Development of airway reactivity to nitrates in subjects with influenza.
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Adult↗
Biomedical subjects
W J Hall
Publications and source records attributed to W J Hall.
Airway reactivity in subjects with viral upper respiratory tract infections: the effects of exercise and cold air.
To define airway hyperreactivity further in symptomatic upper respiratory tract infection (URI), we compared in the setting of viral URI the respiratory effects of inhaling histamine to that of exercising with room air (993 +/- 300 kpm/min; 22 degrees +/- 2 degrees C), cold air breathing (-8 +/- 2 degrees C), and exercising with cold air (993 +/- 300 kpm/min; -8 degrees +/- 2 degrees C). Thirteen previously healthy, nonsmoking, nonatopic adults with URI were evaluated at the time of presentation and 1, 3, and 6 wk thereafter. At the initial presentation there was a 28 +/- 14% decrease in mean airway conductance (SGaw) after inhalation of histamine (p > 0.001). By 6 wk, airway reactivity to histamine decreased in 9 of 13 subjects. After exercise with cold air, there was a 12.5 +/- 7.5% decrease in mean SGaw (p < 0.001). By 6 wk, exercise with cold air no longer produced a decrease in SGaw (p > 0.05). In 5 additional subjects this airway reactivity to exercise with cold air was blocked by previous administration of atropine and by oropharyngeal anesthesia. We conclude that during viral URI there occurs transient airway hyperreactivity ot the combination of exercise with cold, dry air and that the upper airway and parasympathetic nervous system have important roles in these responses.
Adult↗
Study of antibody-coated fungi in patients with funguria and suspected disseminated fungal infections or primary fungal pyelonephritis.
The direct immunofluorescence method for the detection of antibody-coated bacteria in urine sediments has been used by investigators to distinguish invasive bacterial disease of the renal parenchyma from noninvasive bladder bacteriuria. The purpose of the present investigation was to test the usefulness of the demonstration of urinary fungal immunoglobulins and complement in distinguishing patients with fungal cystitis from those with suspected disseminated fungal disease. Twenty-one patients with microscopic funguria were suspected clinically of having disseminated fungal infection. Urine specimens from these patients were tested for the presence of antibody- and complement-coated fungi by direct immunofluorescence with the use of specific goat antisera to human immunoglobulins and complement. No unexpected frequencies of combinations of urinary yeast staining by specific antibody were noted. Urine specimens demonstrating funguria from 12 patients with uncomplicated illnesses were also examined for the presence of antibody- and complement-coated fungi; no unexpected frequencies of combinations of urinary yeast staining were noted in this group and no differences in frequencies of specific antibody staining were noted when compared with results in patients with suspected invasive fungal disease. Thus, no difference in the occurrence of specific antibody or complement adsorbed to urinary yeasts was observed between patients suspected of having invasive fungal disease and a small group of control patients.
Antibodies, Fungal↗
Diffuse pneumonitis due to adenovirus type 21 in a civilian.
A patient with severe pneumonitis due to adenovirus type 21 responded to oxygen delivered by continuous positive airway pressure through a face mask. Pulmonary function studies over ten months demonstrated resolving, restrictive lung disease. The prognosis of severe adenovirus pneumonia may be better than expected based on previous reports.
Adenoviridae Infections↗
Clinical and physiological manifestations of bronchiolitis and pneumonia. Outcome of respiratory syncytial virus.
The physiological abnormalities and clinical correlates of 32 infants consecutively hospitalized with lower respiratory tract disease from respiratory syncytial virus (RSV) were studied in an attempt to characterized the infant most at risk for the acute and long-term complications of RSV infection. Arterial oxygen saturation (Sao2) determinations were obtained daily by means of an ear oximeter. On admission all infants were hypoxemic with a mean Sao2 of 87% (range, 74% to 95%). The mean of the lowest Soa2 recorded during their hospitalization was 85.5% (range, 53% to 96%). The hypoxemia improved little during hospitalization but showed improvement three to seven weeks later. The severity of the hypoxemia correlated significantly with the duration of viral shedding, occurrence of apnea, respiratory rate, age, and percentage of immature neutrophils. Clinical severity did not correlate with the degree of hypoxemia.
Age Factors↗
Attenuated influenza produced by experimental intranasal inoculation.
To assess the relative effect of natural versus experimental influenza illness on pulmonary function, we compared 43 normal adults with documented nonpneumonic influenza A infection during three outbreaks, 1974 (A/Port Chalmers/74), 1975 (A/Port Chalmers/74), and 1976 (A/Victoria/75) to 24 normal volunteers following nasal inoculation with wild-type influenza A/England/42/72, A/Scotland/74 or A/Victoria/75. In naturally acquired illness, abnormalities in small airway functiion and transiently increase airway reactivity were observed. In contrast, no such dysfunction was observed in experimentally induced illness. This group manifested milder illness and significantly shorter duration of cough.
Adolescent↗
Amantadine aerosols in normal volunteers: pharmacology and safety testing.
The acceptability and pharmacology of intermittent aerosol administration of amantadine was assessed in healthy volunteers. Amantadine solutions of 2.5, 1.5, or 1.0 g/100 ml were used for 12 30-min, twice-daily aerosol treatments in 15 subjects. Overall, the aerosol treatments were well tolerated. During and up to 1 h after aerosol exposures, nasal irritation, rhinorrhea, dysgeusia, or a combination of symptoms was experienced by some of the subjects receiving either of the two higher amantadine concentrations. Aerosol treatments were associated with small but statistically significant decreases in maximal expiratory flow rates. One hour after aerosol treatments with the 1.0-g/100 ml solution, amantadine levels in nasal wash samples (mean, 30.3 micrograms/ml; range, 1.7 to 108 micrograms/ml) greatly exceeded blood and nasal wash levels reported after oral administration. Amantadine can be administered safely by small-particle aerosol to humans in doses that could be expected to exert an antiviral effect in influenza A virus infections.
Adolescent↗
Sensitivity and specificity of the nonspecific transbronchial lung biopsy.
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Biopsy↗
Clinical significance of pulmonary function tests. Alterations in pulmonary function following respiratory viral infection.
Respiratory viral illness is a major cause of morbidity in both adults and children. This report focuses on both the acute and chronic effects on respiratory function of these ubiquitous infections. Infant airways are particularly vulnerable due to the relatively low conductance in immature peripheral airways. Bronchiolitis, caused predominantly by respiratory syncytial virus, is the most important of these viral illnesses and is emerging as a major risk factor for the subsequent development of obstructive airway diseases in adults, possibly by interference with normal alveolar proliferation. The basic pathogenic mechanism involved in adult respiratory viral infection is bronchial hyperreactivity, presumably secondary to epithelial damage and resultant sensitization of rapidly adapting airway receptors. In addition, there may be virus-related alterations in the autonomic and humoral regulation of airway tone. Viral infections may alter the effects of common air pollutants on respiratory function.
Adult↗
Atypical measles in adolescents: evaluation of clinical and pulmonary function.
During a community outbreak of measles, 10 patients aged 11 through 19 were hospitalized with prominent pulmonary infiltrates and clinical manifestations of high fever and rash. Diagnoses of atypical measles were confirmed by hemagglutination-inhibition and complement-fixation antibody studies. Patients were followed with pulmonary function studies for 12 weeks. The most common admitting diagnoses were varicella, scarlet fever, meningococcemia, and Rocky Mountain spotted fever, due largely to the protean cutaneous manifestations. Roentgenographic studies showed diffuse, segmental, and nodular chest lesions. Hypoxemia (mean arterial Po2, 58 mm Hg) and markedly reduced lung volumes were noted. Gradual resolution of physiologic abnormalities was noted during 12 weeks, but two children had persistent nodular densities seen on chest roentgenograms. Atypical measles in the older child and young adult has a wide spectrum of pulmonary manifestations ranging from acute respiratory failure to isolated nodular lesions. Proper recognition of this syndrome will prevent unnecessary invasive diagnostic procedures.
Adolescent↗
Probability of a positive transbronchial lung biopsy result in sarcoidosis.
Forty-one consecutive patients with suspected sarcoidosis underwent pulmonary function testing and transbronchial lung biopsy at three community teaching hospitals. Transbronchial biopsy disclosed noncaseating granulomas in 22 of 23 patients (96%) in whom parenchymal disease was roentgenographically apparent and in eight of 18 patients (44%) in whom it was not. The stage of the disease as determined by the chest roentgenogram was the most reliable determinant for a positive biopsy result. Not the presence of cough, dyspnea, or constitutional symptoms or pulmonary function as measured by forced vital capacity and carbon monoxide diffusing capacity served to predict a positive transbronchial biopsy finding any more accurately than did the roentgenographic staging of the disease itself. This study suggests that while transbronchial lung biopsy may be an acceptable initial diagnostic procedure in suspected sarcoid patients without parenchymal lung disease, clinical symptoms and pulmonary function abnormalities are not helpful in predicting the liklihood of a positive biopsy result.
Biopsy↗
The contribution of prostaglandins to secretion in guinea-pig ileum [proceedings].
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Animals↗
A bilateral antidiuresis to renal artery infusion of prostaglandin E1 in dogs treated with phenylbutazone.
1. In acute experiments, high levels of endogenous prostaglandins, provoked by operative stress, could obscure or alter the actions of infused prostaglandins on the kidney. For this reason we decided to compare the effects of infusing prostaglandin E(1) into the renal artery of the dog before and after the administration of phenylbutazone, a prostaglandin synthetase inhibitor.2. Infusion of prostaglandin E(1) into the left renal artery of the pre-phenylbutazone treated dog undergoing a mannitol diuresis increased renal plasma flow, glomerular filtration rate and the excretion of salt and water. The findings are in general agreement with those reported by others.3. Following phenylbutazone administration the vascular and saluretic actions of prostaglandin E(1) were unchanged but a reduced diuretic effect was observed. The response to a low dose of prostaglandin E(1) (0.05 mug/min) was reduced from 1.46 +/- 0.15 to 0.96 +/- 0.16 ml./min (P < 0.001) and the response to a high dose (0.5 mug/min) from 1.82 +/- 0.19 to 0.99 +/- 0.31 ml./min (P < 0.002).4. A significantly less dilute urine was excreted during prostaglandin infusion in the dog after phenylbutazone treatment than before. The reduction in the diuretic response was of the same order as the decrease in the free water clearance response, while the increase in osmolar clearance was unchanged.5. In water-loaded dogs treated with phenylbutazone, infusion of prostaglandin E(1) into the left renal artery had a biphasic effect on urine output from the left kidney. An initial diuretic response to a low dose of prostaglandin E(1) disappeared with the infusion of higher doses, and antidiuresis developed in the immediate post-infusion period.6. As prostaglandin was infused into the left kidney progressive antidiuresis was seen in the non-infused right kidney.7. It is concluded that endogenous prostaglandins do not obscure or alter the vascular and saluretic actions of intrarenal prostaglandin E(1). The findings question the proposed link between the vascular and saluretic actions of this compound.8. It is suggested that the reduced diuretic effect of prostaglandin E(1) in series no. 1, and the antidiuresis in the water-loaded dogs, are caused by the release of endogenous ADH. It is further suggested that phenylbutazone unmasks this release by removing the endogenous prostaglandins. If these deductions are correct, the findings support the anti-ADH role assigned to endogenous prostaglandins by Anderson, Berl, McDonald & Schrier (1975).
Animals↗
Airway hyperreactivity and peripheral airway dysfunction in influenza A infection.
We studied 39 consecutive college students with documented nonpneumonitic influenza A/Victoria/3/75/H3N2 infection to examine alterations in pulmonary mechanics and airway reactivity to cholinergic challenge, and to assess the effect of the antiviral agent amantadine on these changes. Thirty-six of the 39 subjects (92 per cent) demonstrated diminished forced flow rates and decreased density-dependent forced flow rates while breathing a helium-O2 mixture as compared to an air mixture. On initial evaluation, there was no significant difference in forced flow rates or density dependence between a group of 18 subjects treated with amantadine and 21 subjects given a placebo. However, the placebo group demonstrated further decreases in density dependence 7 days after initial presentation, whereas the amantadine group demonstrated a significant increase in density dependence (P less than 0.05), which suggested an accelerated improvement in peripheral airway dysfunction in the treated group. After inhalation of carbachol aerosol, 25 subjects showed a significant (P less than 0.05) increase in total respiratory resistance that was prolonged and independent of hay fever history. Airway hyperreactivity gradually diminished during a 7-week period in both groups. There was no significant difference in the initial degree of hyperreactivity or in the rate of improvement between groups. These data suggest that nonpneumonitic influenza infection may be associated with both an inflammatory response predominantly in the peripheral airways and transient bronchial hyperreactivity. By means of its antiviral effect, amantadine may arrest the proliferation of virus and associated inflammatory response in peripheral airways, but airway hyperreactivity presumably related to initially damaged airway depithelium is not attenuated by inhibition of viral replication after infection has been established.
Aerosols↗
Respiratory syncytial virus infection in adults: clinical, virologic, and serial pulmonary function studies.
We prospectively studied 10 previously healthy adults who developed an acute respiratory illness while working in an infants' ward during a community outbreak of respiratory syncytial virus infection. In addition to clinical and viral evaluation, total respiratory resistance before and after carbachol aerosol inhalation was measured. All 10 subjects had respiratory syncytial virus infection documented by viral isolation, and all developed pronounced cough, nasal congestion, and fever. Eight subjects missed work for an average of 6 days. In all 10 patients, the total respiratory resistance was significantly elevated through 8 weeks. Altered airway reactivity, characterized by exaggerated responses of pulmonary resistance to carbachol challenge, was also observed through the first 8 weeks of evaluation. In this group, respiratory syncytial virus produced a protracted illness associated with appreciable morbidity. The pathophysiologic mechanism of this illness in part appeared to arise from altered airway reactivity.
Acute Disease↗
Why wasn't it aspiration of gastric contents?
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Croup↗
Human milk contaminated with Salmonella kottbus. A cause of nosocomial illness in infants.
Human milk contaminated with Salmonella kottbus caused an outbreak of illness in seven of 22 infants in a neonatal intensive care unit. A case-control investigation failed to identify any risk factor except consumption of milk from a single donor, whose milk was subsequently found to be contaminated with S kottbus. Collection of human milk from properly instructed donors screened for microbiological pathogens, refrigeration of this milk at 1 to 5 degrees C after collection, and controlled distribution by a milk bank should minimize the few hazards associated with its consumption.
Breast Feeding↗
Small airways dysfunction in influenza A virus infection: therapeutic role and potential mode of action of amantadine.
Previous studies have demonstrated alterations in gas exchange and pulmonary mechanics in presumed and documented viral upper respiratory infections. In our laboratory, using sensitive and noninvasive testing, we have demonstrated significant and prolonged alterations of pulmonary mechanics in uncomplicated natural influenza A infection, which implicate increased resistance in small airways as the cause of dysfunction. Amantadine administration in established influenza A infection has been associated with an accelerated improvement of clinical illness and pulmonary physiologic dysfunction. Preliminary study suggests that this is due to neither cholinergic blockade nor bronchodilation.
Adult↗