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Biomedical subjects

C E Reed

Publications and source records attributed to C E Reed.

At least 109 records · Page 6Linked to original sources
PubMed1989

Aeroallergens in dairy barns near Cooperstown, New York and Rochester, Minnesota.

We sampled atmospheric barn air using a volumetric air sampler in ten barns near Cooperstown, NY and six barns near Rochester, MN, and, with radioimmunoassays, measured allergens of Aspergillus fumigatus, Thermoactinomyces vulgaris, Micropolyspori faeni, short ragweed, rye grass group I pollen, Alternaria (Alt-1), Dermatophagoides sp. Lepidoglyphus destructor, common insect allergen, mouse urine, rat urine, and cattle epithelium. The most abundant allergen present was A. fumigatus followed by L. destructor. This study provides initial data on barn aerobiology and demonstrates for the first time the abundance of L. destructor allergens in North American dairy barns. More comprehensive study of barns, poultry houses, confinement houses for swine, and other agricultural environments from various geographic locations is needed to define the allergen levels to which millions of farm workers are exposed each day. While most of the allergens were expected, the presence of airborne allergens reactive with antisera to Dermatophagoides suggests indirectly that substantial amounts of pyroglyphid mites are present in some barns.

Air↗
PubMed1989

A comparison of endoesophageal tubes. Improved results with the Atkinson tube.

We reviewed our use of endoesophageal tubes for the palliation of patients with carcinoma of the esophagus from 1973 through 1986. Celestin tubes were implanted by means of laparotomy and traction. Proctor-Livingston tubes were implanted by pulsion with frequent laparotomy for staging. All Atkinson tubes were placed by means of the pulsion method without simultaneous laparotomy in any case. Patients with an Atkinson tube had fewer complications, including aspiration, sepsis, reflux, and pneumonia. Mean hospital stay was shortened to 4 days when the Atkinson tube was used, and hospital death rate was 6% versus 42% when either the Celestin or Proctor-Livingston tube was used. Mean long-term survival (108 days) was significantly lengthened when Atkinson tubes were used. A comparison of all patients receiving tubes revealed a less frequent prevalence of reflux when the distal end of the tube was positioned above the gastroesophageal junction. Laparotomy resulted in significantly more episodes of aspiration, sepsis, reflux, and pneumonia. Laparotomy was also associated with a 41% hospital death rate versus 17% when laparotomy was not performed. Hospital days were shortened to 7 versus 16 days when laparotomy was not performed. The Atkinson tube provided improved palliation and decreased morbidity and mortality in our hands. These benefits were probably the results of ease of insertion without the use of a laparotomy and the ability in most cases to position the distal end of the tube above the gastroesophageal junction.

Aged↗
PubMed1989

Procaterol metered-dose inhaler: a multiclinic study evaluating the efficacy and safety in patients with asthma.

Procaterol hydrochloride aerosol, a potent beta 2-adrenergic bronchodilator, was evaluated in a double-blind, placebo-controlled study for efficacy and safety in 210 patients with documented mild to moderate reversible airway obstruction. Patients were randomized to receive procaterol in two inhalations (high dose) or one inhalation (low dose), 0.01 mg/inhalation, three times daily, or placebo. Pulmonary function tests were recorded at five and 30 minutes and hourly for eight hours after the first dose and following 1 and 2 weeks of treatment. Both doses of procaterol produced significantly greater improvement in PFTs at one hour and for up to seven hours after dosing compared with placebo (p less than 0.05). Mean percent increases in FEV1 were 35% in the high-dose group and 29% in the low-dose group at week 2. The high-dose group showed no loss of duration of bronchodilation with continued dosing. Improvement in PFTs and peak flow rates was significantly greater in the high-dose than in the low-dose group (p less than 0.05). Tremor was the most frequent side effect. Procaterol had no effect on electrocardiograms, heart rate, blood pressure, or clinical laboratory tests. The high dose of procaterol aerosol was shown to be an effective and well-tolerated bronchodilator with a rapid onset and long duration of action.

Adolescent↗
PubMed1989

Chemotherapy, radiation therapy, and resection for carcinoma of the esophagus. Long-term results.

From May 1980 to May 1984, preoperative chemotherapy (mitomycin C and 5-fluorouracil) was added to radiation therapy in patients with potentially operable squamous cell carcinoma of the esophagus. Of 129 patients observed, 122 were followed up until death or to the present. Only 33 were able to complete preoperative chemotherapy and radiation and undergo resection. There were 28 men and five women, their ages ranging from 42 to 81 years (average 60 years). There were 22 black and 11 white patients. The location of the tumor was in the middle third in 70% of the patients. Among the 33 patients, the clinical TNM classification was as follows: T1 N0 M0, three patients; T2 N0 M0, 27 patients; T2 N1 M0, two patients; and T3 N0 M0, one patient. The length of the lesions when measurable in the absence of complete obstruction varied from 3 to 17 cm (average 7 cm). The operative mortality rate in this group was 12% (4/33). There was no viable residual tumor in the surgical specimen of the esophagus in 33% (11/33) of those patients completing triple therapy. However, in two of the 11 patients, left gastric nodes contained tumor and in one there was a minute esophageal perforation. The 2-year survival rate was 33% (11/33), and the 5-year survival rate was 15.4% (5/33). Among the 11 patients having 2-year survival, the surgical specimen was normal in six and abnormal in five. Of the five patients having 5-year survival, the surgical specimen was normal in three and abnormal in two. The absence of tumor in the surgical specimen did not appear to confer any better chance for long-term survival. Data were compared to our 1967-1975 series of 75 patients receiving only preoperative radiation and resection. There was no significant difference in survival rates at 2 years (20% [1975] versus 33% [1984], p = 0.2118) or at 5 years (10% [1975] versus 15.4% [1984], p = 0.5796). The addition of preoperative chemotherapy as an adjunct did not result in a statistically significant increase in 2-year or 5-year survival rates.

Adenocarcinoma↗
PubMed1989

What I would like to learn about the pathogenesis of asthma.

Recent asthma research has emphasized three important points. First, the disease is increasing in severity and probably in frequency. In the United States this increase is concentrated in the large metropolitan counties. Second, the disease formerly considered bronchospasm and bronchial hyperresponsiveness has become recognized as a particular kind of desquamating eosinophilic bronchitis. Third, helper T lymphocytes, particularly those that produce interleukins 3, 4, and 5 seem to play a central role in the pathogenesis of this inflammation. In this essay, I will expound on these points and speculate on their interpretation and where future research may be fruitful in providing better understanding of the disease. The ultimate goal is to suggest a theoretical basis for developing better treatment.

Asthma↗
PubMed1988

Nocturnal asthma: approach to the patient.

Nocturnal asthma can be diagnosed by asking patients whether they awaken at night with asthmatic symptoms and feel the need to use an aerosol bronchodilator. The primary objective in treating nocturnal asthma is to help patients sleep through the night. The bronchoconstriction that underlies nocturnal asthmatic symptoms is a reflection of bronchial hyperresponsiveness, and this hyperresponsiveness is greatly increased by airway inflammation. In patients with allergic asthma, airway inflammation can be reduced by reducing exposure to allergens and, in some cases, by immunotherapy. Nocturnal bronchoconstriction is best controlled by scheduling sustained-release bronchodilators, particularly theophylline, to provide the maximal theophylline blood concentration at the time of maximal obstruction, usually between 4:00 and 6:00 A.M.

Asthma↗
PubMed1988

Immunochemical quantitation, size distribution, and cross-reactivity of lepidoptera (moth) aeroallergens in southeastern Minnesota.

With an immunochemical method, we analyzed outdoor air samples during a 3-year period for concentrations of the predominant local species of moth, Pseudaletia unipuncta (Haworth). Airborne particulates were collected on fiberglass filter sheets with an Accu-Vol sampler located 1.5 m above ground on the southeastern Minnesota prairie. Filter eluates analyzed by RIA inhibition contained concentrations of moth protein peaking in June and August to September of each year, with levels comparable to reported immunochemically measured levels of pollen and mold allergens. These peaks also corresponded with total numbers of moths captured in light traps. Moth-allergen activity was distributed in particle sizes ranging from 0.8 to greater than 4.1 micron when sized samples were obtained by use of an Andersen cascade impaction head. By RIA inhibition, there was cross-reactivity between P. unipuncta and insects of different genera, families, and orders, but not with pollens or molds. Forty-five percent of 257 patients with immediate positive skin tests to common aeroallergens had positive skin tests to one or more commercially available whole body insect extracts. Of 120 patients with allergic rhinitis believed to be primarily caused by ragweed sensitivity, 5% also had elevated specific IgE to moths. We conclude that airborne concentrations of Lepidoptera can be measured immunochemically and that moths may be a seasonal allergen in the United States.

Air Pollution↗
PubMed1988

Effects of topical nasal treatment on asthma symptoms.

During the ragweed season of 1984 we studied 120 patients with hay fever; 58 had a history of asthma during the ragweed season the year before. They were divided into four treatment groups to receive nasal sprays of placebo, cromolyn sodium, flunisolide, or beclomethasone. In controlling hay fever symptoms all medications were superior to placebo; the glucocorticoids were more effective than was cromolyn sodium. Chest symptoms in the 58 patients with a history of asthma were also relieved by the topical nasal treatment. Various explanations for the beneficial effect of topical nasal treatment in asthma symptoms are conceivable. We consider the most likely to be improvement of nasal airway function. With restoration of the filtering action of the nose, less allergen would penetrate to the intrathoracic airways because of reduction in mouth breathing.

Administration, Intranasal↗
PubMed1988

Recommendations for the use of residential air-cleaning devices in the treatment of allergic respiratory diseases.

In an attempt to recommend standards for room air-cleaning devices, a committee reviewed (1) the types and performance characteristics of available domestic air-cleaning devices, (2) the available data on concentrations of allergens in the indoor air, and (3) the studies that have examined the health effects of the use of indoor air-cleaning devices. Absense of adequate data on the clinical relevance of indoor ambient allergen levels, as well as the effect of air-cleaning devices on these levels, plus a general lack of health effects by these devices in published double-blind studies precluded any firm recommendations for their use. It was clear, however, that use of room air-cleaning devices in the absence of other forms of environmental control was not reasonable.

Air↗
PubMed1988

Superior vena cava bypass: use of the azygos vein.

Unexpected involvement of the superior vena cava with dense inflammatory and fibrous tissue was encountered during right pneumonectomy for a T3 N0 M0 squamous cell carcinoma. After expeditiously completing the lung resection, the azygos vein was utilized for a successful superior vena cava bypass.

Azygos Vein↗
PubMed1988

Basic mechanisms of asthma. Role of inflammation.

It is now recognized that the basic reason for airway obstruction in asthma is chronic airway inflammation. The hyperresponsiveness and "bronchospasm" are, in part at least, a consequence of the inflammation. Optimum patient care needs to focus on preventing inflammation when possible and using anti-inflammatory drugs when prevention is not possible. When chronic asthma is mild, aerosol glucocorticoids or cromolyn suffice. Acute exacerbations that do not respond fully to bronchodilator drugs usually should be treated by a course of oral glucocorticoids. A few patients with severe disease require oral glucocorticoid therapy indefinitely.

Asthma↗
PubMed1987

Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy.

Although three effective topical treatments for allergic rhinitis are available, little information to assist the clinician in choosing among them has been reported. Therefore, we conducted a randomized clinical trial to compare beclomethasone nasal solution, flunisolide, and cromolyn with placebo in 120 patients with hay fever during the ragweed season of 1984. We found that all three agents were superior to placebo (P less than 0.001) and that the glucocorticoids were more effective than cromolyn (P less than 0.001). Surprisingly, we also found that these intranasal treatments considerably reduced the symptoms of seasonal asthma. Further study of this therapeutic advantage is needed.

Administration, Intranasal↗
PubMed1987

IgE and IgG antibodies to beta-propiolactone and human serum albumin associated with urticarial reactions to rabies vaccine.

We examined the antibody response to a rabies vaccine doubly inactivated with 0.025% beta-propiolactone and 0.1% tri(n)butyl phosphate and stabilized with 2.5% human serum albumin. Antibodies were measured by using the following four antigen preparations: complete doubly inactivated rabies vaccine, rabies vaccine inactivated only with tri(n)butyl phosphate, beta-propiolactone and human serum albumin, and human serum albumin alone. The fluid phase of the preparation of beta-propiolactone and human serum albumin completely inhibited IgE binding to solid-phase vaccine. Of 21 subjects with urticarial reactions to a booster, 19 had IgE to doubly inactivated vaccine and to beta-propiolactone and human serum albumin. None of 27 immunized subjects without urticaria had detectable IgE. In paired pre- and postimmunization sera, IgE appeared in six of seven of the subjects with urticaria and in one of seven nonreactors. These sera did not contain a significant level of IgE to singly inactivated vaccine or to human serum albumin alone.

Antibodies, Viral↗
PubMed1987

Antigens and allergic asthma.

There are few reliable epidemiologic data on the overall frequency and importance of allergy. We describe a practical method for quantifying the concentration of both amorphous and morphologically defined antigens in the air. A high volume air sampler is used to collect airborne particles and has a facility to separate samples into different particle sizes. Samples are tested for allergenic activity by radioallergosorbent test inhibition assay. Preliminary findings from studies of community wide, amorphous and common household allergens are reported.

Air↗
PubMed1987

Clinical pharmacodynamics of antihistamines.

Antihistamines act by competing with histamine for H1 or H2 histamine receptors on cell membranes. In addition, most of the common antihistamines bind other receptors and thus exert other pharmacologic actions. For all practical purposes, mast cells and basophils are the main physiologic sources of histamine, and the primary usefulness of antihistamines is in diseases characterized by excessive production and release of histamine by these two cell types. Experimental models have proven useful for evaluating antihistamine compounds in humans. In these model systems, a test drug may be employed to block one or more of the known effects of exogenously administered histamine or a histamine agonist. Or the release of endogenous histamine may be brought about in a controlled fashion by agents such as allergens, opiates, or compound 48/80, and the drug's effects on this process may then be measured. In the case of the central nervous system, unfortunately, such models are not available and other means of evaluation must be devised. The dose response and duration of action of orally administered antihistamines can be determined in a simple skin model by their blocking of the wheal and erythema (flare) resulting from an intradermal challenge with histamine, an allergen, or compound 48/80. Antihistamines can also be evaluated in urticaria induced by scratching or cold. Itching that commonly follows injection of histamine or an allergen into the skin is also inhibited by this class of drugs. Most of the commonly used antihistamines are effective in these models, which form the basis for evaluating antihistamines in the treatment of skin diseases. In the nose and conjunctiva, other model strategies are used.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Outpatient management of asthma with regular nebulized beta agonists: comparison of bitolterol mesylate and isoproterenol.

Nebulized bitolterol solution and isoproterenol solution were compared when used on a regular basis, 2.5 mg three times a day for 1 month by patients with chronic asthma. In this multicenter, double-blind trial; 130 nonsteroid-dependent patients were randomized to receive one of the two treatments concomitantly with their regular asthma medications. On study days, at the beginning of the study and after 2 and 4 weeks, treatments were given in the office or laboratory and patients were monitored with pulmonary function tests for eight hours. Both medications induced rapid bronchodilation that had a longer duration after bitolterol. The incidence of tremor was similar with the two medications. Tachycardia and palpitations were more frequent following isoproterenol. Bitolterol has a much longer duration of action and should be considered as a suitable bronchodilator for regular nebulizer treatment of chronic asthma.

Adolescent↗