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Biomedical subjects

D J Shale

Publications and source records attributed to D J Shale.

At least 73 records · Page 4Linked to original sources
PubMed1989

The radiographic differentiation of pulmonary oedema.

A radiographic scoring system has been reported to have a high diagnostic accuracy in the differentiation of pulmonary oedema of renal, cardiac and capillary origin. In the present study, a similar scoring system was used in 51 patients with radiographic appearances of pulmonary oedema due to renal failure (n = 16), cardiac failure (n = 13) and to adult respiratory distress syndrome (ARDS) (n = 22). Evidence of increased pulmonary capillary permeability to transferrin was sought in all patients using a double-isotope method to derive a protein accumulation index (PAI). Using the clinical diagnosis of each type of pulmonary oedema as the "gold standard", sensitivity, specificity and accuracy for the chest radiographic scoring system in pulmonary oedema of cardiac origin were 46, 84 and 75%, respectively. For renal patients these values were 63, 86 and 78% and for ARDS, 89, 33 and 77%. For the PAI in ARDS, sensitivity was 85%, specificity 67% and accuracy 86%. The radiographic scoring system failed to distinguish between pulmonary oedema of renal and cardiac origin and cannot be considered of diagnostic value, but it was more successful in assessment of ARDS. Radiographic appearances suggestive of capillary injury and increased capillary permeability to transferrin occurred in all groups and such findings are not specific to ARDS as currently defined.

Acute Kidney Injury↗
PubMed1988

Neutrophil degranulation and increased pulmonary capillary permeability following oesophagectomy: a model of early lung injury in man.

In nine subjects undergoing oesophagectomy a transient but significant increase in pulmonary vascular permeability to transferrin was detected in both lungs 8 h after surgery. It coincided with a significant increase in plasma lactoferrin, evidence of intravascular and intra-alveolar neutrophil elastase release and with arterial hypoxaemia. The postoperative state in these patients had intravascular and pulmonary features often associated with the adult respiratory distress syndrome, and might be a useful model for the study of the early inflammatory events underlying lung injury in man.

Aged↗
PubMed1988

An assessment of a double-isotope method for the detection of transferrin accumulation in the lungs of patients with widespread pulmonary infiltrates.

1. The accumulation in the lung of the plasma protein transferrin was determined in 44 patients with widespread pulmonary infiltrates of various causes and in 11 healthy volunteers using a double-isotope method based on labelling in vivo of circulating transferrin with indium and erythrocytes with technetium. 2. In 22 patients meeting criteria for the adult respiratory distress syndrome (ARDS) the mean transferrin accumulation rate was threefold greater (P less than 0.005) than in 22 patients not meeting these criteria, although most possessed an appropriate risk factor for ARDS, in addition to extensive radiographic changes. 3. The double-isotope method did not completely separate patients with ARDS from those not meeting the criteria or from control subjects and cannot be considered a diagnostic test for the condition. Statistically significant rates of transferrin accumulation, however, occurred more frequently in patients with ARDS (82%) than in controls (64%) or in those without ARDS (59%).

Adolescent↗
PubMed1987

Trial of ketoconazole in non-invasive pulmonary aspergillosis.

A one year study of the efficacy of the antifungal agent ketoconazole in non-invasive pulmonary aspergillosis was carried out. Ten patients, seven with allergic bronchopulmonary aspergillosis and three with mycetoma, were studied. They were randomly allocated to receive 400 mg daily or placebo orally in a double blind fashion. In the treated group (n = 6), concentrations of serum IgG specific for Aspergillus fumigatus fell significantly during treatment (mean reduction 42% (SEM 2.2%) compared with determinations preceding the study). This effect was evident by three months and continued for the 12 months of treatment. Patients receiving placebo (n = 4) showed no significant change in serum IgG concentration (mean change + 10% (SEM 5.3%]. Asthmatic patients treated with ketoconazole (n = 4) had significantly lower symptom scores than those receiving placebo (n = 3) (+0.45%/month (SEM 6.9%) versus +27%/month (SEM 6.5%); p less than 0.001). None of the patients treated with ketoconazole reported any adverse effects. Ketoconazole may cause serious liver damage but its use may be justified in bronchopulmonary aspergillosis if further experience confirms its ability to alter the course of a potentially serious disease.

Adult↗
PubMed1987

Pulmonary vascular permeability to transferrin in the pulmonary oedema of renal failure.

Thirteen patients with renal failure and pulmonary oedema were assessed for evidence of increased pulmonary vascular permeability to protein by a double isotope technique. Comparison was made with 10 patients with cardiogenic pulmonary oedema, 11 healthy volunteers, and 10 patients with the adult respiratory distress syndrome. There was no significant difference in the accumulation of a radiolabelled plasma protein (transferrin) in patients with renal or cardiogenic pulmonary oedema and normal volunteers. Patients with adult respiratory distress syndrome showed significantly greater protein permeability (p less than 0.001). In pulmonary oedema associated with renal failure managed by current regimens there was no evidence of increased permeability to transferrin.

Adult↗
PubMed1986

Ulcerative colitis and sarcoidosis.

Ulcerative colitis is not commonly associated with recognizable pulmonary disease and only four sporadic cases of sarcoidosis in association with ulcerative colitis have been previously reported. However, in a series of 680 patients with ulcerative colitis, pulmonary or extra-pulmonary sarcoidosis has at some stage been present in eight. These cases are reported in detail. The onset of either condition bore no relationship to the activity or the presence of recognized peripheral manifestations of the other, suggesting that the two diseases were independent. However, three of the patients had the HLA B8 DR3 phenotype which is a higher prevalence than seen in previous studies of either disease alone. Patients with ulcerative colitis who possess this HLA phenotype may possibly be more susceptible to developing sarcoidosis.

Adult↗
PubMed1986

Effect of monocrotaline ingestion on the distribution of protein and angiotensin converting enzyme activity in the rat lung.

The alveolar accumulation of protein and angiotensin converting enzyme activity was compared with the development of right ventricular hypertrophy in male rats after different periods of monocrotaline exposure. Total doses of monocrotaline were varied by dividing the animals into three groups in which ingestion was limited to three, seven, and 15 days. These groups were studied 21 days after the start of monocrotaline exposure and compared with a group treated continuously for 28 days. The total lung weight increased after three or more days of treatment, while after seven days there was significant alveolar accumulation of protein, which was paralleled by an increase in angiotensin converting enzyme activity in alveolar lavage fluid. Identical changes also occurred after 15 and 28 days of exposure to monocrotaline. Lung angiotensin converting enzyme activity was decreased after three days' ingestion of monocrotaline and did not alter further with longer periods of exposure. None of these effects of monocrotaline in the three and seven day treatment groups was associated with right ventricular hypertrophy, which occurred only in animals treated for 15 or more days. The effects of monocrotaline ingestion on the lung were dose related and had no causal relationship to the development of right ventricular hypertrophy.

Animals↗
PubMed1985

The evaluation of a quantitative enzyme-linked immunosorbent assay (ELISA) for anti-Aspergillus fumigatus IgG.

A standard enzyme-linked immunosorbent assay method for anti-Aspergillus fumigatus IgG in human serum was modified to produce a quantitative assay. The resulting assay was reproducible and capable of separating individual precipitin line groups and provided a means of monitoring the variation in antibody levels over long periods in patients with pulmonary aspergillosis.

Antibodies, Fungal↗
PubMed1985

Angiotensin converting enzyme and endotoxin induced lung damage in the mouse.

Acute pulmonary oedema can be induced by intraperitoneal injection of Escherichia coli endotoxin in the mouse. A fall in serum angiotensin converting enzyme activity is found in mice given endotoxin and in patients with septic adult respiratory distress syndrome, and has been proposed as an indicator of lung microvascular injury. Protein concentration and angiotensin converting enzyme activity in serum, lung, and bronchoalveolar lavage fluid were determined in male mice up to eight hours after injection of endotoxin. By six hours the serum protein concentration had increased and the bronchoalveolar lavage fluid protein concentration had fallen, suggesting fluid shift into the lung. Angiotensin converting enzyme activity fell in serum and lung but increased in bronchoalveolar lavage fluid. As these changes in enzyme activity were not paralleled by changes in protein concentration they are unlikely to be a result of fluid shift or protein leak, and may indicate an active role of the enzyme in the response to sepsis.

Animals↗
PubMed1983

Air-flow limitation in myasthenia gravis. The effect of acetylcholinesterase inhibitor therapy on air-flow limitation.

In a survey of 21 patients with myasthenia gravis receiving regular acetylcholinesterase inhibitor therapy, 8 were found to have air-flow limitation associated with their antimyasthenic therapy. In 6 of these subjects, detailed assessments were made of the effect of antimyasthenic therapy on airways function. Pyridostigmine was given together with either placebo or the anticholinergic bronchodilator ipratropium bromide (72 micrograms) by inhalation administered double blind on 2 consecutive days. Airways resistance (Raw) increased significantly after pyridostigmine and placebo inhaler (0.49 +/- 0.13 kPa/L/s basal versus 0.60 +/- 0.13 kPa/L/s at 2 h; mean +/- SEM, p less than 0.05), whereas a significant decrease in Raw followed the combination of pyridostigmine with ipratropium bromide (0.57 +/- 0.08 kPa/L/s basal versus 0.41 +/- 0.07 kPa/L/s at 2 h, p less than 0.05). Thus, acetylcholinesterase inhibitor therapy in subjects with myasthenia gravis with airflow limitation led to significant increase in airways resistance that could be completely reversed by the inhalation of the muscarinic receptor blocker ipratropium bromide.

Airway Resistance↗