Biomedical subjects
Publications and source records attributed to D Davies.
Twenty-four consecutive patients admitted to hospital with severe acute asthma were studied. Eleven were given 10 mg salbutamol by nebulizer followed 2 hours later by 500 micrograms of nebulized ipratropium bromide. These patients had a greater response in PEFR than 13 patients given two doses of 10 mg salbutamol 2 hours apart.
Pet gerbils were identified as the cause of asthma or rhinitis in three out-patients seen over a period of eighteen months. Allergy to gerbils was confirmed by skin tests, RAST and the clinical course. Gerbils are popular household pets and allergy to gerbils may be commoner than recognized.
Five patients had asthma provoked by cyanoacrylates and one by methyl methacrylate, possibly because of the development of a specific hypersensitivity response. Acrylates have wide domestic as well as industrial uses, and inhalation of vapour emitted during their use can cause asthma.
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Twenty-five retired adults living in their own homes (mean age = 71.4), 25 in self-contained independent units within the grounds of established retirement villages (mean age = 76.8), and 25 in hostel accommodations within retirement villages (mean age = 79.8) were interviewed and assessed on levels of fear and aggression, degree of interpersonal activity, and degree of disengagement from social role activities (N = 75, 21 males and 54 females). The results suggest than an expectation of failure in social situations was related to the adoption of an avoidant type of interpersonal strategy that was reflected in the reduction of the aged person's social role activities nd choice of residence.
Four patients are described who had a significant elevation of serum thyroxine-binding globulin (TBG). Review of these patients indicated that inappropriate therapy for thyrotoxicosis had been given in three cases. A study of our laboratory records revealed that significant TBG elevation was a relatively common phenomenon which occurred in approximately 0.45% of our hospital population. Patients with this abnormality have serum thyroxine levels which are comparable to those with clinical thyrotoxicosis. Tri-iodothyronine is frequently elevated though less so than in patients with clinical thyrotoxicosis. Measurement of TBG is indicated in all cases of hyperthyroxinaemia in which the clinical features of thyrotoxicosis are doubtful. The TRH test was found to be most useful in evaluating the thyroid status of these patients.
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The dietary habits of 139 stone patients and 20 control subjects were assessed to investigate the differential features, if any, of the eating pattern between the two groups. There was no significant difference between stone formers and controls, although the data for animal protein was inadequate for statistical analysis. In a separate study, 39 idiopathic calcium stone formers and 18 control subjects were studied by measuring the blood glucose, plasma insulin and glucagon levels following oral glucose. The insulin response was abnormal in 70% of the patients. Increased urinary risk factors for calcium oxalate oversaturation were significantly associated with patients who exhibited an abnormal insulin response.
Twenty-four outpatients who continued to have severe chronic asthma despite attending a chest clinic were studied. All were already using inhaled beta-agonists from a pressurized aerosol and regular inhaled corticosteroids. Nineteen were on long-term oral corticosteroids. Comparison was made between their symptoms and peak expiratory flow rate (PEFR) during 4 weeks on their usual treatment and the following month when they were also given 5 mg terbutaline night and morning by nebulizer. During the second month the symptom score for nocturnal asthma improved by 30% (P less than 0.01), for daytime wheeze by 23% (P less than 0.025) and shortness of breath by 15% (P less than 0.01). The prebronchodilator morning and evening PEFR increased by 8% (P less than 0.025) and 10% (P less than 0.01) respectively. A dose-response study with inhaled terbutaline in six patients before and after 4 weeks of nebulizer treatment showed no evidence of a decline in response. Home nebulizers produced considerable overall improvement. Because of variations in individual responses a monitored trial of the type which we have used is desirable before a decision is made on long-term treatment.
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The use of Sepharose aminohexyl oxamate for the purification of glycolate oxidase and lactate dehydrogenase is described. The kinetics of both enzymes are reported in relation to their possible roles in the production of oxalate. A model is proposed in which glycolate oxidase in the peroxisomes and lactate dehydrogenase in the cytosol cooperate in the production of oxalate.
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The extraction efficiency of benzene, toluene, dichloromethane, acetone:hexane and chloroform:methanol with respect to lipids and polychlorinated biphenyls was investigated using small samples of monkey adipose tissue, liver, kidney, brain, skin, feces and milk. The most efficient solvents were: acetone:hexane and chloroform:methanol for brain, feces, kidney, liver and milk; acetone:hexane and dichloromethane for adipose tissue; acetone:hexane and toluene for blood and dichloromethane for skin tissue. Within these solvent pairs acetone:hexane was the most outstanding with respect to an average of 90% PCB recoveries from fortified samples in the range of 0.02-2 ppm. In addition, a comparison was made between the lipid determination before and after Florisil column chromatography. Only adipose and blood lipids were sufficiently recovered from Florisil to make a lipid determination after chromatography feasible.
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Twenty-one patients with hyperthyroid Graves' disease were treated with carbimazole 30 mg daily, given as a single dose. Propranolol was also given for the first 3 weeks. All became clinically euthyroid with normal serum thyroxine (T4) levels, usually within 1-3 months. Patients with large goitres and raised serum alkaline phosphatase concentrations took longer to respond. In 19 patients a positive thyroid stimulating hormone (TSH) response to intravenous thyrotrophin releasing hormone (TRH) developed. Carbimazole was stopped soon after (median time of treatment 18 weeks, range 9-41 weeks) and 18 patients have been followed. Seven of these (39%) have remained in remission from hyperthyroidism for more than one year (median 77 weeks). Carbimazole 30 mg once daily is a convenient and effective treatment for hyperthyroid Graves' disease. Many patients will achieve prolonged remissions if treatment is stopped when serum T3 and T4 levels are in the low-normal range, usually 2-4 months after clinical euthyroidism has been reached.
Two men developed pneumoconiosis after grinding and packing powdered mica. The disease was characterised by progressive dyspnoea, a restrictive impairment of ventilation, a reduced transfer factor, and hypoxaemia. Radiographs showed widespread fine nodular and linear shadows. Progression occurred after cessation of exposure, but this was much more pronounced in the man who died from coronary artery disease. Postmortem examination showed widespread fine fibrosis and nodules measuring up to 1.5 cm in diameter, all related to the deposition of doubly refractile crystals. Mineral formed over 9% of dry tissue weight, and electron microscopy and x-ray analysis showed it to be muscovite. Other minerals were not found.
Forty-three patients were treated by total adrenalectomy for pituitary-dependent Cushing's disease. The median period of observation was 10 years (range one to 20 years). Thirty-eight patients (88 per cent) had rapid and lasting remissions. Of the 38 in remission, 21 became pigmented but without pituitary enlargement, 11 became pigmented with evidence of further pituitary expansion (Nelson's syndrome) and six neither became pigmented nor showed pituitary expansion. Pituitary expansion was associated with high plasma ACTH values, and treatment of pituitary tumours by surgery or radiotherapy gave poor results. However, when compared with alternative methods of treatment, total adrenalectomy for Cushing's disease is still satisfactory for many patients, despite advances in pituitary surgery, and has advantages over 'medical adrenalectomy' with drugs.