Common respiratory infections: current treatment recommendations.
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Anti-Bacterial Agents↗
Biomedical subjects
C Bryan
Publications and source records attributed to C Bryan.
Prediction of five-year survival following presentation with scleroderma: development of a simple model using three disease factors at first visit.
OBJECTIVE: To identify combinations of easily acquired clinical variables, at first presentation with scleroderma, that would predict subsequent mortality. METHODS: In this prospective study of all new patients at one major scleroderma center, 280 patients with definite scleroderma (according to the American College of Rheumatology criteria) whose disease onset occurred from 1982 to 1991 and who were followed up to the end of 1996 were identified. Standardized data collection was performed at entry to obtain data on major clinical and laboratory variables. Vital status was determined by linkage to the National Death Index. RESULTS: At 5 years, 55 (26%) of 215 women and 21 (32%) of 65 men had died. Univariate analysis showed that older age, diffuse skin disease, higher skin score, low carbon monoxide diffusing capacity, abnormal electrocardiogram findings, proteinuria, hematuria, low hemoglobin level, elevated erythrocyte sedimentation rate (ESR), and presence of antitopoisomerase antibody were all associated with increased mortality. A logistic regression model, validated by Monte Carlo simulation, identified 3 factors, proteinuria, elevated ESR, and low carbon monoxide diffusing capacity, that in combination, had an accuracy of >80% in predicting mortality. The absence of these 3 factors was associated with 93% survival. CONCLUSION: A simple model has been developed that appears to accurately predict mortality over 5 years in a cohort of patients newly presenting with scleroderma.
Adult↗
Survival following the onset of scleroderma: results from a retrospective inception cohort study of the UK patient population.
Scleroderma is a multisystem disease which in many populations is reported to have a substantially reduced survival. One problem with many of the published studies is the inclusion of patients with differing lengths of disease at baseline, with the possibility of left censorship bias. The aim was to determine the survival and its predictors in a cohort of scleroderma patients with new onset of disease. All 283 new patients referred to one of the authors (CMB) who had a reported disease onset after 1 January 1982 were studied. Detailed clinical and laboratory information at baseline and at 1 yr were extracted from the structured records. Vital status as at 1 December 1993 was determined using the UK's NHS Central Register. Expected numbers of deaths were obtained by applying local age and sex all-cause mortality rates. In total, there were 1871 person-years of follow-up with crude mortality rates of 3.9 and 2.6%/year, respectively, in males and females. The mortality rate remained approximately constant over the first 10 yr of follow-up. In comparison with expected survival, based on the age distribution of the cohort, there was an overall 4-fold increased mortality rate in this group which was higher in females [standardized mortality ratio (SMR) 4.6, 95% CI 3.2-6.2] than in males (SMR 3.2, 95% CI 1.8-5.0). Analysis of cause-specific mortality showed that 79% of the excess deaths were scleroderma related, but this proportion was substantially lower in males than in females (67% vs 83.9%). These data confirm the increased mortality rate associated with scleroderma, but these rates are lower than those reported from other centres. Females have a higher age-adjusted mortality which is reflected in the different pattern of mortality between the sexes.
Cohort Studies↗
Becoming a nurse practitioner.
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Career Choice↗
The insulin-like growth factor signaling system and ALS neurotrophic factor treatment strategies.
Because of its multi-faceted potential as a neurotrophic factor, insulin-like growth factor I (IGF-I) has been given to hundreds of ALS patients world-wide. Unlike some patients with post-polio syndrome and fragile elderly males, it is unclear whether any of these patients possess disturbances in IGF signaling. We found that about 25% of ALS patients in a controlled trial of human growth hormone (hGH) had lower or higher than normal IGF-I serum levels. Many ALS patients do have some of the characteristics of type II diabetes mellitus, where IGF-I therapy is also under way. In addition, in type I diabetes significant increase in a circulating molecule that binds IGF-I, IGF-I binding protein 1 (IGFBP-1), occurs along with reduced IGF-I, when neuropathic complications are prominent. We have studied the response of IGFBPs in ALS patients to subcutaneous rhIGF-I and found transient induction of IGFBP-1. Studies related to the IGFBPs have not been done in familial ALS (FALS) patients. However, the gene for another IGFBP, BP-2, co-localizes with the gene for juvenile ALS (ALSJ) on chromosome 2. IGF-I has been given to several models of motor neuron degeneration in the mouse, including motor neuron disease and wobbler, with beneficial effects. However, it is also not known whether any accepted genetic mouse model of motor neuron degeneration possesses any disturbance in the IGF signaling system.
Amyotrophic Lateral Sclerosis↗
Compliance of the respiratory system in newborn infants pre- and postsurfactant replacement therapy.
Surfactant administration causes a rapid and dramatic improvement in gas exchange, but paradoxically, studies have failed to show an improvement in the mechanical properties of the lung. We have measured dynamic and static (passive flow-volume technique) compliance before and after a single dose of bovine lipid extract surfactant in 22 premature infants with RDS. This had no effect on the measured dynamic compliance. In contrast, surfactant significantly increased static compliance from 0.41 +/- 0.02 to 0.55 +/- 0.04 mL/cm H2O/kg. This improvement was the result of a substantial recruitment of lung volume after surfactant administration. This led us to reduce ventilator pressures, which produced an increase in both dynamic and static compliance, but did not recruit additional volume. We conclude that surfactant causes a substantial increase in static compliance due to volume recruitment, which is consistent with reports of increase in the measured FRC. However, despite this improvement, the compliance is still below our normal range.
Female↗
Severe adenoviral nephritis following bone marrow transplantation: successful treatment with intravenous ribavirin.
Invasive adenovirus infection is recognized as an unusual cause of serious end-organ sequelae following BMT. Because symptomatic therapy may be inadequate for more serious infections, the use of investigational agents is justified. We describe a case of severe, progressive nephritis secondary to adenovirus serotype 11 following BMT. Treatment with i.v. ribavirin led to prompt clinical improvement and resolution of adenovirus excretion.
Adenoviridae Infections↗
Comparison of three-compartment Petri dishes and individual plates for routine culture of vaginal swabs.
Recovery of aerobes and facultative anaerobes from 200 consecutive randomly selected high vaginal swabs was evaluated using three-compartment Petri dishes containing Sabouraud, dextrose agar, GC selective agar, and chocolate agar. The method was compared with the traditional method using individual Petri dishes. The two methods produced comparable results both in terms and quantities of organisms recovered from the specimens. As three-compartment Petri dishes use less agar, save time in culturing specimens, yet still maintain the same standard of culture, they provide a more economical alternative to the traditional method for routine culture of vaginal swabs.
Bacteriological Techniques↗
Cardiopulmonary effects of the volume recruitment manoeuvre in infant swine.
The volume recruitment manoeuvre is a non-invasive technique used to measure respiratory mechanics in infants. Because airway pressure increases during this manoeuvre, lung volume, compliance and cardiac output may change. In order to assess possible changes in cardiopulmonary function caused by the volume recruitment manoeuvre, we applied this technique to seven intubated infant swine breathing spontaneously during anaesthesia with halothane and N2O. Tidal volume (VT), respiratory frequency, arterial blood gases, cardiac output (CO) and total respiratory compliance were measured before and after the manoeuvre. In three swine functional residual capacity (FRC) was measured by helium dilution before the manoeuvre, and in four swine diaphragmatic EMG was recorded continuously. Finally, all swine were paralysed during volume recruitment to assess the contribution of the respiratory muscles to post-manoeuvre respiratory mechanics. VT and f increased immediately after the manoeuvre but there were no significant changes in PaCO2, or alveolar to arterial oxygen gradient. There was a small but statistically significant decrease in CO. Compliance increased by 17.8 +/- 3.6 per cent and FRC increased by a mean of 41.1 ml (or 51.9 per cent increase above the baseline FRC). The increase in FRC could not be explained by active mechanisms since the diaphragmatic EMG showed no post-inspiratory activity and neuromuscular paralysis did not decrease FRC. We conclude that the volume recruitment manoeuvre increases FRC and compliance by recruiting collapsed alveoli, and this effect must be taken into consideration when applying this test to infants.
Anesthesia, Inhalation↗
Duration of antagonistic effects of nalmefene and naloxone in opiate-induced sedation for emergency department procedures.
Naloxone is an effective opiate antagonist, but its short half-life limits its usefulness. For outpatient procedures, a longer acting opiate antagonist could eliminate two to four hours of nursing observation in patients postoperatively. A controlled, randomized, double-blind trial comparing the effects of nalmefene, naloxone, and placebo in reversing opiate-induced sedation was carried out to determine efficacy, duration of action, and adverse effects in patients undergoing outpatient procedures. Each patient received 1.5 to 3.0 mg/kg meperidine intravenously before the procedure. After the procedure, each patient received either nalmefene, 1.0 mg; naloxone, 1.0 mg; or saline, 1.0 mL intravenously. Vital signs and assessments for alertness were performed for four hours. Naloxone significantly reversed sedation for only 15 minutes, whereas nalmefene was significantly effective (P less than .05) for up to 210 minutes. Nalmefene was significantly more effective than naloxone in reversing sedation at 60, 90, and 120 minutes. Nalmefene is an effective agent for the reversal of opiate-induced sedation after outpatient procedures.
Adolescent↗
The predictive role of immunologic tests in liver transplant rejection.
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Follow-Up Studies↗
The low incidence of alcoholic cirrhosis in the islands of Lewis and Harris.
The annual incidence of clinically apparent cirrhosis of the liver from all causes in the islands of Lewis and Harris has been found to be 5.5 cases per 100,000 and alcoholic cirrhosis to be 2.76 per 100,000. Sales of alcohol in the island amount to 6.85 million pounds giving a per capita spending on alcohol of 283 pounds in 1984. The incidence of alcoholic cardiomyopathy was found to be 3.7 cases per 100,000 and there were 120 admissions per 100,000 with illnesses directly related to alcoholism. It was suggested that the very low incidence of alcoholic cirrhosis despite the high per capita spending on alcohol could be due to inherited factors, the pattern of drinking and the type of alcohol consumed.
Adult↗
Allergic rhinitis relieved by aspirin and other nonsteroidal antinflammatory drugs.
Aspirin and other non-steroidal antiinflammatory drugs (NSAIDS) are known to cause urticaria and aggravate symptoms of bronchial asthma. This report describes a patient with allergic rhinitis whose symptoms were improved after ingestion of aspirin and the NSAIDS. The beneficial effect was confirmed by oral double-blind challenges.
Administration, Oral↗
Histocompatibility and liver transplant outcome. Does HLA exert a dualistic effect?
An analysis of more than 500 liver transplants has demonstrated that HLA compatibility is associated with diminished allograft survival. Liver transplants with zero mismatches for class I and/or class II HLA antigens have shown significantly lower actuarial survival rates than transplants with one or more mismatches for these loci. In a group of 119 failed liver allografts from patients undergoing retransplantation, a higher incidence of failure due to rejection correlated with a lower degree of HLA compatibility especially for HLA-DR. In contrast, the incidence of liver transplant failures due to primary nonfunction was relatively higher with HLA-DR compatible transplants. Considering the role of HLA as a restriction element in cellular interactions during the immune response, these findings suggest that HLA compatibility may have a dualistic effect on liver transplant outcome. On one hand, HLA compatibility reduced transplant rejection--and on the other hand, it may enhance other immunological mechanisms leading to allograft dysfunction, particularly in patients at risk of developing recurrent autoimmune diseases or infection.
Graft Rejection↗
Effects of high-frequency and conventional ventilation on the premature lamb lung.
Twelve sets of twin lambs were delivered prematurely by cesarean section at 133-136 days gestational age and ventilated for 3 h with either high-frequency oscillation (HFO) or conventional mechanical ventilation (CMV). Blood gases and pH values were monitored at 30-min intervals, and ventilator settings were adjusted to maintain CO2 partial pressure (PCO2) values within the normal range. There were no differences in the sequential blood gas or pH values between the HFO or CMV lambs. Mean airway pressures (MAP) between 8.0 and 20.4 cmH2O were required, indicating lung disease of variable severity in the lambs. The bidirectional protein leak from the vascular space to the airways and alveoli and vice versa was measured with radiolabeled albumins given by intravascular injection and with fetal lung fluid at birth. The albumin leaks in both directions increased as MAP required to normalize PCO2 increased, but the degree of leak was independent of type of ventilation. Pathological findings of epithelial necrosis and hyaline membranes occurred to a similar extent in lung sections from both groups of lambs. In the HFO animals less phosphatidylcholine in the alveolar wash and more of a tracer dose of radiolabeled natural surfactant that had been given at birth became tissue associated. These results indicate a decrease in the initial secretion of surfactant and/or a stimulation of reuptake in the HFO animals. HFO did not protect the immature lung from the development of large protein leaks or the pathological changes of the respiratory distress syndrome.
Animals↗
Ampicillin-resistant Haemophilus in the oropharynx: prevalence in three groups of young, middle-class children.
Infections caused by ampicillin-resistant Haemophilus influenzae type b are prevalent in Fairfax County, VA. In order to gain information on pharyngeal carriage of ampicillin-resistant H influenzae, oropharyngeal cultures were obtained from 249 young children. The study population comprised three groups: 90 healthy children (group A), 79 children who had finished a ten-day course of amoxicillin treatment for acute otitis media (group B), and 80 children who were brought to our office for treatment of purulent nasopharyngitis (group C). Approximately 60% of the children in each group carried Haemophilus in the oropharynx. H parainfluenzae was the predominant oropharyngeal species in group 1. H influenzae was predominant in the other two groups. Ampicillin-resistant Haemophilus sp organisms were recovered from 16% of children in group A, 25% of those in group B, and 17% of patients in group C. Recent exposure to ampicillin was associated with an increase in the recovery of ampicillin-resistant strains of Haemophilus.
Acute Disease↗
Pathological features of persistent infantile sleep apnea with reference to the pathology of sudden infant death syndrome.
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Brain↗