PubMed Health⌕ Search

Biomedical subjects

C J Page

Publications and source records attributed to C J Page.

31 records · Page 2Linked to original sources
PubMed1991

Which apparatus for inhaled pentamidine? A comparison of pulmonary deposition via eight nebulisers.

Aerosolised pentamidine 300 mg in 5 or 6 ml solution was administered via 8 different nebuliser systems to 12 patients with acquired immunodeficiency syndrome. Using 99mTc human serum albumin as an indirect marker for pentamidine, pulmonary, extrapulmonary (gastric and oropharyngeal) and alveolar deposition of pentamidine were measured using a gamma camera. Side effects (visual analogue scales) and changes in lung function associated with each treatment were also quantified. Deposition was completed more rapidly with the ultrasonic than the jet nebulisers. Mean total pulmonary depositions (mg +/- SEM) were Respirgard II, 6.1 +/- 0.5; Centimist, 7.3 +/- 1.0, System 22 Mizer, 14.3 +/- 2.1; System 22 Mizer with particle separator; 4.5 +/- 0.4; System 22 Mizer with Optimist 2, 6.3 +/- 0.9; Fisoneb, 6.0 +/- 1.2; Pentasonic (Portasonic); 4.6 +/- 0.9; Samsonic, 2.9 +/- 0.4. Differences between the nebulisers for peripheral lung and alveolar deposition reflected this pattern. Side effects scores were largest with System 22 Mizer, Pentasonic (Portasonic), and Fisoneb, and these produced the greatest oropharyngeal and gastric deposition. The largest reductions in lung function were associated with System 22 Mizer. A 300 mg dose of pentamidine nebulised via Respirgard II is known to be effective prophylaxis for Pneumocystis carinii pneumonia when given once monthly. Our results show that equivalent pulmonary deposition can be produced by other nebulisers. System 22 Mizer gives over twice the deposition associated with Respirgard II, and used with a pentamidine dose of 150 mg is likely to produce an adequate lung dose for prophylaxis. This nebuliser, however, is associated with more marked side effects.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Donor leucocyte imaging in patients with AIDS: a preliminary report.

Four patients with the acquired immunodeficiency syndrome (AIDS) and fever were investigated using donor leucocyte scans. The lung/liver and lung/spleen uptake ratios in these patients were compared with the uptake ratios in donor leucocyte scans in seven neutropenic (non-AIDS) patients and five patients who had autologous leucocyte scans performed over the same time period. For all scans indium-111-oxime-labelled leucocytes were used, except for one AIDS patient in whom technetium-99m hexamethyl-propylene amine oxide (HMPAD)-labelled donor leucocytes were used. There were no adverse reactions to the donor cell infusions. Two patients had repeat studies 8 weeks apart (from different donors) without ill effect. There were no differences in the 111In uptake ratios between the three groups. There were three positive studies in the patients with AIDS, and these elucidated the cause of the pyrexia in all three. The negative case is more difficult to confirm, but the clinical course and the absence of focal disease on post-mortem have been taken to support the scan findings. There was no difference in the acceptability of the technique or the distribution of the labelled leucocytes between the AIDS and non-AIDS patients. Donor leucocyte imaging of patients with AIDS is probably more effective and considerably less hazardous for technical staff than autologous leucocyte methods. This study demonstrates that the technique can be applied successfully to patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Haemophilia, AIDS and lung epithelial permeability.

Lung 99mTc DTPA transfer was measured in HIV antibody-positive haemophiliacs (11 smokers, 26 nonsmokers, 5 patients with Pneumocystis carinii pneumonia (PCP]. Lung 99mTc DTPA transfer as a marker of lung epithelial permeability was measured as the half time of transfer (from airspace into blood). This half time was faster in smokers compared to nonsmokers and the transfer curve was monoexponential. In nonsmokers no difference was observed between asymptomatic HIV-positive haemophiliacs and normal subjects, with the exception of the lung bases. At the lung bases in HIV-positive haemophiliac nonsmokers the transfer was faster than in normal individuals, implying increased alveolar permeability. Pneumocystis carinii pneumonia resulted in a rapid transfer of 99mTc DTPA (mean T50 of 2 minutes) and the transfer curve was biphasic, confirming previous observations in homosexual HIV antibody-positive patients with PCP. These changes returned to a monoexponential profile by 6 weeks following successful treatment. The DTPA lung transfer study may enable clinicians to instigate therapy for PCP without the need for initial bronchoscopy and provide a noninvasive method for the reassessment of patients should further respiratory signs or symptoms develop. This method is considered to be highly cost-effective in that it obviates the use of factor VIII concentrates required to cover bronchoscopic procedures and, with its early application and ease of use as a follow-up investigation, permits the evaluation of patients on an outpatient basis, thus reducing hospital costs.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Does inhalation of pentamidine in the supine position increase deposition in the upper part of the lung?

To assess the effect of posture on the distribution of nebulized pentamidine isethionate deposition in the lung, ten patients with AIDS were studied. Two nebulizer systems, System 22 Mizer (MedicAid) and Respirgard II (Marquest) were modified by adding 40 cm of corrugated tubing (volume 150 ml) to allow the patients to be studied in both the sitting and supine posture. Modification of the nebulizers caused a reduction in lung deposition in the sitting position for the System 22 Mizer but increased deposition in the Respirgard II compared with the unmodified apparatus. The ratio of upper to lower zone deposition (corrected for 133Xe distribution) was increased in the supine position for both devices (p less than 0.01). The best upper zone deposition was achieved with the unmodified System 22 Mizer in the sitting position. Respirgard II had the lowest nonpulmonary deposition and the lowest incidence of adverse effects. The supine position was associated with a redistribution of deposition to the upper zones. To attempt to reduce upper zone recurrence of Pneumocystis carinii pneumonia, the supine posture is suggested for less efficient nebulizer devices, ie, the Respirgard II, but for more efficient systems, ie, System 22 Mizer, the sitting position is probably suitable. This postulate needs to be confirmed by a clinical trial.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The place of lung 99mTc DTPA aerosol transfer in the investigation of lung infections in HIV positive patients.

Pneumocystis carinii pneumonia (PCP) is the most common cause of pneumonia in HIV antibody positive patients, but other pneumonias remain important, i.e. streptococcal and mycobacterial infections. A definitive diagnosis relies on obtaining samples from the lung either noninvasively (induced sputum), or invasively (bronchoalveolar lavage, transbronchial or open lung biopsy). We have used the noninvasive technique of nebulized 99mTc DTPA transfer, to assess patients with PCP (n = 30) and other lung infections (n = 20) to see whether this test will distinguish between the various infections. The presence of a biphasic, rapid transfer curve indicates severe extensive alveolar damage and is seen in PCP or legionella pneumonia. The mean transfer time (T50 +/- SEM) for patients with PCP (whether smokers or nonsmokers) was 2.1 +/- 0.2 min, and for two of the patients with legionella 3.2 min. In PCP effective treatment causes the transfer to slow (mean T50 22.7 +/- 3.3 min, n = 24) and become monoexponential. Other causes of these changes in transfer are discussed. The other pneumonias (streptococcal, mycobacterial, and staphylococcal) did not result in biphasic curves or very rapid times, their T50 values are indistinguishable from cigarette smokers. In this patient group the DTPA transfer is a useful noninvasive investigation with a very rapid, biphasic curve indicating a high probability of PCP.

Adult↗
PubMed1987

Alveolar permeability in HIV antibody positive patients with Pneumocystis carinii pneumonia.

Pulmonary permeability was assessed using the technique of 99mTc (technetium-99m) diethylene triamene pentacetic acid (DTPA) aerosol transfer in 10 patients who had antibodies to human immunodeficiency virus (HIV) and were non-smokers and in 20 HIV antibody positive smokers. Five patients had Pneumocystis carinii pneumonia (PCP) proved by transbronchial lung biopsy; four were non-smokers and one a smoker. Two findings emerged: patients with PCP had greater epithelial permeability than non-smokers and smokers; and the permeability curves were monophasic in smokers and non-smokers, but biphasic in patients with PCP. The biphasic curve observed is indicative of diffuse alveolar damage and might be useful to predict PCP in patients with antibodies to HIV who have normal chest radiographs. As the study was of only five patients with PCP, however, further studies are necessary to confirm this observation.

Adult↗
PubMed1986

Pulmonary permeability in hematologic malignancies. Effects of the disease and cytotoxic agents.

Pulmonary permeability was assessed using the technique of DTPA aerosol transfer in untreated patients with chronic lymphocytic leukemia (CLL) and in patients with a variety of hematologic malignancies that had all been treated with alkylating agents. Two findings emerged: In the untreated CLL patients, the permeability of the upper and middle lung regions was reduced. This may be due to diffuse infiltration by the CLL; and Treatment with cytotoxic agents increased epithelial permeability in both middle and lower lung regions. Further prospective studies are required to determine the cause of the long T50 values in untreated CLL and to confirm that the DTPA transfer test is a sensitive indicator of the damage which eventually leads to pulmonary fibrosis.

Adult↗
PubMed1986

Functional images of lung 99Tcm-DTPA aerosol transfer in smokers and nonsmokers.

The large amount of information from dynamic 99Tcm-DTPA lung can be simplified and rendered easily interpretable by the use of functional images. Eight such images have been devised: a maximum count image, a minimum count image, a time of maximum count image, a time of minimum count image, percentage maximum change image, a T50 image, a standard error image and a correlation coefficient image. These images enable the distribution of aerosol after inhalation, the reliability of the calculated T50 value and movement artefacts to be easily identified. They also allow rapid assessment of the distribution of T50 values in the lungs which may be particularly useful in segmental lung disease.

Adult↗
PubMed1985

Lung 99Tcm-DTPA transfer: a method for background correction.

A method to correct for background in lung DTPA transfer has been developed for use with a large field of view gamma camera. The method gives comparable values of T50 to those obtained by Jones et al. The correction factors vary from apex to base; therefore to allow intersegmental T50 comparisons each segment should be corrected for background using its own correction factor.

Adult↗
PubMed1985

Regional lung epithelial leakiness in smokers and nonsmokers.

In order to measure regional lung 'leakiness' we have adapted a method developed by Jones et al., to correct for background in the estimation of regional lung transfer of DTPA. It is clear from our study that the half time transfer values (T50) alter from the apex to the base of the lungs in both smokers and nonsmokers. The mean apical T50 values are 56.0 and 56.7 min for the right and left lung respectively in nonsmokers and 12.5 and 12.6 min in smokers. The basal T50 values are 77.5 and 76.9 min for the right and left lung respectively in nonsmokers and 24 and 24.2 min in smokers. These figures suggest that cigarette smoke affects all lung regions and that the transfer values in the apices are more rapid than in the bases in both smokers and nonsmokers.

Humans↗
PubMed1985

Relative afferent pupillary defects in primary open-angle glaucoma--five years' experience.

Afferent pupillary defects may accompany asymmetric primary open-angle glaucoma, though the exact incidence has not been reported. Charts were reviewed on 89 patients attending the Glaucoma/Uveitis Clinic at the North Carolina Memorial Hospital in Chapel Hill, North Carolina over a five-year period. All patients had primary open-angle glaucoma diagnosed by: (1) increased ocular tensions (22 mmHg) in the presence of open-anterior-chamber angles and (2) optic-nerve cupping and atrophy compatible with (3) pressure-dependent, visual-field loss. No subjects with secondary glaucomas, primary-angle-closure glaucoma, or ocular hypertension are included.The presence of the relative afferent pupillary defect was noted in 21 of 89 patients (23 percent). Sixteen of 70 black patients had relative afferent pupillary defect in the more severely affected eye, while five of 19 white patients demonstrated afferent pupils. Other demographic characteristics of this population are described. Two typical primary-open-angle glaucoma patients are discussed to demonstrate comparable changes within the optic nerves and Goldmann visual fields. The presence of the relative afferent pupillary defect best correlates with asymmetric, visual-field loss in the more severely affected eye.

Aged↗