Biomedical subjects
S Godfrey
Publications and source records attributed to S Godfrey.
Unilateral lung disease detected by radioisotopic scanning in children thought to have asthma.
The clinical courses of three children are described. They were initially thought to have troublesome asthma alone or in association with other diseases. The children had radioactive gas lung scans using 13N for studies of ventilation and perfusion which in each case revealed one entirely healthy lung and one disordered lung. The technique of 13N gamma scanning is described and its clinical value in such patients is discussed.
Fibrosing alveolitis.
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Asthma and athletic performance.
Exercise-induced asthma (EIA) is a manifestation of bronchial hyper-reactivity that poses a special problem for the asthmatic engaging in competitive and recreational sports. Recent Olympic successes by swimmers with asthma are not surprising in view of the lessened asthmogenicity of swimming. Neither the cause of EIA nor the reason why some forms of exercise have a greater propensity to provoke EIA is known. Preexercise prophylactic medication with selective beta 2-sympathomimetic agents or cromolyn sodium will reduce or abolish EIA in the majority of asthmatics if administered just before the event. Other agents are less effective or as yet not fully evaluated. With suitable control of exercise-induced asthma, asthmatics should not be unnecessarily restricted, and competitive sports or physical recreation can then occupy an identical role in their lives as it does for their non-asthmatic contemporaries.
Letter: Clinical use of an indwelling umbilical-artery electrode.
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Letter: Inhalation technique in treatment of asthmatic children with steroid aerosols.
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Pulmonary eosinophilic gramuloma in a child.
The occurrence of pulmonary eosinophilic granuloma in a 3-year-old child is described. She presented with a pneumothorax and typical radiological changes and the diagnosis was confirmed by lung biopsy. There was no objective evidence of improvement after radiotherapy when lung function was assessed by gamma scans. She died suddenly while abroad.
Inhibition of exercise-induced asthma by different pharmacological pathways.
Exercise-induced asthma (EIA) was provoked by standardized treadmill running for 6 minutes in 15 asthmatic children. The tests were carried out after the administration of a placebo, salbutamol, sodium cromoglycate, choline theophyllinate, and atrophine methonitrate aerosol in randomized fashion on different days. The mean post-exercise percent fall in peak expiratory flow rate was 45-2, 4-1, 19-6, 18-3, and 24-9 respectively. The proportion of children having significant amelioration of their EIA compared with those taking the placebo was 100% for salbutamol, 80% for cromoglycate and theophyllinate, and 60% for atropine. Salbutamol, choline theophyllinate, and atropine were bronchodilators at rest whereas cromoglycate was not, and the ability to suppress EIA was unrelated to bronchodilator effect. Even after bronchodilatation at rest, further broncho-dilatation occurred during the exercise period.
Estimation of cardiac output by an N2O rebreathing method in adults and children.
A nitrous oxide rebreathing method was used to measure recirculation time and cardiac output (as pulmonary blood flow) in adults and children during exercise. The method was compared with the indirect (CO2) Fick rebreathing method in almost simultaneous measurements of cardiac output. Recirculation time varied from about 15 s at rest to 8.5 s at high levels of exercise, and was slightly longer in children than adults. Cardiac output estimated by both methods was within the normal range for children and adults, being lower for a given oxygen consumption in children. For the adults the mean intrasubject variability of the N2O rebreathing method, measured as the coefficient of variation of cardiac output, was in the range of 6-8% at all levels of work. This was lower than reported for other N2O rebreathing methods, and similar to values based on the indirect (CO2) Fick, direct (O2) Fick, and dye-dilution methods of estimating cardiac output. The method is therefore proposed as a noninvasive technique suitable for rapid, accurate, and reproducible measurements of cardiac output.
The role of artificial ventilation, oxygen, and CPAP in the pathogenesis of lung damage in neonates: assessment by serial measurements of lung function.
Lung volume, airway resistance, and compliance have been measured in 19 infants, 18 of whom suffered from the respiratory distress syndrome (RDS) at birth, while the remaining infant was ventilated for persistent apnea and a pneumothorax. Prior to discharge from the neonatal unit, and after recovery from RDS, most infants were found to have essentially normal lung function. When retested between 4 and 11 months of age, every infant who had received artificial ventilation during the acute illness was found to have developed a raised airway resistance, whereas the remaining infants, who had been treated with continuous positive airway pressure and/or oxygen were all entirely normal. The implications of these results for the management of RDS are discussed.
Exercise-induced asthma.
A review of exercise-induced asthma is presented which describes work that has been carried out by the authors and by other investigators over recent years. The effect of exericse on lung function in asthmatic and normal subjects is compared. The influence of the type and severity of exercise on the response of the asthmatic is noted and the importance this has for interpretation of results. The effects of various drugs on exercise-induced asthma are considered in some detail. The clinical implications of the results of exercise tests in asthmatics, their relatives, and other subjects are considered in terms of the diagnosis and prognosis of asthma and its mode of inheritance. It is concluded that there is as yet no explantation for the mechanism of exercise-induced asthma, but it is a tool of potentially great value for research into the physiology and treatment of clinical asthma.
Exercise-induced asthma--clinical, physiological, and therapeutic implications.
Exercise provokes acute airways obstruction, maximum shortly after stopping, in virtually all asthmatic patients. The severity of this exercise-induced asthma (EIA) depends upon the type of exercise, with running being the most asthmogenic, swimming and walking the least, and cycling intermediate even with the same metabolic stress. The duration and severity of the exercise also affect the amount of EIA, the maximum amount of being obtained after 6 to 8 min of running hard enough to raise the heart rate to 180 beats per minute (bpm) in children or 140 bpm in adults. EIA is not the result of hyperventilation or blood gas changes and appears to depend on the release of relatively short-lived transmitter agents during the exercise period. EIA can be prevented by premedication with bronchodilators, especially with sympathomimetics. Cromolyn sodium is not a bronchodilator but inhibits EIA in most subjects if given before the exercise. EIA can also be inhibited by atropine and alpha adrenergic blockers in some patients, but by steroids in only a minority of cases. Exercise testing provides a good model for study of the physiology and pharmacology of clinical asthma, and is some guide to prognosis, but it must be properly standardized and the important differences must be appreciated.
The place of cromolyn sodium in the long-term management of childhood asthma based on a 3- to 5-year follow-up.
The long-term value of cromolyn sodium in the management of childhood asthma has been assessed over 3 to 5 years in 46 children with chronic perennial asthma who were not initially receiving corticosteroid therapy. The need to use steroids because of poor control during treatment with SCG was taken as a criterion of SCG treatment failure. Most such failures occurred early, but there were a few late treatment failures so that the proportion of SCG successes leveled of at 65% by the fourth and fifth years. Failure with SCG tended to occur in the younger children whose disease had progressed rapidly. By the fifth year, half of the children successfully treated by SCG had been able to discontinue use of the drug, and these children, but not the others, had diminished bronchial lability as shown on exercise testing.
The place of a new aerosol steroid, beclomethasone dipropionate, in the management of childhood asthma.
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Disposition of disodium cromoglycate administered in three particle sizes.
1 Disodium cromoglycate (DSCG) was administered in three particle sizes to five human subjects. 2 Urinary excretion of DSCG, as a proportion of the dose, was highest following small particles; the lower values recorded following intermediate-sized and large particles were similar. 3 DSCG deposited in the mouth was highest following large particles; the lower values recorded following intermediate-sized and small particles were similar. 4 The data were examined in relation to the recent observation that the protective effect of small particles of DSCG is dramatically superior to that of large particles.
The suppression of exercise-induced asthma by disodium cromoglycate (Lomudal).
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Desquamative fibrosing alveolitis unresponsive to steroid or cytotoxic therapy.
A case of desquamative fibrosing alveolitis beginning in early infancy is described. The disease was characterized by tachypnoea, hypoxia relieved by O2, absence of signs in the chest or clubbing, and radiological and physiological evidence of hyperinflation. The diagnosis was made by needle biopsy of the lung. Treatment with steroids and immunosuppression was without effect and the infant died at 9 months. The disease has a high mortality in infancy, only 2 out of 9 reported cases having survived. The difference from the usual course in adults and older children is noted.
Clinical application of regional lung function studies in infants and small children using 13N.
A technique is described for the investigation of regional lung function in infants and children using 13N and a gamma camera. Boluses of isotopic gas are inhaled and perfused while the lung fields are scanned. The child is lightly sedated and breathes normally throughout. Regional function is assessed in terms of the distribution of gas and blood, and the balance between ventilation and perfusion is estimated by comparing an index of the ventilation per unit volume of ventilated lung with that of perfused lung. The use of the method in 8 infants and children with different clinical problems is described to show its application. The method is capable of defining the severity and localization of any abnormality and may also be useful in showing normal function in suspect areas.