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Biomedical subjects

D J Hurst

Publications and source records attributed to D J Hurst.

At least 19 recordsLinked to original sources
PubMed1984

A prospective evaluation emphasizing pulmonary involvement in patients with mixed connective tissue disease.

Pulmonary involvement in mixed connective tissue disease (MCTD) is common, frequently severe, and is often clinically inapparent and variably responsive to corticosteroid/cyclophosphamide treatment. Serial pulmonary evaluation of patients with MCTD is important, since deterioration, as in the diffusing capacity over time, may alert the physician to the need for more invasive evaluation. Patients with a greater degree of overlap in rheumatological symptoms with an element of systemic sclerosis (PSS) may later develop severe disease. Nailfold capillary microscopy also may help in determining which patients will develop severe pulmonary involvement. Significant pulmonary hypertension occurs and cannot be accurately predicted on the basis of history, physical examination, pulmonary function tests, gallium scanning, or exercise testing. The characteristic pathological finding was intimal proliferation with medial muscular hypertrophy in the pulmonary arterioles. In contrast, pulmonary interstitial abnormalities were minimal, suggesting the proliferative vascular lesions are more closely associated with pulmonary hypertension in MCTD. Some patients develop rapidly progressive disease with varying response to corticosteroid and cytotoxic agents. More commonly, however, MCTD patients with long-term disabling disease, including pulmonary dysfunction, have had significant improvement with steroid and/or cyclophosphamide treatment, and clinical remission has occurred in 38% of the patients in this series.

Adolescent↗
PubMed1984

A comparison of cefaclor and tetracycline in the treatment of bacterial bronchitis.

Cefaclor and tetracycline were compared in a single-blind study designed to treat patients with acute bacterial bronchitis and acute exacerbations of chronic bronchitis. Twenty-five pathogens (including 19 of Haemophilus influenzae and four of Streptococcus pneumoniae) were obtained from sputum samples of 48 patients. No pathogen could be cultured from the sputum of 23 patients. All of these pathogens were susceptible to cefaclor, while 12 (63%) of the 19 H influenzae isolates and three of the four S pneumoniae isolates were resistant to tetracycline. When the susceptibility of the 25 isolates to other commonly used antibacterials was tested, 18 isolates of H influenzae were resistant to erythromycin and one was resistant to ampicillin. (One H influenzae isolate was not tested for erythromycin susceptibility.) The four isolates of S pneumoniae were susceptible to erythromycin and ampicillin. Satisfactory results were achieved in 21 of the 23 patients receiving cefaclor. After four to six days of cefaclor therapy, the other two patients were diagnosed as having bronchopneumonia, and parenteral antibiotic therapy was instituted. Of the 25 patients assigned to the tetracycline regimen, three with resistant H influenzae had unsatisfactory clinical responses and required parenteral antibiotic therapy for recovery. Although patients were randomly assigned to therapy, only three of the 16 patients infected with tetracycline-resistant organisms were assigned to the tetracycline group, and all three failed to respond to treatment. Had the patients been more evenly distributed according to susceptibilities, it is possible that more treatment failures would have occurred in the group receiving tetracycline.

Adult↗
PubMed1983

The effect of terbutaline on cardiac function in patients with stable chronic obstructive lung disease.

The effect of 0.25 mg of terbutaline sulfate, a beta 2-adrenergic agent, on the right and left ventricular ejection fractions (RVEF and LVEF, respectively) was studied in 30 patients with severe stable chronic obstructive pulmonary disease (COPD) with a mean forced expiratory volume in 1 s of 0.79 +/- 0.06 L. All bronchodilator therapy was withdrawn 48 hours before the study. The ECG-synchronized gated equilibrium radionuclide ventriculography showed decreased RVEF in 27 patients and LVEF in 16 patients. Both the RVEF and LVEF significantly increased after the terbutaline injection; this increase was noted both in patients with normal and decreased ejection fractions. We conclude that the increase in ejection fractions after terbutaline injection may contribute to the good clinical response to this drug seen in patients with severe stable COPD even though the bronchodilator effect may be minimal.

Adult↗
PubMed1983

Nebulized isoetharine and fenoterol in acute attacks of asthma.

Nebulized, selective beta 2-adrenergic agents were shown to be a safe and effective alternative to subcutaneous epinephrine chloride in the treatment of acute asthma attacks. Results of a trial of nebulized 1% isoetharine hydrochloride and 0.5% fenoterol in 40 patients with acute attacks of wheezing is reported. Both groups showed significant improvement on forced expiratory volume in one second (FEV1), maximum expiratory flow at 25% and 50% vital capacity but those who received fenoterol therapy showed more significant bronchodilation after one hour. Based on clinical criteria and the ability to raise and maintain for four hours an FEV, by 15% above baseline, ten (50%) of the patients who received isoetharine and 16 (80%) of the patients who received fenoterol therapy were successes. Mild side effects were encountered in eight patients of each treatment group. Fenoterol therapy was significantly more effective and had a longer duration of action.

Acute Disease↗
PubMed1983

Technetium-99m glucoheptonate imaging in lung cancer and benign lung disease: concise communication.

We prospectively studied technetium-99m glucoheptonate (Tc-GHA) uptake in 58 patients with newly diagnosed lung cancer and in 20 patients with pulmonary inflammatory disease or metastatic carcinoma. Fifty-three (91%) primary tumors accumulated Tc-GHA: squamous cell 20/22, adenocarcinoma 7/7, large cell 10/11, and small cell 16/18. Intensity of tumor uptake was greatest in small-cell cancer. Supraclavicular metastases were detected in two patients. Fourteen patients with mediastinal evaluation by Tc-GHA imaging and trispiral tomography underwent mediastinoscopy or thoracotomy. Five of ten patients with negative mediastinum by tomography and Tc-GHA imaging showed metastases by biopsy (false-negative Tc-GHA). Less intense accumulation of Tc-GHA was observed in 18/20 cases of pulmonary inflammatory disease or pulmonary metastases. Although Tc-GHA accumulates by an unknown mechanism in primary lung cancer, we cannot recommend its use in detecting mediastinal spread of lung cancer due to its unacceptably high false-negative rate.

Adenocarcinoma↗
PubMed1983

Thrombotic thrombocytopenic purpura seen as pulmonary hemorrhage.

A 33-year-old woman was seen with fever, confusion, and respiratory distress. A diagnosis of thrombotic thrombocytopenic purpura (TTP) was made when renal failure, microangiopathic hemolytic anemia, and thrombocytopenia subsequently developed. An open kidney biopsy confirmed the clinical diagnosis. The patient initially was seen with the roentgenographic and clinical appearance of pulmonary hemorrhage, which was confirmed histologically and, to our knowledge, previously has not been associated with TTP.

Adult↗
PubMed1980

Paracoccidioidomycosis presenting as a cavitating pulmonary mass.

Paracoccidioidomycosis, a granulomatous fungal infection often termed "South American blastomycosis," has been reported in only 11 patients in the United States to date. All have been male patients who had either traveled to or emigrated from South America. We report the findings in a 24-year-old woman with a solitary cavitating pulmonary mass which was proven to be paracoccidioidomycosis. This uncommon presentation of paracoccidioidomycosis was surgically resected, and no antifungal chemotherapy was instituted. The patient remains well and apparently free of the infection.

Adult↗
PubMed1979

Pneumomediastinum following the Heimlich maneuver.

The Heimlich maneuver appears to be a widely accepted technique advocated as a means of clearing an obstructed airway. Reports of complications have been few. We report a case of pneumomediastinum that occurred following the generation of increased pulmonary pressures during performance of the Heimlich maneuver.

Adult↗
PubMed1977

Normal newborn and adult human lung collagen--analysis of types.

Previous work has shown in experimental animals that lung contains extractable collagen of types I and II and possibly III and IV. The current studies describe the types of collagen which are found in normal newborn and adult human lung. Autopsy lung specimens were dissected into tissue which was cartilage free and tissue which contained cartilage. Pleura was excluded. Extraction of distal lung which did not contain cartilage by using 1.0 M NaCl and 0.5 N acetic yielded collagen having the characteristics on acrylamide gel electrophoresis and CM-cellulose chromatography of type I collagen [alpha 1(I)] alpha2. Newborn and adult type I lung collagen are similar as compared by amino acid analysis and cyanogen bromide peptide fragment analysis. Furthermore, distal lung type I collagen is very similar, if not identical, to that found in human skin. Human bronchial cartilage collagen is similar to that found in other human cartilages. Type II collagen, [alpha 1(III)], can be extracted from human distal lung using pepsin digestion and differential salt precipitation at 1.85 M sodium chloride. This distal lung type III collagen appears identical with that found in human skin. These data support the concept that normal human lung contains collagen of types I, II, and III, identical to that found elsewhere in the body. Current techniques have not revealed a unique lung collagen. This should lead to the studies which will investigate the types and ratios of the collagens in diseased human lung.

Adult↗
PubMed1975

Responses to cotton dust.

Twelve cotton textile workers were studied: (1) to compare standard measures of volume and expiratory flow, maximal expiratory flow volume (MEFV) curves, closing volume (CV), and closing capacity (CC) in detection of airway narrowing with cotton dust exposure; (2) to evaluate the response of arterial blood gases to exposure; (3) to measure changes in leukocytes in peripheral blood and airway secretions; and (4) to assess the temporal relationships and correlations between measures. Change in expiratory flow (FEV) most consistently and significantly discriminated between the control and cotton dust exposures. Vmax50%FVC was a more sensitive indicator, but variance was increased proportionately. CV and CC changed inconsistently with relatively large variances. The PaO-2 decreased overall and two subjects had large decrements. Peripheral blood and polymorphonuclear cell counts increased with exposure to cotton dust and polymorphonuclear leukocytes were recruited to the nasal mucosa. Chest tightness and decreased flow were temporally correlated with leukocyte recruitment that may be important in respiratory disease among cotton textile workers and therefore deserves further investigation.

Adult↗