PubMed Health⌕ Search

Biomedical subjects

D Empey

Publications and source records attributed to D Empey.

10 recordsLinked to original sources
PubMed1993

Efficacy and safety of short-term administration of aerosolised recombinant human DNase I in adults with stable stage cystic fibrosis.

Chronic pulmonary infection is the major cause of morbidity and mortality in cystic fibrosis. High levels of DNA in the sputum make the sputum viscous and difficult to expectorate. Recombinant human deoxyribonuclease (rhDNase) in vitro has been shown to reduce the viscoelasticity of the sputum from CF patients. We have done a phase II double-blind randomised placebo-controlled trial in which patients received either 2.5 mg rhDNase twice daily or placebo for 10 days. All patients had forced vital capacity (FVC) above 40% predicted and were clinically stable. Patients were followed up for 42 days from the start of drug/placebo administration. All 71 randomised patients, aged 16-55, completed every aspect of the study and baseline characteristics were similar in the two groups. Baseline forced expiratory volume in one second (FEV1) was 46% of predicted for patients randomised to rhDNase, and 48% for those randomised to placebo; and baseline FVC was 76% of predicted for both groups. The mean percentage change in FEV1 from baseline was a 13.3% rise on rhDNase and a 0.2% fall on placebo (p < 0.001). FVC rose 7.2% in the rhDNase group and 2.3% in the placebo group (not significant). There were no life-threatening adverse events and no anaphylactic reactions. There was no significant difference in side-effects between the groups. This study confirms that short-term administration of rhDNase in stable patients with cystic fibrosis is safe and improves lung function.

Adolescent↗
PubMed1992

Sequential treatment with low dose almitrine bismesylate in hypoxaemic chronic obstructive airways disease.

Daily dose schedules of 100-200 mg of almitrine bismesylate improve arterial blood gases in patients with hypoxaemic chronic obstructive airways disease (COPD) but dose related side effects are evident. In the present study, daily doses approximately half of those previously used were employed in a randomised double blind manner in 85 patients (age 35-79 years) with hypoxaemic COPD. After a one month period to check stability of arterial blood gases, patients were allocated to almitrine (A) or placebo (P) using an unequal code (60% A, 40% P). Tablets, 50-100 mg daily were stopped for one month after 3, 6 and 9 months to counteract drug accumulation. 50 patients in group A and 35 in group P were comparable on entry; mean age 65 (SD = 8) yrs., Pao2 7.8 (0.7) kPa (58.3 (5.0) mmHg), PaCO2 5.8 (0.8) kPa (43.2 (6.0) mmHg), forced expiratory volume in one second--FEV1 0.89 (0.25) l and 6 minute walking distance 296 (97) metres. The improvement in baseline PaO2 values was the same 0.8-1.3 kPa (6-9.8 mmHg) as with previous higher dose therapy. Approximately one third of patients did not respond, defined as PaO2 elevation > 0.67 kPa (5 mmHg). The sequential dosing scheme stabilised blood levels of almitrine within the therapeutic range of 280-300 ng.ml-1. After withdrawal of therapy arterial blood gases and spirometry reverted to pre-treatment levels, suggesting no permanent reversal of pathophysiology. Dose related side effects of breathlessness, indigestion and peripheral neuropathy were not observed. Nerve conduction studies revealed no difference in peripheral nerve dysfunction in hypoxaemic COPD between active and placebo therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Fine structural changes in idiopathic pulmonary haemosiderosis.

Lung biopsies from four children and two adults with idiopathic pulmonary haemosiderosis have been examined by transmission electron microscopy. No qualitative differences were identified between the children and the adults but the changes were more severe in the children. In each case the major damage involved the capillary endothelium and its basement membrane. Capillary endothelial swelling was very noticeable and in one case the endothelium was attenuated but gaps between endothelial cells were very difficult to find. Capillary narrowing and platelet aggregation were common. The capillary endothelial basement membrane showed focal thickening, particularly on the thick side of the air/blood barrier, but no electron dense deposits were identified. Degenerative changes in the alveolar epithelium were not so marked as those in the capillary endothelium and the epithelial basement membrane was normal except for haemosiderin deposition. Haemosiderin was also noted on elastin and within intra-alveolar macrophages. Other secondary changes included mild interstitial oedema and fibrosis. These findings indicate that the major site of damage is the alveolar capillary, but provide no evidence of the cause of the disease.

Adolescent↗
PubMed1986

The initial surgical intensive care unit nursing experience with the permanent total artificial heart.

The Utah experience with implantation of the Jarvik-7 demonstrated that this TAH can be implanted successfully within the confines of the adult human mediastinum. The device has proven its capacity to sustain the patient's life without causing the patient pain. There is no immunologic rejection of the heart, and in fact most other organ systems appear to accommodate well to the artificial pump. As is the nature of any experiment, problems were encountered and questions raised. Laboratory investigation is underway to test the durability of various prosthetic valves in the Jarvik-7. Subsequent recipients of the Jarvik-7 implant have experienced embolic episodes. The quick connects are being scrutinized closely for a predilection for thrombi accumulation. The significance of reperfusing persons who have adapted to chronic states of low cardiac output is still not completely understood. The ramifications of rapidly reperfusing cellular and organ systems is currently being studied. Ethical considerations as described by Woolley are being discussed at length. Protocols are being established with flexible guidelines for management of the TAH patient. Some of these protocols include infection control, anticoagulation, and hematological guidelines; nutritional support, physical therapy, and rehabilitation programs. More extensive preoperative evaluation and testing protocols are being developed. Further clarifications of the nurses' responsibility in maintaining the TAH equipment are being made. Certification methods are being developed to ensure the nurse's competency. Data collection methods are being refined by adapting information flow charts and computer hard copies specifically to the TAH patient. The Utah experience with TAH implantation in humans is still in its infancy. Twenty years of animal research provided a strong base from which to approach the first human subject. However, "there are limitations in extrapolating information from the best animal models and relating it to the critically ill human being." Animals used in the research were young and healthy; human candidates who meet the criteria for implant are generally extremely debilitated. This, coupled with the absence of human historical perspective or precedent, left many unknowns for the first TAH recipient. Our patient expired on March 23, 1982 of pseudomembranous colitis. Despite his death after 112 days of life sustained on the mechanical heart, he participated in a successful pioneering scientific experiment.

Acute Kidney Injury↗