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Biomedical subjects

D J Godden

Publications and source records attributed to D J Godden.

At least 19 recordsLinked to original sources
PubMed1997

Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease.

BACKGROUND: There is some evidence that quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD) may predict clinical outcomes and use of resources. This study examined whether QOL scores could prospectively predict re-admission for COPD or death within 12 months of an original admission, and whether QOL scores predicted home nebuliser provision. METHODS: The study was carried out in all acute medical wards of Aberdeen Royal Infirmary, Woodend and City Hospitals, Aberdeen over 12 months. A total of 377 patients admitted with an exacerbation of COPD were identified in this time, 111 of whom were not included in the study because they refused the interview or died before discharge. The remaining 266 patients completed the St George's Respiratory Questionnaire (SGRQ). Information on spirometric parameters, nebuliser provision at discharge, provision of domiciliary oxygen, and re-admission within 12 months was collected from patient notes. RESULTS: The mean age of the patients was 68 years and 53% were men. The mean (SD) forced expiratory volume in one second (FEV1) was 38.8 (18.0)% predicted and forced vital capacity (FVC) was 58.9 (23.8)% predicted. Higher (worse) scores on the SGRQ were significantly related to re-admission for COPD in the next 12 months (difference = 4.8, 95% CI 1.6 to 8.0). Patients who were re-admitted and died from COPD did not differ in SGRQ scores from those who were re-admitted and survived for more than 12 months. Re-admission was not related to sex, age, or pulmonary function. One hundred and thirty eight patients did not have a home nebuliser before admission. Of these, 14 were provided with a home nebuliser at discharge. Patients provided with nebulisers had significantly worse SGRQ scores and worse FVC. The 41 patients given domiciliary oxygen did not differ in SGRQ or spirometric parameters. Logistic regression analysis of the three SGRQ subscales (Symptom, Impact and Activity), adjusting for lung function, age and sex, showed that all three subscales were significantly related to hospital readmission and that Impact scores were related to nebuliser provision. Women did not differ from men in Symptom scores on the SGRQ but differed markedly on the Activity and Impact scales. CONCLUSIONS: It is concluded that poor scores on the SGRQ, a QOL scale which measures patient distress and coping, are associated with re-admission for COPD and use of resources such as nebulisers, independent of physiological measures of disease severity.

Adult↗
PubMed1995

Outcome of wheeze in childhood: the influence of atopy.

We have previously demonstrated that the adult outcome of childhood asthma differs from that of wheeze occurring only in the presence of infection. This paper examines the role of atopy in relation to outcome. We investigated the atopic status, current symptoms and bronchial reactivity to methacholine of 235 subjects aged 34-40 yrs, originally classified at age 10-15 yrs as having asthma (asthma group), wheeze only in the presence of infection (wheezy group), or no respiratory symptoms (comparison group). Subjects from the original asthma group were more likely to be atopic as defined by skin test reactivity, total serum immunoglobulin E (IgE) measurement or specific IgE radio allergosorbent test (RAST) measurement than those from the wheezy group. The wheezy group differed significantly from the reference group only in RAST results, when other variables were taken into account. In a logistic regression model, the important independent predictors for adult wheezing symptoms were original group, atopy and current smoking. Methacholine responsiveness was independently associated with original group (the asthma group were more likely to respond positively), atopy and female gender. The results suggest that atopy is an important predictor for wheeze and bronchial hyperreactivity in middle age. However, the difference in outcome for children who had asthma compared to those who had wheeze only in the presence of infection cannot be explained by atopy alone.

Adolescent↗
PubMed1994

Outcome of wheeze in childhood. Symptoms and pulmonary function 25 years later.

The outcome after 25 yr was studied for three groups of children classified in a random community survey in 1964 as having asthma (121 subjects), wheeze in the presence of infection (167 subjects), or no respiratory symptoms (167 comparison subjects). Approximately 80% of the subjects in each group, now aged 34 to 40 yr, were successfully traced. Current symptoms and smoking habit were recorded by questionnaire, and ventilatory function, peak flow variability, and bronchial reactivity to inhaled methacholine were measured. Subjects who had asthma in childhood were more likely to wheeze (odds ratio [OR] 14.4) or produce phlegm (OR 3.3) than comparison subjects. They also had significantly lower FEV1 values and greater bronchial reactivity than comparison subjects. Adult FEV1 correlated with childhood FEV1 (both expressed as % of predicted) (r = 0.44, p < 0.01). The prognosis for those children who were classed as having wheeze in the presence of infection in 1964 was better than for those who had asthma. Although they also were more likely to report wheeze (OR 3.8) or phlegm (OR 4.4) than comparison subjects, the wheezy symptoms were unlikely to interfere with activities and the ventilatory function and bronchial reactivity to methacholine did not differ from those of comparison subjects. Smokers were more likely to report wheeze (OR 2.0), cough (OR 7.2), and phlegm (OR 3.1) than never-smokers, and current smokers with current wheezy symptoms had significantly reduced FEV1 values, although smoking was not associated with increased methacholine reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma↗
PubMed1994

Lung capillary albumin leak in oxygen toxicity. A quantitative immunocytochemical study.

The study is based on the hypothesis that lung endothelial cell permeability increases in 100% oxygen and predates the appearance of microscopically visible interstitial edema. Rats were exposed to either 100% oxygen or air in a chamber. Endogenous albumin was used as an index of permeability and measured by electron microscopic colloidal gold linked immunocytochemistry, quantified by systematic random methods. Albumin staining was expressed as relative albumin concentration (RAC), the ratio of gold particles (x 100) per point counted (gp.10(2)/pt) relating to each component. The RAC in lung perivascular/peribronchial interstitial ground substance after 24 h of hyperoxia was five times more than that of rats exposed to air for the same interval. The median value (interquartile ranges) for the oxygen-exposed group was 92.4 (39.5, 149.6) gp. 10(2)/pt compared with 14.7 (6.6, 25.9) gp. 10(2)/pt for the air-exposed group. After 60 h of 100% oxygen, the RAC was 103.4 (65.5, 148.9) gp. 10(2)/pt (60-h air exposed RAC was 11.6 (8.7, 60.4) gp. 10(2)/pt), no different from 24-h exposures. These results suggest that there was a significant leak of albumin to the perivascular/peribronchial interstitium by 24 h of exposure to 100% oxygen, which would indicate endothelial cell permeability to albumin increases earlier than has previously been reported.

Air↗
PubMed1993

Effects of hyperoxia on bronchial wall dimensions and lung mechanics in rats.

The effects of exposure to hyperoxic conditions (> 95 kPa at normobaric pressure) on bronchial wall dimensions and lung mechanics were examined in adult rats. Measurements of baseline pulmonary resistance and changes in pulmonary resistance following acetylcholine aerosol inhalation were made in rats exposed to hyperoxia for 48 and 60 h and in control rats exposed to air. Exposures for 48 h were carried out in humid (80% relative humidity) or dry (35-40% relative humidity) conditions. Morphometric measurements of airway wall thickness in lobar bronchi were made in separate groups of similarly exposed rats. Exposure to hyperoxia was associated with an increase in baseline pulmonary resistance (control rats 0.043 (0.016) cmH2O ml-1 s-1, 60 h exposed rats 0.125 (0.042) cmH2O ml-1 s-1) but hyper-responsiveness to acetylcholine inhalation did not occur. Thickness of the airway wall and its subdivisions, epithelium, lamina propria and muscularis, was not altered by hyperoxic exposure in humid conditions. However, epithelial thickening in the lobar bronchi was observed in rats exposed for 48 h to hyperoxia in dry conditions compared to rats exposed in humid conditions (mean (SD) thickness 13.2 (3.3) microns for controls, 14.5 (1.5) microns for humid exposed rats and 16.5 (3.3) microns for dry exposed rats). The increase in pulmonary resistance caused by hyperoxic exposure is unlikely to be due to airway damage as airway hyper-responsiveness did not occur, and is more likely to be associated with the development of alveolar oedema. Environmental humidity may modulate lung damage induced by hyperoxia, as exposure in dry conditions was associated with significant epithelial thickening.

Acetylcholine↗
PubMed1992

An audit of the clinical investigation of pleural effusion.

BACKGROUND: Pleural aspiration with pleural biopsy is advised for the investigation of pleural effusion. The clinical investigation of pleural effusion in a group of teaching hospitals was audited with reference to adequacy and diagnostic value of sampling procedures. METHODS: A retrospective review of case records of all patients investigated for pleural effusion during an eight month period was performed. The records of 112 patients, age range 16-91 years, who underwent 150 procedures were reviewed. RESULTS: Microbiology samples were obtained from 137 procedures, of which five provided a positive culture, including one for mycobacteria. Cytology samples were obtained from 145 procedures though approximately two thirds of samples were less than the recommended 30 ml. The pleural biopsy rate was 30%, varying from 0% in general or thoracic surgery to 68% in thoracic medicine (thoracic surgeons carried out thoracoscopy). Twenty nine per cent of pleural biopsy samples were of poor quality. The complication rate was 2% for aspiration alone, and 4% for aspiration plus biopsy. The sensitivity of the first diagnostic procedure for a diagnosis of malignancy or tuberculosis was 53% for cytology alone, 50% for biopsy alone and 72% for cytology plus biopsy. CONCLUSION: The samples obtained from pleural aspiration and biopsy in the initial investigation of pleural effusion are often inadequate. Further education is necessary to improve the quantity and quality of specimens submitted for histological and cytological examination.

Bacterial Infections↗
PubMed1991

A comparison of laser Doppler flowmetry with the radiolabelled microsphere reference flow technique to measure tracheal blood flow in dogs.

Measurements of tracheal wall blood flow were made in anaesthetized, ventilated dogs during resting ventilatory conditions, during application of positive end-expiratory pressure (PEEP) and during eucapnic hyperventilation of dry air, using laser Doppler flowmetry and the radiolabelled microsphere reference flow technique. Six regions of the trachea were studied in each dog, and the average laser Doppler flowmetry measurement derived from 12 sites within each region was compared with the reference flow measurement, obtained using 15 microns diameter microspheres labelled with 113Sn, 103Ru, 141Ce or 151Gd. Under each set of ventilatory conditions, there was a weak, but significant, correlation between laser Doppler flowmetry and reference flow values (baseline r = 0.44, hyperventilation r = 0.44, and PEEP r = 0.74). Average laser-Doppler flowmetry and reference flow values showed a similar reduction from baseline during application of PEEP. The mean (SD) change from baseline, expressed as a percentage, was -63 (15)% for laser-Doppler flowmetry values, and -63 (21)% for reference flow values. However, there was no correlation between the magnitude of change measured in individual regions using the two techniques. During hyperventilation, laser Doppler flowmetry measurements showed variable changes from baseline, and the mean change was -12 (45)%, which was not significantly different from zero. Reference flow values increased during hyperventilation, the mean change being 87 (77)%. The results indicate that laser Doppler flowmetry and reference flow measurements of airway wall blood flow are not directly comparable.

Animals↗
PubMed1991

Measurement of airway wall blood flow in sheep by laser-Doppler flowmetry: interpretation and problems.

We have used laser-Doppler flowmetry (LDF), a technique that detects movement of erythrocytes, to measure tracheal and bronchial wall blood flow in anesthetized open-chest sheep. LDF derives continuous measurements noninvasively, although fiber-optic bronchoscopy is necessary to introduce the LDF probe into the airways. The response of the LDF flow signals at four regions of the airway walls to varying bronchial arterial flow rates was examined in both live and dead sheep by cannulation and subsequent perfusion of the common bronchial artery at different flow rates by use of a roller pump. In the live sheep, variations in bronchial arterial blood flow resulted in variations in LDF signals in the principal bronchus and in lobar and segmental bronchi but not in the trachea. In the dead sheep, variations in bronchial arterial blood flow resulted in variations in LDF signals in all four regions. Within regions, the average response of the LDF signals to varying bronchial blood flow rates was approximately linear in both live and dead sheep, but considerable site-to-site variation in response was observed. In the live sheep, significant LDF signals were observed when the bronchial arterial flow was set to zero and when the bronchial artery was perfused with dextran solution, which would in theory be expected to produce no LDF signal. A small LDF signal was also detected under zero flow conditions in the dead sheep. These observations suggest that the LDF technique, in addition to detecting blood flow from the bronchial artery also detects background noise and/or collateral circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Mechanism for increase in tracheobronchial blood flow induced by hyperventilation of dry air in dogs.

To test whether the consistent increase in tracheal and bronchial blood flow observed in dogs during hyperventilation of dry air might be the result of release of mediators such as vasodilatory prostaglandins or neuropeptides, we studied two groups of anesthetized mechanically ventilated dogs. Group 1 (n = 6) was hyperventilated for four 30-min periods with 1) warm humid air (38-40 degrees C, 100% relative humidity), 2) warm dry air (38-40 degrees C, 0% relative humidity), 3) warm humid air, and 4) warm dry air. After period 2, a loading dose of indomethacin (4 mg/kg iv) was given over 15 min followed by a constant infusion (4 mg.kg-1.h-1). Group 2 (n = 10) was hyperventilated for four 15- to 20-min periods by use of the protocol described above. After period 3 (group 2a) or period 2 (group 2b), topical 4% lidocaine hydrochloride solution was instilled into the trachea and main stem bronchi. Five minutes before the end of each period of hyperventilation, cardiac output and vascular pressures were measured. To determine airway blood flow, differently labeled radioactive microspheres were injected into the left atrium. After the last measurements, dogs were killed and the lungs excised. Blood flow to the trachea, main stem bronchi, and parenchyma (group 1 only) was calculated. Results showed that hyperventilation of dry air produced a significant increase in blood flow to the trachea and bronchi (period 2). In group 1, this increase was attenuated (P less than 0.02) after administration of indomethacin.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Reflex and nervous control of the tracheobronchial circulation.

Determinants of blood flow through the tracheobronchial vasculature include systemic arterial blood pressure, airway pressure, central venous and pulmonary vascular pressures, alveolar and arterial gas tensions, neural influences and chemical and humoral mediators. There is anatomical and physiological evidence of a role for cholinergic, adrenergic and peptidergic nerves in the control of the vasculature. Physiologically, adrenergic and peptidergic influences appear to be more important than cholinergic. The vasodilator response to inhalation of cold or dry air observed in the tracheobronchial vasculature of several species is unaffected by cholinergic or adrenergic blockade, but is attenuated by pretreatment with lignocaine, suggesting that it may be related to axon reflexes in sensory nerves resulting in release of tachykinins. This may also be the mechanism of the tracheobronchial vasodilator response to allergen challenge. The role of peptidergic nerves in other reflex responses of the tracheobronchial vasculature is at present unknown.

Animals↗
PubMed1988

Hypertonic aerosol inhalation does not alter central airway blood flow in dogs.

Tracheobronchial blood flow in dogs increases with cold or dry air hyperventilation, possibly as a result of airway drying leading to increased osmolarity of airway surface fluid. This study was designed to examine whether administration of aerosols of various tonicity to alter airway surface fluid osmolarity would induce similar blood flow changes. Tracheobronchial blood flow was measured by the radioactive microsphere technique in six anesthetized dogs ventilated with warm humid air (100% relative humidity) for 15 min (period 1), air containing ultrasonically nebulized saline aerosol (1,711 mosmol/kg) for 3 min (period 2) and 12 min (period 3), and the same aerosol at a higher nebulizer output for a further 3 min (period 4). Between periods 3 and 4, the dogs were ventilated with warm humid air for 30 min to reestablish base-line conditions. In another five dogs, measurements were made after 30 min of ventilation with 1) warm humid air, 2) isotonic saline aerosol, 3) warm humid air, 4) distilled water aerosol (3 dogs), and hypertonic saline aerosol (2 dogs). After the last measurement was made, each dog was killed, the trachea and major bronchi were excised, and blood flow was calculated. No change in blood flow was found during any period of aerosol inhalation. The osmolar load imposed on the airways was estimated and was similar to that occurring during cold or dry air hyperventilation. These data suggest that increasing osmolarity of airway surface fluid does not explain the blood flow changes seen during hyperventilation of cold or dry air.

Aerosols↗
PubMed1987

Real-time ultrasound diagnosis of deep vein thrombosis: a comparison with venography.

A prospective study comparing real-time ultrasound scanning with contrast venography in the diagnosis of deep venous thrombosis of the lower limb was performed in a group of 46 patients. The sensitivity of ultrasound scanning for thrombus within the iliofemoral segment, femoral vein, and popliteal vein was 94% with a specificity of 100%. Additional information obtained by ultrasound included the diagnosis of popliteal cysts, pelvic and inguinal lymphadenopathy, popliteal haematoma, and traumatic arterial aneurysm. Real-time ultrasound scanning is a rapid and non-invasive alternative to contrast venography in the diagnosis of lower limb deep venous thrombosis.

Humans↗
PubMed1987

Stenosed bicuspid aortic valves in twins.

Hereditary factors may have a part to play in the development of bicuspid aortic valve. This report concerns a pair of identical twins, probably monozygotic, who required aortic valve replacement as a result of aortic stenosis occurring in bicuspid aortic valves. This supports the contention that there may be a genetic influence in the development of bicuspid aortic valve, though environmental factors may be of greater importance.

Aortic Valve↗
PubMed1987

Correcting a block?: successful experience of a small British pacing centre.

The establishment of a local permanent pacemaker service in a district general hospital increased the pacemaker implantation rate from 22 per million population per year to 152 per million population per year over the first 6 years of the service. Forty eight per cent of patients were referred by general practitioners and 52% by hospital specialists. Single chamber demand pacing (VVI) was used exclusively. Indications for pacing and complications were comparable to those of specialist cardiac centres. Management of symptomatic bradycardia by cardiac pacing in the United Kingdom may be facilitated by further development of small pacing centres.

Aged↗