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D S Postma

Publications and source records attributed to D S Postma.

At least 343 records · Page 19Linked to original sources
PubMed1985

Effect of oral slow-release terbutaline on early morning dyspnoea.

Eight male patients with partly reversible airflow obstruction, who had a diurnal variation in peak expiratory flow rate (PEFR) of more than 20% were treated with placebo and slow-release terbutaline tablets (5 mg at 08.00 hours and 10 mg at 20.00 hours) for 8 days. On Day 8 of each period, PEFR and serum terbutaline were measured at 4 and 2-h intervals, respectively. PEFR on the terbutaline day showed a significant increase at 08.00, 12.00, 24.00, 04.00 and 08.00 hours as compared to the placebo day. Slow-release terbutaline prevented early morning dyspnoea. The serum concentration was 3.3 ng/ml during the day and 3.5 ng/ml during the night. During terbutaline therapy the patients reported fewer complaints than during the placebo period. It was concluded that slow-release terbutaline tablets are suitable for twice daily treatment.

Administration, Oral↗
PubMed1985

Influence of the parasympathetic and sympathetic nervous system on nocturnal bronchial obstruction.

To determine whether an autonomic nervous system imbalance might underlie the nocturnal dyspnoea in patients with chronic airflow obstruction (CAO), we determined FEV1, sinus arrhythmia gap (SA gap), heart rate and urinary adrenaline and noradrenaline excretion every 4 h over 24 h. Measurements were performed in eight non-allergic patients with CAO and eight age- and sex-matched normal controls. The amplitude of the circadian changes in FEV1 in patients and controls was 27 +/- 2% and 7 +/- 1% respectively (P less than 0.001). Both an increased SA gap and a decreased heart rate are features of increased vagal activity. This vagal activity was significantly increased in patients, compared with normal controls (difference P less than 0.01), the difference being maximal at night. This increased activity might contribute to a bronchial obstruction in these patients. Urinary adrenaline excretion was significantly higher by day than by night in both patients and normal controls (P less than 0.01). The urinary levels of adrenaline in the patients were significantly decreased at all hours of observation as compared with levels in normal controls (P less than 0.05). Urinary noradrenaline levels were significantly lower in patients as compared with normal subjects (P less than 0.01), and lower by night than by day. Urinary histamine and Nt-methylhistamine excretion were in the normal range in each individual. Urinary levels, however, were significantly higher in patients at all hours of observation (P less than 0.05). No circadian rhythm was shown. Plasma cortisol levels showed a normal circadian variation, similar in patients and normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Effect of beta-adrenergic stimulation on the circulatory lymphocyte count: studies in normals and in patients with chronic airflow obstruction.

In eight non-allergic patients with chronic airflow obstruction (CAO) and eight age and sex matched, healthy control subjects the circadian variation in circulatory lymphocyte count was studied in relation to serum cortisol and urinary epinephrine levels. In addition, we investigated the effect of the beta-adrenergic agent terbutaline on the lymphocyte count in two ways: as a long-term effect after 8 days of oral slow-release terbutaline with constant diurnal and nocturnal serum levels in patients, and as a short-term effect by a constant rate infusion of 0.2 micrograms/min over 4 hr in normals. Both patients and controls showed similar circadian patterns of urinary epinephrine excretion and lymphocyte counts. Patients with CAO, however, had significantly lower epinephrine levels and significantly higher lymphocyte counts at all hours of observation (every 4 hr from 0800 to 0800 hr the next day), as compared with normal controls. After 8 days of slow-release terbutaline the lymphocyte count in the patient group decreased to levels not significantly different from that of normals. The circadian rhythm of the lymphocytes, however, persisted under terbutaline therapy. No correlation existed between the lymphocyte count modulating factor, serum cortisol and the lymphocyte count over 24 hr. On placebo infusion in the control persons an increase of lymphocytes over 4 hr occurred, as a consequence of circadian rhythmicity. On terbutaline infusion a significant increase of lymphocytes after 1 hr was followed by a decrease to levels significantly below those on the placebo day. The same pattern was found in the leucocyte count. From this study it is concluded that beta-adrenergic stimulation corrects the relative lymphocytosis to counts comparable with normals. Other coinciding factors must regulate, however, the circadian rhythmicity.

Adult↗
PubMed1985

The effects of oral slow-release terbutaline on the circadian variation in spirometry and arterial blood gas levels in patients with chronic airflow obstruction.

The circadian variation of spirometry and blood gases was studied in eight male, normoxemic, patients with chronic air flow obstruction and complaints of early morning dyspnea. The patients were selected for a high amplitude in circadian variation of PEFR. They were treated for eight days with placebo and slow-release terbutaline tablets (5 mg at 8 am and 10 mg at 8 pm). Thereafter, arterial blood gas levels were measured at four-hour intervals over 24 hours. Just after blood sampling, FEV1 measurements were performed. The results on placebo therapy were compared with results in eight healthy volunteers matched for age, sex, and smoking habits. The circadian rhythms of FEV1, PaO2, and SaO2 in these patients showed a higher amplitude than in normal subjects. The decrease of FEV1 in the patient group at 8 am coincided with the decrease in PaO2 and SaO2. In normal subjects no significant nocturnal fall in FEV1, PaO2, or SaO2 occurred. Administration of slow-release terbutaline tablets for eight days, providing comparable diurnal and nocturnal serum levels, prevented the nocturnal decrease of FEV1, PaO2, and SaO2. The increase of the FEV1 at all hours of observation showed a significant correlation with the increase of the PaO2.

Administration, Oral↗
PubMed1985

Assessment of ventilatory variables in survival prediction of patients with chronic airflow obstruction: the importance of reversibility.

The relative usefulness of various indices of (ir) reversibility in predicting survival is reported for 129 patients with severe chronic airflow limitation (initial Forced Expiratory Volume in one second, FEV1, less than or equal to 1000 ml). The generally applied increase of FEV1 as a percentage of the initial FEV1 value (delta FEV1% in) and the increase of FEV1 as a percentage of the predicted FEV1 after an anticholinergic drug (delta FEV1%pred) are not related to survival. The increase of FEV1 as a percentage of the "maximal" attainable increase to the predicted level, as estimated by predicted minus initial FEV1 (delta FEV1%(predin], is, next to the severity of airflow obstruction after bronchodilation (FEV1pb% pred), significantly related to prognosis. After controlling for smoking, delta FEV1% (pred-in) was the best indicator of reversibility in prognosis prediction. Next to smoking and delta FEV1% (pred-in) also the irreversible part of airflow obstruction FEV1%FIV1 after bronchodilation appeared to influence survival independently in this particular patient population with severe airflow obstruction.

Cross-Sectional Studies↗
PubMed1985

Severe chronic airflow obstruction: can corticosteroids slow down progression?

A long-term (14-18 yr) prognostic study on patients with severe Chronic Airflow Obstruction (CAO) (FEV1 less than 1000 ml) is reported. In 65 of the 79 patients under study at least 7 serial FEV1 values were available. At the beginning of the study long-term treatment with oral prednisolone in doses of 10-15 mg/d was started. Side-effects and introduction of inhalation corticosteroid therapy resulted in a decrease or complete cessation of oral corticosteroid treatment. Three distinct patterns of the course of FEV1 were recognized: 1) no change, 2) initial increase followed by decrease, and 3) linear decrease. Initially 138 clinical parameters, including reversibility of airflow obstruction, were comparable in groups 1, 2 and 3; group 3 showed somewhat stronger evidence of emphysema in lung function parameters. The 3 patterns of FEV1 showed strong association with the long-term use of prednisolone. At an oral dose of 7.5 mg or less/d, FEV1 decreased, often after a considerable time-lag (6-32 months). The results of the study suggest that in CAO oral prednisolone, in doses above 7.5 mg/d, may slow down progression of the disease.

Female↗
PubMed1984

Radiation recall supraglottitis. A hazard in head and neck chemotherapy.

The enhanced effects of chemotherapy on previously irradiated tissue have been well demonstrated. When chemotherapy is given some time after irradiation and elicits a tissue reaction in the radiation field, the reaction is termed radiation recall. We review known interactions between chemotherapy and radiotherapy and report, to our knowledge, the first case of a supraglottitis radiation recall reaction. Familiarity with this phenomenon and potential complications of chemotherapy following head and neck irradiation may expedite early diagnosis and appropriate lifesaving treatment.

Cytarabine↗
PubMed1984

Severe hospitalized croup: treatment trends and prognosis.

We have reviewed 43 cases of severe croup admitted from 1977 to 1981 at North Carolina Memorial Hospital. All patients were treated with mist, 23 (54%) of 43 were treated with racemic epinephrine, but only 7 (16%) of 43 were treated with steroids. None of the 5 patients who required intubation received steroids. Nine (36%) of 25 patients available for at least 6 months of follow-up had subsequent clinical diagnoses of asthma. We have concluded that: 1. males with subglottic narrowing on x-ray, high leukocyte counts, and no steroid treatment appear to have increased need for airway support; 2. while humidification and racemic epinephrine are accepted forms of treatment, steroids are still rarely used even in severe croup; 3. severe croup may be a signal for the later development of asthma. Because it is difficult to predict which patients with severe croup will need later airway management, we strongly recommend that all patients with croup requiring racemic epinephrine be treated with at least a single dose of 1.0 to 1.5 mg/kg of dexamethasone.

Aerosols↗
PubMed1983

Prognosis in severe chronic obstructive pulmonary disease with regard to the electrocardiogram.

A long-term prognostic study of 128 patients with severe chronic obstructive pulmonary disease (initial value for Forced Expiratory Volume in one second, [FEV1] less than or equal to 1,000 ml) with regard to electrocardiographic and lung function parameters as obtained at the entry visit is reported. Many initial ECG-variables and lung function parameters were significantly different between survivors and non-survivors after five years. We used a discriminant analysis to determine which factors actually provided independent information for detection of those subjects with a survival less than five years. In a discriminant analysis of the initial 25 ECG-variables only P-amplitude in lead II and S-amplitude in lead V6 were predictors of five-year survival (diagnostic accuracy 66.1%). In a discriminant analysis in which initial lung function variables were also considered next to the ECG-variables, the best prediction of five-year survival was made by P-amplitude in lead II, increase of FEV1 after thiazinamium i.m., and residual volume as percentage of total lung capacity [RV/TLC, %] (diagnostic accuracy 73.2%).

Adult↗
PubMed1983

Tracheostomy.

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Emergencies↗
PubMed1982

Findings and long-term surgical results in the hearing loss of osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is an inherited connective-tissue disorder of variable penetrance. With OI, the triad of blue sclera, osseous fragility, and a conductive hearing loss is known as the van der Hoeve-de Kleyn syndrome. Blue sclera with a conductive loss may be a clinical subgroup of OI. Clinical findings and long-term surgical results in 62 operations in 43 patients with blue sclera are given. Osteogenesis imperfecta differs from otosclerosis in the following ways: (1) earlier onset (in the second and third decades of life), (2) more severe middle ear involvement, and (3) a higher incidence of sensorineural hearing loss. One year after stapedectomy, 38 (75%) of 51 operations had complete closure of the air-bone gap. Of the 24 operations followed up for an average of seven years (range, two to 18 years), 15 patients (62%) had no deterioration in their immediate postoperative hearing gain. Our study supports the concept that OI is clinically distinct from otosclerosis and establishes surgical intervention for its conductive hearing loss as a reasonable alternative to amplification.

Adolescent↗
PubMed1979

Prognosis in severe chronic obstructive pulmonary disease.

A long-term prognostic study of 129 patients with severe chronic obstructive pulmonary disease (initial value for forced expiratory volume in 1 sec [FEV1] smaller than or equal to 1,000 ml) is reported. Data from the patients (72 per patient) were obtained in a clinically stable phase during the first hospital admission and subsequent regular outpatient visits; the data were processed using multiple regression and discriminant analysis. Five- and 10-year cumulative survival rates were 69 and 40 per cent, respectively. Prediction of survival rate was determined mainly by the rate of decrease in initial FEV1 per year and the degree of increase of initial FEV1 after administration of thiazinamium, a bronchodilator. Initial FEV1 values per se contributed to prediction only when they were less than 450 ml. Study of the data from the individual patients showed the presence of different types of decrease in FEV1: linear, exponential, combined linear-exponential, and phasic. FEV1 sometimes remained unchanged for several years or even showed an increase. No sudden decreases were observed. The better survival rate in patients with greater reversibility of airway obstruction after administration of thiazinamium has important bearing on treatment policy. The hypothesis is put forward that the better survival rate in the present study might be the result of continuing medical care. Comprehensive treatment, provided it includes a component directed at preventing and treating reversible airway obstruction, may be of major importance in determining survival in patients with severe chronic obstructive pulmonary disease. The value of so-called dominant, survival-predicting factors is considered to be of secondary importance; their main function is to alert the physician to the fact that prognosis as concerns survival may be unfavorable and that preventive and therapeutic measures should be taken without delay.

Blood Pressure↗