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Biomedical subjects

P Small

Publications and source records attributed to P Small.

At least 19 recordsLinked to original sources
PubMed1992

Suppression of epicutaneous reactivity by terfenadine and loratadine.

We compared the relative antihistaminic effects of loratadine (10 mg), terfenadine (120 mg), and placebo in patients with tree pollen-induced allergic rhinitis. Wheals were produced by epicutaneous tests with serial dilutions of histamine phosphate, tree and grass pollen extracts before ingestion of medication. Repeat tests were performed after seven days of treatment. Terfenadine was more effective than both loratadine (P less than .01) and placebo (P less than .001) at suppressing histamine induced wheals. Terfenadine was more effective than placebo (P less than .01), but not loratadine at inhibiting both tree-induced and grass-induced epicutaneous reactions. In this study, terfenadine was more potent than loratadine in inhibiting both histamine-induced and allergen-induced epicutaneous wheals.

Cyproheptadine↗
PubMed1992

Sustained improvement in asthma with long-term use of formoterol fumarate.

Inhaled formoterol fumarate, a long acting beta 2 agonist, produces bronchodilatation that is sustained for approximately 12 hours. To determine whether such bronchodilator effects are maintained and asthma control sustained during chronic administration, we monitored airflow indices and clinical control in 112 asthmatic patients who self administered formoterol twice daily for periods ranging from 9 to 12 months. Subjects were recruited immediately following completion of a 3-month double-blind comparison of formoterol, 12 micrograms, bid versus salbutamol, 200 micrograms, qid. Assessments were conducted at baseline, 3, 6, and 9 months, where baseline represents the final visit of the 3-month comparative study. Patients were asked to complete diary cards and twice daily PEFR for a 2-week period before each assessment. Throughout the follow-up study, there was no indication of worsening of asthma control or deteriorating lung function. For the patients who continued to receive formoterol, the previous improvement in asthma control and lung function was maintained at the level reached in the 3-month study. There was an improvement in flow rates and asthma symptoms in the group switched from salbutamol to formoterol by the first clinic visit. This improvement in asthma control and lung function was maintained over the subsequent 6 months. Formoterol was well tolerated during the study period. We conclude that prolonged use of formoterol fumarate twice daily results in sustained improvement in symptoms and flow rates in asthma with no evidence of tachyphylaxis.

Adolescent↗
PubMed1992

Relationship between allergen-specific skin testing and nasal provocation in patients with perennial rhinitis.

Patients with perennial rhinitis were evaluated by allergen challenge epicutaneously and intranasally. Nasal provocation was assessed by clinical score, graded 0-12, to include rhinomanometry, secretions (mL), sneezes, and stuffy nose. All 40 patients with perennial symptoms had no clinical history of seasonal exacerbations but did have both positive skin tests and nasal provocation to the same allergen. Skin test wheel size correlation with nasal provocation (P less than .02).

Allergens↗
PubMed1992

Does nasal provocation play a role in the diagnosis and management of ragweed-induced allergic rhinitis?

Twenty-seven patients with ragweed allergic rhinitis were evaluated before the season by allergen-induced nasal reactivity. Symptom scores were recorded during the season, and repeat nasal challenges performed at the end. Nasal response to ragweed insufflation did not predict seasonal symptoms. No change in threshold reactivity occurred at the end of the season, once peak symptoms had passed. In the evaluation of patients with allergic rhinitis, specific nasal challenge did not help predict seasonal clinical symptoms.

Double-Blind Method↗
PubMed1991

Wegener's granulomatosis presenting as temporal arteritis.

A granulomatous giant cell vasculitis of the temporal artery was observed in a biopsy specimen from a patient with corresponding clinical symptoms. Within weeks, the new onset of pulmonary infiltrates and renal failure prompted biopsy of the patient's kidney. A necrotizing glomerulonephritis, compatible with a diagnosis of Wegener's granulomatosis, was present. Vasculitis of the temporal artery may be a feature of Wegener's granulomatosis.

Aged↗
PubMed1991

Subacute effects of respiratory syncytial virus infection on lung function in lambs.

We examined the effects of ovine respiratory syncytial virus (RSV) infection on lung mechanics, lung histology, and airway reactivity in lambs. Nine lambs were inoculated with ovine RSV and seven control lambs with normal saline or viral media. Serum neutralization titers were obtained prior to and 3 weeks post-inoculation (PI). Open lung biopsies were performed 1 and 3 weeks PI. Lung mechanics including dynamic compliance (Cdyn), resistance of the lung (RL), and functional residual capacity (FRC) were measured 2 and 6 weeks PI using a plethysmograph. Airway reactivity to aerosolized carbachol, citric acid, and histamine was determined 2 and 6 weeks PI. Most RSV and control lambs were asymptomatic after inoculation. Control lambs had significantly greater average daily weight gain by the third week after inoculation. Seven RSV lambs tested had a fourfold or greater rise in serum neutralization titers, while two control lambs had a fourfold increase. At 2 weeks PI, RSV lambs had significantly lower FRC and higher RL. At 6 weeks RL remained significantly elevated in the RSV lambs. Airway reactivity was not increased in the RSV group. This animal model is useful for studying the effects of RSV infection on lung growth and lung function over time.

Animals↗
PubMed1991

A three-month comparison of twice daily inhaled formoterol versus four times daily inhaled albuterol in the management of stable asthma.

We compared the efficacy of inhaled formoterol, a long-acting beta 2-agonist, with inhaled albuterol in 145 stable adult asthmatics in a 12-wk multicenter trial. Patients were allocated in randomized double-blind fashion to maintenance therapy with either formoterol 12 micrograms twice a day or albuterol 200 micrograms four times a day in addition to their other asthma medications. Patients were allowed to use "rescue" 100-micrograms albuterol puffs on an as-needed basis. Mean baseline FEV, in the morning before bronchodilator was 2.14 +/- 0.76 L and 1.98 +/- 0.71 L for the formoterol and albuterol groups, respectively, these values being used as baseline covariates in subsequent analysis of predrug and postdrug FEV1. Measured at each clinic visit, morning predrug FEV1 rose significantly with formoterol treatment and was significantly greater at all visits than in the albuterol group, the greatest difference being in Week 8 (2.40 +/- 0.77 versus 1.92 +/- 0.66 L, p less than 0.001). Morning FEV1 30 min postdrug was significantly higher in the formoterol group at Weeks 2 and 8, the trend not reaching statistical significance at other times. Diurnal variation in prebronchodilator peak flow rates was significantly reduced in the formoterol group throughout the trial (17 versus 42 L/min at Week 12, p less than 0.0001). The number of asthma episodes per week was significantly less in the formoterol group during Weeks 4, 8, and 12 as were the number of sleep disruptions during Weeks 2, 4, 6, 8, and 12. Significantly more rescue albuterol was required in the albuterol group by Week 2 and throughout the remainder of the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1991

Helicobacter pylori and Meckel's diverticulum.

Helicobacter pylori is invariably associated with peptic ulceration of the upper gastrointestinal tract. This has led to speculation about its pathogenic role in peptic ulceration. The literature and this present study show that H. pylori is not often associated with peptic ulceration in Meckel's diverticulum and hence it is unlikely that it has any significant role in peptic ulceration at this site.

Adolescent↗
PubMed1991

Effects of high doses of topical steroids on both ragweed and histamine-induced nasal provocation.

Patients with ragweed-induced seasonal allergic rhinitis were assigned randomly to be challenged intranasally either with ragweed or histamine while asymptomatic before the ragweed season. After initial challenge, all were treated either by placebo (P), beclomethasone dipropionate (BE), 400 micrograms daily, or budesonide (BU), 1200 micrograms daily, intranasally for 14 days. Repeat challenge was then compared with the previous ones in order to assess the effects of both usual (400 micrograms) and high doses (1200 micrograms) of topical steroids on both allergen-induced and nonspecific (histamine) nasal reactivity. Incremental doses of either histamine or ragweed were insufflated intranasally until a positive response defined the threshold reactivity. Reactions were assessed by a combination of changes in flow rates (rhinomanometry), secretions (mL), and sneezes with ten minutes of challenge. There was no difference in initial threshold reactivities among the treatment groups. Neither BE nor BU changed reactivity to ragweed. There were no adverse reactions except epistaxis in two BU patients. Histamine challenges disclosed a change in threshold reactivity, BU (P much less than .01) greater than BE (P much less than .05), compared with placebo. In summary, even high doses (1200 micrograms) of topical steroids had minimal effects on the early response to intranasal ragweed challenge. In contrast, both usual and high doses affected nonspecific histamine reactivity; this may contribute to some of the clinical improvement noted in symptoms of allergic rhinitis.

Administration, Topical↗
PubMed1990

Estimation of lung volume in infants by echo planar imaging and total body plethysmography.

Echo planar imaging (an extremely fast method of magnetic resonance imaging) was used to measure lung volume in a group of nine infants, all of whom had had respiratory problems. The mean echo planar imaging estimate of total lung volume was 44 +/- 9 ml/kg. In each case the right lung was larger than the left (ratio 52.8:47.2%). The mean thoracic gas volume was 36 +/- 8 ml/kg. The entire sequence of images of the thorax (about 400) takes five minutes to complete, infants require no sedation, and there are no side effects.

Female↗
PubMed1990

Relationships among ragweed skin tests and both allergen specific and nonspecific nasal provocation.

Twenty-six patients with ragweed-induced allergic rhinitis were evaluated prior to the onset of seasonal symptoms. Ragweed skin tests and nasal challenges were performed 2 weeks after histamine nasal provocation. A correlation between ragweed skin tests and nasal challenges was detected (r = .4867, P much less than .01). Histamine challenges did not correlate with either of the other variables. A properly performed skin test predicts nasal reactivity to the same allergen. A clinical role for nonspecific nasal provocation could not be determined.

Adult↗
PubMed1990

Effects of azatadine, terfenadine, and astemizole on allergen-induced nasal provocation.

Fifty-six patients with ragweed seasonal rhinitis were challenged intranasally with ragweed. A clinical score (0-12)--including measurements of rhinomanometry, secretions, and sneezes--was generated. Each patient then received either azatadine (A), terfenadine (T), astemizole (AS), or nothing (control), for 1 week. Repeat challenges revealed changes in clinical score with A 3.6 (P less than .01), AS 3.1 (P less than .02), and T 2.7 (P less than .05). All three antihistamines similarly inhibited the nasal provocation response to ragweed.

Adolescent↗
PubMed1989

Sebaceous carcinoma of the eyelids. The role of adjunctive cryotherapy in the management of conjunctival pagetoid spread.

The extension of sebaceous carcinoma of the eyelid within the epithelium of the palpebral, forniceal, and bulbar conjunctiva (pagetoid spread) is a frequent indication for exenteration, but this recommendation is controversial. Six patients with upper eyelid tumors and variable degrees of epibulbar pagetoid extension were treated without exenteration. All underwent wide local resections of their upper eyelids (repaired by Cutler-Beard procedures), with adjunctive cryotherapy to the involved epibulbar surfaces after preoperative map biopsies of the conjunctiva had been done. Cryotherapy was applied during the second-stage Cutler-Beard procedure after initial resection of the tumor bulk. Follow-ups ranging from 12 to 50 months, with conjunctival biopsies at 6-month intervals, showed no recurrence of pagetoid tumor. Although exenteration was avoided, dry-eye symptoms, symblepharon, corneal erosion, and vascularization were side effects, which the patients were willing to tolerate to avoid radical surgery. The complications were most severe in the two patients who were either elderly or had more than two quadrants of epibulbar pagetoid disease.

Adult↗
PubMed1989

Probable azathioprine hepatotoxicity: a case report.

A patient with polymyositis was treated initially with corticosteroids. Subsequently, azathioprine was added but was associated with transient hepatotoxicity on two separate occasions, 6 months apart. Both episodes occurred 3 weeks after starting the latter drug. This is the first case of azathioprine toxicity documented by both histopathology and drug challenge.

Arthritis, Rheumatoid↗
PubMed1988

Evaluation of infants by echo planar imaging after repair of diaphragmatic hernia.

Three infants were studied by echo planar imaging after repair of congenital diaphragmatic hernias. Total lung volume and individual lung volumes were estimated using echo planar imaging. In the two patients with left sided hernias, the right lung was more than twice as large as the left. The patient with a right sided hernia had developed emphysema on the right side, and the right lung was twice as large as the left when estimated by echo planar imaging. Echo planar imaging studies took less than five minutes to perform and no sedation was required.

Female↗