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Biomedical subjects

R J Butland

Publications and source records attributed to R J Butland.

At least 19 recordsLinked to original sources
PubMed1994

Omeprazole in the treatment of asthmatics with nocturnal symptoms and gastro-oesophageal reflux: a placebo-controlled cross-over study.

Eleven adult patients with nocturnal asthma, and gastro-oesophageal reflux documented by endoscopy or ambulatory oesophageal pH monitoring completed a double-blind cross-over study (4 week treatment, one week run-in and cross-over periods) comparing the effects of omeprazole 20 mg daily and placebo on asthma control assessed by symptoms, peak expiratory flow rate and bronchodilator usage. Omeprazole treatment did not improve asthma symptoms during the day or night, or peak expiratory flow rate readings. There was no difference in bronchodilator inhaler usage during omeprazole therapy. Treatment of gastro-oesophageal reflux with omeprazole in patients with nocturnal asthma and gastro-oesophageal reflux does not improve asthma symptoms or peak expiratory flow rate. This suggests that gastro-oesophageal reflux does not exacerbate bronchoconstriction in nocturnal asthma.

Aged↗
PubMed1990

The effect of nicardipine, a calcium channel blocker, on the sweat test in adult patients with cystic fibrosis.

In vitro studies have suggested a potential role for calcium channel blockers in manipulating the basic ionic defect of cystic fibrosis. In 17 adult patients with cystic fibrosis nicardipine was administered either intravenously or topically using iontophoresis or occlusive dressings. Sweat tests were performed before and after drug administration and examined using two way analysis of variance. No statistically significant difference was observed. We conclude that nicardipine used in vivo does not exert the easily demonstrable effect on the chloride ion defect that has been observed with other agents in vitro.

Adult↗
PubMed1989

The effect of nicardipine, a calcium channel blocker, on the sweat test in adult patients with cystic fibrosis.

Impaired cell membrane chloride ion movement in cystic fibrosis results in reduced resorption of sodium and chloride from sweat gland ductules producing the high concentrations measured in the sweat as a diagnostic test. Normal chloride ion movement can be restored in vitro by blocking transepithelial calcium flux with lanthanum, suggesting a potential role for calcium channel blocking drugs in the management of cystic fibrosis. We studied the effect of nicardipine, a calcium channel blocker, on the sweat sodium in 17 adult patients with cystic fibrosis. Nicardipine was administered intravenously or topically using iontophoresis or occlusive dressing. No significant change in sweat sodium concentration was observed between pre- and post-drug administration. We conclude that nicardipine used in vivo does not exert the same effect as lanthanum demonstrates in vitro on transepithelial cell membrane chloride ion movement in cystic fibrosis.

Administration, Topical↗
PubMed1987

Oral ciprofloxacin compared with conventional intravenous treatment for Pseudomonas aeruginosa infection in adults with cystic fibrosis.

40 adult patients with cystic fibrosis (CF) were admitted to hospital with acute exacerbations of infection associated with isolation of Pseudomonas aeruginosa from sputum. The patients were randomly allocated (20 per group) to receive intravenous azlocillin 5 g and gentamicin 80 mg, or oral ciprofloxacin 500 mg. Both treatments were given three times a day for 10 days. The patients were assessed on days 1 and 10, and at 6 weeks. There was a significant improvement in lung function between days 1 and 10 in both groups (p less than 0.001). Significant improvement was maintained at 6 weeks after ciprofloxacin but not in the intravenous group. Improvement after ciprofloxacin was superior at day 10. Sputum weight decreased in both groups (p less than 0.001). Patient-recorded symptoms also improved in both groups. There was no serious toxicity or side-effects. Drug resistant organisms were isolated no more frequently after ciprofloxacin than after intravenous therapy. 17 of the ciprofloxacin-treated patients said they preferred oral treatment to intravenous therapy. Oral ciprofloxacin is a useful short-term treatment for patients with CF who are infected with Ps aeruginosa.

Acute Disease↗
PubMed1986

The radiology of aseptic cavitation in pulmonary infarction.

Eight patients with aseptic cavitation of sterile pulmonary infarcts are described. All except one had left ventricular failure and/or chronic airflow obstruction. Infarcts with cavities were commonly single (75%) and right-sided (69%) and usually followed a sizeable area of consolidation (larger than 4 cm) after about 2 weeks. Of the 62% that could be localised to a segment, all were in the apical or posterior segment of an upper lobe or the apical segment of a lower lobe and the majority (85%) had scalloped inner margins and cross cavity band shadows. At the time of cavitation, 38% had additional features on the chest radiograph that were suggestive of pulmonary embolic disease. A number of cavities developed a tertiary infection and an air-fluid level but the latter feature was non-specific. Aseptic cavitation of a sterile pulmonary infarct should be considered in the differential diagnosis of any cavitating lung lesion, particularly if it shows the above features.

Aged↗
PubMed1984

Fibrosing alveolitis associated with amiodarone.

We report a patient with fibrosing alveolitis associated with amiodarone therapy. Review of the literature suggests that amiodarone induced pulmonary disease generally occurs on a maintenance dose of at least 400 mg of amiodarone daily; there is however a wide range in the duration of therapy or total dose administered prior to presentation.

Aged↗
PubMed1983

Effect of beta-adrenergic blockade on hyperventilation and exercise tolerance in emphysema.

Ventilation, heart rate, and arterial blood gas tensions were measured at rest and during incremental exercise in 10 patients with emphysema after intravenous placebo or 7 mg metoprolol. Metoprolol reduced heart rate by 14% (P less than 0.001) and ventilation by 11% (P less than 0.01), but there was no significant difference in arterial O2 or CO2 tension (Pao2 and PaCO2, respectively). Metoprolol increased the time to exhaustion on a cycle ergometer (P less than 0.05) but did not improve the 12-min walking distance. A double-blind randomized crossover comparison of 4 wk treatment with atenolol (100 mg/day), metoprolol (100 mg/day), or matched placebo was performed in 12 patients with emphysema. Both beta-adrenoceptor antagonists reduced resting heart rate by 33% (P less than 0.001) and resting minute ventilation by 11% (P less than 0.025). There was no change in resting or exercise Pao2 or Paco2. During steady-state exercise on a cycle ergometer, atenolol and metoprolol reduced ventilation by 14 and 4%, respectively. This was accompanied by 11 and 5% reductions in O2 consumption (P less than 0.05) and 13 and 6% falls in CO2 production (P less than 0.05). There were no significant changes in tests of exercise tolerance, but forced expiratory volume in 1 s and forced vital capacity were reduced during beta 1-adrenergic blockade. beta 1-Blocking drugs reduce hyperventilation in emphysema by reducing pulmonary gas exchange without a change in arterial blood gas tensions. Increased airflow obstruction prevents this reduction being of therapeutic value.

Administration, Oral↗
PubMed1982

The selectivity of the beta-adrenoceptor for ventilation in man.

1 Minute ventilation, alveolar PCO2, CO2 production and heart rate were measured in eight normal subjects before and during infusions of noradrenaline 0.2, 1.0 and 5.0 micrograms min-1 and isoprenaline 0.04, 0.2 and 1.0 microgram min-1. 2 These measurements were repeated after propranolol 3.5 mg, atenolol 8 mg or metoprolol 7 mg by intravenous injection. 3 Noradrenaline 5.0 micrograms min-1 and isoprenaline 1.0 microgram min-1 significantly increased ventilation and CO2 production and decreased alveolar PCO2. These changes were attenuated by propranolol, atenolol and metoprolol. There was no significant difference between the blocking effects of the three beta-adrenoceptor blockers for these three variables but propranolol was more effective than atenolol or metoprolol in blocking isoprenaline induced tachycardia (P less than 0.001). 4 The hyperventilatory response to catecholamines is predominantly a beta1-effect.

Adrenergic beta-Antagonists↗
PubMed1982

Carbimazole and exercise tolerance in chronic airflow obstruction.

Ten patients with severe dyspnoea and chronic airflow obstruction entered a randomised double-blind crossover trial comparing the effect of carbimazole 80 mg daily for two months with that of placebo. Assessment of thyroid function, lung function, and exercise tolerance was performed monthly. The mean free thyroxine index after two months of carbimazole was significantly lower at 64.1 (+/- 10.5, SEM) than the 89.1 (+/- 3.8) while on placebo. Serum tri-iodothyronine was reduced and thyroid stimulating hormone raised while on the active drug. There was no significant difference in the 12-minute walking distance (TMD), the rating of perceived exertion during the TMD, the oxygen cost score, the dyspnoea grade, the resting arterialised capillary blood gas tensions or the resting minute ventilation. During a progressive exercise test to exhaustion on a cycle ergometer, there was no significant difference in the minute ventilation, heart rate, blood gas tensions at exhaustion, or the total work done. There were no symptoms or signs of hypothyroidism. Lung function (FEV1, FVC, TLC, KCO) was unchanged. Thus a 28% reduction in the free thyroxine index produced no symptomatic or objective benefit in exercise tolerance in patients with severe airflow obstruction. These results provide no support for the use of carbimazole in chronic airflow obstruction.

Carbimazole↗
PubMed1982

Propranolol uptake by dog lung: effect of pulmonary artery occlusion and shock lung.

First-pass lung uptake of propranolol in catheterized ambulant dogs was measured by comparison the difference between the ratios of [14C]propranolol to indocyanine green (ICG) before and after a single passage through the pulmonary circulation. Uptake was 56 +/- 5, 53 +/- 8, and 61 +/- 10% (mean +/- SD) when 0.02, 0.2, and 2.0 mg of propranolol were injected, respectively. There was a negative though unimportant correlation between percent uptake and cardiac output. Analysis of paired propranolol and ICG outflow curves confirmed the lack of saturation with increasing dose and suggested the involvement of simple diffusion. In four dogs uptake fell from 4.76 +/- 6.8 to 40.4 +/- 8.2% (0.05 greater than P greater than 0.025) during partial occlusion of the pulmonary circulation by a Swan-Ganz catheter balloon and rose again to 51.2 +/- 6.4% after relief of the occlusion. Propranolol uptake, measured serially in five dogs with indwelling catheters, was initially 55% but fell linearly to 30% over 2 wk (r = -0.59, P less than 0.001), and necropsy showed pathological features of shock lung. A similar study performed on three dogs within 4 days of catheterization showed no change in uptake of the drug. Propranolol uptake appears to reflect both quantitative and qualitative changes in the pulmonary endothelium. This method may therefore be valuable in studying the pulmonary endothelium in health and disease.

Animals↗
PubMed1982

Impaired lung uptake of propranolol in human pulmonary emphysema.

First-pass lung uptake of propranolol was studied in 10 patients with normal lungs, 8 patients with severe pulmonary emphysema, and 1 patient with primary pulmonary hypertension. Propranolol uptake was measured by comparing the ratio of [14C]propranolol (0.5 mg) to indocyanine green (5 mg) injected into the right atrium with the ratio of their concentrations in arterial blood collected over the duration of the first-pass dye outflow curve. Mean uptake was 69 +/- 4% (n = 18) in patients with normal lungs; 55 +/- 7% (n = 13) in patients with emphysema (p less than 0.001), and 51% in the patient with primary pulmonary hypertension. Cardiac index in the normal group (2.78 +/- 0.48 L/min/M2, n = 16) was not significantly different from the group with emphysema (2.90 +/- 0.48, n = 12). There was no correlation between lung uptake and conventional lung function indexes in patients with emphysema. We conclude that propranolol uptake is reduced when the pulmonary vascular bed is damaged. This may have pharmacologic consequences, and it is possible that other pharmacokinetic functions of the lung may similarly be impaired in pulmonary disease. The method is relatively simple, and may be suitable for assessing pulmonary endothelial function in patients with lung disease.

Adult↗
PubMed1981

First-pass lung uptake of propranolol enhanced in anaesthetized dogs.

Uptake of 14C-propranolol after a single passage through the pulmonary circulation was studied in three groups of Labrador dogs using a double indicator dilution method. Uptake in conscious, ambulant animals was 53%. This increased to 81% in dogs anaesthetized with thiopentone, nitrous oxide and halothane and to 64% in dogs anaesthetized with thiopentone, nitrous oxide and fentanyl. Interaction between lipid-soluble anaesthetic agents and pulmonary endothelial cell membranes may be an important factor in increasing lung uptake of lipophilic propranolol, although alteration in pulmonary perfusion associated with a reduction in cardiac output during general anaesthesia may play a part. The pharmacological effects of propranolol administered i.v. during general anaesthesia may be unpredictable.

Anesthesia, General↗