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Biomedical subjects

C J Clark

Publications and source records attributed to C J Clark.

At least 55 records · Page 3Linked to original sources
PubMed1990

Benefits and problems of a physical training programme for asthmatic patients.

The clinical and physiological effects of a medically supervised, indoor physical training programme were investigated in 36 asthmatic subjects aged 16-40 years. After clinical evaluation, lung function assessment, and progressive incremental exercise testing subjects were randomly allocated to control and training groups. The measurements were repeated after a six week run in period and after a further three months in which those in the training group underwent an indoor training programme. The measurements made at three months were compared with those at the end of the run in period. There was no significant change in anthropometric characteristics, blood lipid profiles, or the provocative concentration of histamine causing a 20% fall in FEV1 (histamine PC20) in the group who underwent training. After training there were significant increases in mean maximal oxygen uptake (ml kg-1 min-1) from 23 (5) to 28 (6), oxygen pulse (ml/beat) from 8.8 (2.3) to 10.8 (2.4), and anaerobic threshold (1/min) from 1.11 (0.27) to 1.38 (0.33). These changes were significantly greater in the group undergoing training than in the control group. There was also a significant fall in breathlessness scores (Borg ratings), blood lactate, carbon dioxide output, and minute ventilation during submaximal exercise in the training group, with no change in the control group. The subject's motivation, the initial level of fitness, and the symptom score at the time of training were the most important factors influencing improvements in cardiorespiratory fitness. Thus submaximal physical exercise of controlled intensity, sustained for three months, produced significant improvements in fitness and cardiorespiratory performance that should be advantageous to the exercising asthmatic patient. The availability of medical supervision throughout the exercise programme appears to have contributed to the successful outcome.

Adolescent↗
PubMed1988

Role of pulmonary alveolar macrophage activation in acute lung injury after burns and smoke inhalation.

Bronchoalveolar lavage cells from 42 fire victims and from 18 patients who were smokers attending for diagnostic bronchoscopy (controls) were assessed morphologically and by chemiluminescence. 10 of the victims had inhaled smoke only; 15 had cutaneous burns only; and 17 had combined injury. The combined injury group had significant increases in polymorphonuclear leucocytes and macrophages, especially mature forms, compared with controls. These increases were higher than those expected from the individual injuries. The combined injury group had significantly greater spontaneous chemiluminescence than controls, again greater than that expected by the individual injuries. The chemiluminescence response to stimulation by opsonised bacteria was significantly higher in the combined injury group than in controls, but significantly lower than that in the smoke inhalation only group. The size of the alveolar cellular response to smoke and cutaneous burns suggests that lung damage follows from excess release of inflammatory mediators, exhaustion of the reserve of mature phagocytes and consequent reduced ability to fight bacteria, or both.

Acute Disease↗
PubMed1988

Assessment of work performance in asthma for determination of cardiorespiratory fitness and training capacity.

In view of the lack of objective information on work performance in asthma, a progressive incremental exercise test was carried out in 44 subjects with mild to moderate asthma and 64 normal, healthy subjects matched for habitual activity, to compare cardiorespiratory fitness and to determine the relative contribution of airflow obstruction to exercise limitation. The two groups achieved similar maximum heart rates (mean (SD) 176(12) and 175(10) beats/min). After allowance for confounding factors the asthmatic subjects had a lower maximum oxygen consumption (VO2 max) (by 199 ml min-1) than control subjects. Having asthma also accounted for a significant reduction in anaerobic threshold (125 ml min-1) and oxygen pulse (0.805 ml/beat). There was no correlation of FEV1 with VO2 max, anaerobic threshold, or oxygen pulse either before or after bronchodilator. The dyspnoea index (VE/MVV%) was increased in the asthmatic subjects at peak exercise, but was less than 60% in all subjects at a workload that produced 75% of the predicted maximum heart rate. Thus the asthmatic subjects had a maximum heart rate similar to that of normal subjects but the low VO2 max, anaerobic threshold, and oxygen pulse suggest suboptimal fitness, which was not directly due to airflow obstruction. All had sufficient ventilatory reserve to allow toleration of training at a work intensity adequate to permit improvements in cardiovascular fitness.

Adult↗
PubMed1987

An instrumental phonetic study of lingual activity in articulation-disordered children.

Traditional auditory-based assessment procedures for diagnosing articulation disorders are limited in that they provide no direct information on activities of the speech organs. In this study electropalatography (EPG) was used to obtain details of tongue contacts with the hard palate in 4 articulation-disordered children, 2 of whom had been categorized as dysarthric. Their lingual-palatal contact patterns during four repetitions of word lists containing lingual consonants in different phonetic environments, were compared with each other and with a group of normal speakers. EPG provided relevant diagnostic information in that all 4 experimental subjects showed patterns that differed from the normals in both spatial configuration and variability. The nature of their distorted patterns allowed a tentative diagnosis of 2 of the children as verbal dyspraxic.

Alveolar Process↗
PubMed1987

Transpulmonary angiotensin II formation in patients with chronic stable cor pulmonale.

The activity of the renin-angiotensin (RA) system and the ability of the lungs to generate angiotensin II (AII) were studied in 11 patients with stable cor pulmonale and respiratory failure caused by chronic obstructive bronchitis and emphysema. Angiotensin I concentrations (18.7 +/- 8.3 pmol/L) were normal, and transpulmonary AII formation rates (TRAIIFR) (14.2 +/- 18.1 pmol/min) were not significantly different from those recorded in nonedematous cardiac subjects (19.9 +/- 20.1 pmol/min), matched for sex, age, and diuretic therapy. The main determinant of TPAIIFR was the mixed venous AI concentration. Administration of oxygen for 30 min led to a small increase in TPAIIFR in the majority of patients. This increase could not be accounted for by changes in mixed venous AI. There was no correlation between serum angiotensin-converting enzyme levels and either the TPAIIFR or the systemic arterial AII concentrations.

Aged↗
PubMed1987

Reducing infant mortality in rural America: evaluation of the Rural Infant Care Program.

The Rural Infant Care Program (RICP), initiated in 1979, was developed to improve perinatal health care in ten rural sites with histories of high infant mortality rates. Time-series regression models indicate that neonatal mortality rates were reduced, following program initiation, by 2.6 per 1,000 live births (p = .0002); black neonatal mortality rates were reduced by an estimated 4.5 per 1,000 (p = .0004). Three sets of comparison areas exhibited no significant changes in rates. Postneonatal mortality rates did not increase in the target areas following initiation of RICP, indicating that deaths were not merely being postponed. Nine of ten individual sites showed reductions in infant mortality following program initiation. Birthweight-specific mortality data indicated that the decline was due mainly to reductions in neonatal mortality among low-birthweight infants. No reductions in the incidence of low birthweight were observed in the target areas. Substantial gaps in the delivery of prenatal care remained due to the continuing poverty of the population and the resultant lack of financial coverage for health services. We conclude that improved perinatal medical care can reduce infant mortality in poor rural areas to average levels experienced in the United States, and that the high rates still observed in some rural counties are unnecessary.

Black or African American↗
PubMed1986

Mortality probability in victims of fire trauma: revised equation to include inhalation injury.

There are no clear guidelines on the early diagnosis of injury due to inhalation of smoke. A clinical scoring system in the form of a previously prepared questionnaire may be used in the accident and emergency department by staff who are inexperienced in the management of inhalation injury. By quantifying injury due to smoke inhalation, its contribution to mortality in a large group of fire victims was established and a revised mortality probability equation derived using age, percentage surface area of the burn, and extent of inhalation injury. This mortality probability equation may be used to divide patients into risk categories for early intensive care management and allows the comparison of mortality data between accident and emergency units receiving varying numbers of patients with injuries due to burns and smoke inhalation.

Adolescent↗
PubMed1984

Manic psychosis in childhood. Report of two cases.

Two cases of acute manic psychosis in prepubertal children are described. Mania in adolescence has been described with increasing frequency, but the existence of childhood-onset mania remains controversial. That may be attributed to the presence of schizophreniform features in mania in young individuals. The management and prognosis of juvenile-onset mania are discussed.

Acute Disease↗
PubMed1983

Respiratory injury in the burned patient. The role of flexible bronchoscopy.

The purpose of the study was to investigate the role of flexible bronchoscopy in the management of patients admitted to a busy Regional burns unit, with particular reference to possible smoke inhalation injury. The basic procedure employed was that used in routine bronchoscopy for the diagnosis of bronchial carcinoma, with modification of the premedication required in view of the shorter duration of the technique and the lack of a requirement for bronchial biopsy. We have found the procedure easy to perform, well tolerated by the patients and not associated with any complications. It provides additional information not otherwise available, which can influence the subsequent management of the patient. An experienced bronchoscopist and additional personnel skilled in resuscitation techniques are required. It should be performed in patients with clear evidence of smoke inhalation injury and in particular with facial burns in order to visualise the extent of airway injury, remove debris and give some indication of the likelihood of subsequent complications such as acute upper airways obstruction.

Adult↗
PubMed1981

Blood carboxyhaemoglobin and cyanide levels in fire survivors.

Blood carboxyhaemoglobin and cyanide concentrations were measured in 53 fire survivors, 36 of whom had clinical evidence of smoke inhalation. Carboxyhaemoglobin and cyanide levels were raised only in patients with smoke inhalation. Blood carboxyhaemoglobin measurement can be used to confirm the diagnosis of severe smoke inhalation in cases in which the clinical data are inconclusive, provided that the time of sampling after exposure is taken into account. A nomogram has been constructed for this purpose. There is no quick method of measuring blood cyanide levels, but the close relation between cyanide and carboxyhaemoglobin levels suggests that carboxyhaemoglobin concentrations, which can be rapidly and easily measured, could be used to identify those who might benefit from treatment with cyanide antidotes.

Apnea↗
PubMed1981

Home aids exhibition.

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Community Health Nursing↗