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Biomedical subjects

D A Henry

Publications and source records attributed to D A Henry.

At least 91 records · Page 5Linked to original sources
PubMed1989

The use of non-prescription salbutamol inhalers by asthmatic patients in the Hunter Valley, New South Wales. Newcastle Retail Pharmacy Research Group.

Because of concern over the unsupervised use of bronchodilator aerosols, we studied the characteristics of a group of asthmatic subjects who purchased their salbutamol inhalers and a group of asthmatic subjects who obtained their inhalers by prescription. Community pharmacists distributed 360 questionnaires to consecutive patients who requested salbutamol inhalers; 320 questionnaires were returned (response rate, 89%). Of these, 240 respondents described themselves as asthmatic and stated that they obtained their inhalers exclusively or predominantly by either purchase (120 subjects) or prescription (120 subjects). Purchasers were younger than were users of prescribed inhalers and were more likely to be in current employment. The "purchase" group perceived less disability from chest disease than did the "prescription" group but were not different from the prescription group with respect to more-objective measures of disease severity, such as the occurrence of wheeze every day, nocturnal wakening with wheezing, and admissions to hospital with asthma. The purchasers had a low rate of consultation with family practitioners and specialists and reported a low use of prescription-only medications, particularly of inhaled corticosteroid agents. This study highlights the possible disadvantages of providing bronchodilator aerosols without prescription, and emphasizes an important counselling role for community pharmacists in the management of bronchial asthma.

Administration, Inhalation↗
PubMed1989

The post-cardiac surgery chest radiograph: a clinically integrated approach.

The post-cardiac surgery chest radiograph is often read without full knowledge of the patient's pathophysiology or of the specific surgical approach employed. This lack of clinical integration severely limits the effectiveness of the radiologic consultation. This article synthesizes a pathophysiologic foundation for interpretation, drawing on (1) the preoperative physiology and radiographic findings, (2) the events of surgery, cardiopulmonary bypass, and hypothermia, and (3) a detailed survey of the postoperative occurrences and their radiographic presentations including the various appliances, disturbances in fluid balance and ventilation, and complications encountered in the immediate postoperative period. The objective is to define the perioperative events and their radiographic correlations more accurately so that effective radiologic consultation will result.

Cardiac Surgical Procedures↗
PubMed1989

Enzyme induction by eating charcoal-grilled steak with no effect on blood lipids.

1. There has been interest in the suggestion that enzyme-inducing drugs, such as anticonvulsants, may produce beneficial changes in lipoprotein levels, in particular a rise in the ratio of high density lipoprotein cholesterol to total cholesterol. 2. This controlled study observed the effects of diets of charcoal or oven-cooked beef on antipyrine clearance (a commonly used measure of drug metabolizing capacity), the apparent oral clearance of phenacetin (a measure of cytochrome P448-dependent enzyme activity) and blood lipids in 18 healthy volunteers. 3. Charcoal-cooked beef increased antipyrine clearance by an average of 20% (P less than 0.059) and increased the apparent oral clearance of phenacetin fivefold (P less than 0.01). In contrast, oven-cooked beef did not significantly alter either measure of microsomal function. Neither diet had any effects on blood lipids. 4. We conclude that the type and degree of enzyme induction achieved by this type of dietary manipulation does not produce beneficial changes in lipoprotein profiles. A previously noted rise in high density lipoprotein cholesterol levels in volunteers fed charcoal-cooked beef may have been due to the effects of charcoal formed by charring of the beef during cooking.

Antipyrine↗
PubMed1989

Orthotopic cardiac transplantation: evaluation with CT.

As cardiac transplantation has become widely available, computed tomography (CT) of the chest has played a useful role in the examination of patients after heart transplantation. To determine anatomic features related to the procedure, the authors evaluated 59 scans in 46 patients who had undergone orthotopic cardiac transplantation. Aortic anastomosis (seen in 98% of scans) and altered spacing between the great vessels (83%) proved to be the most common and most reliable findings. Other features including atrial anastomosis, high main pulmonary artery segment, remnant superior vena cava, and cardiac reorientation were also seen. Accurate interpretation of adenopathy, mediastinal abscess, and pericardial effusion will be enhanced in these patients through a better understanding of the cardiovascular-pericardial complex, which is afforded by CT.

Anastomosis, Surgical↗
PubMed1988

Patients as a direct source of information on adverse drug reactions.

To determine whether patients should participate directly in detecting adverse reactions to drugs their ability to provide written reports of symptoms experienced during treatment with amoxycillin or trimethoprim-sulphamethoxazole was investigated. When compared with telephone interviews forms on which patients reported events were reliable (the observed agreement with the same statements posed during telephone calls was 85%, kappa = 0.56) and valid (sensitivity = 54%, specificity = 94%). Patients were also supplied with forms that invited them to report adverse reactions, and their perceptions were compared with those of a panel of experts, who were informed of all clinical events that had been reported during the detailed telephone interviews. Patients were more conservative than the experts in attributing clinical events to drug treatment. The extent of agreement varied and was notably poor for skin and bowel complaints (kappa = 0.13 in each case). The performance of event report forms and reaction report forms as instruments of detection was compared in a hypothetical situation in which the experts' views represented the "truth" about adverse reactions to a new drug. Event reporting had a higher sensitivity than reaction reporting (42% v 24%) but a lower specificity (58% v 98%). National centres monitoring adverse drug reactions should probably resist pressure to accept reports of reactions directly from the public, but a system based on large scale reporting of events might be valuable in aiding the early detection of symptomatic reactions to new drugs.

Adolescent↗
PubMed1988

Side-effects of non-steroidal anti-inflammatory drugs.

Despite a continuing lack of good quality epidemiological studies, our knowledge of the side-effects of NSAIDs has advanced in recent years. The most important reactions are those which are related predictably to the pharmacology of the drugs and these need to be considered whenever a NSAID is prescribed, particularly for patients who can be identified as belonging to high-risk groups. The important reactions are: 1. Gastrointestinal damage, which is now known to extend to some degree from the oesophagus to the rectum, although the acid contact areas of the stomach and duodenum are the most important. Although the studies have produced heterogeneous results, NSAIDs probably double or triple the risk of an individual developing serious gastrointestinal haemorrhage or perforation. The risk increases with age and previous history of ulceration, and, in communities with particularly high use of NSAIDs, the drugs may account for up to 30% of all cases of ulcer complications. 2. Renal syndromes, of which functional renal impairment is the most important. This may precipitate cardiac failure, and hyperkalaemia is an additional hazard. Antagonism of the action of diuretics may contribute to the fluid retention, and antagonism of antihypertensive therapy is probably quite common and may result in additional unnecessary therapy. Patients at risk of functional renal impairment from NSAIDs can be identified readily and in these subjects the drugs have to be used with great care and with appropriate monitoring. 3. Respiratory effects, in particular acute bronchospasm in subjects with a history of aspirin sensitivity. NSAIDs should be used with caution in asthmatics, and patients purchasing NSAIDs without prescriptions need to be warned of these effects. Other uncommon serious reactions include hepatocellular damage, acute interstitial nephritis, agranulocytosis and aplastic anaemia, Stevens-Johnson syndrome and toxic epidermal necrolysis. These are unpredictable reactions which generally need not be considered before prescribing. However, in patients who present with any of these conditions, NSAIDs, because of their wide use, should always be considered as a possible cause.

Animals↗
PubMed1988

Comparison of bactericidal activity of selected beta-lactam antimicrobials against Pseudomonas aeruginosa.

The efficacy of ceftazidime, piperacillin, tobramycin and ticarcillin was tested in vitro against 102 clinical isolates of Pseudomonas aeruginosa. The MIC and MBC of each agent alone were determined. In addition, the rate of killing of 27 isolates by each beta-lactam agent was tested both singly and in combination with tobramycin. The concentrations of beta-lactams and of tobramycin were tailored to each organism; these were double the MBC in the case of the beta-lactams and half the MBC for tobramycin. Although 85.2% of isolates were susceptible to piperacillin and only 58.8% were susceptible to ticarcillin, the MBC90 was higher for piperacillin (greater than 256 mg/l) than ticarcillin (199.7 mg/l). The addition of tobramycin in sublethal concentrations increased the rapidity of killing of bacteria.

Anti-Bacterial Agents↗
PubMed1988

Intrathoracic granular cell myoblastoma.

Intrathoracic granular cell myoblastoma (GCM) is most commonly a benign neoplasm of Schwann cell origin that occurs in the large airways, the segmental bronchi, and rarely in the mediastinum. The tumor predominantly affects blacks during the fourth decade, and shows no sex predilection. Tracheobronchial GCM most commonly produces cough and chest pain, with focal consolidation or atelectasis shown on chest x-ray films. Extraesophageal mediastinal GCM produces few or no symptoms, and should be included in the differential diagnosis of a posterior mediastinal mass. Computerized tomography is helpful in evaluating the extent of the lesion, defining its relationship to adjacent structures, and planning the therapeutic approach. The diagnosis of tracheobronchial GCM usually can be made by bronchoscopy and/or biopsy. Treatment remains controversial, but most studies suggest surgical or endoscopic resection as the treatment of choice. The prognosis of intrathoracic GCM is good but is dependent upon complete removal.

Adult↗
PubMed1987

Fatal peptic ulcer complications and the use of non-steroidal anti-inflammatory drugs, aspirin, and corticosteroids.

Although non-steroidal anti-inflammatory drugs are known to cause peptic ulcer and its complications, controversy exists about the number of deaths from ulcer which are attributable to their use. A case-control study was therefore performed to determine whether prior use of non-steroidal and other anti-inflammatory compounds was associated with an increased case fatality rate from complications of peptic ulcer. Non-steroidal anti-inflammatory drugs were used by 39% of a series of 80 patients who had died from peptic ulcer complications and by 37% of 160 controls who were survivors matched for sex, age, ulcer site, and nature of complication (odds ratio 1.1; 95% confidence interval 0.6 to 2.1). Similarly, the rates of prior use of aspirin by cases and controls were almost identical (odds ratio 1.2; 95% confidence interval 0.5 to 1.9). Thus neither nonsteroidal anti-inflammatory drugs nor aspirin were associated with increased case fatality rates from peptic ulcer complications. In contrast, corticosteroids were associated with an increased mortality (odds ratio 4.2; 95% confidence interval 0.9 to 25.6). Although this increase in the estimated relative risk was not statistically significant, a review of the case records indicated that most deaths in steroid users were due to serious sepsis, indicating that there might be a causal association between use of the drugs and the mode of death.

Adult↗
PubMed1987

Comparison of agar disk diffusion, microdilution broth, and agar dilution for testing antimicrobial susceptibility of coagulase-negative staphylococci.

A collection of 120 oxacillin-susceptible and 120 oxacillin-resistant coagulase-negative staphylococci (CNS) from six tertiary care hospital laboratories were tested by agar disk diffusion, three microdilution broth systems (Sensititre, Dynatech, and Alpkem), and the Vitek AutoMicrobic system for comparison with reference agar dilution results. The antimicrobial agents tested were oxacillin, cefazolin, cefotaxime, cefuroxime, cefamandole, fusidic acid, rifampin, and vancomycin. Incubation was at 30 or 35 degrees C for 24, 48, and 72 h. The broth media were supplemented with 2% NaCl for some antimicrobial agents, and the agar dilution method was used with and without the addition of 4% NaCl. The CNS were identified to species by the method of Kloos and Schleifer. The results showed a lack of concordance between two hospitals with respect to oxacillin susceptibility testing by agar dilution with no NaCl supplement. The reasons are not clear but may be related to variations in media. The 4% NaCl supplement or extended incubation to 48 h eliminated this difference. The cefazolin and cefotaxime susceptibility results in the agar disk diffusion test were unreliable if accepted at face value. Cefamandole testing correlated well with the reference method regardless of the method used, and salt supplementation is not recommended. Most of the oxacillin-resistant CNS were resistant to the other beta-lactam drugs except cefamandole. Of 22 CNS resistant to cefamandole, 21 were S. haemolyticus.

Anti-Bacterial Agents↗