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Biomedical subjects

M F Sudlow

Publications and source records attributed to M F Sudlow.

At least 19 recordsLinked to original sources
PubMed1998

The management of pulmonary tuberculosis in adults notified in Scotland in 1993.

The management of pulmonary tuberculosis (TB) in Scotland in 1993 was studied by asking the physicians responsible for all 321 adult cases of the disease notified that year to complete a standardized questionnaire relating to drug treatment and bacteriology. The response rate to the questionnaire was 100%. Isoniazid and rifampicin were used together in initial therapy in 98.4% of cases, while pyrazinamide was prescribed in 90.3% of cases, broadly in keeping with existing treatment guidelines. However, considerable variability was observed both in the drug regimens employed, and in the duration of initial and continuation phases of chemotherapy. Treatment regimens were therefore frequently at variance with published recommendations. Among patients prescribed drug regimens other than those recommended satisfactory completion of therapy was less common. Microbiological confirmation was provided for 84% of cases in which clinical samples were submitted. However, in approximately 11% of cases, no clinical samples were submitted. Closer adherence to existing treatment guidelines and more rigorous pursuit of microbiological confirmation should further improve the overall management of pulmonary TB in Scotland.

Adolescent↗
PubMed1996

Adenocarcinoma of the lung--clinical features and survival.

Four thousand patients were registered by the Edinburgh Lung Cancer Group in 1981-1987; 9.5% had adenocarcinoma. Of these, 102 patients with pathological confirmation of the diagnosis, presenting to one hospital group in Edinburgh, were reviewed. Two cases were excluded after case note review. Of the remaining 100, 64 were male and 36 were female, with a mean age of 73 years. The majority (89%) were smokers or ex-smokers, and 52% had a poor performance status (Karnofsky Index 10-70). Significantly, more adenocarcinoma patients underwent surgery compared to other cell types (39 vs. 19%, P < 0.01), and less were treated with radiotherapy (19 vs. 31%). The 5-yr survival rate for the adenocarcinoma patients was 19 vs. 7% in the remainder of patients. Of 39 patients referred for surgery, 37 had lung resections and their 5-yr survival rate was 42%. Post-operative staging showed 48% in Stage I, 27% in Stage II and 24% in Stage III. The majority of the long-term survivors had Stage I disease (64%). Forty-two percent of the patients received palliative therapy alone (all died within 10 months). Ten percent of patients receiving radiotherapy survived for 5 yr. Review of these cases suggested two patterns of presentations: (1) patients with poor performance status, extensive disease and often pleural involvement (16%); and (2) patients with more localized disease (39%), many of whom were suitable for surgical resection with surprisingly good prognosis.

Adenocarcinoma↗
PubMed1994

Deficiencies of management of spontaneous pneumothoraces.

In a retrospective, case-note based, audit of the initial management of spontaneous pneumothoraces in a large teaching hospital, 38 events were identified in 37 patients admitted over 12 months to the end of September 1991. The initial management was intercostal tube drainage in 21 (55%), decided upon by middle grade staff, with a cost in terms of the duration of hospitalisation (median 7 (range 2-18) days), chest radiography (6 (3-10) films) and potential for complications including infections (3 wound, 2 chest). Aspiration was performed in only three cases, the remainder were managed by observation. We suggest that undue reliance is placed upon intercostal tube drainage to treat spontaneous pneumothoraces with aspiration alone performed too infrequently. Moreover, other deficiencies in management including the practise of drain clamping and incomplete follow-up were identified.

Adolescent↗
PubMed1992

Lung cancer in young patients.

During 1981-1986 the Edinburgh Lung Cancer Group prespectively registered 3560 new patients with lung cancer of whom only 48 (1.3%) were aged less than 45 years. When compared with 3512 older patients aged more than 45 years, a similar proportion of young patients were female (17/48; 35% vs. 28% of the older patients) and had equally advanced disease (30/48; 62% vs. 58% in stage III). Slightly more young patients were in better Karnofsky performance status groups (28/48; 59% vs. 45%, score > 80) and duration of symptoms was considerably shorter (median 45 vs. 93 days); only three of the younger patients were non-smokers. A pathological diagnosis was obtained more often in young patients (47/48; 98% vs. 81%). The commonest cell type was small cell (16/48; 34% vs. 24%) with 10/48 adenocarcinoma (20% vs. 13%) and less squamous carcinoma (11/48; 23% vs. 48%). Although only 12/48 young patients (25% vs. 19%) underwent surgical resection, six of these were still alive after 5 years (50% vs. 30% in older patients). More young patients received chemotherapy either alone (14) or combined with radiotherapy (6)--42% vs. 16% in older patients. There were no long-term survivors and the median survival was 8 months in 13 patients with small cell and only 4 months in seven with non-small cell carcinoma.

Adenocarcinoma↗
PubMed1992

Factors affecting asthma mortality in Scotland.

Asthma mortality in the age group 5-44 years appeared to be stable in Scotland in both males and females at a rate of approximately 1.0 per 100,000 during the period 1970-1988 despite an increase in the hospital discharge rate for asthma of approximately 4% per annum during that period. Two-thirds of these deaths occurred outside hospital. There was evidence of a seasonal variation in asthma deaths with a peak mortality occurring in August, four to six weeks after the peak in total pollen counts. Monthly variation in atmospheric pollution did not appear to account for the variation in asthma mortality. It is suggested that the seasonal variation in asthma mortality provides a basis for further studies to elucidate the factors contributing to these deaths.

Adolescent↗
PubMed1991

Extent of pulmonary emphysema in man and its relation to the loss of elastic recoil.

1. We assessed lung density, determined by computerized tomography, as a measure of emphysema and related this to lung function and measurement of the elastic recoil of the lung in normal subjects and patients with chronic obstructive lung disease. 2. We found a significant correlation between measurements of elastic recoil pressure at 90% of total lung capacity and both the forced expiratory volume in 1 s (r = 0.80, P less than 0.001) and the transfer factor for carbon monoxide (r = 0.70, P less than 0.001). Measurements of elastic recoil of the lung also correlated with lung density as measured by computerized tomography scanning (P less than 0.001). 3. Multiple regression analysis demonstrated a correlation between the density of the lowest fifth percentile of the computerized tomography lung-density histogram, and both the natural logarithm of the shape parameter of the pressure-volume curve (P less than 0.01), and the transfer factor for carbon monoxide (P less than 0.01). However, the mean computerized tomography lung density correlated, in addition, with the elastic recoil pressure of the lungs at 90% of total lung capacity (P less than 0.001). 4. Since the elastic recoil pressure correlates with computerized tomography lung density, and hence with emphysema, and since elastic recoil pressure also correlates with the forced expiratory volume in 1 s, these results suggest that loss of elastic recoil is one determinant of airflow limitation in patients with chronic obstructive lung disease.

Adult↗
PubMed1991

Lung cancer in lifelong non-smokers. Edinburgh Lung Cancer Group.

The Edinburgh Lung Cancer Group registered 3070 new patients with lung cancer in the five years 1981-5 from a catchment population of 950,000. After review only 74 (2%) were classified as lifelong non-smokers. They differed significantly from the 2996 smokers with lung cancer in that far more were female (77% v 26%) and their mean age was higher (75.4 v 68.0 years). More were in the worst Karnofsky performance categories and fewer patients underwent surgery. The stages of disease were similarly distributed in the two groups and the five year survival was equally poor (5%). Histological cell type was determined in 59 of the 74 patients. All histological cell types were present. More non-smokers had adenocarcinoma than smokers (42% v 13%) and fewer had squamous cell carcinoma (32% v 49%) or small cell carcinoma (15% v 24%). Lung cancer in lifelong non-smokers is uncommon and the diagnosis should therefore always be questioned.

Adenocarcinoma↗
PubMed1991

Vindesine and etoposide chemotherapy in the management of patients with small cell lung cancer and poor prognosis.

Twenty-five patients with histologically proven small cell lung cancer who were in too poor physical condition to receive 'aggressive' chemotherapy were treated with vindesine and etoposide (VE). The median survival was 195 days, and there were 4 survivors of greater than 460 days. Eight patients died before the second pulse of chemotherapy, and these all had a Karnofsky score of less than or equal to 20 at diagnosis. Toxicity of the chemotherapy regimen was minimal, and the results suggest that VE chemotherapy may be suitable for the treatment of patients with small cell lung cancer who are unsuitable for more toxic chemotherapy.

Administration, Oral↗
PubMed1990

A new method of analysing pulmonary quasi-static pressure-volume curves in normal subjects and in patients with chronic airflow obstruction.

1. Exponential analysis of lung pressure-volume curves is used to deal with the non-linearity of the pressure-volume relationship. A major problem of this procedure is to define the lower volume limit for exponential curve fitting. 2. In 12 healthy subjects and 24 patients with chronic airflow obstruction, a cubic function was fitted to the quasi-static pressure-volume curves to define an inflection point. 3. The exponential function of Colebatch et al. (Colebatch, H.J.H., Ng, C.K.Y. & Nikov, N.J. Applied Physiol. 1979; 46, 387-93) was then fitted to the data for volumes above the inflection point. 4. Exponential analysis with a cubic determination of an inflection point provides an objective way to describe the elastic properties of the human lungs in vivo.

Adult↗
PubMed1990

Performance and prognosis in patients with lung cancer. The Edinburgh Lung Cancer Group.

The Edinburgh Lung Cancer Group prospectively registered 651 new patients presenting with lung cancer during 1981; only 47 survived five years (7%). The survival rate was highest in patients selected for surgery (35/116, 30%) and in this group was related to cell type, stage of disease, and possibly to Karnofsky performance score (not statistically significant). By comparison with non-surgical patients these 116 patients undergoing surgery were highly selected in terms of age, favourable histological type, stage of disease, and performance score. Forty-two of the 535 non-surgical patients were given radical radiotherapy alone and seven (17%) survived five years. The remaining 493 received palliative radiotherapy, chemotherapy (alone or combined with radiotherapy), or symptomatic treatment alone; only five (1%) survived five years. Median survival was related to cell type (adenocarcinoma 2.6 months, squamous cell carcinoma 6.2 months), stage (stage I 8.5 months, stage III 4 months), and Karnofsky performance index (greater than or equal to 90 9.3 months, less than or equal to 50 1.2 months). Age and sex had no independent prognostic value in any group. Performance score was highly correlated with stage (and age) and in this study represented the "best prognostic factor" in clinical practice.

Adenocarcinoma↗
PubMed1987

Effect on spirometry of distilled water and cromoglycate solutions nebulised by a small portable ultrasonic nebuliser.

The airway response to inhaled ultrasonically nebulised distilled water and three disodium cromoglycate solutions (DSCG in distilled water, normal saline and buffered saline) produced by a small portable nebuliser was determined by spirometry in 12 stable adult asthmatics in a double-blind trial. The mean percentage falls in forced expiratory volume in 1s (FEV1) were 13.4% following distilled water, 5.6% following DSCG in distilled water, 4.8% following DSCG in normal saline, 6.9% after DSCG in buffered saline. The fall in FEV1 was significantly greater (p less than 0.01) after distilled water than after all DSCG solutions with no significant difference between the DSCG solutions. Coughing was also greater during inhalation of nebulised distilled water than during inhalation of nebulised DSCG solutions (p less than 0.01).

Adult↗
PubMed1986

Pneumonia.

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Anti-Bacterial Agents↗
PubMed1983

The dependence of maximal flow in man on the airway gas physical properties.

The changes in maximum expiratory flow rates after washing out lung air with a helium/oxygen mixture (He/O2, 80 : 20) were measured in 24 patients with chronic irreversible airflow obstruction (FEV1 1.77 +/- SD 0.39 litres; FVC 3.62 +/- 0.59 litres), and in six normal subjects. The percentage increase in flow breathing He/O2 was variable; however, it was similar in normal subjects and in patients with airflow obstruction, and in both groups decreased at low lung volumes. Contrary to previous studies, only three patients with chronic airflow obstruction failed consistently to increase flow rates by greater than or equal to 20% when breathing He/O2 at all lung volumes measured. In six normal subjects and 12 patients with chronic airflow obstruction airway gas viscosity was increased by breathing a neon/oxygen mixture (Ne/O2, 80 : 20). The response to Ne/O2 was again variable (normal subjects delta Vmax.40 4 +/- SD 14%; patients delta Vmax.40 18 +/- 8%). Only two normal subjects and one patient with airflow obstruction consistently reduced their flow rates when breathing Ne/O2. These results indicate either that there is no difference in the distribution of airflow resistance in normal subjects and in patients with chronic airflow obstruction, or that density as well as viscosity is an important determinant of flow in very small airways. In either case, He/O2 breathing is not a good discriminator of the site of airflow obstruction.

Adult↗
PubMed1983

Treatment of small cell carcinoma of the bronchus by combined chemotherapy--clinicopathological correlation with response.

Thirty-seven consecutive patients, referred to a respiratory unit with a histological diagnosis of small cell carcinoma of the bronchus, were treated with a combined chemotherapy regime of adriamycin, vincristine and cyclophosphamide. Palliative radiotherapy was given for the control of symptoms. Thirty of 37 patients responded to treatment, 11/37 having a complete and 19/37 a partial response. The median survival of those patients with a complete response was 55 weeks, significantly higher (P less than 0.01) than either those with partial or no response to treatment. Those patients with limited disease survived longer. A high proportion of patients relapsed at the primary site of the tumour in the lungs. The relationship between the therapeutic response and the histological subtype of small cell carcinoma suffered from the limitations of the available pathological material. However, more of the patients with a complete response were of the lymphocytic-like pattern of small cell carcinoma. Useful survival in these patients with inoperable small cell carcinoma was achieved using this regime of chemotherapy, even in those patients with extensive disease, five of whom had survived for over one year.

Adult↗
PubMed1982

Effects of inhalation of beta-sympathomimetic and atropine-like drugs on airway calibre in normal subjects.

1. Bronchodilatation was produced in eight normal subjects by inhalation, on separate occasions, of the atropine-like drug ipratropium bromide (0.16 mg by pressurized inhaler; 1 mg nebulized) and the beta 2-sympathomimetic salbutamol (0.8 mg by pressurized inhaler; 5 mg nebulized). 2. Mean specific airways conductance (sGaw) increased from a mean value of 0.185 +/- SE 0.002 to 0.292 +/- 0.023 s-1 kPa-1 after ipratropium bromide, and from 0.184 +/- 0.020 to 0.303 +/- 0.026 s-1 kPa-1 after salbutamol. These increases in sGaw were not significantly different from each other. 3. During both maximal and partial expiratory flow volume manoeuvres similar increases in flow rates were produced by each drug, at all lung volumes, from 40 to 20% of vital capacity. 4. Changes in maximal and partial flow volume curves after washout of lung air with helium/oxygen (4:1) were measured before and after each drug. Flow rates increased in all subjects and the percentage increase in maximum flow when helium was breathed was not significantly different, when repeated after each drug. 5. Thus our results suggest that salbutamol and ipratropium have similar sites of action, both affecting both large and small airways, and produce similar degrees of bronchodilatation. This is supported by our results after the helium/oxygen breathing, where the lack of change in density dependence of maximal flow suggests that there was no change in the distribution of airways resistance after the drugs.

Adult↗