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Biomedical subjects

C Borland

Publications and source records attributed to C Borland.

At least 19 recordsLinked to original sources
PubMed1999

A randomized controlled trial of day hospital and day centre therapy.

OBJECTIVE: To compare the outcome of day hospital to day centre rehabilitation. DESIGN: Single blind randomized controlled trial with home assessments at baseline (twice), six weeks and three months. SETTING: Mainly rural health district. Day hospital and social services day centres in market towns. SUBJECTS: One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discharge from hospital (66) or referred as outpatients (39). INTERVENTIONS: Day hospital treatment or day centre rehabilitation by a physiotherapist and two health support workers. MAIN OUTCOME MEASURES: Barthel Index, Philadelphia Geriatric Morale Scale and Caregiver Strain Index. RESULTS: More day centre (23/55) than day hospital patients (6/50) (p <0.001) withdrew from allocated treatment by choice or because of operational difficulties. Both groups improved significantly in functional ability and reduction of care-giver strain by three months but there was no significant difference between groups. The mean improvement in Barthel Index (standard error) for day hospital = +1.5 (0.41) (n = 34) and day centres = +1.5 (0.48) (n = 38). The mean difference (95% confidence interval) between day hospital and day centre was 0 (-1.28, +1.28). Likewise the mean Philadelphia Geriatric Morale Scale improvement for day hospital +1.8 (0.66) (n = 35) and day centres was +0.9 (0.63) (n = 38). The mean difference was -0.88 (-2.7, +0.95). The mean reduction in Caregiver Strain for day hospital was -1.45 (0.5) (n = 23) and day centre was -1.59 (0.47) (n = 27). The difference was -0.14 (1.52, +1.24). (These analyses are all on an intention-to-treat basis.) CONCLUSION: Whilst the improvement in functional ability and care-giver strain was similar in both groups, day centre rehabilitation was less popular and had practical difficulties. If these difficulties can be overcome the model should be tested elsewhere.

Aged↗
PubMed1997

Delayed cyanide poisoning following acetonitrile ingestion.

Acetonitrile (methyl cyanide) is a common industrial organic solvent but is a rare cause of poisoning. We report the first recorded UK case. Acetonitrile is slowly converted to cyanide, resulting in delayed toxicity. We describe a case of deliberate self-poisoning by a 39-year-old woman resulting in cyanide poisoning 11 hours later which was successfully treated by repeated boluses of sodium nitrite and thiosulphate. The half-life of conversion of acetonitrile was 40 hours and harmful blood cyanide levels persisted for over 24 hours after ingestion. Departments treating or advising in cases of poisoning need to be aware of the delayed toxicity of acetonitrile. Monitoring in an intensive care unit of cases of acetonitrile poisoning should continue for 24-48 hours.

Acetonitriles↗
PubMed1996

Reduction of pulmonary capillary blood volume in patients with severe unexplained pulmonary hypertension.

BACKGROUND: Unexplained or primary pulmonary hypertension results in an obliteration and obstruction of resistance pulmonary arteries. In these patients gas exchange is impaired and the measurement of gas transfer for carbon monoxide is usually reduced. This has been thought to represent a reduction in pulmonary alveolar capillary blood volume (Vc). A single breath test, measuring simultaneously the uptake of both nitric oxide (NO) and carbon monoxide (CO), provides a simple and practical measurement of membrane diffusion (Dm) and Vc. METHODS: A standard single breath test for the measurement of gas transfer for carbon monoxide (TLCO) was adapted to include NO (40 ppm) in the inhaled gas mixture and a breath-hold time at total lung capacity of 7.5 seconds was used. Twelve patients with primary pulmonary hypertension and 10 similar normal volunteers were studied while seated at rest. RESULTS: The patients had reduced values for TLCO and TLNO. The mean (SD) value of Dm in the patients was 36.7 (32.1) mmol/min.kPa compared with 52.8 (23.9) mmol/min.kPa in the normal subjects. Vc in the patients was 0.03 (0.03) 1 and 0.06 (0.01) 1 in the normal subjects. CONCLUSIONS: The simultaneous measurement of NO and CO uptake is possible in healthy volunteers and patients with primary hypertension. In these patients capillary blood volume is reduced compared with normal subjects.

Adult↗
PubMed1995

Effect size.

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Asthma↗
PubMed1995

Elevated exhaled nitric oxide in patients with hepatopulmonary syndrome.

The hypoxaemia of hepatopulmonary syndrome, seen in severe chronic liver dysfunction, occurs as a result of precapillary pulmonary arterial dilatation and arteriovenous communications. These abnormalities contribute to the mismatch between ventilation and perfusion, and the right to left blood flow shunting. Nitric oxide (NO) is a powerful vasodilator concerned with the regulation of pulmonary vascular tone in man. Using a chemiluminescence analyser, we have measured endogenously produced NO in the exhaled air of three patients with the hepatopulmonary syndrome, six normoxaemic cirrhotic patients and six healthy volunteers. The subjects breathed NO-free air throughout the measurements. The molar rate of production of exhaled NO was raised almost threefold in the patients with hepatopulmonary syndrome compared with normal volunteers and with normoxaemic cirrhotic patients. Hypoxia per se, achieved in the normal volunteers by breathing a hypoxic gas mixture, reduced rather than increased the exhaled NO. One hepatopulmonary syndrome patient received an orthotopic liver transplant and achieved normoxaemia after 3 months. The exhaled NO also returned to normal. Increased pulmonary production of NO could contribute to the development of the hepatopulmonary syndrome.

Blood Gas Analysis↗
PubMed1994

Mixed expired nitric oxide in primary pulmonary hypertension in relation to lung diffusion capacity.

The mixed expired nitric oxide (NO) production of the lungs of patients with primary pulmonary hypertension (PPH) and normal subjects was measured to determine the relationship between NO production and the diffusion capacity of the lung (KCO). Expired air was collected from eight patients with PPH and 20 healthy volunteers for analysis by a chemiluminescent analyser. Mean pulmonary artery pressure in the PPH patients was 59.5 +/- 6.45 mmHg and their mean cardiac output was 2.95 +/- 0.35 l/min. All patients and subjects underwent measurements of FEV1, VC and KCO. The rate of production of NO in mixed exhaled air was lower in the PPH group compared to the controls (2.85 +/- 0.7 vs. 4.69 +/- 0.35 nM/min; p < 0.05). There was a good correlation of expired NO with the KCO (r = 0.7; n = 30; p < 0.001). When corrected, KCO differences in exhaled NO were not significant (p = 0.09). We conclude that the low exhaled NO observed in PPH patients is a reflection of the reduced blood capillary volume in these patients rather than a decreased basal production of NO.

Adult↗
PubMed1993

Measurement of exhaled nitric oxide in man.

BACKGROUND: Nitric oxide is released from pulmonary endothelial cells and contributes to the low pulmonary vascular resistance. The resistance pulmonary arteries are in close anatomical proximity to membranous airways, so it is likely that some pulmonary endothelial nitric oxide will enter the airspace to allow its measurement in the exhaled breath. METHODS: Exhaled air was collected from a single full exhalation and during tidal breathing. This was analysed for concentrations of nitric oxide, nitrogen dioxide, and carbon dioxide to give alveolar (FA) and mixed expired (FE) concentrations. Eight normal subjects were studied and laboratory air was similarly analysed using, respectively, chemiluminescent and infrared analysers. RESULTS: There was no relation between FA concentrations and the laboratory air concentrations. From the single breath, the ratio of (Fano/Faco2) x (Feco2/Feno) had a mean value of 0.92 (95% confidence interval 0.7 to 1.14). As this does not differ from unity, nitric oxide is likely to be derived from the same regions of the lungs as carbon dioxide. During tidal breathing the Feno ranged from 8.3 to 20.3 parts per billion. CONCLUSIONS: It is possible to measure endogenous pulmonary nitric oxide production in the exhaled air in man.

Adult↗
PubMed1987

Nitric oxide yields of contemporary UK, US and French cigarettes.

To determine what governs nitric oxide (NO) yields of cigarettes and to obtain a range of yields for contemporary cigarettes 17 UK, 14 US, 8 French and 1 Turkish brand were analysed using a chemiluminescent analyser and standard smoking machine. The country of origin appeared to be the major factor affecting NO yield. US and French brands exceeded UK values by 3-5 fold. Apart from a reduced NO yield in UK ventilated filtered brands, the design of a cigarette and its tar, nicotine and carbon monoxide (CO) yield had little effect on NO yield. It is argued that these international differences in NO yields reflect differences in the nitrate content of tobaccos traditionally used in manufacture in those countries over many years. Despite their probable increased lifetime exposure to NO (and by implication nitrosamine exposure) there appears to be little evidence that US and French smokers are at greater risk of lung disease than their UK counterparts.

Carbon Monoxide↗
PubMed1986

Chemical specificity of coughing in man.

The purpose of this study was to test whether cough response to inhaled ultrasonically nebulized fluid is dependent on the ionic content of the fluid. Coughing was recorded in human volunteers during inhalation of aqueous solutions in a series of double blind randomized experiments. The occurrence of cough was found to be dependent on the concentration of chloride ions in the inhaled fluid, cough frequency progressively increasing as chloride ion concentration was reduced. It is proposed that the ion composition of the surface lining fluid of the airway may moderate the cough response by means of a chemo-receptor, although tonicity may also be important.

Acetates↗
PubMed1986

Biochemical and clinical correlates of diuretic therapy in the elderly.

To estimate the frequency of diuretic-related electrolyte disorders in the elderly, 561 consecutive admissions to three acute geriatric units were studied. For the 287 admissions to one unit, discharge/death diagnoses were also examined in relation to admission diuretic therapy. Sodium concentrations were significantly lower, and urea and creatinine significantly higher, in patients on diuretics, though the size of the differences was small. Comparing different preparations sodium concentrations were significantly lower on Moduretic than on Dyazide or Navidrex K and on frusemide when combined with a potassium-retaining diuretic rather than a potassium supplement. Potassium concentrations were significantly lower on Bendrofluazide alone compared to Navidrex K or Moduretic. Diuretics were positively associated with cardiac failure, ischaemic heart disease, airflow obstruction and obstructive large bowel disorders but negatively with Parkinson's disease. No significant association was found with falls, immobility or confusion. Major electrolyte disorders on diuretics appear to be unusual but important differences exist between preparations. Similarly major illness resulting from diuretic therapy is rare but minor morbidity may be more common.

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