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Biomedical subjects

S L Spector

Publications and source records attributed to S L Spector.

At least 91 records · Page 5Linked to original sources
PubMed1985

Physiologic changes that occur in response to allergen induced challenge.

In summary, bronchial inhalation challenges with allergens can serve as a clinical and investigative tool to better ascertain the role of airborne allergens in asthma. A thorough understanding of the factors influencing a given response, as well as the biochemical and physiologic changes that occur, ultimately will be translated into improved modalities of therapy.

Adrenal Cortex Hormones↗
PubMed1985

Advances in the treatment of bronchial asthma.

Asthma is defined as a syndrome of variable and reversible airway obstruction. The successful treatment of the acute attack of asthma depends on prompt and appropriate intervention, while the aim of management following the acute attack should be that of optimal control of chronic symptoms and avoidance of recurrent attacks. A better recognition of triggers and improved medical management prompt optimism regarding the treatment of this potentially reversible process.

Adrenal Cortex Hormones↗
PubMed1985

Central nervous system effects of antiasthma medication--an EEG study.

The relationship between electroencephalographic (EEG) abnormalities (in particular paroxysmal activity) and theophylline alone or in combination with corticosteroids and/or ephedrine was examined in 161 adult and 93 pediatric patients. For each patient, total theophylline dosage was calculated and a theophylline blood level was obtained at the time of EEG recording. The major findings indicated: The presence of EEG paroxysmal activity in a greater percentage of the population studied than that which has been reported in a group of nonhospitalized individuals of similar age in the general population. There is a greater probability of EEG paroxysmal activity among patients with higher theophylline blood levels or total dosages than among those with lower blood levels or total dosages. There is an increase in EEG abnormalities with the addition of ephedrine. There is a possible protective effect of steroids against theophylline-related central nervous system disturbances.

Adrenal Cortex Hormones↗
PubMed1984

Paranasal sinus anatomy and pathophysiology.

Mucociliary function keeps the normal sinuses free of drainage despite the fact that several of the sinus otia are not favorably located for gravitational drainage. This function of drainage is lost if the ostium becomes occluded or mucociliary function is impaired. The precise mechanisms of ostial occlusion remain to be elucidated. The normal healthy sinus is free of bacteria, despite the presence of normal bacterial flora in the nasopharynx. In sinusitis bacteria probably gain access to the sinus via the ostium, although in some cases (eg, dental abscess) bacteria penetrate from contiguous structures. Bacteria in an occluded sinus rapidly convert the gas environment to favor their rapid growth. The increased growth and purulence as well as the low PO2 may impair local immune defense mechanisms by degradation of immunoglobulins as well as impaired granulocyte killing. The natural course of sinusitis continues until the ostial occlusion resolves, allowing mucociliary function to drain the affected sinus. In this way spontaneous resolution of sinusitis is possible. Spontaneous drainage cannot occur if the mucociliary function is congenitally deficient, damaged by scarring from previous severe infection, or surgically removed. In addition, chronic sinusitis may occur if there is persistent ostial obstruction from nasal polyps or tumors. The drainage may be diminished by an anatomically small ostium or tortuous drainage duct. Drainage of the sinus may be increased by the effects of erect posture on ostial resistance. Besides adequate drainage, the importance of the local immune defense mechanisms must be emphasized. The occurrence of chronic sinusitis in patients with various immunoglobulin deficiencies reinforces this point.(ABSTRACT TRUNCATED AT 250 WORDS)

Cilia↗
PubMed1983

Multi-center, double-blind, placebo-controlled trial of fluocortin butyl in perennial rhinitis.

Fluocortin butyl (FCB) is a newly synthesized corticosteroid with a high ratio of topical to systemic activity. FCB was studied in a multi-center, double-blind, placebo-controlled trial of therapy of perennial rhinitis. The study was conducted between January and May 1981. Patients evaluated suffered from either chronic allergic or chronic nonallergic rhinitis or both. A total of 306 patients from 16 investigative centers were evaluated by comparing FCB to placebo. Three separate dosage regimens were employed. Patients received a total daily dose of 2, 4, or 8 mg. FCB was found to be an effective therapeutic agent. It reduced symptoms of nasal congestion, rhinorrhea, postnasal drainage, and sneezing. It also markedly reduced the use of concomitant medications (chlorpheniramine maleate and/or pseudoephedrine). Relief of symptoms was noted as early as the first week of therapy, and the degree of improvement increased progressively during the study. There was little difference between the relief produced by the 4 mg and 8 mg regimens. Both of these were superior to the 2 mg regimen. The drug was well tolerated; no significant side effects were noted.

Adult↗
PubMed1983

The bronchodilator response to inhalation of increasing doses of aerosolized albuterol.

Forty-four asthmatic patients were treated on separate days with increasing doses of albuterol in four double-blind studies that included placebo controls. Twenty-six subjects received one, two, four, six, and eight inhalations from a metered dose inhaler; 18 subjects received 1.25, 2.5, 5, 10, and 15 mg delivered by IPPB. There was a significant linear relationship in both groups between the maximum increase in FEV1 and the log dose of albuterol. The response to four, six, and eight inhalations from the metered dose inhaler was significantly greater than the response to one inhalation, and the response to 15 mg by IPPB was significantly greater than the response to any other dose by IPPB. The results suggest that in many patients maximum possible bronchodilation is not achieved by customarily recommended doses.

Administration, Intranasal↗
PubMed1983

Relationship between serum theophylline levels and pulmonary function before and after inhaled beta-agonist in "stable" asthmatics.

In 9 "stable" adult asthmatics, the relationship between serum theophylline level and pulmonary function, as well as the interaction of aminophylline and inhaled beta2-agonist on pulmonary function, were studied. At varying levels of serum theophylline between 6 and 25 micrograms/ml, which were brought about by increasing oral doses of a slow-release theophylline preparation, the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), airway resistance (Raw), and lung volume were assessed before and after inhalation of a B2-sympathicomimetic (isoetharine). In those subjects in whom it was possible to obtain blood levels within all 3 ranges of less than 10, 11 to 15, and greater than 15 micrograms/ml, there was a significant (p less than 0.05) increase in FEV1 between a mean level of 6.4 +/- 0.9 micrograms/ml and one of 12.8 +/- 0.2 micrograms/ml, but there was no further significant improvement at a mean value of 19.2 micrograms/ml +/- micrograms/ml. Specific airways conductance (SGaw) showed no change at increasing serum theophylline levels. In addition, inhaled beta-agonist increased FEV1 and SGaw maximally at all times, irrespective of the serum theophylline level, and there was no relationship between the response to inhaled bronchodilator and the serum theophylline level. The data indicate that unlike the patient in serious difficulty, ventilatory function was not improved by maximizing serum theophylline levels in this population of stable asthmatics. This suggests that theophylline may be less useful for the stable asthmatic patient than for the acutely ill patient.

Administration, Intranasal↗
PubMed1983

Effects of particulate air pollution on asthmatics.

Twenty-four asthmatic subjects in Denver were followed from January through March 1979, a three-month period in which Denver air pollution levels are generally high and variable. Dichotomous, virtual impactor samplers provided daily measurements (micrograms/m3) of inhaled particulate matter (total mass, sulfates, and nitrates) for coarse (2.5--15 micrograms in aerodynamic diameter) and fine fractions (less than 2.5 micrometers). Carbon monoxide, sulfur dioxide, ozone, temperature, and barometric pressure were also measured. Twice daily measurements of each subject's peak expiratory flow rates, use of as-needed aerosolized bronchodilators, and report of airways obstruction symptoms characteristic of asthma were tested for relationships to air pollutants using a random effects model across subjects. During the time actually observed, there were very few days in which high levels of suspended particulates were recorded. Of the environmental variables studied, only fine nitrates were associated with increased symptom reports and increased aerosolized bronchodilator usage.

Adult↗
PubMed1983

The treatment of the asthmatic mother during pregnancy and lactation.

In summary, the management of asthma in the pregnant patient does not differ much from the management of asthma in a patient who is not pregnant. An awareness of how asthma medications affect the fetus is important since it is rare to reach the ideal management where no medication at all is given. The benefit to risk ratio must be considered for both mother and her fetus should be medication be required. Since hypoxemia is the greatest single danger to both the mother and fetus important medications should not be withheld and the physician should not wait too long. The mother should be counseled about avoiding medications that include tetracycline, iodine products, aspirin or non-steroidal anti-inflammatory agents, tartrazine, sedatives, and beta-adrenergic blocking agents. It is just as important to remember that alcohol and cigarettes are potent drugs or interact with other medications. Inapropriate exercise, irritants or allergens might also require counseling so that the pregnant mother can avoid them. A good common sense and caring approach of a physician to a well informed patient represents the most appropriate management of asthma in the pregnant patient and nursing mother.

Adrenal Cortex Hormones↗
PubMed1982

Steroid-specific and anticonvulsant interaction aspects of troleandomycin-steroid therapy.

Troleandomycin (TAO) is a macrolide antibiotic that has an apparent "steroid-sparing" effect when used in the treatment of severe steroid-dependent asthmatic patients. Recent observations demonstrated the effect of TAO on inhibiting methylprednisolone elimination, possibly contributing to its beneficial effects. Prednisolone and methylprednisolone disposition were studied before and 1 wk after initiation of TAO therapy in three patients. Methylprednisolone elimination was characteristically impaired in the presence of TAO therapy; however, there was no apparent effect on prednisolone elimination. Methylprednisolone elimination was also evaluated before and after initiation of TAO therapy in three patients receiving concomitant anticonvulsant therapy with phenobarbital-1, phenytoin-2. Methylprednisolone clearance before TAO was at least 4 times faster than normal and was probably related to enzyme induction by the anticonvulsant medication. Methylprednisolone clearance was subsequently reduced by approximately 70% in the presence of TAO therapy. The effect of TAO on corticosteroid disposition is steroid-specific and TAO can diminish the effect of certain drugs on the induction of corticosteroid metabolism.

Asthma↗
PubMed1982

Dose- and time-related effect of troleandomycin on methylprednisolone elimination.

Effects of varying doses of troleandomycin (TAO) on methylprednisolone disposition were examined in five steroid-dependent asthmatic patients. The characteristic reduction in methylprednisolone elimination in the presence of TAO after a 40 mg IV methylprednisolone was also present after methylprednisolone doses as low as 4 mg. In patients receiving continuous TAO on an every-other-day basis, inhibition of methylprednisolone elimination was impaired to a greater extent on the "day on" TAO than on the "day off" TAO Methylprednisolone elimination on the day off TAO was still slower than that before TAO, however, TAO on a multiple-dose schedule resulted in greater reduction of methylprednisolone elimination than after a single TAO dose. These results suggest that TAO induces immediate and continued inhibition of methylprednisolone disposition.

Asthma↗
PubMed1982

Beneficial effects of propylene and polyethylene glycol and saline in the treatment of perennial rhinitis.

Although propylene-and-polyethylene-glycol and saline have been used in clinical studies as placebos, their possible therapeutic role as wetting agents in the treatment of perennial rhinitis was investigated. Clinical and laboratory response to these agents was measured in eighteen patients during a 2-week baseline period and with 4 weeks of active treatment in a double blind randomized study. After 2 and 4 weeks there was a significant improvement compared to baseline in nasal function (P less than 0.05) and blockage index (P less than 0.01) combining both groups, with no difference between treatments. Patients had less sneezing at 2 and 4 weeks (P less than 0.01), and less stuffiness at 4 weeks (P less than 0.01). There was a significant correlation between improvement in blockage index and nasal biopsies when both were judged independently of the other. This study has demonstrated that wetting agents offer both subjective and objective improvement in the treatment of perennial rhinitis and merit consideration prior to (or along with) other agents with known systemic side effects.

Adult↗
PubMed1982

The use of cultures and immunologic procedures to predict oropharyngeal candidiasis in patients on steroid aerosols.

Sixty-seven asthmatic individuals treated with either beclomethasone diproprionate or flunisolide were sequentially evaluated for up to 32 months to determine the incidence of oropharyngeal candidiasis as well as laboratory parameters which might be predictive of this complication. Throat cultures and measurements of Candida antibody by immunodiffusion and radioimmunoassay were performed and compared over time and treatment groups. Unlike other studies, pre-treatment Candida precipitins did not predict increased risk for clinical thrush nor did quantitative determinations of Candida antibody. Those patients with positive cultures pre-trial, however, had a significantly higher incidence of clinical thrush than those with negative cultures (P less than 0.01). No significant changes occurred over time or between drugs for any of the parameters. Symptomatic thrush, however, was slightly more common in those patients treated with beclomethasone.

Adolescent↗