Biomedical subjects

D G Milne

Publications and source records attributed to D G Milne.

4 recordsLinked to original sources

PubMed2003

Retrospective review of children presenting with non cystic fibrosis bronchiectasis: HRCT features and clinical relationships.

Non cystic fibrosis (CF) bronchiectasis in children presents with a spectrum of disease severity. Our aims were to document the extent and severity of disease in children with non-CF bronchiectasis, to review the inter- and intraobserver agreement for the high-resolution computed tomography (HRCT) features examined, and to assess correlations between HRCT features and clinical measures of severity. We performed a retrospective review of 56 children from the Starship Children's Hospital. HRCT scans were scored by a modified Bhalla system, and the chest X-rays using the Brasfield score. Scores were correlated with demographics, number of hospitalizations, disease duration, pulmonary function, clinical examination, and chronic sputum infection. The bronchiectasis seen was widespread and severe, particularly in Maori and Pacific Island children. The kappa coefficient for intraobserver agreement was better than that for interobserver agreement. Comparisons between HRCT scan and lung function parameters showed that the strongest relationships were between forced expiratory volume in 1 sec (FEV(1)) and forced expiratory flow between 25-75% of forced vital capacity (FEF(25-75)) with the extent of bronchiectasis, bronchial wall thickening, and air trapping. Children with digital clubbing and chest deformity showed significantly higher scores for extent of bronchiectasis, bronchial wall dilatation and thickness, and overall computed tomography (CT) score. No relationship was demonstrated between chronic sputum infection and CT score. The HRCT score demonstrated a stronger correlation between the extent and severity of bronchiectasis, and spirometry values, than the chest X-ray score. In conclusion, pediatric non-CF bronchiectasis in Auckland is extensive and severe. The good intraobserver ratings mean that consistency of scoring is possible on repeated scans. This study cannot comment on the relationships of CT and less severe disease.

Adolescent↗

PubMed2000

Airflow obstruction in bronchiectasis: correlation between computed tomography features and pulmonary function tests.

BACKGROUND: An obstructive defect is usual in bronchiectasis, but the pathophysiological basis of airflow obstruction remains uncertain. High resolution computed tomographic (CT) scanning now allows quantitation of static morphological abnormalities, as well as dynamic changes shown on expiratory CT scans. The aim of this study was to determine which static and dynamic structural abnormalities on the CT scan are associated with airflow obstruction in bronchiectasis. METHODS: The inspiratory and expiratory features on the CT scan of 100 patients with bronchiectasis undergoing concurrent lung function tests were scored semi-quantitatively by three observers. RESULTS: On univariate analysis the extent and severity of bronchiectasis, the severity of bronchial wall thickening, and the extent of decreased attenuation on the expiratory CT scan correlated strongly with the severity of airflow obstruction; the closest relationship was seen between decreased forced expiratory volume in one second (FEV(1)) and the extent of decreased attenuation on the expiratory CT scan (R(s) = -0.55, p<0. 00005). On multivariate analysis bronchial wall thickness and decreased attenuation were consistently the strongest independent determinants of airflow obstruction. The extent of decreased attenuation was positively associated with the severity of bronchial wall thickness, but was not independently linked to gas transfer levels. Endobronchial secretions seen on CT scanning had no functional significance; the severity of bronchial dilatation was negatively associated with airflow obstruction after adjustment for other morphological features. CONCLUSIONS: These findings indicate that airflow obstruction in bronchiectasis is primarily linked to evidence of intrinsic disease of small and medium airways on CT scanning and not to bronchiectatic abnormalities in large airways, emphysema, or retained endobronchial secretions.

Adult↗

PubMed1998

Pulmonary sarcoidosis: morphologic associations of airflow obstruction at thin-section CT.

PURPOSE: To identify relationships between the obstructive defects of pulmonary sarcoidosis and the computed tomographic (CT) patterns of disease. MATERIAL AND METHODS: CT scans obtained in 45 patients were scored semiquantitatively for extent of five CT patterns, and the functional importance of each pattern was evaluated. RESULTS: The most prevalent CT patterns were decreased attenuation (n = 40), a reticular pattern (n = 37), and a nodular pattern (n = 36). At univariate and multivariate analyses, a reticular pattern was the main determinant of functional impairment, particularly airflow obstruction. The extent of a reticular pattern was independently associated with airflow obstruction, as shown by the inverse relationships with the forced expiratory volume in 1 second (FEV1) (P < .001), FEV1-forced vital capacity ratio (P < .01), maximum expiratory flow at 25% above residual volume (P < .001), and maximum expiratory flow at 50% above residual volume (P < .001) and the positive relationship with the residual volume-total lung capacity ratio (P < .001). CONCLUSION: In sarcoidosis, CT features compatible with small airways disease are common but contribute little to airflow obstruction, particularly in more advanced disease, which is characterized by an extensive reticular pattern. A reticular pattern at CT is the major morphologic association of airflow obstruction.

Adult↗

PubMedDate not supplied

Nitrofurantoin-induced lung disease: two cases demonstrating resolution of apparently irreversible CT abnormalities.

A reticular pattern on high resolution CT (HRCT) invariably represents significant lung pathology and is the dominant feature of irreversible fibrosis. We present two cases of nitrofurantoin-induced pulmonary toxicity in which the initial HRCT showed a widespread reticular pattern and associated distortion of the lung parenchyma, thought to represent established fibrosis. Follow-up HRCT scans after withdrawal of the drug showed resolution of this supposedly irreversible pattern.

Aged↗