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Biomedical subjects

D E Stableforth

Publications and source records attributed to D E Stableforth.

At least 55 records · Page 3Linked to original sources
PubMed1990

Changes in hospital management of acute severe asthma by thoracic and general physicians in Birmingham and Manchester during 1978 and 1985.

Hospital management of acute severe asthma in 14 large hospitals in Birmingham and Manchester was audited in a random 20% of 1196 patients aged 15-45 years admitted in 1985. Of the 239 admissions randomised, 192 were suitable for study. Results were compared with those from a study in the same hospitals using the same methods in 1978. The age and sex of the patients and their smoking history, duration of asthma, and hospital attendance were similar in 1978 and 1985. A much smaller proportion of patients presented with symptoms of over seven days' duration in 1985 (8.5%) than in 1978 (26%). The inpatient management of asthma appears to have improved in both thoracic and general units, with more thorough functional assessments, more frequent performance of relevant investigations (arterial blood gases and peak expiratory flow rates) and more frequent use of recommended treatment (nebulised bronchodilators, oral and intravenous corticosteroids). Less difference was found in 1985 between units with a specialist thoracic interest and those without, though some differences remained in 1985 in monitoring of peak expiratory flow rate and arterial blood gases, outpatient prescribing, and follow up arrangements. Inhaled preventive medication was prescribed more frequently than in 1978. In 1985 there was a 56% increase in admissions for asthma. The proportion of severely ill patients was similar to that in 1978, but in the most severe functional grade mean arterial carbon dioxide tension was higher in 1985 and more patients were ventilated. Our results suggest that hospital management by thoracic and general physicians has improved over the period 1978-85. Patients presented earlier in 1985, though there seems to have been an increase in asthma of all grades of severity.

Adolescent↗
PubMed1990

Sweat sodium and chloride concentrations--essential criteria for the diagnosis of cystic fibrosis in adults.

Criteria for a positive sweat test in children (sweat sodium greater than 60 mmol/L and sweat chloride greater than 70 mmol/L) were investigated in a series of adults aged between 18 and 40 years using the standard Gibson and Cooke technique of pilocarpine iontophoresis. A significant number of non-cystic fibrosis adults had sweat sodium values greater than 60 mmol/L whereas a concentration of chloride greater than 70 mmol/L always discriminated adults with cystic fibrosis from normal adults and those with chest disease not due to cystic fibrosis. In all cases of adult cystic fibrosis the sweat sodium concentration was greater than 80 mmol/L. The Na:Cl ratio and sum of Na and Cl provided additional helpful criteria in distinguishing between adults with and without cystic fibrosis.

Adolescent↗
PubMed1988

The effects of ketotifen on beta-adrenergic activity in asthmatics.

In order to examine a possible mechanism of action of ketotifen in asthma, a double-blind study was undertaken to determine whether ketotifen showed any effects on the beta-adrenergic system in asthmatic patients. The effects of ketotifen 1 mg b.i.d. for one month on the changes in spirometry, plasma potassium and serum glucose nebulized salbutamol was compared with placebo. In addition the degree of inhibition caused by local salbutamol on the wheal volume due to intradermal prostaglandin E and bradykinin, was compared following ketotifen and placebo. Nebulized salbutamol produced consistent improvements in spirometry and changes in potassium and glucose levels. Local salbutamol significantly decreased the wheal volume induced by intradermal prostaglandin E and bradykinin. However, none of these salbutamol-induced effects were altered following ketotifen or placebo. Ketotifen, in the doses used, has no demonstrable effect on the beta-adrenergic system in asthmatic patients.

Adolescent↗
PubMed1988

Susceptibility to tuberculosis in patients with coeliac disease.

An increased prevalence of past tuberculosis is reported in an adult coeliac population. Of 76 adult coeliac disease patients, 6 had had a history of tuberculosis. This compared with the finding of no cases in a population of 81 patients with non-inflammatory bowel diseases, (p = 0.023), which was matched for age, sex, smoking, ethnic origin and social class. The 'expected' number of cases of tuberculosis amongst ACD patients has also been calculated based on local annual notification rates; this was 2.9. Radiological evidence of past tuberculosis was found in 13 (17%) ACD patients, compared with 4 (5%) control patients (p less than 0.05). It is postulated that the increased prevalence of past tuberculosis in ACD patients is the result of depressed cell mediated immunity and/or malnutrition.

Adolescent↗
PubMed1987

Effect of nifedipine on serum theophylline concentrations and asthma control.

The effect of adding slow release nifedipine to oral theophylline has been studied in eight patients with stable but symptomatic asthma, a double blind placebo controlled crossover protocol being used. No change in asthma control occurred during the nifedipine treatment period as assessed by serial peak flow measurements and symptom scores. Serum theophylline concentrations were significantly lower after nifedipine than after placebo (6.8 v 9.7 micrograms/ml) and in three patients were well below the therapeutic range (less than 4 micrograms/ml).

Aged↗
PubMed1986

Intravenous aminophylline in patients already taking oral theophylline: effect on calculated dose of knowledge of serum theophylline concentration on admission.

Measurement of serum theophylline concentration is usually recommended before intravenous aminophylline is given to patients taking oral theophylline. Fifty patients with worsening airflow obstruction, all of whom were taking oral theophyllines and who had no contraindication to the use of parenteral aminophylline, were randomly allocated into two groups before treatment was given. The dose of aminophylline was calculated without (group A) and with (group B) knowledge of admission serum theophylline concentration. In group A a regimen incorporating corrections to account for factors affecting theophylline clearance was used in an attempt to represent a "knowledgeable" approach; in group B a formula incorporating the known serum theophylline concentration at the time of admission was used. All loading doses were given over 30 minutes as "mini infusions." The two groups were well matched for age, blood gas tensions, and severity of airflow obstruction. The results for four patients (one from group A and three from group B) were excluded from analysis after completion of the study. In each group the mean admission serum theophylline concentration measured (group A: 8.4 (SD 6.0)mg/l; group B: 7.2 (5.7)mg/l) and the aminophylline doses used (group A: loading bolus 172 (45.5)mg, infusion 815 (198)mg; group B: loading bolus 233(189)mg, infusion 788(214)mg) were similar. Mean serum theophylline concentrations during 24 hours' aminophylline treatment, number of patients with a serum theophylline concentration greater than 20 mg/l, symptoms of toxicity, and outcome were also similar in the two groups. Although satisfactory use of parenteral aminophylline was achieved for most patients without knowledge of serum theophylline concentration at the time of admission to hospital (with the aid of a "knowledgeable" clinical approach and constant infusion pumps), prompt measurement of serum theophylline concentration at the time of admission identified patients with either suboptimal or potentially hazardous theophylline concentrations.

Administration, Oral↗
PubMed1986

Large lung bullae in sarcoidosis.

Large lung bullae are a rare manifestation of pulmonary sarcoidosis. Of three patients with this complication, all had pulmonary infiltrates at presentation and two had bilateral hilar adenopathy. Hypercalcaemia developed during the course of the illness in all three patients. In each case the bullae had developed within four years of the diagnosis of sarcoidosis. In one woman a bulla resolved almost completely after it had become infected.

Adult↗
PubMed1986

Effect of ketotifen on the bronchodilating action of aminophylline.

The use of methyl xanthine derivatives for the treatment of bronchospasm is limited by unwanted side-effects which are frequently dose related. Potentiation of the bronchodilating effects of these derivatives would therefore have obvious clinical advantages. This paper reports the results of a trial designed to elucidate whether potentiation occurs between aminophylline and ketotifen.

Adolescent↗
PubMed1985

A study of the use of ultrasonically nebulized lignocaine for local anaesthesia during fibreoptic bronchoscopy.

The use of nebulized lignocaine, with and without intravenous diazepam premedication, was compared with lignocaine given by bolus in 52 patients undergoing fibreoptic bronchoscopy (FOB). Changes in airflow, cardiac rhythm, and transcutaneous PO2 were recorded, and patient acceptability, blood lignocaine levels, and the duration of the procedure were also monitored. Nebulized lignocaine alone provide adequate anaesthesia and the procedures were performed more quickly (P less than 0.05) than when bolus lignocaine was used. Nebulized lignocaine without diazepam was acceptable to the patients and was not associated with the significant (P less than 0.03) falls in transcutaneous PO2 which followed diazepam administration. Nebulized lignocaine, with and without, diazepam premedication is a safe, effective and acceptable method of inducing topical anaesthesia for FOB.

Aerosols↗
PubMed1985

The use of parenteral aminophylline in patients taking slow release theophylline preparations: an observation of clinical practice.

Parenteral theophylline usage was studied in 53 patients with worsening airflow obstruction who had been prescribed slow release theophylline drugs and were admitted to a hospital lacking facilities for rapid serum theophylline concentration estimation. Individual clinicians varied in their practice with respect to parenteral aminophylline, but in general its use was favoured in patients with asthma rather than simple chronic airflow obstruction. There was no significant difference in admission serum theophylline concentrations between 31 patients who were subsequently given intravenous aminophylline and 22 who were not. There was also no significant difference in admission serum theophylline concentrations between ten patients given an aminophylline bolus and an infusion, seven patients given a bolus alone and 14 patients given an infusion alone. Individual patient's serum theophylline concentrations were variable during infusions and often suboptimal. The results indicate that the use of parenteral aminophylline in patients receiving slow release theophyllines is imprecise and possibly hazardous without facilities for prompt serum theophylline concentration estimations. This facility should be available in hospitals where parenteral aminophylline is used.

Adolescent↗
PubMed1984

Circumstances of death from asthma.

Mortality from asthma in England and Wales has remained unchanged for at least 20 years, even in the age group 15-44. Yet in those 20 years "modern" drugs have been introduced for the treatment of asthma, such as beta 2 agonist bronchodilators and corticosteroids. Why do patients still die? Detailed review of the circumstances of 90 deaths from asthma showed that a few were inevitable but that in the remainder four main sets of circumstances in the fatal attack contributed to the death. These were, firstly, the patient's failure to recognise the severity of the asthma; secondly, very rapid progress in the severity of the attack; thirdly, misjudgment in the management of the attack; and, fourthly, delay from many causes. Patients admitted to hospital with severe acute asthma usually survive. Those at risk of a life threatening attack should be identified and taught to monitor the severity and progress of their asthma objectively. Their direct admission to hospital should be facilitated.

Acute Disease↗
PubMed1984

The influence of transbronchial lung biopsy and bronchoalveolar lavage on arterial blood gas changes occurring in patients with diffuse interstitial lung disease.

Serial arterial blood gases were measured during fibreoptic bronchoscopy in 26 patients with diffuse interstitial lung disease. All those having transbronchial biopsy with or without bronchoalveolar lavage, performed breathing room air, showed significant falls in PaO2, at the time of passage of the bronchoscope through the vocal cords both at the beginning and end of the procedure. Patients having bronchoalveolar lavage and transbronchial biopsy performed with supplementary oxygen at least maintained their basal PaO2 levels. Cessation of the supplementary oxygen 30 minutes after withdrawal of the bronchoscope did not result in rebound hypoxaemia. Bronchoalveolar lavage and transbronchial biopsy can be performed safely in patients with diffuse interstitial lung disease without significant hypoxaemia developing, if oxygen is started before the procedure and continued for 30 minutes after withdrawal of the bronchoscope.

Adult↗
PubMed1983

Prolonged small-intestinal transit time in cystic fibrosis.

A lactulose hydrogen breath test was performed on 10 patients with cystic fibrosis and 15 control subjects matched for age and sex. All normal subjects had a fasting breath hydrogen concentration of less than 20 ppm. In contrast, seven of the patients with cystic fibrosis had high concentrations (25-170 ppm), which fell to 20 ppm or below on prolonged fasting (14-23 hours). Two patients showed no rise in breath hydrogen concentrations after lactulose, and in one patient the breath hydrogen concentration rose at 15 minutes, suggesting bacterial colonisation of the small bowel. Seven of the patients had prolonged small-bowel transit times (160-390 minutes) compared with those in the control group (50-150 minutes).

Adolescent↗
PubMed1983

Dysphonia caused by inhaled steroids: recognition of a characteristic laryngeal abnormality.

Nine of 14 asthmatic patients who presented with persistent dysphonia while taking inhaled corticosteroids had a bilateral adductor vocal cord deformity with bowing of the cords on phonation. This causes the dysphonia and usually occurs without candidiasis. It was seen with beclomethasone dipropionate (in both pressurised aerosol and dry powder preparations), betamethasone valerate, and budesonide. It was related to the dose and potency of inhaled steroid and may represent a local steroid myopathy. It was reversed when the inhaled steroid was stopped, although resolution sometimes took weeks. Laryngeal candidiasis may have contributed to the vocal cord abnormality in two of these nine patients. Of the five patients without vocal cord deformity, laryngeal candidiasis was the sole cause of dysphonia in three. In the remaining two dysphonia was thought to be psychogenic. The vocal cord deformity may exist subclinically. Of nine patients who started to take aerosol steroid and who were examined monthly for one year, three developed vocal cord deformity but only one had persistent dysphonia. Vocal abuse did not appear to contribute to dysphonia.

Adult↗