Fever of unknown origin: a prospective study of 100 patients.
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Biomedical subjects
Publications and source records attributed to P Howard.
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In a study of 106 predominantly young, lower-social-class men participating in a methadone maintenance program, the authors found that about one-third were moderately to severely depressed as assessed on standard rating scales of depression. The depressive symptoms were associated with a decrease in social functioning, increase in stress in the past 6 months, and a history of alcohol abuse. Because the combination of depression and drug addiction creates a high risk for suicide, depressive symptoms require early detection and treatment. The authors point to the need for more research on treatment approaches, particularly the use of psychotropic drugs.
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Vasoconstriction occuring a unventilated or hypoxic lung was studied in dogs and cats to elucidate mechanisms which both cause and reverse it. Lungs were perfused in vivo at constant pressure or constant blood flow; alternatively blood flow and pressure were measured with minimal operative interference. Stimulus-response curves of lung vessels to hypoxia showed a large response within the physiological range of P02 values. Vasoconstriction in unventilated lung caused by bronchial occlusion sometimes matched that caused by an equal degree of ventilation hypoxia but was sometimes greater. Responses to both stimuli varied widely between animals and in one animal at different times. This could be due to variable availability of a transmitter or variable presence of vasodilator substances. Both histamine and beta-adrenoreceptor stimulants caused pulmonary vasodilatation in unventilated lung. Histamine caused pulmonary vasoconstriction and vasodilatation in different circumstances which could be blocked respectively by H1 and H2 antihistamine drugs. Potent alpha- and beta-adrenoreceptor action on pulmonary vessels was demonstrated in both species. Alpha-adrenoreceptor blocking drugs caused dilatation and beta-adrenoreceptor blocking drugs caused vasoconstriction. The possible role of histamine and catecholamines in causing or reversing hypoxic vasoconstriction or in maintaining pulmonary vascular tone is discussed.
The mixed cell agglutination reaction was studied in 22 patients with stage A transitional cell bladder tumors. The absence of antigens on the original tumor was found to correlate with development of invasive cancer on followup. The presence of antigens on the original tumor correlated with failure to develop stage B or greater disease within 5 to 14 years of followup.
1. Body weight was measured through forty consecutive illnesses in seventeen patients with oedema in association with chronic bronchitis and hypoxia. All patients were taking diuretic drugs at the time. 2. Body weight increased little as peripheral oedema and a raised jugular venous pressure appeared. The subsequent weight-loss during treatment was usually greater than the pre-treatment weight-gain. Body weight increased slowly in convalescence to equal or exceed hospital admission weight without a deterioration of general health or reappearance of oedema. 3. Total body water, exchangeable sodium and exchangeable potassium were measured in patients after treatment of the acute illness and clearance of oedema and again in six patients of the group 2-3 months later in convalescence. Total exchangeable sodium was normal or slightly reduced after treatment of oedema and in convalescence between recurrent acute illnesses. Even when gross oedema was present exchangeable sodium was substantially increased in only one of three patients studied at this stage. Total exchangeable potassium was invariably severely depressed. 4. Large changes of body tissue weight without comparable change in exchangeable sodium support previous evidence that oedema in hypoxic bronchitis is not simply a further form of congestive cardiac failure. 5. It is suggested that at least some of the tissue loss in acute exacerbations is a direct result of hypoxaemia and similar to that observed at high altitude. Part of the oedema fluid is thought to be derived from intracellular water released during dissolution of tissue matrix.
A total of 178 patients with obstructive airways disease were studied between 1966 and 1972, a period which followed a substantial fall in atmospheric pollution in Sheffield. Compared with patients from an earlier study of the same age and smoking habits they had less productive cough, fewer winter illnesses, less severe breathlessness, and only one-third of the rate of decline of forced expiratory volume (FEV). The analysis of the change in the annual loss of FEV was complicated. There were virtually no sudden steep falls of respiratory function, and patients with very low values of FEV survived for long periods. The predominant cause of death was cor pulmonale.Chronic hypoxia may be more of a problem in the next few years than bronchial infection. I believe that the clean air policy has effected an improvement and that the nature of chronic bronchitis with severe obstructive airways disease is changing, but further studies will be needed to confirm this.
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