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Biomedical subjects

M Greenstone

Publications and source records attributed to M Greenstone.

At least 37 records · Page 2Linked to original sources
PubMed1998

How long should Atrovent be given in acute asthma?

BACKGROUND: In acute asthma the optimal duration of treatment with combination beta agonist and anticholinergic nebuliser solutions is unknown; most studies have investigated single doses or treatment for up to 12 hours. To determine whether longer treatment with ipratropium bromide might aid recovery a study was undertaken in 106 patients with acute asthma. METHODS: A double blind, randomised, placebo controlled, three group study was performed with all patients receiving ipratropium for 12 hours and salbutamol for 60 hours after admission (both nebulised four hourly), systemic steroids and, if necessary, theophylline. At 12 hours ipratropium was stopped in group I (n = 35) but was continued in the other two groups, and at 36 hours ipratropium was also stopped in group II (n = 35) while patients in group III (n = 36) continued with ipratropium for 60 hours. Spirometric tests were performed before and after salbutamol, and again 30 and 60 minutes after ipratropium or placebo at 12, 36 and 60 hours. Peak flow rates (PEFR) were measured before and after each nebulisation. RESULTS: There were no differences between the groups in PEFR on admission (group I: 214 l/min, group II: 198 l/min, group III: 221 l/min), or mean forced expiratory volume in one second (FEV1) at 12 hours (group I: 1.81, group II: 2.01, group III: 2.21), 36 hours (group I: 2.11, group II: 2.31, group III: 2.41), or at 60 hours (group I: 2.21, group II: 2.31, group III 2.51). Despite this, median time to discharge was significantly higher for patients in group I (5.4 days) than for those in groups II (4.1 days) and III (4.0 days). CONCLUSIONS: Combination nebulised therapy can be continued beyond 12 hours and up to 36 hours after admission with improved recovery time. Lung function testing may not reflect the full benefit of treatment.

Acute Disease↗
PubMed1988

Efficacy of "mucoregulatory" agents in Young's syndrome.

Eight patients with Young's syndrome were treated with four "mucoregulatory" agents for eight weeks in a randomised, open crossover study. There was no improvement in tracheobronchial clearance, pulmonary function, or sperm count.

Adult↗
PubMed1988

Primary ciliary dyskinesia: cytological and clinical features.

Thirty patients with functional and/or morphological abnormalities of respiratory tract cilia were identified. The diagnosis of primary ciliary dyskinesia was based on observed abnormalities of ciliary ultrastructure or beating in vitro (beat pattern, beat frequency or percentage of motile cilia). Beat frequency and motility indices approached the normal range in some cases and suggests that the term 'immotile cilia syndrome' is not appropriate. Morphological abnormalities were most commonly due to deficiency of dynein arms, affecting the outer arms (n = 7), inner arms (n = 3) or both (n = 10). Examples of radial spoke and microtubular defects were also identified but in seven subjects ciliary ultrastructure was normal. In six patients paired samples of nasal and bronchial cilia were obtained and showed consistent abnormalities of motility and ultrastructure. Adenosine triphosphate and adenosine triphosphatase did not restore in vitro motility when added to dynein deficient cilia. The clinical picture was of life-long sinusitis and recurrent bronchial infection but the spectrum was broader than that encompassed by Kartagener's triad (dextrocardia, sinusitis and bronchiectasis). Fourteen patients had normal cardiac situs and definite or highly suggestive evidence of bronchiectasis was present in only 17 patients. Radiological evidence of sinusitis was common but absence of frontal sinuses was not universal. Chronic serous otitis media was a frequent finding but deafness was rarely profound. Fertility problems were common but were not universal in female subjects. Lung function testing revealed evidence of airflow obstruction but this was mild in most cases.

Adenosine Triphosphatases↗
PubMed1987

Effect of high dose inhaled beclomethasone dipropionate on carbohydrate and lipid metabolism in normal subjects.

The metabolic effects of four weeks' high dose inhaled beclomethasone dipropionate (500 micrograms twice daily) were studied in nine normal subjects with an open study design. No effect was found on fasting blood glucose concentration or glycosylated haemoglobin concentration. Peak blood glucose concentration 30 minutes after a 75 g oral glucose load was, however, significantly higher (7.1 (SEM 0.2) versus 6.7 (0.1) mmol/l, or 128 (3.6) v 121 (1.8) mg/100 ml). After treatment there was a 36% increase in fasting serum insulin concentration (7.6 (0.7) versus 5.6 (0.5) mU/l) and a 32% increase in the area under the serum insulin concentration curve after glucose challenge. High dose inhaled beclomethasone dipropionate treatment raised the fasting plasma cholesterol concentration (4.62 (0.25) v 4.16 (0.26) mmol/l, or 178 (9.7) v 161 (10.0) mg/100 ml) and high density lipoprotein cholesterol (1.19 (0.065) versus 0.97 (0.065) mmol/l, or 45 (2.5) v 37 (2.5) mg/100 ml). Fasting blood lactate and pyruvate concentrations were also significantly higher and blood glycerol lower. The findings indicate that high dose inhaled beclomethasone dipropionate may disturb both carbohydrate and lipid metabolism.

Administration, Inhalation↗
PubMed1987

Deleterious effects of purulent sputum sol on human ciliary function in vitro: at least two factors identified.

Patients with chronic bronchial sepsis have impaired mucociliary clearance. A study was carried out on the effect of sputum sol (obtained by rapid centrifugation of purulent sputum) from 20 patients with chronic bronchial sepsis on the beating of human nasal cilia in vitro by a photometric technique. Thirteen sols caused significant (p less than 0.001) ciliary slowing. Two patterns of slowing were observed: firstly, a gradual onset associated with epithelial disruption (inhibited by alpha 1 antiprotease) and, secondly, an immediate onset associated with ciliary dyskinesia and ciliostasis (inhibited by chloroform extraction). The ciliary slowing activity of sputum sols was associated with the isolation of Pseudomonas aeruginosa (p less than 0.01). It is concluded that purulent sputum contains at least two factors that impair ciliary beating--one a serine protease, which is probably a product released by the host's phagocytic defences, and the other, which is chloroform extractable and probably a bacterial product.

Bronchiectasis↗
PubMed1986

Delayed onset of polymyalgia in polymyalgia rheumatica.

Four female patients presenting with systemic symptoms of polymyalgia rheumatica are described. They suddenly developed classical girdle pains up to a year after the onset of severe systemic symptoms, a course not often emphasized.

Aged↗
PubMed1983

A nose clinic: initial results.

A Nose Clinic, run jointly by an ENT surgeon and a chest physician, has been established to consider the relationship between diseases affecting the upper and lower parts of the respiratory tract and the contribution of malfunctioning respiratory defence mechanisms to such disease. The logistics of the clinic are described. Initial results suggest that mucociliary clearance abnormalities, immunity deficiencies and secondary infection in allergic rhinitis underlie a number of conditions presenting to ENT clinics. It is proposed that investigation of such patients leads to a better understanding of the pathogenesis of these conditions and, hence, a more logical approach to both medical and surgical treatment. It is suggested that early recognition and treatment of such underlying abnormalities may avoid irreversible damage.

Adult↗