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Biomedical subjects

M A Berry

Publications and source records attributed to M A Berry.

At least 19 recordsLinked to original sources
PubMed2005

Observational study of the natural history of eosinophilic bronchitis.

BACKGROUND: Eosinophilic bronchitis is an important cause of chronic cough. Treatment with inhaled corticosteroids is associated with a short-term improvement in cough and reduced sputum eosinophil count but the long-term outcome is uncertain. OBJECTIVE: To determine the long-term outcome in patients diagnosed with and treated for eosinophilic bronchitis. METHODS: We have performed a longitudinal study of symptoms, eosinophilic airway inflammation, spirometry and airway hyper-responsiveness in all patients diagnosed with eosinophilic bronchitis over 7 years. RESULTS: We identified 52 patients with eosinophilic bronchitis and longitudinal data of greater than 1 year (mean 3.1 years) was available in 32 patients, all of whom were treated with inhaled steroids. Three (9%) patients developed symptoms consistent with asthma and a methacholine PC20<8 mg/mL on one or more occasion. Five (16%) patients developed fixed airflow obstruction defined by a persistent post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity<70%. One (3%) patient had complete resolution of symptoms and eosinophilic airway inflammation off treatment. The remaining patients had ongoing eosinophilic airway inflammation and/or continuing symptoms. Multiple linear regression identified smoking, female gender and area under the curve of sputum eosinophil count over time as the most important predictors of decline in FEV1. CONCLUSIONS: The most common outcome in eosinophilic bronchitis is continuing disease and complete resolution is rare. Asthma and fixed airflow obstruction developed in relatively few patients. The most important factors associated with a more rapid decline in FEV1 were female gender, smoking and prolonged eosinophilic airway inflammation.

Administration, Inhalation↗
PubMed2005

The use of exhaled nitric oxide concentration to identify eosinophilic airway inflammation: an observational study in adults with asthma.

BACKGROUND: Assessment of eosinophilic airway inflammation may be helpful in the management of asthma. Nitric oxide (NO) has potential advantages as a tool to monitor airway inflammation although little is known about the relationship between NO and eosinophilic airway inflammation and the factors which influence it. METHODS: We set out to define the relationship between exhaled NO and the sputum eosinophil count, identify the exhaled NO concentration that best identified a sputum eosinophil count >3% and investigate the impact of several potential confounding factors in 566 consecutive patients with varying severity of asthma. Finally we examined the ability of exhaled NO concentrations measured at differing exhalation flows to identify the presence of a sputum eosinophilia. RESULTS: We found a significant positive relationship between exhaled NO and sputum eosinophil count (R(2)=0.26, P<0.001) which was best described using a non-linear model. There were no clinically important confounding factors to this model. In non-smokers an exhaled NO concentration of >8.3 p.p.b. at 250 mL/s gave 71% sensitivity and 72% specificity for identifying a sputum eosinophil count of >3%. CONCLUSIONS: This value of exhaled NO would seem to be the best for identifying significant eosinophilic airway inflammation. It is applicable to a wide range of non-smoking patients with asthma; exhalation flow does not alter the ability of exhaled NO concentration to detect a sputum eosinophilia.

Adolescent↗
PubMed2005

Expression of CXCR6 and its ligand CXCL16 in the lung in health and disease.

BACKGROUND: Chemokine receptors (CR) play an important role in T cell migration, but their contribution to lung trafficking is unclear. OBJECTIVE: We hypothesized that if a particular CR was involved in T cell homing its expression would be enriched on lung T cells compared with peripheral blood T cells (PBT). METHODS: We have measured the CR expression on BAL T cells from patients with sarcoid, other interstitial lung diseases (ILD), asthma and healthy volunteers. RESULTS: Of 14 CR studied in sarcoid, CXCR6 expression was the most markedly increased in the lung compared with the blood, a finding that was also seen in ILD patients. A striking although lesser increase was also seen in asthmatics and healthy controls. Analysis of expression of the CXCR6 ligand, CXCL16, by immunohistochemistry suggested that alveolar macrophages (AM) were the major source of CXCL16 in the lung. AM expressed mRNA for CXCL16 and released nanogram quantities after adhesion to plastic as shown by RT-PCR, Western blotting and ELISA. Bronchoalveolar lavage (BAL) fluid from all subjects contained large amounts of CXCL16. The full-length CXCL16 was the predominant isoform in AM lysates, supernatants and BAL. CONCLUSION: This data suggests that CXCR6 and CXCL16 may play a role in T cell recruitment to the lung.

Adult↗
PubMed2000

Endovascular surgery in the treatment of chronic primary and post-thrombotic iliac vein obstruction.

OBJECTIVES: To compare the results and complications of endovascular surgery in limbs with post-thrombotic and non-thrombotic disease and to detail some technical aspects of the procedure. DESIGN: A single centre, prospective study. MATERIALS AND METHODS: Between March 1997 and August 1999, 139 consecutive lower extremities with chronic iliac venous obstruction (61 limbs with primary disease [MTS] and 78 with post-thrombotic disease [PTS]) were treated by balloon dilation and stenting. History, clinical examination, procedure and follow-up data were recorded. RESULTS: Mortality was zero. Non-thrombotic complication rate was only 3%. Postoperative (8%, 6/78) and late occlusion (3%, 2/69) occurred only in post-thrombotic limbs. Primary, primary-assisted and secondary cumulative patency rates of the stented area at 2 years were 52%, 88% and 90%, respectively, in the PTS group as compared to 60%, 100% and 100% in the MTS group. Clinical improvement in pain and swelling was significant in both groups. Half of active venous ulcers healed after the procedure. CONCLUSIONS: Chronic iliac vein obstruction appears to be a symptomatic lesion that can be treated safely and effectively by endovascular surgery regardless of aetiology. Generous use of IVUS is suggested in both diagnosis and treatment since phlebography is unreliable. The clinical improvement was significant in both groups; however, more excessive neointimal hyperplasia and a higher early and late occlusion rate were observed in post-thrombotic disease. Stenting after balloon dilation is advised in all venoplasties; stents should be inserted well into the IVC when treating iliocaval junction stenosis. A wide-diameter (16 mm) stent is recommended. The stent should cover the entire lesion as outlined by the IVUS.

Adolescent↗
PubMed2000

Transcommissural valvuloplasty: technique and results.

PURPOSE: The purpose of this study was to describe the technique of a variation of closed external venous valve repair (transcommissural valvuloplasty), its complication rate, and duplex scan durability. METHODS: The "blind" transcommissural valve repair of the vein was performed by placing transluminal sutures along the valve attachment lines, which simultaneously closed the valve attachment angle and also tightened the valve cusps. A total of 179 successfully repaired valve sites of 141 limbs in 129 patients were followed up 1 to 42 months through clinical observation and with duplex Doppler ultrasound scan. RESULTS: Postoperative complications (< 30 days) occurred in 12 (9%) of 141 limbs: superficial (1) and deep (1) wound infection, large wound hematoma (4), seroma (1), and deep vein thrombosis (5), with associated pulmonary embolus in one patient. Seventy-eight percent (reflux time </= 0.5 seconds) and 81% (reflux time </= 1.0 seconds) of valve sites were competent. The cumulative competency rate at 30 months was 59% and 63%, respectively. The cumulative ulcer recurrence-free interval was 63% at 30 months (n = 92). The pain score and swelling grade substantially improved. CONCLUSION: Transcommissural valvuloplasty is a safe procedure with low morbidity. It is relatively rapid and simple to perform, and its competency rates are comparable to those of internal valvuloplasty. Advantages over the internal repair are that venotomy is not required, repair can be extended to small-caliber veins, and multiple valve stations can be repaired in a single stage.

Adult↗
PubMed1997

The alternate iron transport pathway: mobilferrin and integrin in reticulocytes.

Iron transport in reticulocytes is known to occur via the well-described transferrin-receptor-endosome pathway. An alternative pathway for iron transport independent of transferrin has been postulated in reticulocytes and other cells. Transport of iron into reticulocytes from ferric citrate solutions was shown to be saturable and independent of transferrin. During transport of iron from ferric citrate, both cell surface integrins, and a soluble protein, mobilferrin, were labelled. This demonstrated that the reticulocyte transferrin independent pathway for iron transport involved integrins and mobilferrin similar to intestinal absorptive cells. This pathway would be expected to transport iron into cells under conditions of iron overload and was capable of providing iron for haemoglobin synthesis. Mobilferrin was also radiolabelled when radioiron labelled transferrin was incubated with reticulocytes and this occurred with a different time course than was observed following reticulocyte exposure to radiolabelled ferric citrate. This suggested that mobilferrin may serve as an intermediary in both pathways.

Animals↗
PubMed1997

Growth of very premature infants fed intravenous hyperalimentation and calcium-supplemented formula.

OBJECTIVE: To describe growth during initial hospitalization for very small premature infants fed intravenous hyperalimentation, then calcium supplemented 1460 mg/L (36.5 mmol/L) 81 kcal preterm formula. POPULATION: A total of 109 survivors whose <1000 g birth weight was appropriate for gestational age. Mean gestational age was 25.8 weeks. RESULTS: Graphs were constructed for weight, length, and head circumference by week of age. Mean and +/- 2 SD lines were depicted, with mean intrauterine growth lines for comparison. Separate graphs showed mean weight, length, and head circumference growth by 100 g birth weight cohorts. Mean Z scores based on normal intrauterine growth curves were calculated. Weight Z scores were -.35 at birth, -1.79 at 14 days, and -1.87 at 56 days. Length Z scores were -.32 at birth, -1.29 at 14 days, and -2.24 at 56 days. Head circumference Z scores were 0.01 at birth, -1.26 at 14 days, and -1.06 at 56 days. (Z score = [measured parameter - intrauterine mean for gestation]/intrauterine SD for gestation). Repeated-measures multivariate ANOVAs showed the following significant Z score changes. There were decreases in Z scores for weight, length, and head circumference between birth and 14 days and an additional decrease for length between 14 and 56 days. Head circumference Z scores increased from day 14 to day 56, but remained smaller at day 56 than at day 0. Initially, head circumference Z scores were better than weight or length (possibly because of late head measurement timing). At day 14, the Z scores for weight were lower than those for length and head circumference. At day 56, the head circumference Z scores were higher than those for length or weight. CONCLUSION: Compared with intrauterine standards, weight, length, and head circumference were all worse at day 56 than at birth, although there was relative head-sparing and weight growth paralleled intrauterine growth after 14 days. Length worsened from day 14 to day 56 in spite of the use of calcium and phosphorus-enriched formula.

Analysis of Variance↗
PubMed1997

Gastrointestinal lavage for colon cleansing.

Colon cleansing preparations for diagnostic and surgical procedures continue to be evaluated in an effort to improve the quality of colon exam. Modifications of older barium enema x-ray preparations have led to the development of many alternative forms of bowel cleansing. Formal study has allowed carefui comparison of gut lavage, diet and cathartic as well as oral sodium phosphate preparation. Gut lavage with electrolyte lavage solutions represents the most popular form of bowel preparation. Patient variability and special circumstances such as gastroparesis, surgically altered anatomy or patient preferences may dictate selection of colon cleansing preparations.

Journal Article↗
PubMed1997

Factors associated with growth of extremely premature infants during initial hospitalization.

OBJECTIVE: To quantify the factors associated with growth of very small premature infants during initial hospitalization. POPULATION: Study patients were 109 infants who were appropriate for gestational age, weighed <1000 g at birth, and were fed intravenous hyperalimentation then calcium-supplemented 81-kcal preterm formula according to a protocol. ANALYSIS: Multiple regression analysis was performed for periods of 0 to 56, 0 to 14, and 15 to 56 days of age. Growth was determined as change in weight during the period. Variables assessed in the initial model were caloric intake, protein intake, respiratory support duration, patent ductus arteriosus, dexamethasone use, infection, birth weight ratio (weight divided by expected intrauterine weight for gestation), gestational age, sex, calendar time from study start, maternal betamethasone administration, and necrotizing enterocolitis. For the 0 to 14-day period, maximum oxygen requirement for respiratory distress syndrome replaced respiratory support duration, and 5-minute Apgar score was added, whereas dexamethasone and necrotizing enterocolitis were deleted. RESULTS: Mean change in weight was 785 g for 0 to 56 days, -16 g for 0 to 14 days, and 770 g for 15 to 56 days. Mean weight was 94% (13 SD) of mean intrauterine at birth, 73% (10 SD) at 14 days, and 73% (12 SD) at 56 days. Regression models explained 85%, 43%, and 80%, respectively, of variation in growth. Of the initial variables assessed, the following were the independent prognostic determinants of growth. There was a positive association with caloric intake at 0 to 56 days and 15 to 56 days, and with protein intake at 0 to 14 days. Negative associations were found for birth weight ratio and gestational age at 0 to 56 and 0 to 14 days. Respiratory support duration was negatively associated at 15 to 56 days, and dexamethasone was negatively associated at 0 to 56 and 15 to 56 days. Formulas to predict growth were established from the final regression models. CONCLUSION: The growth failure in appropriate-for-gestational-age, <1000-g birth weight infants can be related in part to dexamethasone use and respiratory support duration. Increasing caloric intake and early protein intake improves growth. However, for the majority of these patients, early losses are not corrected completely by 56 days using currently recommended intakes.

Dexamethasone↗
PubMed1996

Pericarditis causing exercise test induced ST-elevations.

Pericarditis has not been well associated with exercise test induced ST-elevations. This case report of a pericarditis patient who underwent exercise stress testing and other similar cases found in the literature suggest that this is an unrecognized clinical manifestation of pericarditis.

Electrocardiography↗
PubMed1994

Review article: orthograde gut lavage for colonoscopy.

Most colon cleansing regimens for surgical and diagnostic procedures such as colonoscopy are modifications of older barium enema X-ray preparations which have evolved in gastrointestinal laboratories influenced by empiric experience. Recent formal study allows for careful comparison of gut lavage, diet and cathartic, and oral sodium phosphate preparations. This review will evaluate oral lavage solutions and address their safety, tolerance and efficacy. Administration options are discussed as well as other diet and cathartic methods previously referred to as 'standard preps'.

Administration, Oral↗