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Biomedical subjects

D Veale

Publications and source records attributed to D Veale.

At least 73 records · Page 4Linked to original sources
PubMed1995

Breathing pattern awake and asleep in patients with myotonic dystrophy.

Patients with myotonic dystrophy often have an irregular pattern of breathing at rest, implying abnormality of breathing control. No central medullary defect has been found in such patients. We postulated that irregular breathing in myotonic dystrophy due to abnormal central respiratory output would persist during slow-wave sleep. We examined the patterns of breathing whilst awake and asleep in seven patients with myotonic dystrophy, seven similarly weak nonmyotonic subjects and seven normal controls. Polysomnography was performed, and the coefficients of variation (CoV) of the breath intervals were analysed during different stages of sleep. The myotonic group showed significantly greater variation in breath intervals than the other two groups whilst awake (median CoV 37 vs 18% for nonmyotonics) and during light sleep (31 vs 13%). This difference was not evident during slow-wave sleep (median CoV 12 vs 9% in nonmyotonic). We conclude that irregular breathing in patients with myotonic dystrophy whilst awake and during light sleep, does not persist during slow-wave sleep. These results suggest that "behavioural" influences play a role in the abnormal breathing pattern found in myotonic dystrophy. The source of the irregular breathing is unlikely to be found in the medulla, but may originate from forebrain influences.

Adult↗
PubMed1994

Basaloid bronchial carcinoma. A histologic group with a poor prognosis.

BACKGROUND: Basal cell carcinomas (BCCs) have been described in various locations, such as skin, anal canal, tongue, larynx, and recently, the lungs. These tumors seem to have a poor prognosis. METHODS: A series of 115 surgically resected lung tumors, previously classified as poorly or undifferentiated carcinoma, were reviewed retrospectively. From these, 37 cases were reclassified as BCCs and were compared in terms of clinical features and survival, with 40 cases reclassified as poorly differentiated squamous cell (PDSC) carcinoma of the lung. RESULTS: There was no difference between the groups regarding age, clinical presentation, pattern of relapse, and cause of death. Median and overall survival were different between the two groups, especially for Stage I and II patients: 5-year actuarial survival in the BCC group was 15% and in the PDSC group 47% (P = 0.004). CONCLUSIONS: This subset of non-small cell lung cancer (NSCLC) has a worse prognosis than other NSCLC, and this should be considered in survival studies and new treatment trials.

Adult↗
PubMed1994

The effect of controlled-release salbutamol on sleep and nocturnal oxygenation in patients with asthma and chronic obstructive pulmonary disease.

Patients with asthma or chronic obstructive pulmonary disease (COPD) may have falls in oxygen saturation at night. We have investigated the effect of a long acting beta agonist (salbutamol CR) on nocturnal oxygen saturation (SaO2) in asthma and COPD. Eleven asthmatic and 14 COPD patients in stable condition were randomly allocated to 8 mg salbutamol CR or placebo twice daily in a double-blind, cross-over study. FEV1 at entry was 71.5% predicted in the asthmatic patients and 36% predicted in the COPD group. Each treatment period lasted 7 days, at the end of which measurements of ventilatory function and detailed sleep studies were performed. There was a significant improvement in morning FEV1 in the asthmatic patients when on active treatment and a small, but non-significant improvement in the COPD group. Sleep architecture and oxygenation were similar on placebo and on active treatment in both groups. We conclude that salbutamol CR has no significant effect on nocturnal oxygenation or sleep pattern in patients with mild asthma or moderately severe COPD.

Albuterol↗
PubMed1994

Classification of clinical subsets in psoriatic arthritis.

The classification of PsA is controversial. Two recent papers have suggested new subgroup classifications, however both have served only to expand the controversy. In this study the clinical and radiologic features of 100 patients with PsA are recorded in order to examine possible clinical or radiologic features which may be associated with functional disability and to examine the usefulness of recent reclassification proposals in our patient population. Results indicate that an asymmetric oligoarthritis (AO) pattern of disease is most common occurring in 43%. A symmetric polyarthritis (SP) was present in 33%, and this subgroup had the highest number of erosions and deformities, and a higher proportion of patients with grade III/IV ARA functional disability. While the DIP joints were involved in 46%, predominant DIP joint disease occurred in 16%. As the DIP group had the shortest duration of arthritis, it may be that this group represents recent onset PsA which will evolve into one of the other subgroups. Sacroiliitis was a feature in 14% with predominant spondylitis (SPON) in 4%. Arthritis mutilans (AM) was rare occurring in only 2% of this population, perhaps representing patients with end-stage SP disease. Finally, 2% of patients had features of the synovitis-acne-pustulosis-hyperostosis-osteomyelitis (SAPHO) syndrome. A classification comprising just three subgroups (AO, SP, SPON) is proposed as being of most use clinically though a long-term prospective study is needed for verification.

Acne Vulgaris↗
PubMed1994

Tussometry and lung function.

The tussometric parameter peak value time (PVT) has been proposed as an objective measure of laryngeal function. Whether the lower respiratory tract function influences its value is, however, unknown. This study investigates the relationship between lung function parameters forced expiratory volume in 1 second, vital capacity, peak expiratory flow rate, forced expiratory flow at 50% of vital capacity and total lung capacity (FEV1, VC, PEFR, FEF50, TLC) and PVT in 79 subjects. PVT proved to be independent of lung function. It is therefore specifically a measure of laryngeal function, and lung function need not be considered when interpreting PVT values.

Adult↗
PubMed1994

Circadian changes of left ventricular ejection fraction in normal subjects.

Sleep has a specific physiology with related cardiovascular changes. We have previously found in respiratory patients [chronic obstructive pulmonary disease (COPD) and sleep apnea syndrome (OSAS)] an unexpected decrease in left ventricular ejection fraction (LVEF) at waking in the morning when compared with the rest period during the day. Whether this observation was linked to the consequences of the respiratory abnormalities or reflected physiological fluctuations related to the changes in autonomic nervous system tone remained unknown. Thus, we have set out to analyze the changes in LVEF with sleep in normal individuals. Eight healthy young men had LVEF measured before and after submaximal exercise, at rest before bedtime, and on waking in the morning. Technetium-99m with in vivo red cell labelling was used. Sleep parameters were assessed using classical polysomnography. In order to detect any influence of autonomic nervous system stimulation on LVEF, sympathovagal tone (SVT) was also assessed during night-time LVEF measurements using spectral analysis of RR intervals. LVEF at rest was within the normal limits for all the subjects (range 51-62%). On submaximal exercise, the LVEF increased in four subjects, was unchanged in two, and decreased in two. The main result concerns the changes in LVEF overnight. In the morning, LVEF decreased dramatically in three subjects and reached a level of < 30% in four. These decreases in LVEF were not related to changes in SVT or sleep structure. LVEF values returned to normal in 30 min. The LVEF changes during exercise are in accordance with previous data in the literature. The dramatic decrease in LVEF observed in the morning could be related either to vascular resistance changes or to nocturnal variations in cardiac contractility, which both need further studies to be established.

Adult↗
PubMed1993

Reduced synovial membrane macrophage numbers, ELAM-1 expression, and lining layer hyperplasia in psoriatic arthritis as compared with rheumatoid arthritis.

OBJECTIVE: To define the immunohistologic features of the synovial membrane (SM) of patients with psoriatic arthritis (PA) and to compare them with those of an age- and disease-duration-matched population of patients with rheumatoid arthritis (RA). METHODS: Synovial membrane needle biopsy was performed on 15 PA patients with knee involvement (8 had asymmetric oligoarthritis and 7 had symmetric polyarthritis) and on 15 RA controls. Specimens were stained with monoclonal antibodies against T cells (CD3, CD8, CD4, CD45RO), B cells (CD20), macrophages (Mac387, CD14), and cells bearing class II antigens (DAKO-DR). Vascular endothelium was examined using a polyclonal antibody to Factor VIII-related antigen, and adhesion molecule expression was examined using antibodies 1.3B6, 6.5B5, and 1.4C3, which identify endothelial leukocyte adhesion molecule 1 (ELAM-1), intercellular adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1), respectively. RESULTS: There was significantly less lining layer hyperplasia, fewer macrophages, and a greater number of blood vessels in PA SM than in RA SM: ELAM-1 expression was less intense in PA than in RA SM, while there was no difference in expression of ICAM-1 and VCAM-1. Numbers of B cells, T cells, and T cell subsets (predominantly CD4, CD45RO T cells) were similar in both groups of patients. CONCLUSION: Our findings demonstrate important differences in the immunohistologic features of PA and RA SM: The PA SM is more vascular, ELAM-1 expression is less intense, and fewer macrophages invade the stroma and migrate to the lining layer than in RA SM: However, the lymphocytic infiltrate in the SM of both groups is similar.

Adult↗
PubMed1993

The relationship of quantitative epidermal growth factor receptor expression in non-small cell lung cancer to long term survival.

Increased expression of epidermal growth factor receptor (EGFr) has been reported in non small cell lung cancers (NSCLC) when compared to normal lung. We have examined post-operative survival in 19 surgically treated patients with NSCLC who had full characterisation of EGFr on primary tumour membrane preparations from resection specimens. There were ten squamous, seven adeno and two large cell carcinomas. The median concentration of high affinity sites was 31 fmol per mg of protein (4-1532) and the median dissociation constant (Kd) of these high affinity sites was 2.3 x 10(-10) per mol (1.2-30 x 10(-10)). Seven patients survived over 5 years. Twelve patients died between 8.5 and 55 months from the time of surgery. When > 5 year survivors were compared to non-survivors there was no difference as regards tumour size or stage, or as regards age or sex. The survivors had a median concentration of high affinity EGFr sites of 16.1 fmol mg-1 protein compared to a median concentration of 68.6 fmol mg-1 protein in the non-survivors (P = 0.01 Wilcoxon test). No long term survivor had > 35 fmol mg-1 protein of receptor. Thus EGFr quantitation may give independent prognostic information in NSCLC and help to select patients for adjuvant therapy after surgery. These results need confirmation in a larger prospective study.

Adenocarcinoma↗
PubMed1993

Anterior mediastinal fibrosis with superior vena caval obstruction complicating the synovitis-acne-pustulosis-hyperostosis-osteomyelitis syndrome.

A syndrome of predominantly palmo-plantar pustular psoriasis associated with anterior chest wall (sternoclavicular, manubriosternal) inflammation has previously been described. In this case, a further patient is reported where chest wall involvement is complicated by anterior mediastinal fibrosis and superior vena caval obstruction.

Fibrosis↗
PubMed1993

Mechanism of joint sparing in a patient with unilateral psoriatic arthritis and a longstanding hemiplegia.

The case of a 59-year-old female with a longstanding hemiplegia who developed unilateral psoriatic arthritis and unilateral psoriasis on the non-hemiplegic side only is reported. Investigations showed an erythrocyte sedimentation rate of 58 mm/h, with all classes of rheumatoid factor negative in serum and synovial fluid (SF). An inflammatory infiltrate was demonstrated in both knee joints despite the absence of clinical involvement on the hemiplegic side. In addition, while neurofilament and substance P (SP) immunoreactivity was demonstrated in both synovial specimens, conspicuously less SP was present in the clinically involved synovial membrane. Finally, SF levels of SP and IL1 beta were raised in the clinically involved knee only.

Arthritis, Psoriatic↗
PubMed1993

Variability in ciliary beat frequency in normal subjects and in patients with bronchiectasis.

BACKGROUND: There is a wide variation in tracheobronchial clearance of inhaled aerosol in normal subjects and in patients with bronchiectasis, but little information is available on the variability in ciliary beat frequency (CBF). METHODS: The variability in CBF was measured in 10 nasal mucosal samples from each of 19 normal controls and 23 stable bronchiectatic subjects. RESULTS: The CBF varied at different mucosal sites in both normal subjects and bronchiectatic patients. Although the CBF of the fastest beating cilia was similar in both groups, the CBF of the slowest beating cilia was, on average, lower and showed greater within subject variation in bronchiectatic than in normal subjects. CONCLUSIONS: There is a wide variation in CBF in nasal mucosal samples and this is significantly wider in bronchiectatic subjects with some cilia beating slowly. This may be a consequence of chronic inflammation or infection.

Adult↗
PubMed1993

Ciliary beat frequency in transplanted lungs.

BACKGROUND: Patients with lung transplantation are prone to respiratory infections. Generally this is attributable to the effects of immunosuppressive drugs but mucociliary clearance has been found to be impaired in these subjects. A study was performed to determine whether this finding is accompanied by a reduction in ciliary beat frequency (CBF). METHODS: Six patients who had undergone single lung transplantation for fibrosing lung disease were investigated. CBF was measured in mucosal samples from native and transplanted bronchi by a videophotometry method. RESULTS: The CBF was reduced in the transplanted bronchi in all cases when both fastest and slowest beating cilia were examined. The fastest beating cilia on the native side had a mean (SD) CBF of 12.1 (1.3) Hz compared with 9.6 (2.0) Hz on the transplanted side. The slowest beating cilia also had reduced CBF on the transplanted side. CONCLUSION: In patients with fibrotic lung disease, CBF is reduced in transplanted bronchi in comparison with native bronchi.

Adult↗
PubMed1993

Culture of Mycobacterium kansasii in the blood of an HIV negative patient.

A 23 year old man with a congenital myelodysplastic disorder and fibrosing lung disease received treatment with prednisolone. After nine months his condition deteriorated and Mycobacterium kansasii was isolated from blood cultures and lymph node biopsy specimens. He responded to antituberculous treatment. M kansasii has not previously been isolated from the blood stream of HIV negative patients.

Adult↗
PubMed1993

Classification and treatment of obsessional slowness.

Obsessional slowness is regarded as an uncommon but severely disabling variant of obsessive-compulsive disorder. This paper examines the psychopathology, classification, pathophysiology and treatment of obsessional slowness. It argues that primary obsessional slowness does not require classification as a separate syndrome because it can be found to be secondary to recognised phenomena of obsessive-compulsive disorder or anankastic personality disorder. The treatment described in the literature is not thought to be successful in the long term, and controlled trials are required to evaluate new strategies and antidepressant medication.

Aged↗
PubMed1993

Central sleep apnoea syndrome with upper airway collapse.

We report on an 83 yr old man with hypersomnia and central sleep apnoea (CSA). He had several possible causes for CSA, including a central nervous system lesion, hypocapnia and anatomical narrowing of the airway at the hypopharyngeal level. We postulate that reduced central respiratory drive occurring in conjunction with upper airway narrowing may have led to central apnoeas. These in turn could have facilitated a complete passive hypopharyngeal collapse at the end of each apnoea, as visualized by somnofluoroscopy. The CSA could also have been favoured by respiratory instability due to chronic hypocapnia.

Aged↗