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Biomedical subjects

D M Halpin

Publications and source records attributed to D M Halpin.

16 recordsLinked to original sources
PubMed2000

Asthma after childhood pneumonia: six year follow up study.

OBJECTIVE: To establish the long term cumulative prevalence of asthma in children admitted to hospital with pneumonia and to examine the hypothesis that some children admitted to hospital with pneumonia may be presenting with undiagnosed asthma. DESIGN: Prospective study of a cohort of children previously admitted to hospital with pneumonia, followed up by postal questionnaires to their general practitioners and the children or their parents. SETTING: General practices in southwest England. PARTICIPANTS: 78 children admitted to the Royal Devon and Exeter Hospital between 1989 and 1991 with a diagnosis of pneumonia confirmed on independent review of x ray films. MAIN OUTCOME MEASURES: Any diagnosis of asthma, use of any treatment for asthma, and asthma symptom scores. RESULTS: On the basis of a 100% response rate from general practitioners and 86% from patients or parents, the cumulative prevalence of asthma was 45%. A diagnosis of asthma was associated with a family history of asthma (odds ratio 11.23; 95% confidence interval 2.57 to 56.36; P=0.0002). Mean symptom scores were higher for all children with asthma (mean score 2.4; chi(2)=14.88; P=0. 0001) and for children with asthma not being treated (mean 1.4; chi(2)=6.2; P=0.01) than for those without asthma (mean 0.2). CONCLUSIONS: A considerable proportion of children presenting to a district general hospital with pneumonia either already have unrecognised asthma or subsequently develop asthma. The high cumulative prevalence of asthma suggests that careful follow up of such children is worth while. Asthma is undertreated in these children; a structured symptom questionnaire may help to identify and reduce morbidity due to undertreatment.

Adolescent↗
PubMed1995

Home treatment of patients with cystic fibrosis using the 'Intermate': the first year's experience.

Home treatment of patients with cystic fibrosis has many attractions and is becoming increasingly popular. The investigators have studied the use, results and costs of the first year of operation of a home-care intravenous antibiotic service using the 'Intermate' infusion device in a prospective study using questionnaires, spirometric and weight measurements. Ninety-three patients received 166 courses of intravenous antibiotics in full or in part at home during 1991. The average length of treatment was 12.5 days and on average 70% of the treatment was given at home. The mean percentage predicted FEV1 and FVC improved after treatment and the mean improvement was not significantly different to that produced by hospital treatment. Breathlessness, sputum volume, appetite, ability to sleep, mood, energy and overall well-being, as assessed by questionnaire, showed significant improvements after home treatment. The median time spent mixing and administering drugs was 10-19 hours and visiting the hospital was 7-12 hours. The median number of days of lost income to patients or their carers was 0 days. The majority of the patients were extremely satisfied with the treatment and supervision that they received. Using the home care service, 1442 inpatient days were saved. The investigators conclude that home care using 'Intermates' improves a patient's lung function and quality of life.

Adolescent↗
PubMed1994

Extrinsic allergic alveolitis and asthma in a sawmill worker: case report and review of the literature.

A 34 year old sawmill maintenance engineer developed a dry cough that was associated with widespread wheezes and crackles in his lungs. His symptoms worsened, with work related lethargy, fever, and breathlessness, and the loss of a stone in weight. At that time, while still at work, he had a neutrophil leucocytosis and increased concentration of gamma globulins. When seen subsequently some two months after stopping work, his chest radiograph and lung function tests were normal, but the cells recovered at bronchoalveolar lavage showed an increase in lymphocytes and mast cells, a pattern consistent with extrinsic allergic alveolitis. Serum precipitins were identified to extracts of sawdust, wood chips, and bark from the sawmill, and to eight species of mould grown from these samples. Specific IgG binding inhibition studies suggested that a common epitope present on Trichoderma koningii might be responsible for the cross reactivity of the patient's serum with the wood and fungal extracts. A diagnosis of wood associated extrinsic allergic alveolitis was made and since changing his job the patient has remained well. Wood associated allergic alveolitis has not previously been described in British sawmill workers, but has been reported in Sweden, with a prevalence of 5%-10% in exposed workers. A review of published data suggests extrinsic allergic alveolitis in wood workers is primarily caused by inhalation of the spores of contaminating fungi, but inhaled wood dust may exert a synergistic effect.

Adult↗
PubMed1994

Respiratory symptoms, immunological responses, and aeroallergen concentrations at a sawmill.

After identification of a case of extrinsic allergic alveolitis due to exposure to wood dust at a sawmill, all employees at the sawmill where he worked were studied with an occupational, environmental, and symptom questionnaire, spirometry, skin prick tests, and serum specific IgG measurements. Ninety five of current and 14 of 17 ex-sawmill workers were studied. As a basis for comparison, a group of 58 workers from a nearby light engineering factory were also studied. Few women (6) were employed and they were excluded from the analysis. Workers at the sawmill were stratified into high and low exposure groups depending on their place of work. This division was supported both by their subjective assessment of the dustiness of their environment and the results of personal dust samples. There were no significant differences between the three groups in age, height, smoking habits, exposure to other causes of extrinsic allergic alveolitis, forced expiratory volume in one second, forced vital capacity, atopic state, or cutaneous reactivity to moulds. In the high exposure group the prevalence of work related cough and nasal and eye symptoms was higher than in the low exposure and comparison groups. The prevalence of work related wheeze was similar in both the high exposure and comparison groups, but was lower in the low exposure group. The prevalences of chronic bronchitis and symptomatic bronchial hyper-reactivity were similar in the high and low exposure groups but were lower in the comparison group. Serum concentrations of specific IgG against extracts of sawdust and Trichoderma koningii were significantly higher in the high exposure group than in the other two groups. The prevalence of symptoms suggestive of extrinsic allergic alveolitis was 4.4% in the high exposure group, greater than in the low exposure group (0%), and the comparison group (1.9%). In conclusion extrinsic allergic alveolitis probably occurs in British sawmills, and among the exposed population its prevalence may be as high as that reported in Sweden. The allergen responsible is likely to be from mould growing on the wood and may be from Trichoderma koningii.

Adolescent↗
PubMed1991

Switching gears.

Explore the source record for details and available documents.

Clinical Competence↗
PubMed1990

Serum testosterone levels in women with Cushing's disease.

Serum testosterone was measured pre- and post-operatively in 31 women who obtained remission of Cushing's disease following treatment by interstitial irradiation of the pituitary gland. The mean serum testosterone was initially elevated at 3.35 nmol/l, with values ranging from 0.7 to 14.4 nmol/l. Following treatment the mean serum testosterone fell to 1.42 nmol/l (i.e. normal) and all but one of the 15 patients with initially elevated pre-treatment values obtained normal levels. The pretreatment testosterone concentrations correlated significantly (r = 0.47; p = 0.019) with the midnight ACTH concentration. The likely determinant of the raised serum testosterone would appear to be the intensity of the ACTH drive, although an individual's inherent sensitivity to ACTH may also be a factor.

Adolescent↗
PubMed1988

Effects of short-term injection of gonadotrophins on ovarian follicle development in hypogonadal (hpg) mice.

Twice daily injections of purified ovine and human FSH were used to investigate the control of ovarian follicle development in hypogonadotrophic hypogonadal (hpg) mice. Treatment for 5 days with doses greater than 3 micrograms resulted in a significant increase in the total number of growing follicles and the development of antral follicles. This was associated with increases in uterine weights and vaginal opening, indicating that steroidogenesis had also been stimulated. Further studies of the effects of combined injections of FSH and LH, linked with morphological analysis of ovarian interstitial cells, suggested that any contribution of background or contaminating LH to the effects of the FSH injections was minimal. It therefore appears that, in mice, FSH alone is capable of stimulating an increase in the initiation of follicle growth, of triggering the development of antral follicles, and supporting ovarian steroidogenesis.

Animals↗
PubMed1986

Postnatal ovarian follicle development in hypogonadal (hpg) and normal mice and associated changes in the hypothalamic-pituitary ovarian axis.

Significant uterine growth occurred in normal and hypogonadal (hpg) mice between Days 7 and 21 but thereafter no further growth was observed in hpg mice. The ovaries of hpg mice were significantly smaller than those of normals at all ages, but there was no significant difference between the number of non-growing follicles in the ovaries of mutants and their normal littermates at any age studied, and normal and hpg mice showed a marked reduction in the number of non-growing follicles during the first month of life. The size and composition of the growing follicle population in hpg mice, however, differed markedly from those in normal animals and by 21 days of age the number of growing follicles in mutants was significantly reduced. There was no significant difference in the number of Type 3b follicles before 60 days of age, but the number of all other follicle types was significantly less in hpg mice at all ages studied. Follicles in which the antrum is fully developed (Type 7 and 8) were never seen in the ovaries of mutants and corpora lutea were never observed. Interstitial tissue development was also very poor in hpg ovaries. The hypothalamic GnRH content in normal mice remained low until Day 20, before rising sharply to adult levels (approximately 800 pg) between Days 20 and 30. The pituitary FSH content increased over the first 10 days of life to reach a peak of about 5000 ng, before declining to the adult value of about 2000 ng by Day 30, whilst the plasma FSH concentration was high in the first 10 days, but fell to adult levels over the next 20 days. Pituitary LH content increased significantly between Days 5 and 10 to reach the adult level of about 600 ng. Hypothalamic GnRH was undetectable at all ages in hypogonadal mice, but the pituitary content of FSH and LH had risen to the attenuated mutant adult value by Day 15, and unlike normals, plasma FSH concentrations were not elevated during the neonatal period. These results suggest that minimal gonadotrophic stimulation of the ovary from birth has no effect on the total number of follicles but reduces the number of growing follicles and prevents follicle growth beyond the early antral stage. Gonadotrophins therefore appear to have a role in the initiation and continuance of follicle growth in the adult mouse.

Animals↗
PubMed1986

Effects of gonadotrophin deficiency on follicular development in hypogonadal (hpg) mice.

The rates of follicle growth and death in GnRH-deficient hypogonadal (hpg) mice and in normal mice were studied using the stochastic compartmental model of follicle dynamics. The rate estimates derived from this model suggest that in normal mice gonadotrophins act at several stages in the development of ovarian follicles. Gonadotrophins appear to regulate the number of follicles beginning to grow by controlling both the rate at which non-growing follicles enter the growing pool and the loss of non-growing follicles to atresia. They also appear to promote the growth of medium-sized follicles by reducing the rate of loss to atresia of these follicles rather than by stimulating growth per se. Furthermore, these data suggest that an intra-ovarian autoregulatory mechanism may exist to control the number of large follicles that are formed.

Animals↗
PubMed1983

Prolactin measurements in normal and hypogonadal (hpg) mice: developmental and experimental studies.

Plasma and pituitary PRL levels are significantly greater in adult female than in male rats. This difference is thought to be brought about by ovarian steroids. We found a similar sex difference in pituitary PRL content in normal mice from 30 days of age. Ovariectomy reduced pituitary PRL content and this reduction was prevented by sc implants of estradiol-17 beta (E2). Implants of E2 also increased the pituitary PRL content in normal male mice to a level approaching that in normal females. The hypogonadal (hpg) mice did not show a sex difference in pituitary PRL content. Implantation of E2 into mutants of both sexes raised the pituitary content of PRL to the level in normal females. Treatment of intact but not ovariectomized hpg females with two injections/day of 6 micrograms FSH (NIH-FSH-S15) produced uterine growth and an increase in pituitary PRL content. Estrogen implants significantly increased plasma PRL concentrations in ovariectomized normal female and normal male mice but not in adult hpg male or female animals. These results show that elevation of the plasma E2 concentration increased significantly the synthesis of PRL in both normal and hpg mice of both sexes, and in the normal, but not the hpg mice, also increased the plasma concentration of PRL.

Aging↗
PubMed1982

Distribution of 125I-labelled follicle-stimulating hormone and human chorionic gonadotrophin in the gonads of hypogonadal (hpg) mice.

Hypogonadal mice are deficient in LH releasing hormone (LH-RH), the releasing factor for LH and FSH, with a consequent failure of postnatal ovarian and testicular development. After intravenous injection of hypogonadal females with 125I-labelled human chorionic gonadotrophin (hCG), followed by autoradiography of semi-thin (1 micrometer) slices of the ovary, labelled hCG was found to be associated with interstitial cells and thecal cells with little or no labelling of granulosa cells. Labelled human FSH was associated solely with granulosa cells. Hypogonadal females, implanted for 5 days with a silicone elastomer capsule of oestrogen, showed a similar response to that of normal females with hCG labelling of the granulosa cells of the larger follicles as well as of the thecal cell layer. Furthermore, subcutaneous injection of hypogonadal females with LH-RH (50 ng), 12 times daily for 5 days, increased uterine weight and stimulated ovarian development with some large follicles binding hCG to both thecal and granulosa cells. Therefore stimulation of follicular development may possibly be associated with increased oestradiol concentrations. In the male, after injection of 125-I-labelled hCG, silver grains were associated with the interstitial cells alone in both hypogonadal and normal mice. Labelled human FSH was undetectable in semi-thin testicular sections, but the mode of injection (intravenous) not have allowed enough labelled hormone to reach the testis in order to resolve the question as to whether the hypogonadal or normal testis can bind FSH.

Animals↗