Repeat investigations in Pneumocystis pneumonia.
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Biopsy↗
Biomedical subjects
C R Swinburn
Publications and source records attributed to C R Swinburn.
Radiographic features in patients with pulmonary manifestations of the acquired immune deficiency syndrome.
The radiographic findings in 14 episodes of pulmonary pathology, occurring in 13 patients with the acquired immune deficiency syndrome (AIDS) are described. The patients presented over a 15-month period. All were homosexual men with serum antibodies to human T-cell lymphotrophic virus III. Pneumocystis carinii pneumonia was the most common manifestation, occurring in seven of the 14 episodes. Radiographic appearances in five of these were classical, with bilateral perihilar ground-glass shadowing initially. In one the appearances were complicated by a superadded bacterial infection and in one the chest radiograph was normal. Bacterial infections occurred in five of the 14 episodes and, when present, showed the characteristic radiographic appearances of the causative organism. Three patients had widespread Kaposi's sarcoma. Bronchoscopy, broncho-alveolar lavage and transbronchial biopsy were often necessary to identify the causative agent. They were also indicated when atypical radiographic appearances occurred during the course of treatment as additional organisms could be found. The radiographic appearances of the conditions reported are felt to be sufficiently characteristic for the radiologist to play a useful role in suggesting the diagnosis and in monitoring the progression of disease in these patients.
Acquired Immunodeficiency Syndrome↗
Early experience and difficulties with bronchoalveolar lavage and transbronchial biopsy in the diagnosis of AIDS associated pneumonia in Britain.
Bronchoalveolar lavage and transbronchial biopsy have been used as adjuncts to the management of patients with pneumonia associated with the acquired immunodeficiency syndrome (AIDS) at the Middlesex Hospital and the experience gained and difficulties encountered in the first five cases are reported. Widely varying organisms were isolated from lavage aspirates, some of which may have been nasopharyngeal contaminants, and organisms cultured from the transbronchial biopsy specimens may offer a better guide to antimicrobial treatment. Pneumocystis carinii was found in two of the patients. In view of the potentially serious toxicity of high dose co-trimoxazole, continuation of this treatment may be inadvisable if Pneumocystis carinii is not identified by all available methods unless there are strong clinical grounds to suspect its presence.
Acquired Immunodeficiency Syndrome↗
Performance, ventilation, and oxygen consumption in three different types of exercise test in patients with chronic obstructive lung disease.
Seventeen patients (six men and 11 women, mean age 66 years) with severe chronic obstructive lung disease (mean FEV1 0.8 (SD 0.3)1) performed three different types of exercise test on four occasions within one week. Three daily doses of placebo tablets were given between the third and fourth attempt at each test. The tests were the 12 minute walking test, a fixed rate and height paced step test, and a cycle ergometer test in which the work rate was increased by 10 watts each minute. Performance increased significantly (p less than 0.01) between the first and fourth attempts in each type of test (12 min walking distance 16% (SD 20%); steps climbed 96% (74%); duration of cycling 29% (41%]. There was a trend for the increase in performance between successive attempts to become progressively smaller but this was not significant. No effect of placebo on exercise performance was detected. The greatest intersubject range of performance was seen in the step test (14-126 steps) and the least in the walking test (438-1014 m). Significant correlations (p less than 0.01) were observed between performance in all three types of exercise test, but the correlations found between the results of the various tests of exercise performance and the FEV1 and the FVC were either weak (p less than 0.05) or non-significant. Ventilation (VE) and oxygen consumption (VO2) were subsequently measured and compared in eight patients during all three types of exercise test. Both the VE and the VO2 that were achieved in the step test were significantly greater than in either the cycle or the walking test. No patient was able to reach and sustain steady state values of VE and VO2 in the step test, whereas a steady state for both VE and VO2 was reached and sustained by all eight patients in the walking test. It is suggested that at least three practice attempts at any exercise test should be made before the introduction of either placebo or specific pharmacological treatment and that even then it may be necessary to allow for the effects of further repeated testing in the assessment of the results of treatment.
Aged↗
Management of AIDS pneumonia.
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Acquired Immunodeficiency Syndrome↗
Relationship between ventilation and breathlessness during exercise in chronic obstructive airways disease is not altered by prevention of hypoxaemia.
We have examined the hypothesis that hypoxaemia contributes to breathlessness by a mechanism distinct from its action as a ventilatory stimulant. Five patients who developed arterial oxygen desaturation during incremental exercise were studied. Exercise tests were performed on a cycle-ergometer. Breathlessness was measured by using a visual analogue scale technique. All five patients had considerable previous experience of these procedures. Two identical exercise tests were performed by each patient, breathing either room air or 60% oxygen in a blind randomized study. Breathing air, arterial saturation at rest was 93% and fell by 7% during exercise. Breathing 60% oxygen, resting saturation was 98% and there was no fall during exercise. Breathing oxygen, ventilation for a given work load was reduced and exercise duration was increased when compared with air breathing. In each of the five patients the relationship between breathlessness and minute ventilation was the same whether breathing air or 60% oxygen, despite the reduction in ventilation for a given work rate.
Aged↗
Intrinsic and extrinsic asthma, a shared lymphocyte abnormality.
We have examined in vitro cell-mediated lymphocyte responses to Concanavalin A, (Con. A), and the effects of histamine and indomethacin upon these responses, in normal subjects, and patients with extrinsic and intrinsic asthma, and chronic bronchitis. Lymphocytes from both intrinsic and extrinsic asthmatics are particularly sensitive to histamine-induced suppression of their response to Con. A, and this increased sensitivity was reversed by indomethacin. In these respects, lymphocytes from intrinsic and extrinsic asthmatics behave in an identical fashion, but differ significantly from lymphocytes from both normal subjects and patients with fixed airways obstruction (chronic bronchitis). It is suggested that there is a common immunological mechanism in extrinsic asthma and intrinsic asthma.
Adult↗