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Biomedical subjects

D Czarny

Publications and source records attributed to D Czarny.

At least 37 records · Page 2Linked to original sources
PubMed1992

Myopathy in severe asthma.

Myopathy complicating the therapy of severe asthma has been recently described in several case reports. Twenty-five consecutive patients admitted to the intensive care unit (ICU) at this hospital for mechanical ventilation for severe asthma were studied for the incidence of creatine kinase (CK) enzyme rise and for the development of clinical myopathy. Pharmacologic therapy was standardized, every patient receiving corticosteroids and aminophylline intravenously and salbutamol both nebulized and intravenously. Twenty-two patients received muscle relaxant therapy with vecuronium. In 19 of 25 (76%) of patients there was elevation of CK levels to a median of 1,575 U/L (range, 66 to 7,430) occurring 3.6 +/- 1.5 days after admission. In nine patients there was clinically detectable myopathy. The presence of either myopathy or CK enzyme rise was associated with a significant prolongation of ventilation time. Arterial blood gas measurements on admission to the ICU revealed a pH (mean +/- SD) of 7.07 +/- 0.21, a PaCO2 of 87.2 +/- 32.7, and a PaO2 (with a high FIO2) of 129 +/- 97 mm Hg; however, no correlation was found between the severity of initial metabolic disturbance and the subsequent development of myopathy. There was no association between the type of corticosteroid administered and the subsequent development of myopathy. Patients with myopathy had received a significantly higher total dose of vecuronium when compared with those who did not develop myopathy (p < 0.001, Kruskal Wallis test). We have therefore found a surprisingly high incidence of CK enzyme rise and myopathy in this group of mechanically ventilated patients with severe asthma.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1992

Risk factors for morbidity in mechanically ventilated patients with acute severe asthma.

Acute severe asthma is associated with significant morbidity and mortality. We retrospectively quantified hypotension, pulmonary barotrauma, and cardiac arrhythmias in all patients with severe asthma admitted to the intensive care unit (ICU) and prospectively evaluated the predictive value of a measurement of dynamic hyperinflation (DHI) in those patients who required mechanical ventilation. In the first study, 88 ICU admissions for severe asthma over 5 yr (73 patients, 40 +/- 18 yr, 36 men, 37 women) were evaluated. Fifty-one admissions were mechanically ventilated, 29 were not, and 8 previously ventilated patients remained briefly intubated but were not ventilated in the ICU. Hypotension (18/88, 20%), pulmonary barotrauma (12/88, 14%), and arrhythmias (9/88, 10%) were entirely confined to patients who had been mechanically ventilated. There were no significant differences in ventilatory parameters, airway pressures, or blood gases between mechanically ventilated patients with and without complications. Two patients with previous severe hypoxic cerebral damage died from this complication after ICU discharge. In the second study, the end-inspiratory lung volume (VEI) (1) was compared with standard ventilatory parameters in 22 patients. There were no ICU deaths, but high incidences of pulmonary barotrauma (27%) and hypotension (41%) were found. Both minute ventilation (VE and VEI) were significantly higher in patients who developed complications (VE 13.7 +/- 3.0 versus 11.2 +/- 2.5 L/min, VEI 26.1 +/- 4.7 versus 20.0 +/- 7.4 ml/kg, p less than 0.05) but only VEI had a threshold value significantly predictive of complications. For VEI less than 1.4 L, 0/5 (0%) patients had complications; for VEI greater than or equal to 1.4 L, 11/17 (65%) had complications (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Use of a measurement of pulmonary hyperinflation to control the level of mechanical ventilation in patients with acute severe asthma.

Mechanical ventilation causes significant morbidity and mortality in patients with severe asthma. Hypoventilation may reduce this morbidity and mortality, but indicators to guide the degree of hypoventilation are unclear. We used a measure of pulmonary hyperinflation to assess the degree of airflow obstruction and to guide the extent and duration of hypoventilation. Ten patients who required mechanical ventilation for acute severe asthma were studied. All were sedated, paralyzed, and given an initial minute ventilation (VE) of 200 ml/kg/min. End-inspiratory lung volume (VEI) above FRC was measured from the total exhaled gas volume during 40 to 60 s of apnea. VEI was used to regulate VE to a safe level (VEsafe), irrespective of PaCO2, by reducing the rate when VEI was > 20 ml/kg and increasing it when VEI was < 20 ml/kg. Each patient was weaned when VEsafe resulted in PaCO2 < or = 40 mm Hg (the weaning point). FRC was measured computer analysis of anterior and lateral chest radiographs taken at the end of apnea. Using the weaning point criterion, 2 patients (PaCO2 < 40 mm Hg) were weaned shortly after arrival. The remaining eight (initial PaCO2, 63 +/- 17 mm Hg) continued hypoventilation until the weaning point was reached (30 +/- 29 h). The weaning point was reached by the VE required for PaCO2 40 mm Hg decreasing concurrent with the VEsafe increasing. All but 1 patient were successfully weaned within 24 h of the weaning point.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1988

Histamine-binding lymphocytes as a measure of reactivity to bee venom.

Reduced lymphocyte histamine-binding after in vitro exposure of whole blood samples to bee venom appears related to allergen reactivity. The reactivity demonstrated using this method matched the clinical findings and was used to monitor declining responses to allergen during desensitization therapy for hypersensitivity to bee venom. After successful desensitization to bee venom, patients' lymphocytes did not show decreased histamine binding following in vitro exposure to venom. We conclude that lymphocyte histamine-binding sites are down-regulated by allergen-mediated histamine release in hypersensitive subjects, and that this response diminishes with immunotherapy. This report describes a novel method for the in vitro assessment of reactivity to bee venom.

Bee Venoms↗
PubMed1988

Acute myopathy in severe acute asthma treated with intravenously administered corticosteroids.

An association between the use of parenteral corticosteroids in acute asthma and the development of an acute myopathy was first reported in 1977. We report 2 further cases that contribute significantly to our knowledge of this rare complication of the treatment of acute asthma. These cases demonstrate that the acute myopathy is not just a complication of the use of parenteral hydrocortisone in patients requiring ventilatory support during an episode of acute asthma. The acute myopathy can occur with several parenteral corticosteroids, may be severe (with rhabdomyolysis and myoglobinuria), and may have protracted morbidity. Prospective follow-up allowed demonstration of histopathology, electrophysiology, and also the contribution of various pharmacologic agents. Careful analysis of the evidence strongly implicates corticosteroids as the causative agent.

Acute Disease↗
PubMed1987

The efficacy of nedocromil sodium (Tilade) in asthma.

Nedocromil sodium is a new antiasthmatic drug with properties similar to sodium cromoglycate. We examined the efficacy of nedocromil sodium compared to placebo in 71 asthmatic patients in a three-centre double-blind parallel group study over 12 weeks. During the study the patients' maintenance inhaled corticosteroids were progressively withdrawn. Nedocromil sodium had an advantage over placebo in the number of withdrawals related to uncontrolled asthma, 14 and 24 respectively (p = 0.03). Changes in symptom scores, peak flow rates and bronchodilator use favoured nedocromil sodium occasionally during the study. The unusual taste of the active drug was reported frequently. Nedocromil sodium is more efficacious than placebo in asthma maintenance, but does not replace inhaled corticosteroids.

Administration, Inhalation↗
PubMed1986

Analysis of histamine-binding lymphocytes in atopy.

Using flow cytofluorimetry, the histamine-binding properties and T cell subclass distribution of peripheral blood lymphocytes in normal and atopic subjects were investigated. In the case of active (or symptomatic) atopy, the levels of histamine-binding lymphocytes were significantly reduced. However, none of these parameters distinguished between normal individuals and patient groups when the atopics were asymptomatic except the OKT3 marker; in the atopic group, the proportion of OKT3-positive cells was lower. These results indicate that the decreased levels of histamine-binding lymphocytes in atopy are a secondary phenomenon, and that the ratio of T helper to T suppressor/cytotoxic cells is not significantly altered in atopic patients. The changes in histamine-binding lymphocytes appear to be unrelated to the decreased numbers of OKT3-positive cells, since the latter changes were evident in active and asymptomatic atopics.

Antibodies, Monoclonal↗
PubMed1986

A 4-week Australian multicentre study of nedocromil sodium in asthmatic patients.

The use of nedocromil sodium 4 mg q.i.d. in asthmatics with mildly unstable asthma induced by a reduction of their inhaled beclomethasone dipropionate dose was investigated in a double-blind, parallel group, placebo-controlled study. Compared with placebo, nedocromil sodium improved night-time and daytime asthma score, night-time and daytime bronchodilator use, and evening PEFR at some stage during the 4-week treatment. It is concluded that nedocromil sodium exerts a beneficial effect in chronic asthma.

Adolescent↗
PubMed1984

Geographic tongue: sensitivity to the environment.

The prevalence of geographic tongue was assessed among 102 atopic patients with extrinsic asthma and/or rhinitis and was found to be significantly greater in these patients than in an asymptomatic, nonatopic control population. However, there was no difference between the prevalence of geographic tongue among atopic patients with extrinsic asthma and rhinitis as compared to a group of patients with asthma and rhinitis who were not atopic. These findings suggest that geographic tongue is a sign common to those patients who have a tendency to develop recurrent acute inflammatory disease on surfaces in contact with the external environment (for example, asthma or rhinitis), whether they are atopic or not.

Adolescent↗
PubMed1981

Cold-induced urticaria in infectious mononucleosis.

Cold-induced urticaria in a patient suffering from infectious mononucleosis is described. This condition was associated with the presence of cryoglobulins in the serum. To our knowledge this is the first description of cold-induced urticaria associated with infectious mononucleosis.

Adult↗
PubMed1980

Anaphylactoid reaction to 50% solution of dextrose.

Two patients with extrinsic asthma and coexistent insulin-dependent diabetes mellitus sustained an anaphylactoid reaction after the intravenous administration of 50% solution of dextrose. Investigations suggested that the dextrose, rather than any additives, was responsible for the reaction. The effect of varying concentrations of dextrose on the histamine content of the blood of normal, allergic, non-diabetic and diabetic, and non-allergic patients was studied. Preliminary results suggest that the higher concentrations of dextrose induce increased histamine release from blood cells, and that this phenomenon is more marked in diabetic, and particularly diabetic-allergic, individuals. We suggest that the treatment of hypoglycaemia with 50% solution of dextrose is associated with a significant risk factor in those diabetic individuals who are either allergic or are receiving beta-adrenoreceptor blocking drugs.

Aged↗
PubMed1980

Standardization of allergen extracts by inhibition of RAST, skin test, and chemical composition.

Five allergen extracts of Dermatophagoides pteronyssinus, Lolium perenne, Alternaria tenuis, Aspergillus fumigatus and Cladosporium herbarum, obtained from four different manufacturers, were examined by inhibition of RAST, content of protein and carbohydrate, contents of phosphorylcholine (Pc) and tridacnin reactive components, and by skin test. Inhibition of RAST was used as a primary method for establishing allergenic potency and demonstrated wide variations for each preparation supplied by the different manufacturers. The extracts also varied widely in protein and carbohydrate content and in the ratio of these parameters, indicating internal heterogeneity. Pc content was significantly related to RAST potency for extracts of A. fumigatus and A. tenuis, suggesting that Pc content may be used as a primary standarization procedure for these extracts. Skin test reactions undertaken at a single concentration did not show any significant variation in weal size between preparations of a given allergen extract. However, of particular importance to practising clinicians is the finding that varying numbers of patients showed negative skin reactions to one preparation of a particular allergen yet were positive to the corresponding preparations supplied by the other companies.

Allergens↗