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Biomedical subjects

T C Medici

Publications and source records attributed to T C Medici.

At least 37 records · Page 2Linked to original sources
PubMed1993

Are asthmatics salt-sensitive? A preliminary controlled study.

OBJECTIVE: Epidemiologic evidence suggests that high levels of salt consumption are associated with "spastic" disorders of smooth muscles, ie, essential hypertension and bronchial asthma. Experimentally, it has been shown that high intake of salt leads to increased bronchial hyperreactivity in asthmatics, ie, enhanced contractility of bronchial muscle to spasmogenic stimuli. On the basis of these observations, the following questions were asked: (1) Does salt loading worsen the clinical and functional findings in asthmatics? (2) Is it the sodium or the chloride in salt that is important? METHODS: To answer these questions, the effect of salt restriction (= 5 to 6 g NaCl/d = 86 to 103 mmol Na), salt loading (+ 6.1 +/- 2.8 g NaCl/d = + 105 +/- 48 mmol Na), and loading with sodium citrate in nearly equimolar concentrations (+ 140 +/- 40 ml Shohl's solution, = + 120 +/- 30 mmol Na) was investigated in 14 asthmatics in a controlled crossover study. The total sodium load during the high salt diet was 191 to 209 mmol of sodium per day and during the sodium-citrate phase, 206 to 223 mmol of sodium per day. RESULTS: Statistical analysis showed that salt loading worsened symptoms (p = 0.06) and increased the use of inhaled steroids (p < 0.05). The effect on lung function was less equivocal: salt loading worsened the forced expiratory volume in 1 s (p < 0.01) and the peak expiratory flow rate (p < 0.05). This effect was presumably mediated by sodium, not chloride, as is demonstrated by loading with sodium citrate. CONCLUSION: Patients with bronchial asthma seems to be salt-sensitive, the responsible ion being presumably sodium. A low-salt diet appears to have a favorable effect in patients with asthma and to reduce the need for anti-asthma drugs.

Adult↗
PubMed1992

[The "sarcoidosis-lymphoma syndrome"--a lymphocyte dysregulation?].

Sarcoidosis and malignant lymphoma can occur in the same patient; sarcoidosis appears first, the malignant lymphoma follows later. The case histories of three patients illustrate what Brinker first coined as the "sarcoidosis-lymphoma syndrome". In two patients a pulmonary sarcoidosis stage I was diagnosed over 30 years respectively 4 years prior to the histological diagnosis of highly malignant Non-Hodgkin lymphoma. The third patient suffered from generalized sarcoidosis with splenomegaly, , granulomatous hepatitis and interstitial lung disease, in addition to which a lymphoproliferative syndrome was diagnosed. Comparing the pathogenesis of malignant lymphoma and sarcoidosis, parallels such as T-cell dysfunction, which probably facilitates malignant transformation of B-cells, become apparent. In both diseases the transforming gene could be the Ebstein-Barr virus.

Adult↗
PubMed1991

[Bronchial asthma and kitchen salt].

Epidemiological studies show considerable geographic differences in asthma prevalence and mortality. The regions with high prevalence and mortality are countries with Western-type culture and a high degree of technological progress. They differ from less technically developed countries in a number of ways, including their higher salt intake. Air pollution is often given as the cause of the high prevalence of asthma in the industrialized countries. Against this, it must be pointed out that in the urban agglomerations of the developing countries and in rural areas where heating is by means of open fireplaces (indoor pollution), there is also considerable air pollution. Migration studies from New Zealand and South Africa, where asthma prevalence increases parallel to salt intake, provide evidence that other factors arising from westernization and urbanization play a role. In the industrialized countries England and USA there is also a clear connection between salt intake and asthma: the greater the salt consumption, the higher the asthma prevalence and mortality. On the basis of these observations, the following questions were investigated: (1.) Does salt loading worsen the clinical and functional findings in asthmatics? (2.) Is the sodium or the chloride in salt the more important? To answer these questions, the effect of salt loading (+6.1 +/- 2.8 g NaCl/d = 105 +/- 48 mmol Na), salt restriction, and loading with sodium citrate in equimolar concentrations (+140 +/- 40 ml Shohl's solution = 120 +/- 34 mmol Na) was investigated in 14 asthmatics in a controlled crossover study. Statistical analysis showed that salt intake worsened symptoms (p = 0.06) and increased the use of inhaled steroids (p less than or equal to 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Sodium thiophene carboxylate does not facilitate expectoration.

A randomised double-blind crossover study compared the clinical effectiveness of a 21-day treatment with 600 mg per day of sodium thiophene carboxylate and placebo in 33 patients with stable chronic bronchial disease. During the seven week trial, subjective symptoms and findings were recorded, pulmonary function tests performed and sputum physical characteristics determined. Side-effects were closely monitored. Both subjective assessment of overall clinical efficacy and statistical analysis of the above mentioned factors failed to show any significant advantage of sodium thiophene carboxylate to placebo. Sodium thiophene carboxylate appears to be an expectorant and mucoregulatory drug, lacking evidence of clinical effectiveness in the treatment of patients with stable chronic bronchitis.

Asthma↗
PubMed1990

Does alternate-day cloprednol therapy prevent bone loss? A longitudinal double-blind, controlled clinical study.

Osteoporosis is a serious side effect of systemic treatment with steroids. Cloprednol, a synthetic glucocorticoid with an anti-inflammatory potency twice that of prednisone, causes less calcium and nitrogen excretion than does prednisone in equipotent doses. Therefore a double-blind study was undertaken comparing the effects of alternate-day cloprednol and prednisone therapy on bone mineral density in 39 patients (cloprendol: 13 men and 8 women aged 48.5 +/- 2.8 years; prednisone: 9 men and 9 women aged 49.7 +/- 1.7 years) with lung diseases. Ten patients with asthma (9 men and 1 woman aged 37.8 +/- 3.7 years) inhaling daily beclomethasone served as control subjects. Trabecular and total bone density of the distal tibia and radius was determined quarterly during 1 year with a special-purpose computed tomographic system. Initial mean trabecular bone density of the patients receiving cloprednol and prednisone was 17% below normal. After a treatment period of 1 year, we found a loss of radial trabecular bone density (mean +/- SEM) of 1.33% +/- 0.49% in the cloprednol group and 2.38% +/- 0.69% in the prednisone group. In postmenopausal women, prednisone but not cloprednol therapy caused significant (p less than 0.01) trabecular bone loss (5.29% +/- 0.99% versus 0.70% +/- 0.65%). The control group lost 0.91% +/- 0.79%. Loss of cortical bone was insignificant in all three groups. In post-menopausal women, 1 year of alternate-day cloprednol therapy was associated with significantly less bone loss than was prednisone therapy in equipotent dosages.

Administration, Inhalation↗
PubMed1990

Dissecting aneurysm of the pulmonary artery with pulmonary hypertension.

Pulmonary artery dissection was observed in a 64-yr-old female patient with severe pulmonary hypertension, which was probably primary (pulmonary vascular resistance, 817 dyn.s.cm-5; normal range less than or equal to 200 dyn.s.cm-5). The patient was admitted to the hospital because of severe dyspnea on exertion. Echocardiography demonstrated a dissecting aneurysm of the pulmonary artery. Right heart catheterization revealed severe pulmonary hypertension (mean pulmonary artery pressure, 64 mm Hg; normal range, 10 to 22 mm Hg); dissection of the pulmonary artery was confirmed by pulmonary arteriography. One-year follow-up was uneventful. In the literature, 28 patients with dissecting aneurysm of the pulmonary artery are reviewed. The dissection has only been diagnosed in life in one patient (by echocardiography).

Aortic Dissection↗
PubMed1990

[Therapy changes and cost development in bronchial asthma. A 10-year retrospective study at the medical outpatient clinic of the Zurich University Hospital].

The changes that have taken place in asthma therapy during the past ten years and their consequences regarding costs were studied analyzing retrospectively 285 clinical histories of asthmatics treated at the University Hospital Zurich in 1977, 1982 and 1987. The following changes in the use of the five basic antiasthmatic drugs i.e. beta-adrenoceptor agonists, anticholinergic drugs, xanthines, glucocorticosteroids and antiallergic drugs were observed: In 1977 80% of asthmatics received beta-agonists, in 1987 90%. Conversely, parasympatholytics were rarely used: In 1977 in only 2%, in 1982 in 16% and in 1987 in 27% of patients. In 1987 xanthines were prescribed in only 50% of asthmatics whereas in 1982 after the introduction of retarded preparations, these drugs were given to 86% of patients. In 1977 only one-third of asthmatics received glucocorticosteroids; in 1987, however, three-quarters of them. Antiallergic drugs were prescribed in 1977 and 1987 in about 25% of the asthmatics, in 1982 in only 13%. Considering the form of application there was a significant trend towards metered aerosols. This was true for betamimetics, parasympatholytics and glucocorticosteroids. Fixed combinations and rectal applications of xanthines were substituted for retarded formulations. In 1977 one or two antiasthmatic drugs accounted for 75% of asthma therapy. In contrast, in 1987 60% of asthmatics received more than two antiasthmatic drugs. The dosages of salbutamol and beclomethasone increased significantly from 1977 to 1987. Other changes in dosages were not significant. The change in costs of antiasthmatic therapy revealed significant savings in regard of xanthines and antiallergic drugs. During the past ten years the overall costs of antiasthmatic drugs therapy remained the same despite more complex therapy.

Adrenergic beta-Agonists↗
PubMed1989

Ketotifen in the prophylaxis of extrinsic bronchial asthma. A multicenter controlled double-blind study with a modified-release formulation.

In a placebo controlled double-blind multicenter trial, 245 patients with bronchial asthma (131 male and 124 female patients) between 6 and 51 years of age were treated in two parallel groups. A slow-release oral formulation containing 2 mg of ketotifen or placebo was administered daily for a duration of 12 weeks. Over a period of four weeks before the study, 94 percent of the patients had asthmatic attacks. 78 percent had cough, and 62 percent had nasal symptoms. In the group treated with slow-release oral ketotifen, there were 3.9 asthmatic attacks (range, 0 to 20) per week, and in the placebo group, there were 2.9 (range, 0 to 12) (mean values during four weeks prior to start of treatment). At the end of treatment, asthmatic attacks were significantly reduced in the group treated with slow-release oral ketotifen compared with placebo. Significant reduction was also evident for cough and sputum production, as well as nasal discharge and obstruction; however, slow-release oral ketotifen did not significantly improve pulmonary function indices when compared to placebo. The use of concomitant medication (beta-sympathomimetic drugs) was also significantly reduced in the group receiving slow-release oral ketotifen. The overall efficacy assessed by the investigators was "very good" and "good" in 76 percent of the group receiving slow-release oral ketotifen and 30 percent in the group receiving placebo (p less than 0.001). Tolerability rated by the investigators was "very good" and "good" in 90 percent of the group with slow-release oral ketotifen and in 96 percent of the group with placebo (p less than 0.10). The most frequent side effects were "mild" and "moderate" sedation, sleepiness and drowsiness reported in 44 percent of the patients receiving slow-release oral ketotifen and in 26 percent of the patients receiving placebo. This difference was statistically significant (p less than 0.01).

Adolescent↗
PubMed1988

[Familial sarcoidosis. 4 cases from 2 families].

Sarcoidosis is frequently familial. We report on four cases of sarcoidosis which include a father and son and two sisters. As is well known in familial sarcoidosis, our patients show strikingly similar clinical findings within their respective families. The literature is reviewed in regard to racial, ethnic, geographical and familial prevalence, and the findings are interpreted as evidence for a genetic predisposition.

Adult↗
PubMed1988

[Idiopathic lung fibrosis].

Idiopathic pulmonary fibrosis (IPF), also called interstitial pneumonia or fibrosing alveolitis, is a progressive interstitial lung disease of unknown origin. Two distinct forms are known which differ in course, morphologic features and cytological findings in bronchoalveolar lavage: a cellular "desquamative interstitial pneumonia" and a hypocellular and more fibrotic "usual interstitial pneumonia". The two types appear to represent different stages of the same disease. The clinical findings in IPF are dyspnoea, unproductive cough, clubbing and rales. Pulmonary function tests reveal restriction, reduced diffusion capacity and hypoxaemia during exercise. Chest X-rays show localized linear or nodular densities usually accentuated at the lung bases; in 10% of patients with IPF, chest radiography is normal. To assess the inflammatory process bronchoalveolar lavage and transbronchial or open lung biopsy have proven necessary. Before beginning treatment the activity of the inflammatory process and degree of lung function impairment should be established. Therapy of IPF is unspecific and its aim is to suppress alveolitis and the fibrotic process. Corticosteroids are the initial therapy. If there is no improvement after two months, immunosuppressive agents are added. Regular clinical and functional follow-up is required. Course and prognosis vary in different forms of IPF. Without treatment, median survival in the cellular form is over 10 years and in the hypocellular form between 3.2 and 5.6 years. Only 12-30% of patients respond to antiinflammatory treatment.

Adrenal Cortex Hormones↗
PubMed1988

Gram stain and culture of morning and 24 h sputum in the diagnosis of bacterial exacerbation of chronic bronchitis: a dogma disputed.

Bacteriological results from microscopic and cultural examinations of morning and 24 h sputum were compared in an attempt to optimize the diagnosis of bacterial exacerbations of chronic bronchitis. Twelve patients collected sputum randomly on two consecutive days, either fresh morning sputum (3 h sputum) first, followed by 24 h sputum or vice-versa. Sputa were washed three times in 0.9% NaCl and then examined microscopically before and after homogenization with 2% pancreatin. Cultural examinations were performed on homogenized sputum. Haemophilus influenzae, pneumococci and neisseriae were identified more often in Gram stains than in cultures; staphylococci and Gram-negative rods less frequently so. About 50% of organisms microscopically identified as pneumococci failed to grow in cultures. Microscopic examinations revealed a marked reduction of cells and bacteria after homogenization with pancreatin. Gram stains of 24 h sputum show comparable results to those of morning sputum. No differences were found in cultures. Microscopic examination of the Gram stains was found to be superior to cultural examination. The value of microscopic examination was impaired by the addition of pancreatin.

Bacterial Infections↗
PubMed1987

[Early diagnosis of bronchial carcinoma using thoracic roentgen imaging and sputum cytology].

Chest roentgenography and sputum cytology have been used for the early detection of lung cancer since the beginning of the 1950s. Surprisingly, the yield of screening is sufficiently high. In view of the estimated prevalence of lung cancer of 0.5-2% in high risk persons, the detection rate was 0.32-0.95% in three large randomized clinical trials (Cooperative Pilot Study of the American Cancer Society and Veterans Administration 1969, Canadian study of Grzybowski and Coy 1970, National Cancer Institute Cooperative Early Lung Cancer Detection Program 1984). Screening by chest roentgenogram was superior to sputum cytology. More than 70% of all lung cancers were detected by roentgenography alone. Adding sputum cytology, 10-20% more cancers were found. Lung cancers which were additionally detected by cytology were slowly-growing, central squamous cell carcinomas with good prognosis. The sensitivity of chest X-rays varied between 49 and 77% and the sensitivity of sputum cytology between 33-52%. Specificity was higher, the range being 95-99% for chest X-rays and 96-99% for sputum cytology. The costs per lung cancer detected and treated are very high. To these are added the costs which arise from the evaluation of false positive results. The prognosis of lung cancer detected by screening is good: more patients survive, and they live longer than unscreened patients. The overall 5-year survival of patients screened by chest X-rays and sputum cytology of the NCI-study was 35-55% compared with only 15% of patients not screened. However, whether long survival means reduced mortality is uncertain, since long survival only reflects early detection.

Adult↗