Showing papers in "British Journal of Diseases of The Chest in 1972"
TL;DR: Clinically, antibiotic treatment was superior to the placebo, except that chloramphenicol was much better tolerated, and antibiotics should be given to most patients who are moderately or severely ill with purulent exacerbations of chronic bronchitis.
Abstract: In a double-blind study a placebo, tetracycline, and chloramphenicol have been compared in the management of purulent exacerbations of chronic bronchitis. Clinically, antibiotic treatment was superior to the placebo. Patients treated with chloramphenicol benefited little more than those given tetracycline, except that chloramphenicol was much better tolerated. Thus antibiotics should be given to most patients who are moderately or severely ill with purulent exacerbations of chronic bronchitis. Chloramphenicol should be given only after very careful consideration. By a month after treatment the benefits of antibiotics had largely disappeared.
88 citations
TL;DR: With these doses bronchodilatation was maintained at a higher level after terbutaline, the difference being statistically significant during the fourth hour, and there were no clinically important cardiovascular or other unwanted effects after either drug.
Abstract: Inhalation by a group of asthmatics of aerosols of 250 μg terbutaline and of 100 μg salbutamol was followed by the same mean maximum increase in FEV 1 . After inhalation of these doses of each drug there were rapid bronchodilator responses, the amplitudes of which were the same for 90 minutes. With these doses bronchodilatation was maintained at a higher level after terbutaline, the difference being statistically significant during the fourth hour. There were no clinically important cardiovascular or other unwanted effects after either drug. This may or may not be of clinical significance.
63 citations
TL;DR: It was concluded that beclomethasone by inhalation in a dose of 2 mg/day had no real advantage over prednisolone by mouth in the treatment of airways obstruction, in terms either of increase in FEV 1 or of preservation of normal HPA function.
Abstract: In a controlled trial 7 patients with airways obstruction were treated with beclomethasone by inhalation (2 mg/day) and then with prednisolone by mouth (20 mg/day), each for a period of 7 days. In 4 patients the airways obstruction was partially relieved by beclomethasone, but further improvement was recorded in 3 of these patients after subsequent treatment with prednisolone. There was evidence of impairment of hypothalamo-pituitary-adrenal (HPA) function following the administration of beclomethasone by inhalation in 5 of the 7 patients and of complete suppression in all 7 after subsequent treatment with prednisolone by mouth. It was concluded that beclomethasone by inhalation in a dose of 2 mg/day had no real advantage over prednisolone by mouth (20 mg/day) in the treatment of airways obstruction, in terms either of increase in FEV 1 or of preservation of normal HPA function. Limited experience with a smaller dose of beclomethasone (0·4 mg/day) by inhalation in an earlier uncontrolled trial suggested that this dose did not impair HPA function but was insufficient in most cases to relieve airways obstruction.
59 citations
TL;DR: A case is presented of pleural effusion caused by Penicillium lilacinum in an otherwise healthy young adult male.
Abstract: A case is presented of pleural effusion caused by Penicillium lilacinum in an otherwise healthy young adult male.
56 citations
TL;DR: This study suggests that there are α-adrenergic receptors in the bronchial muscle of asthmatics, and that histamine sensitivity in asthma is due to hypersensitivity of these receptors.
Abstract: Histamine induced bronchoconstriction was significantly reduced in 6 patients with extrinsic bronchial asthma by thymoxamine, a specific α-adrenergic 3 . Mean pulse rate and blood pressure in 6 asthmatic patients after intravenous thymoxamine (0 · 2 μg/kg) Mean Mean pulse rate blood pressure Basal 77 124 79 Immediate 81 118 76 5 min 80 119 77 10 min 80 120 81 15 min 80 117 79 30 min 80 117 78 60 min 77 119 81 receptor blocking drug. This study suggests that there are α-adrenergic receptors in the bronchial muscle of asthmatics, and that histamine sensitivity in asthma is due to hypersensitivity of these receptors.
51 citations
TL;DR: A preliminary study of the effect of amoxycillin on advanced chronic bronchial infections, mostly caused by H. influenzae, suggests that this drug has a therapeutic value substantially greater than that of its close relative, ampicillin.
Abstract: A preliminary study of the effect of amoxycillin on advanced chronic bronchial infections, mostly caused by H. influenzae , suggests that this drug has a therapeutic value substantially greater than that of its close relative, ampicillin. Amoxycillin is absorbed approximately twice as efficiently as ampicillin from the bowel, and therefore a dosage regimen of 500 mg amoxycillin 6-hourly was chosen to compare with i g ampicillin 6-hourly. Of 11 patients whose sputum purulence was unchanged by ampicillin, 6 showed loss of pus from the sputum, or almost total disappearance of sputum, when given amoxycillin. There is some evidence that amoxycillin may penetrate the bronchial mucous membrane more easily than ampicillin, and, if this is confirmed, amoxycillin seems likely to prove significantly more effective than ampicillin in bactericidal therapy of chronic respiratory infections.
47 citations
TL;DR: A case report is presented of a thymoma with unusual histological features including the presence of striated muscle (myoid) cells as an intrinsic part of the tumour.
Abstract: A case report is presented of a thymoma with unusual histological features including the presence of striated muscle (myoid) cells as an intrinsic part of the tumour. Both light and electron microscopy of the thymoma are described, the subject of striated muscle (myoid) cells in thymus is briefly reviewed, and the designation of the tumour as a thymic blastoma is suggested.
44 citations
TL;DR: It was concluded that there was no primary abnormality in the acidic mucins produced by bronchial mucous cells in patients with cystic fibrosis and that the change in the proportion of cells producing the different acidic mucin was a secondary phenomenon related to the bronchiectasis.
Abstract: A quantitative histochemical investigation has been made of the types of acidic glycoprotein produced by the mucous and serous cells of the bronchial submucosal glands in patients with cystic fibrosis. No qualitative abnormalities could be identified in the types of acidic glycoproteins produced in this disease. There was a decrease in the proportion of mucous cells producing sialomucin and an increase in the proportion producing sulphated mucin, as in the case of the mucous cells of adults with bronchiectasis in the absence of cystic fibrosis. It was concluded that there was no primary abnormality in the acidic mucins produced by bronchial mucous cells in patients with cystic fibrosis and that the change in the proportion of cells producing the different acidic mucins was a secondary phenomenon related to the bronchial damage.
42 citations
TL;DR: An increase above normal in the ventilatory response to exercise (hyperpnoea) is a feature of patients whose breathlessness is due to one of several abnormalities of function of the heart or lung.
Abstract: AN increase above normal in the ventilatory response to exercise (hyperpnoea) is a feature of patients whose breathlessness is due to one of several abnormalities of function of the heart or lung. These include a transfer defect, a restricted cardiac output and a shunting of blood past the gas exchanging regions of the lung (pulmonary blood shunt) causing hypoxaemia. In some of these conditions the breathing frequency relative to the tidal volume is increased (tachypnoea),
37 citations
TL;DR: The results support the belief that α-adrenergic receptors are present in the human bronchial tree and are believed to be the most specific α- adrenergic blocking drug at present available.
Abstract: Experiments have been carried out in 4 healthy human volunteers to find the degree of protection against histamine induced bronchial narrowing given by three different doses of thymoxamine taken by mouth. This drug is believed to be the most specific α-adrenergic blocking drug at present available. If so, our results support the belief that α-adrenergic receptors are present in the human bronchial tree.
31 citations
TL;DR: The predominance of sulphated mucin in the fetus is not one aspect of a general inability to produce sialomucin in fetal life, nor is it the consequence of an inactive resting phase in the mucous cell activity.
Abstract: The adult mucous cells of the submucosal glands of the trachea and bronchus produce four varieties of acidic glycoproteins. Only one of these, the heavily sulphated type, is produced in the fetus. The percentage of mucous cells producing sulphated mucin falls, and the percentage producing sialomucin rises to the normal adult levels over the first 2–3 years of life. The predominance of sulphated mucin in the fetus is not one aspect of a general inability to produce sialomucin in fetal life, nor is it the consequence of an inactive resting phase in the mucous cell activity. The significance of these findings is discussed.
TL;DR: There was a high death rate, attributable to the proportion of oat cell tumours which was particularly great in the youngest patients, and the only long-term survivors are patients who had tumours other than of the oat Cell type and who were seen early enough for radical surgery.
Abstract: This is an account of 40 cases in which the diagnosis of lung cancer was established histologically before the age of 40 years. Two-thirds of the tumours were oat cell carcinomas, and all but 1 of the patients under 33 had oat cell tumours. Only 5 patients were known to be non-smokers; 5 tumours arose in lung scars but no other aetiological factor was evident. Of the 1 i women in the series 3 were pregnant at the time of appearance of the tumour or its metastases. There was a high death rate, attributable to the proportion of oat cell tumours which was particularly great in the youngest patients. The only long-term survivors are patients who had tumours other than of the oat cell type and who were seen early enough for radical surgery. One of the patients had a pulmonary blastoma but she is alive 14 years after pneumonectomy and 12 years after the appearance of metastases.
TL;DR: Standard tests of pulmonary function were carried out in 6o subjects exposed to asbestos dust for a prolonged period, and in 10 patients, while the chest radiograph was compatible with asbestosis, the dominant functional pattern was characteristic of airways obstruction.
Abstract: Standard tests of pulmonary function were carried out in 6o subjects exposed to asbestos dust for a prolonged period. The results of these tests have been correlated with the clinical and radiographic findings. In 10 patients, while the chest radiograph was compatible with asbestosis, the dominant functional pattern was characteristic of airways obstruction. These subjects did not admit to symptoms of cough and sputum of greater severity or to heavier smoking than was found in other subjects with a restrictive ventilatory defect and no airways obstruction. Possible explanations for airways obstruction occurring in patients with radiographic evidence of asbestosis are suggested.
TL;DR: All patients with positive mediastinal involve- ment were dead within 2& years of operation, with a mean survival of 6 months; only 3 lived longer than I year after resection.
Abstract: MEDIASTINOSCOPY as a method of obtaining histological proof of mediastinal glandular enlargement is now gaining more general acceptance. After its introduction by Carlens ( 1959)) many surgeons considered that, in carcinoma of the lung, a positive mediastinal biopsy was a contra-indication to any further surgical procedure (Car-lens 1959; Reynders 1964; Nohl-Oser 1965 ; Pearson 1968). In order to assess this last theory, g3 unselected cases of bronchial carcinoma, which were considered operable on clinical, radiological and bronchoscopic grounds, were submitted to mediastinoscopy before thoracotomy. The findings at mediastinoscopy were not allowed to influence the subsequent operation, which was carried out as though this procedure had not taken place. In this group there were I I women and 82 men, with an average age of 60 years. All of these cases have been observed for between 4 and 5i years after operation. These g3 patients are included in a total of 450 who were operated on for lung cancer during the same period at the London Chest Hospital. The 357 patients who did not undergo mediastinoscopy have been used as a control group in assessing results and survival. The results have shown that all patients with positive mediastinal involve- ment were dead within 2& years of operation, with a mean survival of 6 months; only 3 lived longer than I year. Those with a negative result from mediastinal exploration followed the normal pattern of survival after resection (Belcher & Anderson I 965).
TL;DR: The histological changes in the lungs of patients with disseminated lupus erythematosus varied from mild capillary dilatation to interstitial pneumonia, with fibrinoid degeneration and haematoxylin-staining bodies seen.
Abstract: The histological changes in the lungs of 12 patients with disseminated lupus erythematosus are described. They varied from mild capillary dilatation to interstitial pneumonia. Fibrinoid degeneration and haematoxylin-staining bodies were seen. Focal atelectasis was occasionally seen.
TL;DR: Acute respiratory distress following some hours after talc inhalation in a child of 7 years is reported and attention is drawn to the quiescent period between inhalation and signs of airways obstruction.
Abstract: Acute respiratory distress following some hours after talc inhalation in a child of 7 years is reported. Possible mechanisms are discussed and attention drawn to the quiescent period between inhalation and signs of airways obstruction.
TL;DR: This method for testing a new bronchodilator drug, erythro-(3-4 dihydroxyphenyl)2 piperidyl methanol hydrobromide, is used in normal subjects because they react reproducibly to histamine inhalation and are more readily available than asthmatic subjects.
Abstract: BRONCHODILATOR drugs are often tested clinically by giving them to asthmatic patients and following the changes in some objective measurement reflecting the severity of airways obstruction such as timed fractions of the forced vital capacity (FVC), or, more specifically, changes in airways resistance itself. Pharmacologists test these drugs on experimental animals; one of the methods which they employ is to give the drug to guinea-pigs which are then exposed to atmospheres containing histamine in the form of an aerosol. Without the drug, the animals develop severe airway obstruction and may die. Active drugs, such as the majority of the sympathomimetic amines, prevent this occurrence completely in suitable dosage or at least mitigate its severity. The possibility of using a similar technique with normal human subjects has already been explored by Griffin and Turner (1971) who investigated the activity of beta-adrenergic drugs; phenoxybenzamine has also been investigated in this way by Kerr et al. (1970). Recently we have used a similar method for testing a new bronchodilator drug, erythro-(3-4 dihydroxyphenyl)2 piperidyl methanol hydrobromide. (This will be referred to as WG 253 because at present it lacks an approved chemical name. A note on the pharmacology of this drug appears in the Appendix.) We decided to use this method in normal subjects because they react reproducibly to histamine inhalation and are more readily available than asthmatic subjects; moreover airways obstruction in asthmatic subjects is, by definition, variable, sometimes over quite short periods of time, and this makes interpretation of 'before and after' studies difficult or uncertain.
TL;DR: Chloramphenicol should be considered as a first choice antibiotic in the treatment of elderly patients suffering from severe exacerbations of chronic bronchitis.
Abstract: Two hundred elderly patients with severe purulent exacerbations of chronic bronchitis were given either ampicillin or chloramphenicol by random allocation. Both antibiotics were given in high doses and with intramuscular supplements. Significant advantages appeared for chloramphenicol during the treatment of the actual exacerbation, but the relapse rate was equal over the subsequent month's observation in patients treated with either antibiotic regimen. Untoward effects were much less with chloramphenicol. Chloramphenicol should be considered as a first choice antibiotic in the treatment of elderly patients suffering from severe exacerbations of chronic bronchitis.
TL;DR: A patient with congenital fistula between the left ventricle and right atrium complicated by bacterial endocarditis is described and Operative correction can be achieved with a very low morbidity and mortality rate.
Abstract: A patient with congenital fistula between the left ventricle and right atrium complicated by bacterial endocarditis is described. The condition was treated medically followed by surgical repair. The clinical features, pathology and treatment of these lesions is discussed. Closure of all these defects, regardless of their size, is recommended because of the relatively high incidence of bacterial endocarditis and the fact that spontaneous closure is very unlikely. Operative correction can be achieved with a very low morbidity and mortality rate.
TL;DR: The pathological appearances favoured the development of tracheopthia osteoplastica by metaplasia of multipotential connective tissue cells, and were not in keeping with other theories, but did conform to the pattern recognized in thromboembolism.
Abstract: A case is described in which tracheopathia osteoplastica was found at autopsy in a patient in whom progressive pulmonary thromboembolic disease was diagnosed before death. The pathological appearances favoured the development of tracheopthia osteoplastica by metaplasia of multipotential connective tissue cells, and were not in keeping with other theories. The abnormalities of pulmonary function did not include evidence of airways obstruction but did conform to the pattern recognized in thromboembolism.
TL;DR: The vital capacity and transfer factor were reduced in all subjects and the serial tests have been of value in providing an objective assessment of the response to treatment and in giving a measurement of the rate of progress of the disease.
Abstract: Serial lung function studies are presented in a group of io patients with cryptogenic fibrosing alveolitis. The vital capacity and transfer factor were reduced in all subjects. The serial tests have been of value, firstly, in providing an objective assessment of the response to treatment and secondly, in giving a measurement of the rate of progress of the disease. Four patients had acute fibrosing alveolitis and all responded to steroid therapy. The 6 patients with the more chronic form of the disease showed no response to steroids. Two died, one showed slow deterioration and in the remainder there was little change in pulmonary function over a period of years.
TL;DR: Nine patients with exercise asthma were given different drugs before exercise under standardized conditions and failures occurred with all these drugs, however, and appeared to be related to the severity of the exercise asthma.
Abstract: Nine patients with exercise asthma were given different drugs before exercise under standardized conditions. Salbutamol and isoprenaline aerosols, disodium cromoglycate and disodium cromoglycate with isoprenaline succeeded in blocking the exercise asthma in most patients. Failures occurred with all these drugs, however, and appeared to be related to the severity of the exercise asthma.
TL;DR: The number of acute attacks of bronchitis was not significantly reduced but the attacks were milder in nature and the total number of monthly purulent sputum specimens was less in the group given sulfametopyrazine.
Abstract: A double-blind controlled clinical trial in male chronic bronchitic patients was carried out over a 12-month period comparing the ultra long-acting sulphonamide, sulfametopyrazine and a placebo. Each patient was given ampicillin in addition at the start of each exacerbation. The number of acute attacks of bronchitis was not significantly reduced but the attacks were milder in nature and the total number of monthly purulent sputum specimens was less in the group given sulfametopyrazine. There were no important unwanted effects.
TL;DR: Ethambutol proved to be an effective companion for isoniazid with remarkably few side-effects and bacteriologically conversion was achieved in 134 of the 139 patients by the end of 6 months' treatment.
Abstract: One hundred and thirty-nine patients with previously untreated pulmonary tuberculosis completed at least 6 months' treatment with 300 mg isoniazid daily plus ethambutol 25 mg/kg body weight daily reducing after 2 months to 15 mg/kg body weight daily. Clinical and radiological progress was satisfactory in all these patients. In all cases tubercle bacilli susceptible to isoniazid and ethambutol were cultured from respiratory secretions before treatment commenced. Bacteriological conversion was achieved in 134 of the 139 patients by the end of 6 months' treatment. Of the 5 patients who were still bacteriologically positive at 6 months, 3 converted after 7 months and 1 after 9 months. In one patient bacterial resistance to isoniazid emerged after 7 months' treatment although the organisms were still fully susceptible to ethambutol. The only unwanted effect noted was one instance of reversible optic neuritis which occurred after 5 months' treatment. Ethambutol proved to be an effective companion for isoniazid with remarkably few side-effects.
TL;DR: Histological examination of a block of lung from necropsy on a woman of 67 years who died from a pontine haemorrhage revealed a nodule of chemoreceptor tissue deep in the lung around small pulmonary veins.
Abstract: Histological examination of a block of lung from necropsy on a woman of 67 years who died from a pontine haemorrhage revealed a nodule of chemoreceptor tissue deep in the lung around small pulmonary veins. Such nodules have been regarded as minute chemodectomas but may in fact represent hyperplasia of chemoreceptor cells normally present around small pulmonary veins.
TL;DR: The extrinsic and intrinsic asthmatics who had the largest increases in the forced expiratory volume in i second also had a significant reduction in lung hyperinflation and a rise in arterial oxygen tension.
Abstract: Twenty-four asthmatic patients, 13 extrinsic and II intrinsic, were given disodium cromoglycate in a double-blind cross-over trial The extrinsics showed significant mean increases in dynamic lung volumes (FEV 1 , FVC and FEV 1 ) and transfer factor and a fall in bronchial lability index The heart rate and tidal volume/physiological dead space ratio on exercise fell and there was general symptomatic benefit: especially a reduction in cough, wheeze and chest tightness Fewer of the intrinsic asthmatics improved, but there was a significant mean increase in forced expiratory volume after a bronchodilator and 3 had a mean increase in the forced expiratory volume of 0·78 litre with equivalent symptomatic benefit, particularly in chest tightness The extrinsic and intrinsic asthmatics who had the largest increases in the forced expiratory volume in i second also had a significant reduction in lung hyperinflation and a rise in arterial oxygen tension