[Beta 2 agonists: are they dangerous?].
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Adrenergic beta-Agonists↗
Biomedical subjects
P Lange
Publications and source records attributed to P Lange.
The effect of inhaled terbutaline on FEV1, FVC, dyspnoea and walking distance in patients with chronic obstructive lung disease.
This double-blind, placebo-controlled, crossover study was performed to evaluate the effect of terbutaline administered by a turbuhaler on spirometry, walking distance and dyspnoea during exercise in patients with chronic obstructive lung disease (COLD) and to evaluate relationships between changes in spirometry and working indices. The patients had a maximum reversibility in FEV1 of 15% predicted, and to ensure the option of studying correlations between changes in spirometry and working indices in patients with COLD a wide range of reversibility in FVC was ensured. Eighteen patients (M, 12; F, 6; mean age 68.5 years) were included in the trial. Mean baseline FEV1 was 0.921 and FVC 2.081. Six minutes unpaced walking distance on flat ground (WD) and Brog dyspnoea index scale (BS) were used as working indices. Baseline mean WD was 467.9 m, and median BS 3.2. No significant difference was found in the effect of terbutaline compared to placebo on the spirometry findings or WD. However, BS during exercise improved significantly on the terbutaline day. No significant correlation was found between changes in working indices and change in spirometry. Thus, the use of exercise testing and dyspnoea-scoring may reveal patients who benefit from acute bronchodilation without significant improvement in lung function.
Administration, Inhalation↗
Bismuth subsalicylate in the treatment of H2 blocker resistant duodenal ulcers: role of Helicobacter pylori.
Fifty nine patients with Helicobacter pylori positive duodenal ulcers that failed to heal after a six week course of treatment with H2 blockers were randomly assigned to one of the following three regimens: (i) bismuth subsalicylate, 600 mg three times daily (n = 19), (ii) ranitidine, 300 mg at night (n = 20), (iii) bismuth subsalicylate plus ranitidine (n = 20). Cumulative ulcer healing rates after four and eight weeks respectively were as follows: bismuth subsalicylate 74% (14/19) and 95% (18/19), ranitidine 40% (8/20) and 65% (13/20), bismuth subsalicylate plus ranitidine 80% (16/20) and 95% (19/20). Bismuth subsalicylate treatment was better than ranitidine at both four and at eight weeks (p less than 0.05). The clearance rates for H pylori after four weeks were: bismuth subsubsalicylate 58%, ranitidine 0%, bismuth subsalicylate plus ranitidine 55%. After stopping bismuth therapy bacterial recrudescence frequently occurred. After bismuth treatment 86% (19/22) of ulcers had healed if H pylori had been cleared, whereas only 65% (11/17) had healed if H pylori persisted (NS). This study shows that bismuth subsalicylate is more effective in the treatment of resistant duodenal ulcers than standard dose ranitidine. It may be that suppression of H pylori by bismuth subsalicylate promotes ulcer healing.
Bismuth↗
Relationship of the type of tobacco and inhalation pattern to pulmonary and total mortality.
Data from The Copenhagen City Heart Study, a prospective population study, were analysed to investigate the influence of the type of tobacco and inhalation on pulmonary and total mortality. The study sample comprised 6,511 men and 7,703 women, selected randomly after age-stratification from the general population. There were 2,986 plain cigarette smokers, 3,222 filter cigarette smokers, 1,578 smokers of cheroots/cigars, 433 male pipe smokers and 773 subjects smoking more than one type of tobacco. From 1976 until the end of 1989, 2,765 subjects died. Lung cancer was considered as main death cause in 268. Chronic obstructive pulmonary disease (COPD) was considered as the main cause in 94 cases and main or contributory cause of death in 195 cases (COPD related mortality). Current smokers had a higher risk of total mortality compared to lifetime nonsmokers: the relative risks (RR) ranged between 1.2 for male pipe smokers and 2.4 for female plain cigarette smokers. With regard to lung cancer mortality, the RR ranged between 4.1 for male pipe smokers and 7.9 for female plain cigarette smokers. Even higher RR values were estimated for COPD related mortality. In both sexes, the RR for the investigated end-points were lower in cheroot/cigar smokers and in pipe smokers than in cigarette smokers, but these differences were markedly diminished after an adjustment for the inhalation habit. The present study substantiates the view that tobacco smoking increases pulmonary and total mortality. The small differences between the various types of tobacco are probably caused by different inhalation patterns.
Adult↗
The isolated perfused rat liver as an experimental model.
Intrinsic liver function may be specifically studied using the isolated perfused liver system. In this report, the metabolic characteristics of the perfused rat liver are described in response to lactate (5 mM) and ammonia (10 mM) loading. These conditions are analogous to the increased substrate availability that accompanies some acute disease states such as trauma. Glucose production (490 +/- 85 nm/gm liver/min) was constant during a 90-minute perfusion whereas albumin secretion exhibited a biphasic kinetic profile in the absence of exogenous amino acids. Liver oxygen consumption (VO2) was responsive to substrate loading as evidenced by a 20 to 60 per cent initial increase in VO2. The authors conclude that a large portion of hepatic VO2 may normally be directed toward substrate clearance. Additionally, although hepatic secretory protein synthesis persists despite the limitation of nutrient amino acid supply, the kinetics of secretion are complex.
Albumins↗
Development and prognosis of chronic obstructive pulmonary disease with special reference to the role of tobacco smoking. An epidemiologic study.
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Adult↗
[Distal biceps tendon rupture. Therapy and forensic insurance evaluation].
Compared with proximal ruptures of the biceps sinew, distal ruptures of the biceps sinew are extremely rare and generally need operative treatment. However, the large number of different operation techniques described in literature clearly shows that a safe method of treatment has still not been found. In the "Bergmannsheil" Hospital in Gelsenkirchen-Buer, 11 distal ruptures of the biceps sinew in 10 patients were operatively treated during 1985 and 1989. The average age of the patients was 44.6 years. All accidents occurred during physical work. The account of how the accident had happened suggested that accident and injury were related in 8 cases, especially when the findings at operation and the course were also taken into consideration. In 3 cases the rupture of the biceps sinew was not caused by any outward influence. The operative treatment took the form of transosseous reinsertion of the biceps sinew in a modification of Platt's technique in 6 patients; in 1 case the sinew was restored by means of a fascia late strip even though 49 days had passed since the accident. In the course of follow-up examinations we noted a considerable deficit of supination power remaining in the affected lower arm, although the clinical results were good otherwise; we have therefore developed our own method, taking particular account of the essentially more important function of the biceps brachii muscle as a supinator in addition to its flexion function. The method applied is described. At the follow-up examination distinctly better supination power was noted in the 4 patients operated on by this method; the flexibility of the cubital joint was not reduced.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Various types of tobacco smoking and development of chronic obstructive pulmonary disease. Results from the Osterbro study].
On the basis of the Osterbro investigation (Copenhagen City Heart Study) which includes several thousand smokers and non-smokers, the authors have analysed the risk of developing chronic mucus hypersecretion and decrease in forced expiration volume in the first second of expiration (FEV1) in the course of a five-year period in the following groups: non-smokers, smokers of cigarettes without filters, smokers of filter cigarettes, smokers of cigarillos/cigars and pipe smokers. All of the types of tobacco investigated led to increased loss of pulmonary function and to increased risk of development of mucus hypersecretion as compared with non-smokers. The differences between the injurious effects of the types of tobacco were limited and were probably due to different inhalation habits in the various groups of smokers. It is concluded that there is no evidence that change from one type of tobacco (eg cigarettes) to another type (eg pipe or cigar tobacco) will reduce the risk of developing chronic obstructive pulmonary disease unless the change is accompanied by considerable reduction of the tobacco consumption.
Adult↗
[Forced expiratory volume in 1 second (FEV1)--a respiratory physiological measurement of considerable prognostic value].
The epidemiologic literature concerning a relationship between a decreased FEV1 and mortality, morbidity and lung cancer was reviewed FEV1 is a very potent predictor of COPD mortality and morbidity, and of lung cancer. Furthermore, FEV1 is a hitherto largely unrecognized potent predictor of general mortality and cardiovascular mortality and morbidity. The consequence of this knowledge should be a more widespread usage of spirometry, both in epidemiologic studies and in daily clinical practice.
Cardiovascular Diseases↗
[Does smoking increase the degree of wrinkles on the face? The Osterbro study].
In order to illustrate whether there is a connection between smoking and the degree of wrinkles on the face, the authors investigated an age-stratified random sample of 4,485 women and 2,485 men aged 40-69 years. The degree of wrinkles lateral to the canthus of the right eye was described without the investigator being aware of the smoking habits of the individual concerned. For both sexes, the prevalence of deep wrinkles increased with increasing age and with decreasing household income but no significant association with body mass index was demonstrated. In men, a significant association was demonstrated between the cumulated cigarette consumption and the degree of deep wrinkles while this was not the case in women. No definite explanation of this difference between the sexes could be found but a difference in exposure to sunlight and use of face cream may be the reasons.
Adult↗
Mechanical left ventricular support as a bridge to cardiac transplantation in childhood.
The mechanical extrathoracic "Berlin Heart" cardiac assist device was used for left ventricular support in an 8-year-old child of 27 kg body weight. Terminal left ventricular failure and life-threatening ventricular tachyarrhythmias in this child were sequelae of coarctation of the aorta, aortic stenosis and resultant severe left ventricular dilatation, hypokinesia and fibrosis. With the assist device, cardiogenic shock could be reversed. The child was extubated and mobilized during an 8-day waiting period for orthotopic heart transplantation. This case illustrates that the use of ventricular assist devices can be successfully extended to children and may be advantageous compared to other techniques of mechanical circulatory support, such as balloon pumping or extracorporeal membrane oxygenation.
Age Factors↗
Ultrastructural localization of blood group antigen A in normal and neoplastic urothelium.
The subcellular distribution of the blood group antigen A in the transitional epithelium of the urinary tract and its neoplastic growths was studied using transmission immuno-electronmicroscopy. Sixty-five tissue specimens from 50 blood group A1 patients were processed according to an immunogold procedure which was optimized for preservation of both antigen and ultrastructure. The reactions were stronger in the glycocalyx of the luminal surfaces and at the interdigitating cytoplasmic processes of the cells. In the intracellular compartment the reactions were associated with tubulovesicular membrane-bound structures and with the Golgi complexes. Secretory products, intra- or extra-cellular, were also positive. The greatest variability was noted in the cell surface reactions, which were positive in 88% of normal but only 41% of neoplastic urothelial specimens. An inverse correlation was found between malignant behaviour and cell surface, but not intracellular, reactions. We conclude that, in transitional cell carcinomas, there is a quantitative defect in the processing of substance A which affects predominantly the cell surface component and may involve either the transport-insertion steps, the plasma membrane-associated glycosyltransferases or internalization of blood group antigen A.
ABO Blood-Group System↗
The effect of forced expirations on mucociliary clearance in patients with chronic bronchitis and in healthy subjects.
Animal studies have shown that frequent coughing may damage the mucociliary apparatus in flow-limiting segments of the central airways. To determine whether mucociliary clearance in humans is affected by repeated dynamic compression associated with forced expirations, we measured pulmonary deposition and mucociliary clearance for 2 h of inhaled [99Tcm]albumin. The subjects inhaled [99Tcm]albumin on 2 study days (randomized) using (A) slow inspirations and forced expirations, while inhalation using (B) forced inspirations and slow expirations served as control. The study was conducted using 10 patients with chronic hypersecretory/obstructive bronchitis and six normal subjects. We found that inhalation of [99Tcm]albumin by the two manoeuvres (A and B) resulted in similar patterns of aerosol deposition. There was no significant difference in retention of radioactivity in the central lung region at 1 h in the patients with chronic bronchitis after inhalation with manoeuvre A (102%) and with manoeuvre B (91.5%), or in the healthy subjects after manoeuvre A (74%) and manoeuvre B (77%). There was also no difference in the retention at 2 h or in overall mucociliary clearance in any of the groups. We conclude that dynamic compression in the central airways associated with forced expiration does not affect bronchial clearance in the airways of healthy subjects or in patients with chronic bronchitis.
Adolescent↗
Effect of terbutaline on mucociliary clearance in asthmatic and healthy subjects after inhalation from a pressurised inhaler and a dry powder inhaler.
BACKGROUND: beta Agonists have been shown to increase mucociliary clearance in some studies but not all. Whether the formulation of beta agonists affects mucociliary clearance is not known but may be important as the use of dry powder inhalers increases. METHODS: The effect of different methods of administration of inhaled terbutaline on mucociliary clearance and forced expiratory volume in one second (FEV1) was assessed in 10 patients with asthma and 10 healthy subjects. Terbutaline (1 mg) was administered through a metered dose inhaler with a spacer (Nebuhaler) or a dry powder inhaler (Turbuhaler), or both treatments were given, in a four way double blind, double dummy trial. Mucociliary clearance was measured by bronchoscintigraphy. RESULTS: Clearance of radioactivity from the lobar bronchi increased in the asthmatic patients by a median of 32% after terbutaline was given by metered dose inhaler and 55% after a combined dose of 2 mg from both inhalers (1 mg from each) compared with placebo but by only 9% after 1 mg of terbutaline was given by a dry powder inhaler. In the healthy subjects mucociliary clearance increased by 51% when terbutaline was given by a dry powder inhaler, by 66% when given by a metered dose inhaler, and by 66% when given by both inhalers combined. The effect of terbutaline on FEV1 was the same with each of the inhalers. CONCLUSION: Despite similar changes in FEV1 with the two formulations terbutaline increased mucociliary clearance significantly in asthmatic and healthy subjects when inhaled from a metered dose inhaler whereas when it was inhaled from a dry powder inhaler its effect was significant only in healthy subjects. The reason for the difference in asthmatic subjects is unclear, but may be associated with differences in the deposition of terbutaline.
Administration, Inhalation↗
Ventilatory function impairment and risk of cardiovascular death and of fatal or non-fatal myocardial infarction.
The relationship of ventilatory function to cardiovascular events was studied in 12,511 men and women, enrolled in 1976-1978 in a prospective population study. Until the end of 1983, 388 subjects died because of a cardiovascular disease, 133 died within 30 days of developing myocardial infarction (fatal myocardial infarction), while 238 had a non-fatal myocardial infarction. Cox proportional hazards models were employed for the analysis. In the models including tobacco smoking, cholesterol level, blood pressure, diabetes mellitus and body-mass index as covariates, forced expiratory volume in one second in percentage of predicted (FEV1% pred), forced vital capacity in percentage of predicted (FVC% pred), and the ratio between FEV1 and FVC (FEV1/FVC) were significantly related to the risk of cardiovascular death, e.g. compared with subjects with FEV1% pred or FVC% pred greater than or equal to 80 the risk of death from cardiovascular disease among subjects with FEV1% pred or FVC% pred less than 60 was approximately twice as high. There was a nonsignificant trend towards an increased risk of fatal myocardial infarction with reduction of FVC% pred, but in general the regression models did not show consistent relationship between lung function impairment and risk of myocardial infarction. In the regression models, which only included age and sex as covariates, reduced FVC% pred and FEV1% pred were significantly related to both cardiovascular mortality and to fatal myocardial infarction, but not to the non-fatal infarction, whereas the FEV1/FVC ratio was not related to fatal or to non-fatal myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Mechanism of action of ultraviolet irradiation of blood: on the possible role of the anti-oxidative enzyme system].
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Arterial Occlusive Diseases↗
The role of omeprazole (40 mg) in the treatment of gastric Helicobacter pylori infection.
The efficacy of omeprazole in the elimination of Helicobacter pylori was investigated in a prospective randomized-controlled trial. 50 patients with upper gastrointestinal symptoms and chronic active H. pylori-associated gastritis were allocated to one of the following four therapeutic schedules: 1) omeprazole 40 mg/d for 4 weeks (n = 13); 2) bismuth subsalicylate (BSS) 3 x 600 mg for 4 weeks (n = 12); 3) omeprazole plus BSS for 4 weeks (n = 13); 4) triple therapy (BSS for 4 weeks, amoxicillin 3 x 750 mg and metronidazole 3 x 400 mg for 10 days) (n = 12). Clinical symptoms, endoscopic and histologic findings, and H. pylori status were reassessed immediately after therapy, and 1 and 6 months later. After cessation of therapy bacterial clearance rates were: 1) omeprazole 2/13 (15%); 2) BSS 6/12 (50%); 3) omeprazole plus BSS 5/13 (38%); 4) triple therapy 10/12 (83%). The degree of density of gastric mucosal infestation with H. pylori and the degree of activity of gastritis was reduced in all treatment groups but was most prominent after triple therapy. Clinical symptoms improved in all treatment groups. One and six months after completion of therapy H. pylori eradication rates were: 1) omeprazole 0/13 (0%); 2) BSS 1/12 (8%); 3) omeprazole plus BSS 1/13 (8%); 4) triple therapy 10/12 (83%). Our study shows that 40 mg/d omeprazole is ineffective in eradicating H. pylori. Dual therapy with omeprazole and bismuth subsalicylate does not improve bacterial elimination. Only triple therapy effectively eradicates H. pylori.
Adult↗
Quantification of virus-specific antibodies in cerebrospinal fluid and serum: sensitive and specific detection of antibody synthesis in brain.
Specific antibody synthesis in brain could be detected with maximal sensitivity by combining an advanced enzyme immunoassay with a sophisticated evaluation method that involves calculating the ratio between the cerebrospinal fluid (CSF)/serum quotients for specific antibodies (Qspec) and total IgG (QIgG). This Antibody Index (AI = Qspec/QIgG) discriminates between a blood-derived and a pathological, brain-derived specific antibody fraction in CSF and takes into account individual changes in blood/CSF barrier function. For local synthesis of polyclonal IgG in the central nervous system (QIgG greater than QLim), we propose the correction AI = Qspec/QLim (QLim represents that IgG fraction in CSF originating only from blood, calculated from the individual albumin quotient of a single patient). The normal reference range for the AI was between 0.7 and 1.3 (n = 250 control patients for each antibody species). Values of AI greater than or equal to 1.5 indicated a local specific antibody synthesis in the central nervous system. Sensitivity and precision were greatest if we analyzed the virus-specific antibodies in CSF and serum simultaneously with an enzyme immunoassay in continuous concentrations (arbitrary units) instead of titer steps. We have applied the method successfully to antibodies to measles, rubella, herpes simplex, varicella-zoster, human immunodeficiency virus (HIV), and cytomegalovirus, and to anti-Toxoplasma or -Borrelia antibodies. Clinical relevance is demonstrated for an acute zoster virus infection (monospecific response), chronic diseases such as HIV encephalitis with acute opportunistic Toxoplasma infection, and multiple sclerosis (secondary polyspecific response).
Antibodies, Viral↗