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Biomedical subjects

N J Cooke

Publications and source records attributed to N J Cooke.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1986

The diagnosis and treatment of adults with obstructive airways disease in general practice.

Two hundred and one patients diagnosed by their general practitioners as having asthma and 113 as having chronic bronchitis were compared by symptomatology and airways reversibility. Though the majority of patients given these two diagnoses could be separated by symptom complex, in about one-third such differentiation was difficult. There was no significant difference in bronchodilator reversibility between the asthmatics and chronic bronchitics. Nine out of 15 (60%) asthmatics and four out of 18 (22%) chronic bronchitics responded by 15% or more to a course of oral corticosteroid drugs. The majority of corticosteroid responders had been undertreated. The problems arising from the poor correlation between airways reversibility and symptomatic diagnosis are discussed.

Adolescent↗
PubMed1986

Pancoast's syndrome associated with invasive aspergillosis.

The combination of lower brachial plexus root pain in the shoulder and arm and of ipsilateral Horner's syndrome was described by Pancoast in 1932 and is usually caused by a malignant tumour at the apex of the lung. We describe a case in which the syndrome occurred in an immunosuppressed patient and was due to invasive fungal infection.

Adult↗
PubMed1986

Platelet activation during exercise induced asthma: effect of prophylaxis with cromoglycate and salbutamol.

Peak expiratory flow (PEF) and plasma concentrations of platelet factor 4 and beta thromboglobulin were measured before and after exercise in nine asthmatic patients and 12 non-asthmatic volunteers. Exercise was preceded by administration in random order of either placebo, salbutamol 200 micrograms, or sodium cromoglycate 2 mg from a pressurised inhaler. In control subjects there were minimal changes in PEF and plasma concentrations of platelet factor 4 and beta thromboglobulin. In the asthmatic patients the typical changes in PEF were seen on exercise; plasma concentrations of platelet factor 4 and beta thromboglobulin rose significantly in parallel, the rise preceding the fall in PEF. The changes in peak flow and platelet activation induced by exercise were attenuated by prior administration of salbutamol or cromoglycate. These results indicate that exercise induced asthma is associated with a rise in platelet release products similar to that observed in antigen induced asthma.

Adult↗
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

Long term study of the effect of rifampicin and isoniazid on vitamin D metabolism.

Eight patients with tuberculosis were studied before, during and after 9 months treatment with rifampicin and isoniazid to assess the overall effect on vitamin D metabolism. No significant uniform change in either 1,25(OH)2D or 25 OH D nor in any of the other biochemistry measured occurred during the study. It seems unlikely that the combined effects of these drugs causes clinically significant derangement of vitamin D metabolism in patients treated over a 9 month period for tuberculosis.

Adult↗
PubMed1984

The diagnosis of pleural effusions--are cancer markers clinically helpful?

We submitted 83 consecutive patients with pleural effusion to routine clinical investigation; 57 were diagnosed as malignant, 18 as benign, and 8 were not diagnosed. Pleural fluid and serum were analysed for carcinoembryonic antigen (CEA), acid glycoprotein (AGP), antichymotrypsin (ACT), C-reactive protein (CRP), alpha 2-pregnancy associated glycoprotein (alpha 2-PAG) and ferritin. Multivariate discriminant analysis was performed on the results of the protein measurements. CEA and ACT values in serum and fluid were found to give a good discriminating function between the benign and malignant groups. The use of such an analysis, in a clinical context, is discussed.

Adult↗
PubMed1984

Pulmonary infiltrates and adult acute leukaemia: empirical treatment and survival related to the extent of pulmonary radiological disease.

In a retrospective review of 141 consecutive adult patients with acute leukaemia there were 33 local and eight diffuse parenchymal pulmonary abnormalities noted on the first abnormal chest radiograph. Empirical treatment was given without any invasive diagnostic procedures. Twenty of the 41 patients (49%) with radiographic abnormalities died--10 of 31 patients (32%) in the "local" group (excluding two who were not actively treated) and all eight patients in the "diffuse" group. One patient in the local group and six in the diffuse group died within 48 hours of the first abnormal chest radiograph. The results in the local group suggest that failure to respond to the initial treatment prescribed would allow time to perform an invasive procedure in most patients that may lead to a change in management. In the diffuse group, however, an early invasive procedure would be required if the result were to have a chance to influence the outcome.

Adolescent↗
PubMed1984

Recent experience of tuberculosis in junior hospital doctors in Leeds and Bradford.

Over a 2-year period, six cases of active tuberculosis were seen in doctors in two adjacent northern cities. Five patients were junior hospital doctors and three were in close contact with children. Pre-employment screening in four doctors did not take place. Despite screening, two subsequently developed active disease. The advisability and difficulties of screening junior hospital doctors are discussed.

Adult↗
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↗