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Biomedical subjects

M F Muers

Publications and source records attributed to M F Muers.

At least 73 records · Page 4Linked to original sources
PubMed1986

Postal survey of bronchoscopic practice by physicians in the United Kingdom.

In 1983 a postal survey of the bronchoscopic practice of chest physicians in the United Kingdom produced a 90% response rate. Two hundred and thirty one physicians were carrying out bronchoscopy; they had performed about 40 000 bronchoscopies in the preceding year, 87% of these being fibreoptic procedures with topical anaesthesia. The mortality rate of fibreoptic bronchoscopy was 0.04%, with a 0.12% incidence of major complications. Transbronchial biopsy carried both an appreciably higher mortality rate of 0.12% and a major complication rate of 2.7%. There is wide variation in the use and choice of sedative drugs for fibreoptic bronchoscopy. Many of the drug combinations could be criticised on pharmacological grounds. The mean dose of lignocaine was 342 mg, most operators exceeding the usual maximum recommended dose; but adverse reactions were rare. Routine supplemental oxygen was given by only 18% of bronchoscopists. Basic resuscitation equipment was often inadequate. Radiological screening was used for transbronchial lung biopsy by 53% of respondents and significantly reduced the incidence of pneumothorax from 2.9% to 1.8%. Both the number of bronchoscopies performed and the complication rate were higher than previous estimates. Bronchoscopists should re-examine their policy on drugs and safety precautions to minimise the risks of the procedure.

Anesthesia↗
PubMed1985

Evaluation of a radioimmunoassay for neuron specific enolase in small cell lung cancer.

A radioimmunoassay for neuron specific enolase (NSE), a marker of neuroendocrine differentiation, has been evaluated in small cell lung cancer (SCLC). In untreated patients 25/38 (68%) with localized SCLC had raised blood levels of NSE (greater than 13 ng ml-1), in extensive disease 34/39 (87%) patients had raised NSE levels. In patients with non-small cell lung cancer (NSCLC) the serum levels were raised in 16/94 (17%). In extensive tumours of non-pulmonary origin NSE levels were increased in 24/116 (20%) patients. Longitudinal studies indicated a good correlation between the response to chemotherapy and fall of NSE levels. Tumour progression was accompanied by a rising NSE in 25/29 patients, with doubling times of 7-90 days. In patients with progression with a normal NSE the recurrence was a NSCLC. Cerebral metastases occurring as the only recurrence during clinical complete remission were not accompanied by a rise of NSE. Serum NSE levels provides a valuable monitor for SCLC during and after chemotherapy.

Carcinoma, Small Cell↗
PubMed1983

Effect of oral prednisolone on response to salbutamol and ipratropium bromide aerosols in patients with chronic airflow obstruction.

We examined the bronchodilator responses to inhalation of salbutamol (200 micrograms) and of ipratropium bromide (40 micrograms) in the morning and in the afternoon before and during a course of oral prednisolone (40 mg daily) in 15 patients with chronic, partly reversible airflow obstruction. Bronchodilatation was assessed by measuring serial peak expiratory flow rates (PEFR) for six hours after aerosol drug administration and calculating the area under the time-response curves. Eleven patients were found to be corticosteroid resistant in not attaining a baseline bronchodilatation of at least 25% during corticosteroid treatment. These patients also failed to show any enhancement of their bronchodilator responses to either salbutamol or ipratropium bromide during prednisolone administration. We therefore conclude that there is no rationale for giving or continuing corticosteroid treatment in known steroid-resistant patients in the hope of nevertheless potentiating their bronchodilator responses to salbutamol or ipratropium bromide.

Aerosols↗
PubMed1982

HLA-A, B, C and HLA-DR antigens in extrinsic allergic alveolitis (budgerigar fancier's lung disease).

Twenty-three patients with extrinsic allergic alveolitis due to an allergy to inhaled budgerigar serum protein (budgerigar fancier's lung disease) were typed for HLA-A, B, C and HLA-DR antigens. Antigen frequencies were compared with those found in 154 healthy control subjects. No statistically significant variation in the frequency of any HLA antigen was detected. Exclusion of two patients who had concurrent coeliac disease, and subdivision of the population into those with acute and chronic disease, failed to reveal any significant association with an HLA specificity. A non-significant increase in B8-DR3 amongst the patients with acute disease was noted. Possible reasons for the apparent HLA associations previously reported by others for extrinsic allergic alveolitis are discussed.

Acute Disease↗
PubMed1982

Cytological sampling at fibreoptic bronchoscopy: comparison of catheter aspirates and brush biopsies.

A prospective study was undertaken to compare bronchial brushings with dry catheter aspiration for the cytological diagnosis of lung cancer at fibreoptic bronchoscopy. Duplicate samples taken by aspirate and brush were obtained at 103 consecutive routine bronchoscopies. Aspirate and brush samples were reported on separately by two cytologists. At the end of the study a 30% sample, including the 19 cases with different findings by the two methods, were subjected to a blind crossover review, and then an open review. Forceps biopsy specimens for routine histological assessment were taken in 94 cases (92%). Ninety-eight of 103 (95%) aspirates and 99 of 103 (96%) brush specimens were technically satisfactory. Carcinoma was diagnosed at bronchoscopy on cytological or histological evidence or both in 57 cases. Fifty-five of these tumours (96%) were recognised by either the aspirate or the brush method, 52 (91%) by brush, and 50 (88%) by aspirate. Thirty-four cases (60%) could be diagnosed from histological specimens. The order of cytological sampling did not systematically affect yield. It is concluded that fine-catheter aspirates, permitting smears to be prepared in the laboratory, are a satisfactory alternative to brush smears for the cytological diagnosis of lung cancer at bronchoscopy. The routine use of both techniques at bronchoscopy will increase diagnostic yield by about 5%. Duplicate sampling may be especially useful in obtaining diagnostic material from upper-lobe or apical-segment tumours.

Biopsy↗
PubMed1981

Prophylactic antibiotics for cardiac pacemaker implantation. A prospective trail.

A prospective trial was conducted to assess the value of prophylactic antibiotic treatment in preventing postoperative infection of permanent transvenous pacemaker systems. Four hundred and thirty-one patients were randomly allocated to treatment (234) or no-treatment (197) groups. Treated patients received systemic benzylpenicillin and flucloxacillin just before operation and one and six hours afterwards. Nine primary generator pocket infections occurred without evidence of wound dehiscence or skin erosion. Seven infections were in untreated patients and two in treated patients. Antibiotic prophylaxis diminishes the risk of infection after pacemaker implantations.

Adult↗
PubMed1981

Diurnal variation in airflow obstruction in chronic bronchitis.

Twelve patients fulfilling strict criteria for chronic obstructive bronchitis recorded serial peak expiratory flow rates (PEFR) five times daily for a two-week period. Despite a 9.2% improvement in forced expiratory volume in one second (FEV1) with ipratropium bromide, and an 11.3% improvement with ipratropium bromide plus salbutamol, the inherent diurnal variation in PEFR while on no medication was greater than the improvement caused by either bronchodilator. In the group as a whole, the difference between the highest and the lowest daily PEFR over the two weeks was 24% of the mean daily value. Using cosinor analysis, 10 of the 12 patients showed a significant rhythm in PEFR with a computed mean amplitude between highest and lowest readings of 8.6% of the mean daily value. This is no greater than that found in normal subjects, but is considerably less than the variation in PEFR in patients with bronchial asthma.

Aged↗
PubMed1980

Legionnaires' disease in a transplant unit: isolation of the causative agent from shower baths.

Legionnaires' disease was diagnosed in two patients in a transplant unit, both patients having occupied the same postoperative cubicle shortly before onset of their illnesses. Legionella pneumophila was found in water taken from the cubicle shower bath and from other showers in the unit. To eradicate the legionellae, the water supply was treated with chlorine, but this had only a temporary effect.

Adult↗
PubMed1972

The reflex cardiovascular depression caused by occlusion of the coronary sinus in the dog.

1. Brief occlusions of the outflow from the cannulated coronary sinus in the open chest anaesthetized dog caused a rise in coronary venous pressure, bradycardia, and systemic hypotension.2. The bradycardia and hypotension were directly proportional to the peak systolic coronary venous pressures above a threshold value of about 50 mm Hg.3. The bradycardia, but not the systemic hypotension, was abolished by intravenous atropine. Both responses were abolished by cutting the cervical vagi, and reversibly abolished by cooling them to less than 7 degrees C.4. During occlusions, there was inhibition of activity in single and small multi-fibre preparations of sympathetic efferent nerves in the ansae subclaviae and the cervical sympathetic.5. On the right side, nearly all afferent fibres ran in the recurrent cardiac nerve. There was no concentration of afferents in one cardiac nerve on the left side.6. It was concluded that the cardiovascular depression was reflex, and was caused by the stimulation of nerves or nerve endings in the ventricles of the heart.

Action Potentials↗
PubMed1972

Action potentials from ventricular mechanoreceptors stimulated by occlusion of the coronary sinus in the dog.

1. In experiments to determine the type of intra-cardiac receptors which cause the coronary sinus occlusion reflex, recordings were made from sixty-nine single and small multi-fibre preparations of cardiac vagal afferents in open-chest anaesthetized dogs.2. Thirty-two fibres were stimulated by occlusion of the coronary sinus outflow through an indwelling Morawitz cannula. No receptors were stimulated during occlusions at peak systolic coronary venous pressures below the threshold for reflex cardiovascular depression. At higher pressures, fibre recruitment and further increases in stimulated discharge were demonstrated.3. The afferent endings of twenty-nine of these fibres were mechanically localized to the epicardium and myocardium of the left ventricle. Three were in the right ventricle. Seventeen single fibres discharged spontaneously at an average of 0.9 impulses/sec. There was cardiac modulation of both resting and stimulated discharge, with most action potentials in systole. Seven of eight fibres conducted at less than 1.0 m/sec.4. These ventricular receptors and a further twenty-two otherwise like them but not stimulated by occlusions were designated epi-myocardial receptors.5. 73% of receptors were stimulated by intrapericardial nicotine (50-100 mug). Presumptively superficial receptors were more sensitive to this stimulus.6. Epi-myocardial receptors were stimulated by intravenous or intracoronary catecholamines, by electrical stimulation of cardiac sympathetic nerves, and by eliciting the carotid sinus occlusion reflex. Aortic occlusion stimulated 66% of fibres tested, but was a less effective stimulus. After all these stimuli, there was a systolic modulation of discharge in more than 70% of fibres.7. It was concluded that the epi-myocardial receptors are similar to those previously shown to cause the epicardial chemoreflex, and to participate in the coronary chemoreflex. It is suggested that they are responsive to systolic mechanical changes which are accentuated by catecholamines. Their possible effectiveness in other cardiac reflexes and in initiating circulatory changes at the beginning of exercise and the vasovagal syndrome is discussed.

Action Potentials↗