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Biomedical subjects

H Teichtahl

Publications and source records attributed to H Teichtahl.

17 recordsLinked to original sources
PubMed1997

The incidence of respiratory tract infection in adults requiring hospitalization for asthma.

UNLABELLED: Acute respiratory tract infections (RTI) are known to worsen asthma particularly in children. There are few studies in adults assessing the incidence of RTI in patients hospitalized with acute asthma. AIM: To document the incidence of RTI in adults hospitalized with acute asthma. METHODS: A prospective study of patients with acute asthma admitted to the Department of Respiratory Medicine, Western Hospital Footscray, over a 12-month period. A control group was studied from elective surgical inpatients. Patients were investigated with serologic tests for Chlamydia, Mycoplasma, Legionella, and influenza A and B. Nasopharyngeal aspirate (NPA) samples were cultured for influenza, respiratory syncytial virus (RSV), adenovirus, parainfluenza, rhinovirus, and herpes simplex virus. If sputum was available, it was assessed with microscopy and culture. Blood cultures were taken if patients were febrile and all patients had a chest radiograph. Control subjects completed serologic tests and NPA. RESULTS: Seventy-nine patients (33 male and 46 female) and 54 control subjects (26 male and 28 female) were studied. Two patients were enrolled twice. Mean (+/-SD) age of patients was 35+/-15 years (range, 16 to 66 years), and mean age of control subjects was 37+/-15 years (range, 18 to 69 years). In the patient group, 29 (37%) had evidence of recent RTI of which 23 were viral. Five of the control subjects (9%) had evidence of recent RTI (p<0.001). Twenty-four patients were positive on serologic and/or NPA culture. Five patients had positive serologic test results and/or NPA culture to two or more agents. Two patients tested positive on sputum, radiograph, and temperature criteria. Three patients tested positive on the basis of radiographic evidence of consolidation, blood neutrophilia, and temperature. Influenza A (13) and rhinovirus (9) were the most common infectious agents. Other agents identified were RSV (one), influenza B (two), adenovirus (one), and Mycoplasma (one). Influenza and rhinovirus infections occurred predominantly in late and early winter, respectively. Summer hospitalization did not relate to RTI. CONCLUSION: Thirty-seven percent of adult patients with acute asthma admitted to the Department of Respiratory Medicine over a 12-month period had evidence of recent RTI.

Acute Disease↗
PubMed1996

Adult asthma and gastro-oesophageal reflux: the effects of omeprazole therapy on asthma.

BACKGROUND: Approximately 40-60% of patients with asthma have gastro-oesophageal reflux (GOR) and it has been postulated that this may worsen asthma severity. AIMS: To investigate the effect of the potent gastric acid inhibitor omeprazole 40 mg orally daily on peak expiratory flow rate (PEFR), asthma symptoms and histamine bronchial responsiveness in adult patients with both asthma and GOR. METHODS: This was a double blind, randomised, placebo controlled, crossover study. Upper gastrointestinal endoscopy, 24 hour oesophageal pH measurements, spirometry and histamine bronchoprovocation test (HIT) were performed prior to entry. Phase 1:2 week placebo run-in period, with baseline recording of PEFR, asthma and GOR symptoms, and use of inhaled beta 2-agonist. Phase 2: patients randomised to receive either placebo or omeprazole 40 mg/d for four weeks. Phase 3: placebo for two weeks. Phase 4: patients crossed over to opposite treatment from that of phase 2. Spirometry, and diary cards were assessed at beginning and end of phases 2 and 4. HIT was performed at the end of phase 2 and at the beginning and end of phase 4. RESULTS: Twenty patients (eight female and 12 male) completed the study. The evening but not morning PEFR (% predicted) were significantly higher on omeprazole vs placebo (82 +/- 4% SEM vs 79 +/- 4% SEM; p < 0.05). No significant differences were found in FEV1, FVC, histamine bronchial responsiveness and diurnal variation of PEFR between placebo and omeprazole treatments. Similarly, there were no significant differences during placebo and omeprazole periods in day time wheeze, cough, breathlessness, beta 2-agonist use or night time wheeze and breathlessness. Day and night heartburn symptoms were significantly better on omeprazole vs placebo (p < 0.05). CONCLUSIONS: Omeprazole 40 mg daily improved evening PEFR in asthma patients with GOR. However, asthma symptoms, inhaled beta 2-agonist use and histamine bronchial responsiveness did not change.

Adolescent↗
PubMed1995

Screening Young syndrome patients for CFTR mutations.

Young syndrome is characterized by obstructive azoospermia associated with chronic sinobronchial disease of an infectious nature, but normal sweat-gland and pancreatic function as well as normal nasal potential differences. Congenital bilateral absence of the vas deferens (CBAVD) in some patients arises from mutations within the cystic fibrosis (CF) transmembrane regulator (CFTR) gene. Because of some similarities between Young syndrome, CF, and CBAVD, we evaluated 13 patients with Young syndrome, including screening for more than 30 different mutations within the CFTR gene. The mean age of the patients was 43 yr (range, 32 to 50 yr), and all were of northern European extraction. The sweat chloride concentration was normal in all patients (mean = 29 mEq/L; range, 8 to 43 mEq/L). Most had intermittent bronchial and sinus infections, but none was chronically colonized with Staphylococcus aureus or Pseudomonas aeruginosa. The FEV1 was normal or only mildly reduced in most patients (mean = 74%; range, 48 to 100% predicted). Of 26 Young syndrome chromosomes, we identified one with the recognized CF mutation delta F508. The incidence of CFTR mutations (1 in 26) did not differ significantly from the expected carrier frequency in this population. In summary, it is unlikely that the typical Young syndrome patient has a clinical disease associated with CFTR mutation on both alleles.

Adult↗
PubMed1994

A pseudoepidemic of Mycobacterium chelonae: contamination of a bronchoscope and autocleaner.

BACKGROUND: At fibreoptic bronchoscopy the potential exists for contamination of bronchoscopes and microbiological specimens. Patients may also be cross infected with acid fast bacilli (AFB). During a five month period, 12 bronchial wash specimens of 65 patients undergoing bronchoscopy, one bronchoscope and an autocleaner, were contaminated with the AFB, Mycobacterium chelonae (MCH). AIM: To eradicate AFB contamination of bronchoscopy specimens by identifying sources of contamination and modifying disinfection procedures. METHODS: To identify the source of contamination, samples for AFB culture were taken from three bronchoscopes, the autocleaner and water taps. To eradicate MCH contamination, the bronchoscopes were soaked in 2% glutaraldehyde overnight and flushed with 70% alcohol. Disinfection procedures were altered by using sterile water and containers in cleaning. Autocleaner use was discontinued. RESULTS: The autocleaner, one bronchoscope and 12 bronchial wash specimens were contaminated with MCH. All contaminants had similar electrophoretic banding on probing of their DNA fragments, suggesting a common clone of origin. After the alterations in disinfection procedures and despite prolonged soaking in 2% glutaraldehyde, three further contaminated wash specimens were isolated from one bronchoscope. Only after ethylene oxide sterilisation of this bronchoscope was the contamination overcome. Since then no further MCH contamination has occurred. No patient required treatment and there has been no clinical evidence of mycobacterial disease. CONCLUSION: To avoid contamination of bronchoscopy specimens with MCH, use of autoclearners should be discouraged and sterile water and containers used in cleaning procedures. If MCH contamination occurs in this setting, the bronchoscope and dismantled valve mechanism should undergo ethylene oxide sterilisation.

Bronchoalveolar Lavage Fluid↗
PubMed1993

Bronchogenic cyst: a cause of pulmonary artery obstruction and breathlessness.

A young woman presenting with breathlessness and a normal chest roentgenogram was found to have unilateral absent lung perfusion on an isotope scan. This was due to a bronchogenic cyst obstructing the right pulmonary artery. This is a rare cause of unilateral absence of lung perfusion and an unusual mode of presentation of a bronchogenic cyst.

Adult↗
PubMed1993

Intravenous aminophylline confers no benefit in acute asthma treated with intravenous steroids and inhaled bronchodilators.

BACKGROUND: The role of intravenous aminophylline in acute asthma is unclear despite meta-analysis of many studies comparing aminophylline with other bronchodilator therapies. AIMS: The aim of this study is to determine whether continuous aminophylline infusion confers any benefit in acute severe asthmatics treated with intravenous steroids and inhaled bronchodilators. METHODS: The study was randomised, double-blind and placebo-controlled. All patients received nebulised salbutamol (1 mL of 0.5%) and ipratropium bromide (1 mL of 0.025%) with glycol diluent (1 mL) at 0, two, four, six, eight and 12 hours, and six-hourly thereafter. In addition all patients were given intravenous hydrocortisone 250 mg six-hourly and oxygen to maintain normoxia. Aminophylline infusions were adjusted to maintain therapeutic levels. Peak expiratory flow rate (PEFR) was measured before and after nebulised bronchodilator on a two-hourly basis in the Emergency Department (ED) and six-hourly on the inpatient wards. RESULTS: Thirty-one patients were clinically sufficiently improved within 12 hours to be discharged home from the ED. The remaining 28 patients were admitted to the inpatient ward for a total trial duration of 48 hours. No significant difference was found between the placebo and treatment groups for measurements of PEFR, or for the duration of stay of the patients in hospital. The power of the study was 80% for a 25% to 33% difference at a 5% level of significance. Presentation values of PEFR and arterial blood gases did not predict which patients would require inpatient admission and which could be safely discharged home from the ED.

Acute Disease↗
PubMed1991

Young's syndrome (obstructive azoospermia and chronic sinobronchial infection): a quantitative study of axonemal ultrastructure and function.

The ultrastructure and function of nasal cilia and sperm tails were examined in 23 men with Young's syndrome and compared with data previously collected from 10 normal subjects. Quantitative electron microscopic assessment showed that sperm tails from patients with Young's syndrome contained significantly fewer central pair microtubules, radial spokes, and inner dynein arms, and their cilia contained less inner dynein arms than normal subjects. The Young's syndrome patients had normal in vitro ciliary beat frequency (11.4 +/- 0.9 Hz), and 12 of the 23 had normal nasal mucociliary clearance (15.0 +/- 5.0 minutes). However, the remaining 11 had markedly abnormal nasal mucociliary clearance in vivo. In these patients, the deficiency of ciliary inner dynein arms did not appear to affect ciliary function in vitro but may under mucus loading lead to abnormal in vivo ciliary function. The consistent abnormalities shown in cilia and sperm tails, though apparently minor, constitute a common factor in both the reproductive and respiratory tracts which may, in combination with abnormalities in the in vivo environment, lead to the features of Young's syndrome.

Adult↗
PubMed1991

Human in vitro nasal and tracheal ciliary beat frequencies: comparison of sampling sites, combined effect of medication, and demographic relationships.

In vitro nasal and tracheal ciliary beat frequencies (CBFs) were measured photometrically in brush samples of 15 patients undergoing bronchoscopy. Tracheal and nasal CBF values in these patients were found to be significantly correlated (r = .74, p less than .01), and the latter did not differ significantly from the nasal CBF of 80 subjects serving as controls. Premedication with morphine and atropine and local anesthesia with lidocaine hydrochloride significantly decreased the CBF. Among the control subjects, a significantly higher CBF (13.6 +/- 1.5 Hz) was found in the young age group (10 to 19 years) as compared to other groups (12.2 +/- 1.7 Hz). Gender and ethnic origin did not influence CBF in any age group. These data support the possible use of the in vitro study of nasal epithelium to reflect the CBF in the lower respiratory tract.

Adult↗
PubMed1986

Kartagener's syndrome with motile cilia and immotile spermatozoa: axonemal ultrastructure and function.

A 35-yr-old infertile man with chronic sinobronchial disease and dextrocardia (Kartagener's syndrome) was found to have immotile sperm and motile nasal cilia in vitro. Ciliary beat frequency in vitro was normal, but in vivo nasal mucociliary clearance was markedly prolonged. Quantitative electron microscopy demonstrated a severe reduction in spermatozoal outer and inner dynein arms compared with normal (p less than 0.001) but normal numbers of outer doublets, central microtubules, and radial spokes were seen. In 2 samples of nasal cilia collected 14 months apart, the number of inner dynein arms was significantly reduced from normal (p less than 0.001), but normal numbers of radial spokes and microtubule structures were seen. Ciliary outer dynein arms were slightly reduced in 1 specimen (p less than 0.001) but were normal in the other. It is suggested that the reduction in the number of ciliary inner dynein arms does not affect ciliary motility in vitro but that, under the increased load of mucus in vivo, this defect prevents the cilia from functioning normally. The difference in axonemal ultrastructure between cilia and spermatozoa from the same patient further suggests a separate genetic control of their structural components.

Adult↗
PubMed1986

Respiratory disease in animal house workers.

A cross-sectional survey was made to determine the prevalence of respiratory disorders, and the association between symptoms and workplace exposure, in 90 animal-house workers (AHW) and 100 controls (C) without occupational exposure to laboratory animals. Each subject provided a detailed history and serum for radioimmunoassays, and underwent: physical examination, skin testing with common inhalant and animal-derived antigens, and pulmonary function studies. Both groups were comparable with respect to age, sex, smoking habits, and atopy. Rhinitis occurred with similar frequency in each group. However, a more frequent occurrence of asthma (p less than 0.05, non-specific infectious respiratory disease (p less than 0.005), and impaired pulmonary functions (p less than 0.001) was found among AHW. An atopic background was a predisposing factor for the development of laboratory-animal-related respiratory symptoms. These findings imply an increased vulnerability to respiratory disease related to workplace exposure to laboratory animals in atopic individuals.

Adult↗
PubMed1985

Structural heterogeneity of the axonemes of respiratory cilia and sperm flagella in normal men.

The ultrastructure of normal human cilia and flagella was examined and quantitatively assessed to determine the normal variations in the structure of the axoneme. Ciliated respiratory epithelial cells and spermatozoa from 10 normal, nonsmoking male volunteers who had normal semen parameters were fixed for electron microscopy. Tannic acid and MgSO4 were included during fixation to enhance, in particular, axonemal components. In 75 axonemal cross sections per sample, the number of outer doublet and central singlet microtubules, outer and inner dynein arms, and radial spokes were recorded. Statistical analysis of the results showed a marked reduction, from the expected value of nine, in the numbers of inner dynein arms (mean +/- SE, cilia, 5.31 +/- 0.13; sperm, 5.38 +/- 0.16) and radial spokes (cilia, 4.95 +/- 0.22; sperm, 5.80 +/- 0.19). The ideal axoneme with all its structural components was seen in only 0.13% of cilia and 0.80% of sperm tails. Significantly more doublet microtubules (P less than 0.05) and less central microtubules (P less than 0.01) and radial spokes (P less than 0.01) were seen in cilia than in sperm tail axonemes. Between subjects there was little variation in the mean number of a structure seen per axoneme. However, within each sample, the variation was considerably higher, particularly for the inner and outer dynein arms and radial spokes. The doublet microtubules had significantly greater standard deviations in the sperm tails compared with the cilia (P less than 0.01), and furthermore, a significantly greater number of sperm tails compared with cilia showed the incorrect number of doublet microtubules (P less than 0.02). In one semen sample, with normal semen analysis, 20% of the sperm tails showed incorrect numbers of doublet microtubules, ranging from 12 + 2 to 5 + 2 compared with only 1.3% in cilia from this subject. This study has demonstrated that the ideal axoneme is rarely seen even in normal samples, probably because of the technical difficulties in resolution and visualization, and stresses the need for thorough documentation of axonemal ultrastructure. This work provides a normal data base for comparison with patients who have chronic respiratory disease and suspected infertility.

Adult↗
PubMed1985

Occupational respiratory disease in veterinarians.

In order to determine the effect of occupational animal exposure on the occurrence of respiratory disease, we studied 257 active veterinarians and 100 control subjects who had not had occupational animal contact. All participants provided a detailed medical history and underwent spirometry, skin tests, and determination of total serum IgE levels. Asthma was significantly more prevalent in veterinarians (16.3%) than in controls (6%), (P less than .05), as was infectious/obstructive respiratory disease, 10.5% in veterinarians, 3% in controls (P less than .025). Only 13 of 257 veterinarians had respiratory symptoms related to animal contact; of these, seven experienced only allergic rhinitis while six reported both asthma and rhinitis. Animal-related allergic rhinitis was found more frequently in laboratory animal veterinarians than among veterinarians in farm, pet, or poultry practice. No symptoms typical of hypersensitivity pneumonitis were reported in veterinarians, nor were precipitins to animal antigens demonstrable.

Humans↗
PubMed1984

Occupational asthma due to poultry mites.

The possible role of the northern fowl mite (NFM) in occupation-related respiratory disease of poultry workers was examined. The study population included 16 poultry workers with workplace-associated asthma and rhinitis, 27 atopic individuals with similar symptoms but no occupational exposure to poultry, and 12 asymptomatic nonatopic poultry-exposed controls. Ten of the 16 atopic poultry workers had immediate wheal-and-flare reactions to NFM, as compared with two of 27 non-poultry-exposed controls (p less than 0.001). In cutaneous testing with five poultry-related antigens, the NFM was the most reactive. On skin tests, four atopic poultry workers were positive for NFM and negative for Dermatophagoides farinae; four workers were negative for NFM and positive for D. farinae. Radioallergosorbent test (RAST) showed specific IgE levels for NFM, with positive RAST scores in 60% of poultry workers having positive skin tests. A provocative bronchial test with NFM extract in a poultry worker having positive NFM skin test and RAST score resulted in an immediate 25% reduction in the FEV1 and a 62% fall in forced expiratory flow volume at 25% of vital capacity. Collectively, the established presence of NFM in the poultry workplace, associated clinical histories, positive cutaneous tests, positive specific-IgE assays, and positive bronchial challenge combine to establish a role for NFM in occupational allergic respiratory disease of poultry farmers.

Adolescent↗
PubMed1984

Occupational asthma in poultry workers.

Sixteen poultry workers with poultry house--related rhinitis and/or asthma underwent clinical and laboratory evaluation that included history and physical examination, skin tests with common inhalant and PAg, total- and specific-IgE levels, and pulmonary-function studies. Sixteen age- and sex-matched atopic subjects who were not occupationally exposed to poultry and 12 asymptomatic veterinarians with occupational exposure to poultry served as controls. Rhinitis and asthma developed only in symptomatic poultry workers after exposure to poultry; only in these individuals could immediate wheal-and-flare reactions to poultry antigens be detected (p less than 0.001). The elapsed time between the initial poultry exposure and the onset of poultry house--related symptoms averaged 10 yr. In the symptomatic poultry workers, immediate skin test reactivity and RAST reactions were most frequently associated with NFM. The association between respiratory symptoms temporally related to poultry house exposure and the demonstrable IgE antibody-mediated reaction suggests a relationship between the two.

Adolescent↗