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Biomedical subjects

L Clancy

Publications and source records attributed to L Clancy.

At least 19 recordsLinked to original sources
PubMed1992

Skin anergy and tuberculosis.

In our experience tuberculin skin anergy (negative response to 10 TU Mantoux) occurs in 8% of patients with tuberculosis. In this study we compare 81 patients with skin anergy and proven tuberculosis with a background reactive population of patients with tuberculosis. Patients with skin anergy and tuberculosis were older and had fewer symptoms--less cough, less sputum production, less haemoptysis, less malaise, less chest pain--than patients with skin reactivity. There was no difference with respect to male/female ratio, marital status, smoking habits, coexistent major illness, prescribed medications at diagnosis, nor the proportion of patients with extrapulmonary tuberculosis, previous history of BCG vaccination or past history of tuberculosis. Comparison of chest radiographs showed more advanced, more bilateral and more miliary disease in the anergic patients. Pyrexia and elevated ESR at diagnosis were also more common in this group. Fewer of the anergic group of patients were consistently culture negative after 1 month's treatment compared to the background population. Mortality was higher in the anergic group, but this excess mortality occurred from causes other than tuberculosis. Repeat Mantoux testing was performed in 20 of the 81 anergic patients, after a minimum of 3 months of antituberculous chemotherapy, and 14 had become tuberculin positive, suggesting that tuberculin skin anergy may be a temporary phenomenon.

Adult↗
PubMed1992

AIDS, i.v. drug use and mycobacterial disease: the Dublin experience.

In the period 1980-1985, we treated 1641 patients for tuberculosis of whom two were known to be intravenous drug users (IVDU) and none had HIV infection. Of the next 1000 patients treated for tuberculosis (January 1986-December 1989), six were HIV-negative intravenous drug users (IVDU), 18 patients were HIV-positive (12 IVDU; six homosexual/bisexual). Statistical analysis (chi 2) showed a numerically small but statistically significant (P < 0.00001, d.f. = 1, chi 2 = 20.38) increase in intravenous drug users with a diagnosis of tuberculosis. The HIV-positive patients who completed treatment responded well to anti-tuberculous drugs. The importance of tuberculosis in the context of HIV infection is that it is preventable, treatable and is the only bacterial infection to which HIV subjects are prone which can be readily transmitted to a non-HIV infected subject.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Effects of the addition of nedocromil sodium to maintenance bronchodilator therapy in the management of chronic asthma.

STUDY OBJECTIVES: To assess the efficacy and safety of nedocromil sodium metered dose aerosol as an adjunct to sustained-released theophylline therapy in adult theophylline-dependent asthma patients and to examine the ability of nedocromil sodium to substitute for theophylline. DESIGN: Randomized double-blind placebo-controlled parallel group study. Two-week baseline, eight-week treatment period. SETTING: Out-Patient Clinic. PATIENTS: Sequential sample of 35 adult chronic asthmatic patients maintained on a regimen of sustained-release theophylline (dose range, 400 to 800 mg daily) and on-demand inhaled beta 2-bronchodilators. All patients completed the study. INTERVENTIONS: 2 x 2-mg nedocromil sodium metered dose aerosol twice daily or matching placebo randomly allocated after two-week baseline. Theophylline dose reduced by half or one third after four weeks of test treatments, then stopped for final two weeks. Use of inhaled beta 2-bronchodilators permitted throughout trial period. MEASUREMENTS AND RESULTS: The following results were in favor (statistically significant findings, p less than 0.05) of nedocromil sodium compared with placebo: all diary card efficacy variables (nighttime asthma, morning tightness, daytime asthma, cough, twice daily peak expiratory flow [PEF], inhaled beta 2 use) during all periods of assessment (weeks 1 to 2, 3 to 4, 5 to 6, and 7 to 8) with the exception of cough and nighttime beta 2 use during weeks 1 to 2; patient and clinician opinion of treatment efficacy (end of weeks 4 and 8); ability to reduce the theophylline dose; clinician assessment of asthma severity at the end of the study, and clinic FEV1 at weeks 4, 5, 6, and 8. One placebo-treated patient reported transient moderately severe nausea and taste loss. No clinically significant changes were seen in the laboratory data. CONCLUSION: Nedocromil sodium, 4 mg twice daily, conferred significant benefit when added to sustained-release theophylline therapy. The results suggest that nedocromil sodium may permit a reduction in theophylline dosage and possibly substitute for theophylline in previously dependent patients.

Adolescent↗
PubMed1991

Structure of the adipate complex [Na2(C6H9O4)2(C6H10O4)].2H2O from neutron diffraction at 220 and 295 K.

The crystal structure of sodium hydrogen adipate-adipic acid (2/1) dihydrate, [Na2(C6H9O4)2(C6H10O4)].2H2O, Mr = 518.4, has been determined from neutron diffraction data collected at 220 and 295 K. Crystals are monoclinic, space group C2/m, with Z = 2. At 295 K, a = 9.378 (2), b = 13.379 (5), c = 10.247 (3) A, beta = 95.93 (3) degrees, V = 1278.8 (7) A3, Dn = 1.346, Dm = 1.348 (1) g cm-3 (in dibromomethane/bromobutane), lambda = 1.1588 (2) A, mu = 2.186 cm-1, F(000) = 176.4 fm, R(F2) = 0.108 for all 1995 nonequivalent reflections with sin theta/lambda less than 0.71 A-1. The crystal structure is similar at 220 K except for reduced nuclear mean-square displacements. Hydrogen adipate subunits (called A) are linked end-to-end in infinite chains by very short O...O (2.44 A) hydrogen bonds where the H nuclei are on centers of symmetry within the experimental error. The Na cation is octahedrally coordinated by O atoms from molecules A and also by non-ionized adipic acid molecules (called B). The B molecules have large mean-square nuclear displacements which are described in terms of anharmonicity and disorder.

Adipates↗
PubMed1991

Small-cell lung cancer in elderly patients: the case for chemotherapy.

We present a retrospective analysis of survival in 48 elderly (older than 65 years) and 70 young patients with small-cell lung cancer. Thirty-four elderly and 62 young patients had combination chemotherapy. Overall probability of survival with combination chemotherapy was similar for old and young patients (chi 2 = 0.79, d.f. = 1, p = 0.374). Peripheral neuropathy secondary to vincristine was more common with elderly patients. We believe that decisions about chemotherapy in elderly patients with small-cell lung cancer should be based on performance status, extent of disease and clinical condition rather than age.

Adult↗
PubMed1991

Hypertrophic osteoarthropathy in association with pulmonary tuberculosis.

Three white male patients with advanced cavitary pulmonary tuberculosis presented with HOA. No other pathology to explain the osteoarthropathy was detected. The osteoarthropathy responded symptomatically to NSAI drugs and treatment of tuberculosis but resolved radiologically in only one patient.

Adult↗
PubMed1991

Erythema induratum (Bazin's disease).

Four patients with erythema induratum (EI) have been diagnosed at the Dermatology Department within the past two years. All four patients had a history of recurrent painful nodules on their calves for at least three years before diagnosis. Three of the patients, all with positive Mantoux reaction to tuberculin skin tests, had neither a personal or family history of tuberculosis. The other patient who had a six year history of recurrent painful leg nodules developed a tuberculous breast abscess. There was a dramatic response to anti-tuberculous chemotherapy in all four patients but one subsequently had recurrent nodules which spontaneously subsided without further chemotherapy.

Aged↗
PubMed1991

Tuberculosis elimination in the countries of Europe and other industrialized countries.

The working group summarized the conclusions of the workshop with the intention of providing a guide for the preparation of national plans for tuberculosis elimination. The basic strategies that appear consistently effective are: 1. Direct government responsibility for diagnosis, treatment and prevention of tuberculosis (the government is responsible by law for assuring that tuberculosis is identified early, and that cure of the patients is achieved). 2. Maintenance (or development) of properly designed disease surveillance and a programme monitoring system. 3. Availability of specialized tuberculosis personnel at regional and provincial level, responsible for close monitoring of the diagnostic skills and patient prioritization in general health institutions. Regarding research it was felt that no immediate practical applications of new techniques in the diagnosis of mycobacterial diseases, in treatment, or in vaccination can be recommended, but that further basic research in the field of mycobacteria should be pursued and supported.

Communicable Disease Control↗
PubMed1991

Isoniazid resistant tuberculosis in a school outbreak: the protective effect of BCG.

An outbreak of isoniazid resistant tuberculosis occurred in a large second level school. A total of 1,160 teenage pupils were at risk. Nineteen cases of tuberculosis were diagnosed, 15 were students, 9 of whom were among 251 non-vaccinated students and 6 among 909 vaccinated students. Two cases of miliary tuberculosis, one of whom also had tuberculous (TB) meningitis, occurred in the non-vaccinated group. The number of children with Heaf grade +3 or +4 was significantly greater among children who had been given Bacille Calmette-Guérin (BCG) vaccination (8 vs 4.4%). This suggests a boosting effect on the response in vaccinated children. The protective effect of neonatal BCG vaccination in this school outbreak suggests that it provides significant protection against tuberculosis lasting into adolescence.

Adolescent↗
PubMed1990

The effect of peritoneal dialysate on pulmonary function and blood gasses in C.A.P.D. patients.

There have been many reports showing diminished vital capacity (VC), total lung capacity (TLC), and functional residual capacity (FRC), after the infusion of peritoneal dialysate in patients on continuous ambulatory peritoneal dialysis (C.A.P.D.) for chronic renal failure. We also examined the effects of the infusion of two litres of dialysate on airways resistance (Raw) using total body plethysmography and on arterial blood gasses. Ten patients on C.A.P.D. were selected. The mean results of dialysate infused (in) and dialysate drained (out) are as follows: FVC 3.66 l (in) and 3.73 l (out) (not significant); VC 3.81 l (in) and 3.99 l (out) (p less than 0.05); FEV1 3.02 l (in) and 2.94 (out) (n.s.); TLC 5.89 l (in) and 6.33 l (out) (p less than 0.05); FRC 3.56 l (in) and 3.78 l (out) (p less than 0.05); Raw 4.79 cmsH21/l/s (in) and 4.72 cmsH20/l/s (out) (n.s.); Pa02 11.03 kPA (in) and 11.35 kPA (out) (p less than 0.001). We conclude that two litre dialysate causes significant reduction of TLC, VC and FRC, and a reduction in Pa02 and A-a02 but has no effect on airways resistance.

Airway Resistance↗
PubMed1990

Pulmonary tuberculosis in the Republic of Ireland: an epidemiological profile from a single unit.

We present a retrospective epidemiological analysis of 1011 adults with a first time diagnosis of pulmonary TB seen between 1980-1985. Most (98.7%) were from the Republic of Ireland and 68.4% were male. Both males and females showed a bimodal age distribution with 37.6% of females and 18.8% of males aged younger than 30 years. More than half (58.6%) of patients smoked cigarettes and 63.7% consumed alcohol. Two patients indulged in the use of hard drugs. Only 5% of patients were asymptomatic and 0.9% of patients had symptoms for longer than 1 year. Radiologically, 54.7% of patients had bilateral disease; 58.5% had cavities and 10% had pleural effusions. Mantoux testing was positive to 1 tuberculin unit Mantoux in 76%; to 10 tuberculin units Mantoux in 15.3%; to 100 tuberculin units Mantoux in 3.7%; and negative to 100 tuberculin units in 5.0%. Primary drug resistance occurred in 0.9% of patients. Ninety (9.0%) of patients died before completing antituberculous treatment and in 40 patients tuberculosis was the principle or main cause of death.

Adolescent↗
PubMed1990

Raised PPD antibodies in active pulmonary tuberculosis.

Antibodies to purified protein derivative of tuberculin (PPD) were measured in 47 patients with active pulmonary tuberculosis and in various control subjects using an enzyme linked immunosorbent assay. Raised IgG anti PPD antibodies were found in 30 patients with active tuberculosis, in one of 28 patients with miscellaneous non tuberculous diseases and in one of 49 healthy control subjects. This gave the assay a sensitivity of 65% and a specificity of 98%. Antibodies were also measured in a further 20 patients with suspected tuberculosis but in whom microbiological evidence was absent. In eight of these patients active tuberculous disease was subsequently validated on the basis of clinical response to chemotherapy: raised PPD antibodies were found in six of this group but in none of the remaining 12 patients in whom the diagnosis of tuberculosis was considered doubtful. Further studies showed that patients' PPD antibody level fell over a one year period of successful therapy and that tuberculin skin testing and BCG vaccination did not cause a rise in antibodies in healthy subjects. These results suggest that the measurement of PPD antibodies is a useful adjunctive test in the diagnosis of tuberculosis.

Antibodies, Bacterial↗
PubMed1990

Fibreoptic bronchoscopy in the management of lone pleural effusion: a negative study.

In a retrospective review of 3,000 consecutive fibreoptic bronchoscopies, fifty were performed for investigation of lone pleural effusion. While 7 patients had bronchogenic carcinoma, in only one case was it visible endoscopically. In the absence of radiological or clinical features suggesting an endobronchial lesion, fibreoptic bronchoscopy is unlikely to aid in the diagnosis of lone pleural effusion.

Bronchoscopy↗
PubMed1989

Short course chemotherapy for pulmonary tuberculosis. A randomised controlled trial of a six month versus a nine month oral regimen.

We report on the first trial in the Republic of Ireland to look at chemotherapy for TB. This management trial, carried out in single unit, which treats a third of all TB cases in the Republic of Ireland compared to effectiveness of a three drug/nine month regimen (Rifampicin (R), Isoniazed (R), supplemented with Ethambutol (E) for the first two months = RHE9) with a four drug six months regimen (R, H supplemented with E and Pyrazinamide (Z) for the first two months = RHEZ6). Two hundred and eighty eight patients (288) were entered into the study. A total of 143, (76 were in the RHE9 group and 67 in the RHEZ6 group) completed the trial as planned. At the end of the third month, significantly more patients in the RHEZ6 regimen (98%) were culture negative compared to the RHE9 regimen (88%). All were culture negative at the end of chemotherapy. Drug intolerance was seen in 35 (12%) patients with no significant difference in hepatitis between the two regimens. Toxicity from Pyrazinamide was minimal. One hundred and forty five (145) patients were invalid for analysis for the following reason:- bacteriologically negative TB (41), drug intolerance (35), death (23), non-compliance (19), diagnosis not TB (10), drug resistance (7), extrapulmonary disease (4), consent withdrawn (3), Mycobacteria other than tuberculosis (3). All patients are being followed to monitor relapse rates.

Administration, Oral↗