Biomedical subjects
Publications and source records attributed to N J Cooke.
Severe reactions to oily propyliodone are rare. Side-effects are usually mild and self-limiting. Three cases are reported of early pulmonary reactions, the cause of which may be a chemical pneumonitis or possibly an allergic response to one of the components of the contrast medium. There was a good response to corticosteroid therapy in all three patients.
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Multiple pleural biopsies (up to 10) were taken with the Abrams needle through a single aspiration site in 55 patients with pleural effusions. A definite positive or suggestive pleural biopsy diagnosis was made in 33 patients (60%). In 32 of the 33 patients the pathological abnormality was confined to only a proportion of the biopsies. Pleural biopsies were positive or suggestive in 26 out of 36 patients (72%) eventually shown to have tumour and seven out of eight patients (88%) with tuberculosis. Small pneumothoraces occurred in four patients and surgical emphysema in two.
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This survey of acute asthma admissions points to a number of factors that may be relevant to the continuing asthma mortality at home and in hospital. 1. Complications in hospital occur with increasing frequency with increasing pulse rate, but mortality is low with intensive management. 2 Young patients tend to have the higher pulse rates and greater risk of complications. 3. Many patients with severe asthma do not receive adequate drug treatment, particularly corticosteroids, from their general practitioners before admission to hospital. 4. Many severe attacks of asthma come on quickly and these patients are particularly at risk.
Ten patients with cor pulmonale complicating severe chronic bronchitis and emphysema have been treated with 2 litres/min of oxygen for prolonged periods in the day, at home, over 12 to 62 months. Two patients died after 12 and 36 months of treatment. Pulmonary arterial pressure was reduced in seven patients, and red cell mass in eight, when the oxygen was given for over 15 hours in the day. Hospital inpatient treatment was greatly reduced following the start of long-term oxygen treatment in all patients. This treatment is expensive, and a controlled trial is necessary to establish its definitive place and cost-effectiveness, but the results of such a current Medical Research Council trial will not be available for a further two years.
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The hospital medical records of a patient with chronic lung disease and intractable social problems have been analysed. Multiple admissions resulted in the patient spending nearly three years out of seven and a quarter years in Edinburgh hospitals and in the performance of repeated and ofter unnecessary medical investigations. Such patients are a source of considerable uneconomic expense to the National Health Service, but at present it is difficult to see how their medical and social demands can be met in any other way.
Direct measurements of the factors determining blood oxygen transport in 10 patients with chronic hypoxic respiratory failure led to the conclusion that wide differences in the position of their oxygen binding curves, due to spontaneous differences in red-cell 2, 3-diphosphoglycerate, had little effect on oxygen delivery to the tissues, as assessed by the mixed venous oxygen tension when they were breathing air. This result arises from the shape of the oxygen binding curve. A drug which could shift the curve to the right would help tissue oxygenation in cardiogenic and other forms of shock, when a low cardiac output can not be improved though arterial blood can be well oxygenated.
Three patients with chronic asthma developed pulmonary eosinophilia while oral prednisolone was being withdrawn after the introduction of treatment with beclomethasone dipropionate aerosol. These observations suggest that the development of pulmonary eosinophilia in patients with chronic asthma can be prevented by the systemic administration of corticosteroids, but not by a corticosteroid aerosol given by inhalation. It is considered that radiological examination of the chest should be carried out at frequent intervals during and for a few months after the substitution of corticosteroid aerosol therapy for oral corticosteroid therapy in order to ensure that those patients who are liable to develop pulmonary eosinophilia will be identified at an early stage. These precautions are even more essential when there is a previous history of pulmonary eosinophilia.
The bronchodilator and cardiac effects produced by aerosols of 0.5% salbutamol and 0.5% and 1% rimiterol administered for three minutes in 40% oxygen by intermittent positive-pressure ventilation (I.P.P.V.) were compared in 15 asthmatic patients. Salbutamol and both the concentrations of rimiterol were equipotent in peak bronchodilator effect, but salbutamol had a significantly longer duration of bronchodilator action. There was significantly less increase in heart rate after rimiterol than after salbutamol. Aerosols of 0.5% rimiterol, 0.5% salbutamol, and saline were administered by I.P.P.V. to 10 normal volunteers. There was no difference between the mean heart rates after 0.5% rimiterol and saline but a highly significant increase in mean heart rate was observed after 0.5% salbutamol. It was concluded that 0.5% rimiterol was an effective short-acting bronchodilator drug with little or no cardiac beta(1)-adrenergic activity when administered for three minutes by I.P.P.V. in 40% oxygen.
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Explore the source record for details and available documents.
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Explore the source record for details and available documents.