H. M. S. G. Beadnell of Lusignan hospital has kept a record of all cases of pulmonary fibrosis referred to him. 14 of these patients were interviewed and examined. All were Indian aged 49-75 years, and 9 were women. The onset had been insidious, there being progressive dyspnoea, dry cough and weight loss. Common findings were central cyanosis, basal crepitations and signs of right ventricular hypertropy. Chest X-ray showed diffuse fibrotic changes and areas of consolidation. Lung function showed severe obstructive airways disease in most, and restrictive lung disease in a few. Patients were questioned about previous occupations, dust exposure and smoking habits. This revealed that all smoked blackfat tobacco smoking was determined during a population survey of two local communities. Only eleven blackfat tobacco smokers were found, all Indian women, and three of these had typical pulmonary fibrosis. 16 people known to smoke blackfat tobacco were examined; 12 had evidence of respiratory disease and 5 had radiographic appearances of pulmonary fibrosis. Further epidemiological studies undertaken more recently lend support to these findings(AU)