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Biomedical subjects

M E Hodson

Publications and source records attributed to M E Hodson.

At least 163 records · Page 9Linked to original sources
PubMed1987

Cystic fibrosis in adolescents and adults.

Three hundred and sixteen patients with cystic fibrosis were seen at the Brompton Hospital during 1965-83; 178 (56.3%) of them were male and 136 female, and their ages ranged from 12 to 51 years. Most patients presented in infancy with respiratory symptoms and malabsorption, but 19 (6%) were diagnosed in adult life, three in their 30s. Pulmonary disease was almost universal (99.7%), being responsible for 97% of all deaths and three quarters of hospital admissions. All patients had developed a productive cough by the age of 21 and over half before the age of 5. Many complained of wheezing, but reversible airflow obstruction was present in only 40% of those tested. Minor haemoptysis was very common (62%), but major episodes less so (10%). Pneumothorax was seen in 61 cases (19%), and was often recurrent. Some irreversible airflow obstruction was present in all patients with pulmonary disease. Two patients have been followed for over 20 years without showing appreciable decline in lung function. Thirty five patients (11%) had no symptoms of malabsorption. Acute meconium ileus equivalent was seen in 16% and a chronic partial obstruction with episodic symptoms in a further 19%. Diabetes mellitus developed in 36 patients, 13 of whom were insulin dependent. Hepatomegaly was common (29%), often occurring without abnormal results in biochemical tests of liver function; only 1% of patients developed portal hypertension with varices and ascites. Skin reactions to at least one common allergen, including Aspergillus fumigatus, were positive in 70%, but very few patients suffered from hay fever or eczema. One hundred and twenty one patients have died, 97% from infection or other pulmonary complications, and 195 were alive in December 1983 (mean age 23 years). Seventy eight per cent of patients were in full time education or full or part time employment, or were housewives, and only 41 were unemployed for reasons for health. Many patients are married and 10 women have borne children. Most patients were admitted to hospital only three or four times during the period of follow up and 50 individuals (16%) have never been in hospital at all. The improvement in prognosis and quality of life for adults with cystic fibrosis should encourage a positive attitude in those who care for them.

Adolescent↗
PubMed1987

Enteric coated microspheres of pancreatin in the treatment of cystic fibrosis: comparison with a standard enteric coated preparation.

In an open, randomised crossover study enteric coated microspheres of pancreatin were compared with a standard preparation of enteric coated pancreatin over two consecutive 28 day treatment periods in 23 adults with steatorrhoea due to cystic fibrosis. Lipase intake was equal to the patients' previous requirements and was the same during the two months. Patients performed 72 hour faecal collections at the end of each month and completed diary cards daily throughout. Comparison of the month of treatment with enteric coated microspheres with the month of standard enteric coated tablets showed a significant increase in body weight on microsphere capsules (p less than 0.02). There was also a reduced frequency of bowel actions (p less than 0.001) and abdominal pain (p less than 0.05), and improvement in stool character (p less than 0.001) on microsphere capsules. Faecal fat excretion was reduced by 44% with the microsphere capsules (p less than 0.01), and 86% of patients showed an increased coefficient of fat absorption (mean increase 13%, 95% confidence limits 6.5-19.1%; p less than 0.001). Eighty one per cent of patients preferred microsphere capsules of the two treatments. Thus enteric coated microsphere capsules are more effective in treating steatorrhoea in cystic fibrosis than standard enteric coated tablets.

Adult↗
PubMed1987

Lymphocyte subpopulations and function in cystic fibrosis.

Circulating lymphocytes subpopulations and their function have been studied in 25 young adults with cystic fibrosis (CF) and 25 normal controls. Mean absolute numbers of all lymphocyte subsets in the CF group were not significantly different from the controls. Antibody-dependent cell cytotoxicity was significantly higher in the CF patients who had Pseudomonas aeruginosa in their sputum compared with those who had not and compared with the normal controls. Within the CF group the numbers of B cells, total T cells and OKT4+ helper cells fell as percent predicted peak expiratory flow (PEF) declined and similar significant positive correlations were found between lymphocyte subsets and percent predicted body weight. Serum albumin levels also showed a positive correlation with total T lymphocyte numbers (p less than 0.05). In vitro lymphocyte proliferative responses to mitogen were not significantly different from the control group, but again correlated positively with body weight in the CF patients. This provides further evidence that immune function in CF patients may become impaired as pulmonary disease and nutritional status deteriorate.

Adolescent↗
PubMed1987

Autoantibodies in infections of the respiratory tract with Mycoplasma pneumoniae or influenza virus A.

The sera from 26 patients with serological evidence of infection with Mycoplasma pneumoniae and 23 patients with influenza virus A infection were examined for autoantibodies to smooth muscle, cell nuclei and 'reticulin'. There is an increased incidence of autoantibodies to smooth muscle (46%) in the serum of patients infected with M. pneumoniae. There is no increase in autoantibodies to cell nuclei or 'reticulin' in these patients. There is no increased incidence of autoantibodies in patients infected with influenza virus A. The possible aetiology of the raised incidence of smooth muscle autoantibodies in the patients with M. pneumoniae is discussed.

Autoantibodies↗
PubMed1986

Effects of postural drainage, incorporating the forced expiration technique, on pulmonary function in cystic fibrosis.

Detailed pulmonary function tests were performed on 12 patients with cystic fibrosis (CF) before and after 3 days treatment with postural drainage incorporating the forced expiration technique. The results following treatment showed a statistically significant improvement in FEV1 (P less than 0.001), FVC (P less than 0.001), PEFR(P less than 0.001), PIFR (P less than 0.001), and VEmax50 (P less than 0.025). The study demonstrates objective benefit from this form of physiotherapy in cystic fibrosis patients with copious bronchial secretions.

Adolescent↗
PubMed1986

Pharmacokinetics and sputum penetration of ciprofloxacin in patients with cystic fibrosis.

Levels of ciprofloxacin in serum and sputum were studied for eight patients with cystic fibrosis who were infected with Pseudomonas aeruginosa. Patients were studied in a steady state on a dosage of 500 mg every 8 h. Peak levels in serum ranged from 1.27 to 5.6 mg/liter (mean, 3.16 +/- 1.27), and absorption was rapid, the time to peak concentration ranging from 0.5 to 3.0 h (mean, 1.5 +/- 0.9). The antibiotic penetrated sputum well, achieving areas under the curve of approximately 46% of those obtained in serum.

Adolescent↗
PubMed1986

Effect of abnormal liver function on vitamin E status and supplementation in adults with cystic fibrosis.

Patients with cystic fibrosis tend to have reduced serum concentrations of vitamin E and are therefore at risk of developing the neurological complications associated with vitamin E deficiency. Improved survival in cystic fibrosis has resulted in an increasing number of older patients who may develop hepatobiliary complications which may further impair the absorption of vitamin E. In this study the vitamin E status and results of supplementation with oral vitamin E were compared in adult patients with and without evidence of liver involvement as assessed by routine liver function tests. The serum vitamin E concentrations were reduced below normal in 24 of 25 patients. The mean serum vitamin E concentration was significantly lower (p less than 0.05) in those patients with abnormal liver function. When vitamin E status was assessed as the serum vitamin E/cholesterol ratio, however, there was no significant difference between those patients with normal and abnormal liver function. After supplementation with oral vitamin E, either 10 mg/kg/day for one month or 200 mg/day (equivalent to 3.4 to 4.4 mg/kg/day) for up to three months, there was no significant difference in the vitamin E status between the two groups. The results of this study indicate that in general, patients with cystic fibrosis and abnormal liver function do not require increased supplements of vitamin E compared with those with normal liver function.

Adolescent↗
PubMed1986

Prednisolone in the treatment of airflow obstruction in adults with cystic fibrosis.

The effect of oral prednisolone on the lung function of 20 adult patients with cystic fibrosis who had severe stable airflow obstruction was assessed in a placebo controlled study, blind to the patients. Placebo tablets were followed by prednisolone given in a median dose of 0.48 mg/kg body weight/day (20 mg/day in 11 patients, 30 mg/day in nine patients), each for three weeks. No significant improvement was seen in lung function in the group after receiving prednisolone, and none of the individual patients had clinically useful improvements in lung function. Atopic subjects showed an improvement in evening recordings of peak expiratory flow rate (PEF) while taking prednisolone (p less than 0.05). Significant deterioration in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was seen after withdrawal of prednisolone. Two patients developed pneumothoraces while taking prednisolone.

Adolescent↗
PubMed1986

Evaluation of positive expiratory pressure as an adjunct to chest physiotherapy in the treatment of cystic fibrosis.

It has been suggested that positive expiratory pressure may assist the clearance of bronchial secretions in the treatment of cystic fibrosis. It has been compared with currently used postural drainage techniques. Three treatment regimens were compared in 18 patients with cystic fibrosis. Treatment A consisted of breathing exercises emphasising inspiration, interspersed with the forced expiration technique in gravity assisted positions; treatment B comprised breathing exercises with positive expiratory pressure alternating with the forced expiration technique in the same gravity assisted positions; and treatment C comprised breathing exercises with positive expiratory pressure and the forced expiration technique in the sitting position. During treatment A a significantly greater quantity of sputum was produced than during treatments B and C (p less than 0.025 and p less than 0.001 respectively). Treatment B produced more sputum than treatment C (p less than 0.005). There were no significant differences in arterial oxygen saturation, FEV1 or forced vital capacity. Most adolescent and adult patients are able to carry out their treatment independently using gravity assisted positions, breathing exercises emphasising inspiration, and the forced expiration technique. Sputum clearance was less effective when positive expiratory pressure was included in the treatment regimen.

Adolescent↗
PubMed1986

Twice daily beclomethasone dipropionate administered with a concentrated aerosol inhaler: efficacy and patient compliance.

The efficacy of twice daily inhaled beclomethasone dipropionate administered by a concentrated aerosol inhaler (one puff twice daily-500 micrograms/day) has been compared with that of treatment four times daily with a standard dose inhaler (two puffs four times daily-400 micrograms/day) in 21 patients with stable asthma. Double placebo inhalers were used in a randomised crossover fashion during two four week treatment periods. Mean peak expiratory flow (PEF), mean symptom scores, and number of extra salbutamol inhalations required were not significantly different between the two treatment periods. Local side effects were more common during treatment with the four times daily active preparation; overt oropharyngeal candidiasis, however, was not found in either group during the study. On completion of the crossover study patients were transferred to the twice daily regimen. At the three month follow up all patients had remained stable and the outpatient PEF was significantly higher (mean 382 (SD 26)l min-1) than at entry into the trial (mean 345 (24)l min-1) (p less than 0.05). Twice daily beclomethasone administered by a concentrated aerosol inhaler appears to be as effective as the standard four times daily regimen in controlling stable asthma.

Adult↗
PubMed1985

Selenium deficiency and possible increased risk of carcinoma in adults with cystic fibrosis.

20 young adults with cystic fibrosis (CF), including 2 with cancer, were found to have low serum selenium concentrations. Serum vitamin E concentrations were also low. It is suggested that low levels of circulating selenium are associated with increased risk of carcinoma, particularly in the presence of reduced vitamin E levels. Older patients with CF may be at increased risk for the development of carcinoma.

Adult↗
PubMed1985

Cystic fibrosis in adult life: a study of coping patterns.

Despite comparable degrees of physical disability, some patients with cystic fibrosis (CF) cope more successfully than others with the difficulties of competitive adult life. This study found substantial differences between a coping and non-coping sample of adult CF patients. Non-copers had twice as many hospital admissions as copers over a year, even though their ventilatory function was better. The non-coping sample compared unfavourably with the copers in four main spheres of psychosocial functioning--their vocational records; level of family support; awareness of anomalies in sexual function; and knowledge about CF.

Adolescent↗
PubMed1985

Use of gas liquid chromatography in the clinical diagnosis of anaerobic pleuropulmonary infection.

Evidence of anaerobic infection was sought in 83 patients with pulmonary disease with anaerobic culture and gas liquid chromatography (GLC) of mucopurulent sputum, or pleural fluid where appropriate. Saliva samples from nine healthy controls and 14 patients with cystic fibrosis were examined by the same methods to assess anaerobic content. Clinically significant anaerobic pleuropulmonary infection was not found in our patients with bronchitis, bronchiectasis and cystic fibrosis and occurred in only some of our patients with empyema and lung abscess. GLC of pleural fluid (empyema) or sputum (lung abscess) was helpful in identifying these cases, when a strongly positive reading was obtained. The gas liquid chromatogram was negative or only weakly positive in those patients where the presence of anaerobes was clinically insignificant, most probably resulting from contamination of the sputum samples by saliva. Results were rapidly available and the need for transtracheal aspiration to obtain specimens of bronchial secretion uncontaminated by mouth flora was avoided. The semiquantitative GLC would therefore appear to be a useful method for investigating specimens from patients with suspected anaerobic pleuropulmonary infection.

Adult↗
PubMed1985

Cystic fibrosis: ultrasonographic findings in the pancreas and hepatobiliary system correlated with clinical data and pathology.

Abdominal ultrasonography was performed on 35 adult patients with proven cystic fibrosis. Thirty-three patients showed pancreatic abnormalities. The most marked ultrasonographic features were increased parenchymal echogenicity, atrophy, non-visualisation of the duct and cyst formation. There was no correlation between these features and the severity of the pulmonary disease, the age of the patient, weight or glucose intolerance. Abnormalities of the biliary tract were demonstrated in nine (26%) patients and were associated with poor nutritional status. Multivariate analysis revealed a significant association between the following: hepatomegaly, increased liver echogenicity, splenomegaly, biliary disease; secondly, between lung function and serum albumin. Ultrasonography is useful in showing organ morphology but not in assessing disease severity.

Adolescent↗
PubMed1985

Circulating immune complexes in patients with cystic fibrosis in relation to clinical features.

Immune complexes have been previously reported in the serum of patients with cystic fibrosis. This study was undertaken to relate the finding of complexes with the clinical features of the disease. Immune complexes detected by the 125I-C1q binding assay were found in the sera of 17/60 (28%) of patients with cystic fibrosis (CF). There was no association between the finding of raised levels of immune complexes and duration of chest symptoms, duration of daily sputum production, age, sex, weight, atopy, the presence or absence of malabsorption, pneumothorax, diabetes, Aspergillus precipitins or specific bacterial pathogens in the sputum. There was however a correlation between the finding of increasing circulating immune complexes and decrease in the respiratory function; forced expiratory volume in 1 sec (P less than 0.001) and forced vital capacity (P less than 0.005); also with weight (P less than 0.02). It is possible that the finding of immune complexes, at low levels, in cystic fibrosis are the result of tissue damage rather than its cause.

Adolescent↗