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Biomedical subjects

M R Pratter

Publications and source records attributed to M R Pratter.

At least 37 records · Page 2Linked to original sources
PubMed1990

The clinical value of pharmacologic bronchoprovocation challenge.

Pharmacologic bronchoprovocation challenge (PBC) can be of considerable clinical value in patients in the pediatric age group and adults because bronchial hyperresponsiveness is present in virtually all symptomatic asthmatics and it can be accurately, reliably, and safely demonstrated by PBC. The principal, proven indication for performing PBC is to rule out or help rule in the diagnostic possibility of asthma as the cause of any unexplained chest complaints in patients with normal or near normal spirometric values.

Asthma↗
PubMed1990

Primary testicular choriocarcinoma with pulmonary metastases presenting as ARDS.

We report a case in which ARDS was the presenting manifestation of testicular choriocarcinoma with numerous metastases to the lungs. We also review the literature on other cases in which ARDS developed as a result of neoplastic infiltration of the lungs and stress the fact that it may be indistinguishable from ARDS from other causes. Because potentially effective chemotherapy for the neoplastic processes most commonly involved (ie, germ cell tumors, acute leukemia and lymphoma) is available, we emphasize the importance of considering a neoplastic disorder in the differential diagnosis of cases of otherwise unexplained ARDS. Early accurate diagnosis could conceivably result in an improved outcome in these cases.

Adult↗
PubMed1989

Chronic cough as the presenting symptom of oculopharyngeal muscular dystrophy.

A patient had chronic, persistent cough as the presenting symptom of the neuromuscular disorder oculopharyngeal dystrophy (OPD). The presence of a significant smoking history initially resulted in the cough incorrectly being attributed to COPD. By using a systematic diagnostic approach, the correct etiology was determined.

Aged↗
PubMed1989

Cause and evaluation of chronic dyspnea in a pulmonary disease clinic.

To test whether, in patients with chronic dyspnea, a diagnostic approach based on objective confirmation of suspected diagnoses would be superior to one based on clinical impression alone, we prospectively studied 85 patients with a primary complaint of dyspnea seen in a pulmonary subspecialty clinic. We achieved 100% success in determining the causes of dyspnea compared with only 66% accuracy based on clinical impression alone. Four groups of disorders, asthma, chronic obstructive pulmonary disease, interstitial lung diseases, and cardiomyopathy accounted for two thirds of the cases. Findings on the history and physical examination were too nonspecific to determine the specific diagnosis. Pulmonary function testing, including a methacholine bronchoprovocation challenge, were the most useful diagnostic tests, particularly for chronic obstructive pulmonary disease and asthma. Chest roentgenogram was most useful for interstitial lung disease, and comprehensive exercise testing for dyspnea due to psychogenic factors or deconditioning. Specific therapy was effective in reducing or eliminating dyspnea in the majority of cases. We conclude that a diagnostic approach to chronic dyspnea based on objective findings and verification, rather than clinical impression alone, will consistently lead to an accurate diagnosis and an improved therapeutic outcome.

Adolescent↗
PubMed1988

Cough and the common cold.

To determine whether the cough of the common cold arises from upper respiratory stimuli and whether antihistamine-decongestant therapy is an effective treatment for this cough, we prospectively evaluated volunteers with uncomplicated common colds in a randomized, double-blind, placebo-controlled study. After completing a standardized questionnaire and undergoing a physical examination, throat-culturing, and pulmonary function testing, subjects took the active drug or identical-appearing placebo for 7 days while they kept a diary in which they ranked the severity of 17 symptoms for 14 days. Pulmonary function testing was repeated, on average, on Days 4, 8, and 14. Forty-six percent of the variation in cough severity could be explained by throat-clearing and 47% of the variation in throat-clearing severity by postnasal drip. FIF50%, the only physiologic parameter that significantly correlated with cough, rose as cough severity fell. Antihistamine-decongestant therapy reduced postnasal drip and significantly decreased the severity of cough, nasal obstruction, nasal discharge, and throat-clearing during the first few days of the common cold. In addition, cough was 20 to 30% less prevalent in the active drug group within 3 days of starting therapy. We conclude that the cough of the common cold arose from upper respiratory tract stimuli and that cough and other cardinal symptoms of the common cold were reduced with antihistamine-decongestant therapy when these symptoms were at their worst.

Adult↗
PubMed1987

The effects of drugs on cough.

The pharmacologic treatment of cough can be divided into two main categories: therapy with controls, prevents or eliminates cough (i.e., antitussive) and therapy that makes cough more effective (i.e., pro-tussive). Definitive antitussive therapy depends on determining the aetiology or operant pathophysiologic mechanism and then initiating specific treatment; it can be almost uniformly successful. Non-specific antitussive therapy is directed at the symptom; it is indicated when definitive therapy cannot be given. For pathologic cough in man, predominantly studied in patients with chronic bronchitis, the following non-specific antitussive drugs have been shown to be effective: aerosolized ipratropium bromide, all narcotics of the phenanthrene alkaloid group (e.g., morphine and codeine), and the non-narcotics, dextromethorphan, glaucine, diphenhydramine, caramiphen, viminol and diviminol. Although studies have shown that hypertonic saline aerosol can improve cough clearance, there are no data, to date, that have convincingly demonstrated this agent or any other pro-tussive drug to be clinically useful.

Antitussive Agents↗
PubMed1987

The clinical implications of bilaterally abnormal impedance plethysmography.

Although impedance plethysmography (IPG) is a test of recognized value in the diagnosis of acute proximal deep venous thrombosis (DVT), its meaning in patients with bilaterally abnormal IPGs is unclear. Consequently, we sought to determine the clinical significance of the bilaterally abnormal IPG in hospitalized patients. In a five-month prospective study, 19% (81/425) of all IPGs done at our institution were bilaterally abnormal (55% of all abnormal IPGs). Acute proximal DVT was found in 26% (14/53) of patients with bilaterally abnormal IPGs who underwent further diagnostic testing. Thirty-five percent of the patients with DVT were found to have either bilateral lower extremity DVT or clots in the inferior vena cava. A numerical score, the venous function index (VFI), was computed for the 101 legs for which further definitive diagnostic evaluations for DVT had been completed. The mean VFI of seven for legs with acute proximal DVT was significantly less than the mean VFI of 13 for legs with no DVT. Fifty percent of legs with a VFI less than or equal to five had DVT, whereas only 7% of legs with a VFI greater than 15 had DVT. The bilaterally abnormal IPG is a common clinical occurrence, is frequently associated with acute DVT, and the VFI is helpful in discriminating legs with acute proximal DVT from normal legs in patients with a bilaterally abnormal IPG.

Adolescent↗
PubMed1985

Airway reactivity and lung function in triiodothyronine-induced thyrotoxicosis.

To evaluate the possible relationship between asthma and hyperthyroidism, airway reactivity and lung function were prospectively compared in healthy volunteers before, during, and after liothyronine (triiodothyronine, T3)-induced hyperthyroidism. Base-line evaluation of the 10 subjects included clinical evaluation, thyroid and pulmonary function tests, and airway reactivity assessed by methacholine inhalational challenge (MIC). All studies were normal. During T3-induced hyperthyroidism, no subject developed respiratory symptoms or changes in pulmonary function or airway reactivity. The mean percent change in forced expiratory volume at 1 s from base line (delta FEV1) of -2.4 +/- 3.0 after MIC was not significantly different from that obtained before T3 administration (-1.4 +/- 1.5, P greater than 0.2). When all serum T3 concentrations and delta FEV1 values before, during and after T3-induced hyperthyroidism were compared, there was no significant correlation. We conclude that T3-induced hyperthyroidism of 3-wk duration has no effect on airway reactivity or lung function in normal volunteers.

Adult↗
PubMed1985

Stability of stored histamine diphosphate solutions. Clinically useful information.

Histamine bronchoprovocation challenge has been shown to be extremely safe and useful as both a clinical diagnostic test and as a research tool in the study of bronchial asthma. Despite its widespread usage, information on the stability of histamine diphosphate (HDP) solutions has been lacking. We therefore studied the stability of HDP solutions as a function of time, concentration, fluorescent light exposure, and sterility. Our results indicated that HDP solutions between 2.76 and 22.10 mg/ml (histamine base, 1 to 8 mg/ml) show no evidence of degradation over a 4-month period when kept at 12 degrees C, unless gas sterilization techniques were used in preparing the solutions bacterial contamination was frequent, and at lower concentrations (i.e., between 0.08 and 0.28 mg/ml) HDP solutions that became contaminated with bacteria showed complete degradation within 9 to 11 wk of their preparation.

Bacteria↗
PubMed1984

Postnasal drip causes cough and is associated with reversible upper airway obstruction.

We prospectively evaluated nine patients with cough from postnasal drip for evidence of extrathoracic upper airway obstruction. Patients compared before treatment to normal control subjects had physiologic evidence of extrathoracic upper airway obstruction; their mean FIF50%/FEF50% and FIF25-75%/FEF25-75% ratios of 0.88 and 0.98 were significantly less than the values in control subjects of 1.28 and 1.37 (p less than 0.001). With specific therapy, postnasal drip decreased, cough disappeared and upper airway obstruction physiologically and physically resolved in all patients. We conclude that: 1) when postnatal drip is causally associated with cough, flow-volume loops can provide objective documentation of this clinical association; 2) flow-volume loops can be used as an objective method in comparing the efficacy of different therapeutic agents for cough due to postnasal drip; and 3) normal predicted values of extrathoracic airway function should not include measurements from patients who have recently recovered from cough associated with postnasal drip.

Adolescent↗
PubMed1983

Diagnosis of bronchial asthma by clinical evaluation. An unreliable method.

To determine the predictive value of wheeze compared to methacholine inhalation challenge (MIC) in diagnosing asthma, we prospectively evaluated 34 patients considered to be difficult diagnostic problems, referred with a history of wheeze. On the basis of MIC results, 12 patients had hyperreactive airways consistent with asthma, while 22 had airways that were no more reactive than those of normal controls. Compared to MIC, a history of wheeze was predictive of hyperreactive airways 35 percent of the time, a prior clinical diagnosis of asthma 62 percent, and scattered monophonic expiratory wheeze 43 percent. We conclude that: (1) a history of wheeze, a prior clinical diagnosis of asthma, and expiratory wheezing on physical examination are much less reliable than MIC in predicting the presence or absence of asthma; (2) these parameters cannot be used as reliable epidemiologic markers for asthma; and (3) the clinical suspicion of asthma should be confirmed by bronchoprovocation challenge or the demonstration by spirometry of reversible expiratory airflow obstruction.

Adolescent↗
PubMed1982

Prediction of tracheobronchial colonization in current cigarette smokers with chronic obstructive bronchitis.

To help in clarifying the conflicting data on the role of tracheobronchial microflora in chronic bronchitis, the tracheobronchial microflora of a homogeneous group of clinically stable patients with chronic obstructive bronchitis was characterized by transtracheal aspiration. Their mean percentage ratio of forced expiratory volume in 1 sec to the forced vital capacity was 45%. The results were that (1) a bacterial tracheobronchial microflora was present in only 50% of the patients, (2) viridans streptococci were the bacteria most frequently isolated, and (3) the presence or absence of a tracheobronchial microflora was significantly associated with the amount of present cigarette smoking. The fact that patients who smoke less than one pack per day were most likely to have a sterile tracheobronchial tree (P=0.015) implied that there was a critical amount of cigarette smoke that impaired the clearance and/or detoxification of bacteria from the tracheobronchial tree and that it must have been persistently present.

Adult↗