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Biomedical subjects

J E Earis

Publications and source records attributed to J E Earis.

32 records · Page 2Linked to original sources
PubMed1990

Assessment of reversibility of airway obstruction in patients with chronic obstructive airways disease.

Spirometry before and after an inhaled beta agonist or a course of oral prednisolone is widely used to detect reversible airflow limitation in patients with chronic obstructive lung disease. How many of these patients have a response and how the response to beta agonists relates to the response to corticosteroids is not clear. In 127 outpatients (mean (SD) FEV1 0.92 (0.38) 1) who had a clinical diagnosis of chronic obstructive lung disease (continuous breathlessness for more than six months and an FEV1/forced vital capacity (FVC) ratio less than 60%) and who appeared to be stable, the change in FEV1 was measured after salbutamol 200 micrograms from a metered dose inhaler and 5 mg from a nebuliser. Symptoms and spirometric values were recorded before and after two weeks of oral prednisolone 30 mg. Reversibility was defined as a response in FEV1 of 15% or more from baseline alone and as a 15% change and a minimum increase of at least 200 ml. The latter gave results that showed greater internal consistency between the drug regimens. On the basis of this criterion 56 patients (44%) had no response to salbutamol or prednisolone, 71 responded to salbutamol (including all 27 steroid responders), and 25 patients had a response to salbutamol 5 mg but not to 200 micrograms. In general, the largest increase in FEV1 after salbutamol occurred in the subjects with greatest improvement after prednisolone. Subjects showing a response in FEV1 after two weeks' prednisolone had a fall in total symptom score, unlike those who had no response to any treatment or a response to salbutamol only. These data show that reversibility in response to beta agonists is common in patients diagnosed on clinical grounds as having stable chronic obstructive lung disease, that it can be substantial, and that it is best detected by using a larger dose of salbutamol. Salbutamol responders were those most likely to improve after a trial of oral prednisolone. Allowance should be made for the variability of FEV1 in the calculation of the percentage response at low baseline values (less than 1 litre).

Albuterol↗
PubMed1990

Expiratory lung crackles in patients with fibrosing alveolitis.

Inspiratory lung crackles are a diagnostic feature of interstitial pulmonary fibrosis, but expiratory crackles are not well documented. In a phonopneumographic study of 13 patients with fibrosing alveolitis, expiratory crackles were audible with the stethoscope in 12. Phonopneumographic analysis of these 12 patients showed the crackles to be fine with the initial wave deflection of the expiratory and inspiratory crackles in opposite directions. They were few in number, occurred predominantly in mid- and late expiration, and were not affected by varying the volume history or by breath holding maneuvers. These observations support the theory that some crackles are produced by vibration of the walls of peripheral airways. In addition, this group of patients showed a significant correlation between the number of expiratory crackles and the reduction in predicted transfer factor, suggesting that expiratory crackles may be a clinical indicator of the severity of disease in fibrosing alveolitis.

Aged↗
PubMed1985

Complement activation after myocardial infarction.

Complement activation as reflected by C3, C4, and C3d levels was studied in 56 patients following myocardial infarction, 13 with the postmyocardial infarction syndrome (PMIS); 12 with prolonged postinfarction pyrexia; six with clinical evidence of pulmonary embolism; and 25 control patients without apparent complications. In most patients, C3d levels were elevated during the first ten postinfarction days and at the time of any pulmonary embolism; this probably represented local nonimmunologic complement utilization. The PMIS patients had much higher C3d levels associated with significantly lower concentrations of C3 at the time of disease activity. It is suggested that heart reactive antibodies combine with circulating cardiac antigens to form soluble immune complexes, and in the PMIS, these may become deposited in various sites resulting in complement-mediated tissue damage. The high C3d levels associated with the PMIS may also be of value in differentiating this condition from pulmonary embolism, as both problems may have similar clinical and roentgenographic features.

Antigen-Antibody Complex↗
PubMed1983

Tetanus: an unusual source and site of infection.

Tetanus is reported in a previously immunised patient who was exposed to the dust of old building plaster containing horse hair. The site of infection was a squamous cell carcinoma of the scalp.

Aged↗
PubMed1982

The inspiratory "squawk" in extrinsic allergic alveolitis and other pulmonary fibroses.

An inspiratory musical sound ("squawk") was recorded in 14 patients with diffuse pulmonary fibrosis. These were divided into two groups: nine patients suffering from extrinsic allergic alveolitis (seven with bird fancier's lung and two with farmer's lung) and five patients with pulmonary fibrosis due to other causes, including rheumatoid disease, Wegener's granulomatosis, systemic sclerosis, and sarcoidosis. Clinical studies and phonopneumographic analysis of 10 consecutive squawks in each patient showed that the sound in the group with extrinsic allergic alveolitis was of shorter duration, occurred later in inspiration, and tended to be of higher frequency than the sound heard in the other group. Inspiratory crackles were present in all patients and in eight a single loud crackle preceded the squawk. We suggest that squawks, like crackles, result from the opening of airways and that the differences between the squawks in the two groups may reflect the size of the affected airways.

Adult↗
PubMed1981

Pleural mesothelioma presenting as apparent recurrent pulmonary embolism.

Three patients with malignant mesothelioma of the pleura presented with unilateral pleural effusion and recurrent horizontal linear opacities on the chest radiograph. Although an initial diagnosis of pulmonary embolism was made in all three patients and two received anticoagulants, it is more likely that the opacities represented plate atelectases due to restriction of basal lung expansion by severe chest pain. It is suggested that the early manifestations of malignant mesothelioma of pleura may be confused with recurrent pulmonary embolism.

Adult↗
PubMed1981

Relationship between asthma and gastro-oesophageal reflux.

Twenty patients with bronchial asthma who also had gastro-oesophageal reflux were investigated. The severity of their reflux was graded using symptom score of heartburn and regurgitation and by the following investigations: barium swallow and meal, fibreoptic endoscopy and biopsy, manometry and pH monitoring of the distal oesophagus, and an acid infusion test. Full lung function studies were performed and patients were entered into a double-blind crossover study using cimetidine to control their reflux in order to assess beneficial effects with respect to their respiratory problems. Eighteen patients completed the study. Significant improvements were seen in reflux and night time asthmatic symptoms, both these indices being measured on a scoring system. Home monitoring of peak flow values showed a statistical improvement for th last peak flow reading of the day. Fourteen patients felt that their chest symptoms had significantly improved during the cimetidine period.

Adult↗