Audit of control of heparin treatment.
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Biomedical subjects
Publications and source records attributed to A G Fennerty.
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To determine whether airway receptors are responsible for the rapid, shallow breathing pattern seen in hypercapnic chronic obstructive lung disease, 10 patients underwent upper airway anaesthesia with inhaled lignocaine in a placebo controlled study. There was a significant reduction in breathing frequency after lignocaine (p less than 0.001) that was due to an increase in expiratory time (p less than 0.001). The inspiratory time remained unchanged, but tidal volume increased significantly (p less than 0.02). It is concluded that, while airway receptors may have a role in determining the frequency of breathing in chronic obstructive lung disease, other factors are responsible for the reduced inspiratory time.
We report the results of a double-blind control crossover trial of slow release theophylline Nuelin S.A. in improving symptoms of 'morning-dipping' in twelve asthmatic patients. Sleep disturbance was lessened and 'morning-dipping', though not abolished, was improved by 24% (P less than 0.01). Mean peak expiratory flow-rate (PEFR) on waking was significantly higher on active drug (262 l/min vs 226 l/min, P less than 0.001) as were the evening PEFRs (316 l/min vs 285 l/min, P less than 0.05). Seven of the 12 patients achieved 26% improvement in mean PEFR (P less than 0.05) with plasma theophylline levels in the range 28-44 mumol/l. The other five patients improved by 9% (P less than 0.02) with levels in the range 55-66 mumol/l. Mean plasma cyclic AMP 4-6 h after theophylline was significantly higher than with placebo (27.0 nmol/l vs 17.6 nmol/l, P less than 0.05) but significant correlations between cyclic AMP and theophylline levels, and cyclic AMP and PEFR were not demonstrated. A total of nine patients, 33% of those originally recruited for this study, withdrew prior to the double-blind phase because of unacceptable side-effects of theophylline, namely nausea and headache.
A case is reported in which a tracheal tumour presented with symptoms suggestive of bronchial asthma. In the assessment and management of airways obstruction and wheeze, it is important to bear in mind that disease other than asthma and chronic bronchitis may present in this way.
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An occupational survey was completed on 87 patients with end-stage renal failure to determine their exposure to hydrocarbon based compounds. 59% of patients with renal failure due to glomerulonphritis had significant contact with hydrocarbons compared with 25% of patients with renal failure due to other causes (P < 0.01). 81% of patients with glomerulonephritis were male and of these 64% had significant hydrocarbon exposure compared with 35% of an age matched control group of male hospital in-patients with no renal pathology. Occupational exposure to hydrocarbons may account for the male predominance in patients with glomerulonephritis.