Chronic cough: diagnosis and treatment.
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Antitussive Agents↗
Biomedical subjects
J G Burdon
Publications and source records attributed to J G Burdon.
Bird fancier's lung after an unusual exposure to avian protein.
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Alveolitis, Extrinsic Allergic↗
The use of levamisole as an adjunct to chemotherapy and radiotherapy in the treatment of small cell carcinoma of the lung.
To test the efficacy of immunotherapy in the treatment of small cell carcinoma of the lung, patients were allocated at random, in a double-blind controlled trial, to treatment with either levamisole or placebo as an adjunct to chemotherapy with multiple drugs (cyclophosphamide, vincristine, methotrexate and adriamycin) and to radiotherapy. We report here the results of a pilot study of 13 patients. The median survival period of the patients who were given levamisole was 25 weeks. This was significantly shorter (P less than 0.05) than that of the patients who were given placebo (46 weeks).
Adult↗
Allergy associated with Paterson's Curse.
A case of allergic rhinitis which occurred on exposure to Paterson's Curse (Echium plantagineum) is described. Symptoms developed on exposure both to flowering and to dead, dried plants. Inhalational challenge tests with pure preparations of pollen and epidermal debris, including plant hairs, resulted in the symptoms and signs of allergic rhinitis. Field experiments in a large natural stand of Paterson's curse showed that pollen and particulate plant debris, including plant hairs, were airborne during the flowering season. These findings indicate that pollen, epidermal hairs, and particulate matter cause allergic symptoms in susceptible subjects, and suggest that allergies to Paterson's Curse may be encountered beyond the main flowering period.
Adult↗
Pattern of breathing during exercise in patients with interstitial lung disease.
The responses to exercise were studied in 41 patients with pulmonary fibrosis, in whom vital capacity (VC) was reduced to 62% of predicted normal values. Maximum power output (POmax) was 53% predicted; there was a significant relationship between POmax and VC (r = 0.564). The maximum ventilation achieved during exercise was also related to VC (r = 0.614). Although arterial oxygen saturation (SaO2) fell by more than 5% in 13 of 31 patients, there was no relationship between either SaO2 at POmax or the exercise related fall in SaO2 and POmax. Heart rate responses were higher than normal predicted values in seven patients, all of whom showed a low POmax (36% predicted); this finding was due only in part to a fall in SaO2. The ventilatory response to exercise was within normal limits for the patients as a whole; those subjects with the lowest POmax showed relatively higher ventilatory responses to exercise but the difference was not significant. The pattern and timing of breathing was studied in 32 patients and compared with control subjects matched by sex, age, and size. Tidal volume (VT) was low in the patients; maximum VT was related to VC (r = 0.761), but at low values of VC VTmax was higher than in healthy subjects with comparable VC. The total breathing cycle time (Ttot) fell with progressive exercise in patients and controls; Ttot for a given ventilation was shorter in the patients. Inspiratory time (Ti) was shorter in patients than controls, as was Ti/Ttot. In most patients with diffuse pulmonary fibrosis exercise is limited by a reduced ventilatory capacity, despite the adoption of a short Ti and high inspiratory flow rate, both of which serve to optimise tidal volume and breathing frequency and presumably reduce both the force developed by inspiratory muscles and the sensation of breathlessness.
Adolescent↗
Effect of background loads on the perception of added loads to breathing.
Using open-magnitude scaling, we compared the perceived magnitude of externally added resistive and elastic loads to breathing in normal subjects with that perceived when the background load (i.e., the minimum load of the circuit) was increased by the addition of either resistive or elastic loads of increasing magnitude. The study was carried out over four experimental sessions. After a control experiment (no added background load), the background load was increased by the addition of either a resistive or an elastic load for a duration of 3 min. The perceived magnitude of a further series of loads, proportionately increased, was then ascertained. This sequence was then repeated after a further increase in background. The results showed that the perceived magnitude of the load was closely related [mean r = 0.96 +/- 0.01 (SE)] to the magnitude of the physical stimulus expressed as the peak inspiratory pressure by a power function relationship in keeping with Stevens' law. After the increases in background resistance or elastance, there were no significant differences in either exponents or intercepts compared with basal conditions. There was no significant difference in the perceived magnitude of the loads after adaptation. At the smallest load, the perceived magnitude was less than expected from the control experiment. However, this reduction did not reach statistical significance. In the special senses, moderate-to-large stimuli show little change after adaptation, whereas small stimuli are reduced. Although not conclusive, we suggest that the relationship is similar with loaded breathing.
Adaptation, Physiological↗
Detection latency of added loads to breathing.
1. Detection latency of a range of added elastic (0.95-4.50 kPa/l) and resistive (0.73-3.29 kPa l-1 s) loads to breathing were measured in five normal subjects. Detection latency was defined as the time from the onset of the breath to detection of the load. 2. Detection latency followed a curvilinear relationship when plotted as a function of the magnitude of the added loads. A similar relationship was found with both elastic and resistive loads although detection latencies to added elastances were longer than for added resistances. 3. When the added load was expressed in terms of comparable magnitude (peak inspiratory pressure) detection latencies for added elastances were found to be consistently longer than for added resistive loads. 4. These studies show that the detection latency to added inspiratory loads follows a reciprocal relationship, that detection latencies for elastic and resistive loads are clearly different and suggest that these loads are detected during the respiratory cycle at a time when the mechanical information regarding muscular pressure is greatest.
Adult↗
Effect of ventilatory drive on the perceived magnitude of added loads to breathing.
Using open-magnitude scaling we studied the importance of ventilatory drive on the perceived magnitude of respiratory loads by applying a range of externally added resistances (2.1-77.1 cmH2O X l-1 X s) to normal subjects at rest and at three increasing levels of ventilatory drive induced by exercise, CO2-stimulated breathing, and hypoxia. Under all conditions studied the perceived magnitude of the added loads increased with the magnitude of the resistive load and as the underlying level of ventilatory drive increased. When the results were expressed in terms of peak inspiratory pressure, the perceived magnitude was related to the magnitude of the peak inspiratory pressure by a power function (mean r = 0.97). These results suggest that the perceived magnitude of added resistive loads increased with increasing ventilatory drive, in such a manner that the increase in sensory magnitude is proportional to the increase in the inspiratory muscle force developed and suggests that something dependent on this force mediates the sensation.
Adult↗
The perception of breathlessness in asthma.
We studied the perception of breathlessness as a function of air flow obstruction in 45 asthmatic subjects using a category scaling technique. Air flow obstruction and breathlessness were induced by inhalations of histamine acid phosphate in twofold-increasing concentrations from 0.03 to 16 mg/ml. The FEV1 was measured after each inhalation of histamine, and the subject was asked to rate his symptoms of breathlessness. The results showed that breathlessness increased as the FEV1 decreased but, despite a close linear relationship in all subjects (mean r = 0.88 +/- 0.15 SD), there was a considerable variation in the severity of breathlessness for any particular degree of air flow obstruction (mean intercept, 0.50 +/- 0.89 SD). However, the increase in sensory magnitude with increasing air flow obstruction did not show the same degree of variability (mean slope, 0.13 +/- 0.06 SD). The variability in breathlessness in asthmatic patients is likely to have many components. Two of these components were identified. First, we found that there was less respiratory distress in those subjects in whom air flow obstruction was present at the onset of the study. However, the presence of air flow obstruction at this time does not result in a reduction in sensation for further increases in air flow obstruction as might be expected from discrimination studies. Second, there was a significant relationship (p less than 0.01) between bronchial responsiveness and the magnitude of respiratory distress. Those subjects highly responsive to histamine experienced less respiratory distress than the less responsive subjects.
Adolescent↗
Cystic fibrosis and bronchial hyperreactivity. Concomitant defects or cause and effect?
Bronchial reactivity and lung-function tests were measured in 19 young adults with cystic fibrosis. There was moderately severe airways obstruction without hyperinflation, and mild hypoxaemia with normocapnia. Bronchial reactivity (fall in FEV1 after the administration of methacholine aerosol) was increased in about two-thirds of patients, and was markedly enhanced in nearly half of them. It was considered that the airways obstruction characteristic of cystic fibrosis can have a reversible element, and that this may provide a rationale for the use of bronchodilators in some patients. Although bronchial hyperreactivity in cystic fibrosis could represent concomitant underlying defects, a more attractive suggestion is that the chronic inflammation of cystic fibrosis has, in turn, led to acquired bronchial hyperreactivity.
Adolescent↗
Maximal mid-inspiratory to maximal mid-expiratory flow rate ratio in upper airway obstruction.
The maximal mid-inspiratory to maximal mid-expiratory flow rate ratio (MMIF/MMEF) was measured in 16 patients with upper airway obstruction, in eight with pleural disease, in 25 with chest wall abnormalities, in 64 with various lung diseases and in 28 normal subjects. MMIF/MMEF ratio values of less than 1.0 were recorded in eight out of 16 patients with upper airway obstruction, in nine out of 25 patients with chest wall abnormalities and in one normal subject. Our findings show that a MMIF/MMEF ratio less than 1.0 although suggestive, is not diagnostic of upper airway obstruction. However, reduced MMIF/MMEF ratio in the presence of airflow obstruction is specific in localizing obstruction to the upper airway.
Airway Obstruction↗
"Barbiturate burns" caused by glutethimide.
A case of glutethimide overdose associated with skin lesions resembling burns is reported. These characteristic skin lesions are usually ascribed to barbiturates. Their aetiology, incidence, and association with other drugs and neurological disorders are discussed.
Adult↗
Small cell carcinoma of the lung. Prognosis in relation to histologic subtype.
Forty-six of 59 patients with small cell carcinoma of the lung who were treated with multiple drug chemotherapy and radiotherapy were subclassified according to the World Health Organization classification. Subtyping was not possible in the 13 other patients who were diagnosed on sputum cytology findings alone. There was no significant difference in extent of disease, response, duration of response to treatment, or median survival between the different subtypes. Two main difficulties arise in applying the subtyping classification. First, many tumors showed features of several histologic subtypes, implying the existence of a morphologic continuum within the general group of small cell anaplastic carcinomas. Second, tissue crushing artefact was common. Our results do not reveal any advantage in knowing the tumor subtype. It remains essential to differentiate small cell anaplastic carcinoma from other forms of lung carcinoma not responsive to chemotherapy.
Antineoplastic Agents↗
Combination chemotherapy including high dose methotrexate and radiotherapy, in the treatment of small cell carcinoma of the lung.
Twenty-nine (88%) of thirty-three patients who were treated with multiple drug chemotherapy, including high dose methotrexate, and radiotherapy for small cell carcinoma of the lung showed significant improvement in their clinical condition and quality of life. Treatment was well tolerated and toxicity acceptable. Cerebral metastases were not detected in any patient on presentation and only developed in three patients (9%). Little information exists regarding the use of high dose methotrexate in small cell carcinoma of the lung. There is no evidence, on the data available, that high dose methotrexate is any more effective than conventional doses.
Adult↗
Toxic rash associated with high dose methotrexate therapy.
Fifteen rashes were observed in thirteen patients in association with high dose methotrexate therapy. The lack of recurrence of the rash with further treatment courses and the association of the rash with other toxic manifestations and with larger doses of methotrexate suggests a toxic mechanism. Rashes have frequently been reported in association with dose methotrexate therapy (Van Scott, Auerbach & Weinstein, 1964; Leone, Albala & Rege, 1968; Mitchell et al., 1968; Capizzi et al., 1970; Jaffe et al., 1973; Rosen, Suwansirikul & Kwon, 1974; Pratt et al., 1975; Jaffe & Traggis, 1975; Ensminger & Frei, 1977; Stoller et al., 1977). They include perifolliculitis, transient erythema progressing to maculopapular eruptions, occasionally desquamating, sloughing over pressure areas, reactions confined to radiation portals, exacerbation of acne, photosensitivity and rarely urticaria. Relatively few reports sufficiently document the incidence or types of rash. It has been suggested that the rash is allergic in nature (Mitchell et al., 1968) or a toxic phenomenon (Djerassi et al., 1972; Djerassi & Kim, 1976), possibly related to drug effects on small vessels (Van Scott, 1963).
Erythema↗
Combined chemotherapy and radiotherapy for the treatment of small cell carcinoma of the lung.
Twenty-nine (88%) of 33 patients who were treated with multiple drug chemotherapy and radiotherapy for small cell carcinoma of the lung showed significant improvement in their clinical condition and quality of life. Treatment was well tolerated and toxicity was acceptable.
Adult↗
A trial of cephalothin sodium in colon surgery to prevent wound infection.
A double-blind trial of preoperative and perioperative cephalothin sodium in patients undergoing colonic surgery was carried out to test the value of this drug in reducing wound infection rates. Two studies were performed. In the first trial, 1 gm of cephalothin sodium or a placebo was given intravenously at the beginning of operation, and 1 gm one hour later. In the second trial, the dose of cephalothin or placebo was increased to 2 gm. There was no significant reduction in wound infections in either study in the groups receiving cephalothin, although over two thirds of the organisms cultured from the infected wounds were sensitive to cephalothin. It is suggested that meticulous attention to technique to avoid gross contamination remains the most important factor in the prevention of wound infections after colon surgery.
Cephalothin↗
Are antibiotics necessary in acute cholecystitis?
The value of antibiotics in 302 cases of acute cholecystitis was examined. Antibiotics are valueless in decreasing the incidence of local septic complications, such as empyema or pericholecystic abscess formation. Antibiotics are valuable in decreasing the number of wound infections and the incidence of septicaemia in patients who are at risk. Patients at risk are aged over 60 years or have a debilitating disease which lowers host resistance to infection or already have a septic complications, such as a pericholecystic abscess. Patients who are aged under 60 years and who have uncomplicated acute cholecystitis do not require antibiotics.
Abscess↗