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Biomedical subjects

B J Hartnett

Publications and source records attributed to B J Hartnett.

11 recordsLinked to original sources

The use of fibreoptic bronchoscopy with sterile catheter in the diagnosis of pneumonia.

The use of fibreoptic bronchoscopy with sterile catheter sampling of pulmonary secretions was evaluated in 70 patients with a provisional diagnosis of pneumonia. In 37 patients quantitative analysis of the sterile catheter isolates was performed (colony forming units (CFU) per ml). Potential bacterial pathogens were isolated in 37 patients and in the quantitative analysis, 14 of 22 isolates were grown in counts greater than or equal to 10(3) CFU/ml. Sterile catheter increased the bacterial isolation rate as in only 19 patients blood (2) or sputum (18) cultures yielded the same organisms. Sputum cultures showed a 25% false-positive rate in patients with no growth from sterile catheter. Quantitative analysis did not yield any further information in patients receiving antibiotics. Atypical or fungal pneumonia was diagnosed in 22 patients, while ten patients had other pathology simulating pneumonia. Sterile catheter sampling of pulmonary secretions at fibreoptic bronchoscopy proved to be a valuable tool in the diagnosis of bacterial pneumonia.

Adolescent

Tracheobronchopathia osteochondroplastica.

The clinical, pathological and physiological features of two patients suffering from tracheobronchopathia osteochondroplastica (TO) are described. Unequivocal evidence of extrapulmonary airways obstruction was not able to be obtained by lung function testing, despite extensive central airway involvement in both patients. TO is a rare condition of which there is only one other clinical report from this country. As the bronchoscopic appearance may closely resemble that of endobronchial neoplasms, TO should be remembered in the differential diagnosis of patients with haemoptysis.

Aged

Assessment of combined oral theophylline and inhaled beta-adrenoceptor agonist bronchodilator therapy.

1. The bronchodilator effects of 500 microgram rimiterol by pressurized aerosol, 375 mg oral theophylline and both drugs in combination were compared in a randomized, placebo-controlled, double-blind trial in eight patients with chronic, partially reversible airways obstruction. 2. The four treatments were (i) oral theophylline, placebo aerosol (TP); (ii) oral placebo, rimiterol aerosol (PR); (iii) oral theophylline, rimiterol aerosol (TR) and; (iv) oral placebo, placebo aerosol (PP). The aerosol was administered 2 h after the oral treatment. 3. Significant bronchodilatation (% FEV1 change from control) compared to PP occurred with TP from 60 to 480 min and with TR from 60 to 300 min, whereas with PR only for 45 min (P less than 0.05). 4. The mean, peak % FEV1 increases from control were 51.8% at 125 min, 31.7% at 125 min, 26.1% at 210 min and 0.9% at 30 min for TR, PR, TP and PP respectively. 5. At 125 min (5 min after aerosol inhalation) the mean % FEV1 change from control with TR (51.8%) Was significantly greater than with PR (31.7%), TP (22.2%) (P less than 0.05) and PP (-2.4%) (P less than 0.01). 6. The mean, peak plasma theophylline levels were 10.19 microgram/ml at 120 min and 9.98 microgram/ml at 180 min with TR and TP respectively. Theophylline half-life ranged between 4.3 and 12.5 h (mean +/- s.e. mean, 8.0 +/- 0.8 h). 7. Additive bronchodilatation was produced when rimiterol was administered with theophylline at a time when therapeutic plasma theophylline levels were achieved.

Administration, Oral

Comparison of terbutaline and salbutamol aerosols.

The bronchodilator effects of terbutaline, 500 microng, and salbutamol, 200 microng, by pressurised aerosol were compared in 16 patients (eight asthma, eight chronic bronchitis with asthma). Salbutamol produced greater bronchodilatation than terbutaline for the initial hour after inhalation. Thereafter, there was no difference in action and an effective bronchodilator response was maintained by each drug for at least four hours. beta2-adrenoceptor stimulating drugs by inhalation are widely used in the treatment of asthma. The purpose of this study was to compare the bronchodilator efficacies of two of these drugs, terbutaline and salbutamol by pressurised aerosol, in patients with partially reversible airways obstruction.

Adult

Terminal exacerbation of chronic melioidosis in New South Wales.

A fatal case of melioidosis, thought to be the third recorded from New South Wales, is presented. Infection probably occurred in Queensland. The patients presented with a subcutaneous abscess complicated by pyaemia, extensive lung involvement and septicaemic shock. The diagnosis was bacteriologically confirmed shortly before death, by isolation of Pseudomonas pseudomallei from blood, pus swabs and tracheal aspirates. There is a need for greater awareness of this disease in persons who have resided in South-East Asia and in North-Eastern Australia.

Adult

Doxycycline in serum and bronchial secretions.

The concentration of doxycycline hydrochloride was measured in serum and bronchial secretions in five patients with chronic bronchitis receiving doxycycline orally in normal therapeutic dosage for seven days (200 mg day 1, 100 mg days 2 to 7). After the loading dose of 200 mg, serum concentrations ranged between 5-40 and 3-45 mug/ml (mean 4-33 mug/ml) at 3 hours, declining to between 2-28 and 1-21 mug/ml (mean 1-71 mug/ml) at 23 hours. The mean serum levels for days 2 to 7 were 2-15, 1-79, and 1-38 at 3, 8, and 23 hours respectively. There was considerable individual variability and a wide range of concentrations of doxycycline in the sputum (0-07 to 2-10 mug/ml, mean 0-34 mug/ml). During the course of treatment there was a progressive increase in sputum levels and sputum/serum concentration ratios. There was no correlation between sputum concentration and degree of purulence. The clinical efficacy of doxycycline does not appear to be related to sputum concentration, although the progressive increase in sputum doxycycline levels may be relevant in preventing recurrence of acute infection when the drug is administered as long-term prophylactic therapy.

Bacillus cereus