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Mishra EK, Clive AO, Wills GH, Davies HE, Stanton AE, Al-Aloul M, Hart-Thomas A, Pepperell J, Evison M, Saba T, Harrison RN, Guhan A, Callister ME, Sathyamurthy R, Rehal S, Corcoran JP, Hallifax R, Psallidas I, Russell N, Shaw R, Dobson M, Wrightson JM, West A, Lee YCG, Nunn AJ, Miller RF, Maskell NA, Rahman NM. Randomized Controlled Trial of Urokinase versus Placebo for Nondraining Malignant Pleural Effusion. Am J Respir Crit Care Med 2019; 197:502-508. [PMID: 28926296 DOI: 10.1164/rccm.201704-0809oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Patients with malignant pleural effusion experience breathlessness, which is treated by drainage and pleurodesis. Incomplete drainage results in residual dyspnea and pleurodesis failure. Intrapleural fibrinolytics lyse septations within pleural fluid, improving drainage. OBJECTIVES To assess the effects of intrapleural urokinase on dyspnea and pleurodesis success in patients with nondraining malignant effusion. METHODS We conducted a prospective, double-blind, randomized trial. Patients with nondraining effusion were randomly allocated in a 1:1 ratio to intrapleural urokinase (100,000 IU, three doses, 12-hourly) or matched placebo. MEASUREMENTS AND MAIN RESULTS Co-primary outcome measures were dyspnea (average daily 100-mm visual analog scale scores over 28 d) and time to pleurodesis failure to 12 months. Secondary outcomes were survival, hospital length of stay, and radiographic change. A total of 71 subjects were randomized (36 received urokinase, 35 placebo) from 12 U.K. centers. The baseline characteristics were similar between the groups. There was no difference in mean dyspnea between groups (mean difference, 3.8 mm; 95% confidence interval [CI], -12 to 4.4 mm; P = 0.36). Pleurodesis failure rates were similar (urokinase, 13 of 35 [37%]; placebo, 11 of 34 [32%]; adjusted hazard ratio, 1.2; P = 0.65). Urokinase was associated with decreased effusion size visualized by chest radiography (adjusted relative improvement, -19%; 95% CI, -28 to -11%; P < 0.001), reduced hospital stay (1.6 d; 95% CI, 1.0 to 2.6; P = 0.049), and improved survival (69 vs. 48 d; P = 0.026). CONCLUSIONS Use of intrapleural urokinase does not reduce dyspnea or improve pleurodesis success compared with placebo and cannot be recommended as an adjunct to pleurodesis. Other palliative treatments should be used. Improvements in hospital stay, radiographic appearance, and survival associated with urokinase require further evaluation. Clinical trial registered with ISRCTN (12852177) and EudraCT (2008-000586-26).
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Affiliation(s)
- Eleanor K Mishra
- 1 Norfolk and Norwich Pleural Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, United Kingdom
| | - Amelia O Clive
- 2 Academic Respiratory Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, United Kingdom
| | | | - Helen E Davies
- 4 Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | | | - Mohamed Al-Aloul
- 6 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Alan Hart-Thomas
- 7 Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Justin Pepperell
- 8 Somerset Lung Centre, Musgrove Park Hospital, Taunton, United Kingdom
| | - Matthew Evison
- 6 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Tarek Saba
- 9 Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Richard Neil Harrison
- 10 North Tees and Hartlepool Hospitals NHS Foundation Trust, North Tees, United Kingdom
| | - Anur Guhan
- 11 University Hospital Ayr, Ayr, United Kingdom
| | | | | | - Sunita Rehal
- 3 Medical Research Council Clinical Trials Unit and
| | - John P Corcoran
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Robert Hallifax
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Ioannis Psallidas
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Nicky Russell
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Rachel Shaw
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Melissa Dobson
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - John M Wrightson
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Alex West
- 15 Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Y C Gary Lee
- 16 School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; and
| | | | - Robert F Miller
- 17 Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | - Nick A Maskell
- 2 Academic Respiratory Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, United Kingdom
| | - Najib M Rahman
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom.,18 National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
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Jeebun V, Harrison RN. Understanding local performance data for EBUS-TBNA: insights from an unselected case series at a high volume UK center. J Thorac Dis 2017; 9:S350-S362. [PMID: 28603645 DOI: 10.21037/jtd.2017.05.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We reviewed the diagnostic performance of endobronchial ultrasound transbronchial aspiration (EBUS-TBNA) on an unselected large cohort of patients who underwent the procedure in our institution in the past 3 years and to compare against published standards and existing literature. METHODS All consecutive patients who underwent EBUS from January 2013 to December 2015 were included in the retrospective analysis, with a minimum of 6 months of clinico-radiological follow up. For assessing EBUS-TBNA performance, patients were analysed in three subgroups based on the indication for the EBUS-TBNA: in investigation of isolated mediastinal and/or hilar lymphadenopathy (IMHL), in staging of suspected or confirmed non-small cell lung cancer (NSCLC) and in making a tissue diagnosis in suspected thoracic or extrathoracic cancer. For patients subjected to EBUS-TBNA for staging in suspected lung cancer, accuracy of EBUS was measured by its ability to determine the true N2 stage. RESULTS A total of 1,656 lymph nodes and 138 peribronchial/peritracheal masses were sampled in 940 patients over the study period. The prevalence of reactive lymphadenopathy was 34%. The overall sensitivity to detect pathological disease was 81.6% (95% CI: 74.2-87.6%) whilst NPV was 74.8% (95% CI: 65.2-82.8%). Amongst patients who underwent EBUS-TBNA for staging purposes, the sensitivity for N2 staging was 83.7% (95% CI: 76.2-89.6%) and NPV was 81.6% (95% CI: 73.2-88.2%). The prevalence of N2 disease was 58%. In the subgroup of patients who proceeded to surgical sampling, the sensitivity was higher with the N2/N3 disease prevalence of 67.4%. The sensitivity of EBUS-TBNA to make a tissue diagnosis of thoracic or extrathoracic cancer was 88% (95% CI: 85.1-90.5%) and a NPV of 62% (95% CI: 54.7-69.0%). The disease prevalence was 83.6%. CONCLUSIONS This retrospective study of a large volume of patients represents real life practice and provides an accurate representation of the typical cohort of patients referred in for EBUS-TBNA to the general respiratory physician in UK. Our study highlights the pitfalls in collecting and analyzing data but also demonstrates how they can be used to improve service performance.
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Affiliation(s)
- Vandana Jeebun
- Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Cleveland, UK
| | - Richard Neil Harrison
- Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Cleveland, UK
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Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R, Wijesinghe M, Harrison RN, Steen N, Simpson AJ, Gibson GJ, Bourke SC. The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD. Thorax 2017; 72:686-693. [PMID: 28235886 PMCID: PMC5537524 DOI: 10.1136/thoraxjnl-2016-209298] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/03/2017] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
Background One in three patients hospitalised due to acute exacerbation of COPD (AECOPD) is readmitted within 90 days. No tool has been developed specifically in this population to predict readmission or death. Clinicians are unable to identify patients at particular risk, yet resources to prevent readmission are allocated based on clinical judgement. Methods In participating hospitals, consecutive admissions of patients with AECOPD were identified by screening wards and reviewing coding records. A tool to predict 90-day readmission or death without readmission was developed in two hospitals (the derivation cohort) and validated in: (a) the same hospitals at a later timeframe (internal validation cohort) and (b) four further UK hospitals (external validation cohort). Performance was compared with ADO, BODEX, CODEX, DOSE and LACE scores. Results Of 2417 patients, 936 were readmitted or died within 90 days of discharge. The five independent variables in the final model were: Previous admissions, eMRCD score, Age, Right-sided heart failure and Left-sided heart failure (PEARL). The PEARL score was consistently discriminative and accurate with a c-statistic of 0.73, 0.68 and 0.70 in the derivation, internal validation and external validation cohorts. Higher PEARL scores were associated with a shorter time to readmission. Conclusions The PEARL score is a simple tool that can effectively stratify patients' risk of 90-day readmission or death, which could help guide readmission avoidance strategies within the clinical and research setting. It is superior to other scores that have been used in this population. Trial registration number UKCRN ID 14214.
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Affiliation(s)
- C Echevarria
- North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - J Steer
- North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK
| | - K Heslop-Marshall
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.,Royal Victoria Hospital, Newcastle upon Tyne, UK
| | - S C Stenton
- Royal Victoria Hospital, Newcastle upon Tyne, UK
| | - P M Hickey
- Northern General Hospital, Sheffield, South Yorkshire, UK
| | - R Hughes
- Northern General Hospital, Sheffield, South Yorkshire, UK
| | | | - R N Harrison
- University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
| | - N Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - A J Simpson
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - G J Gibson
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - S C Bourke
- North Tyneside General Hospital, North Shields, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
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Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R, Wijesinghe M, Harrison RN, Steen N, Simpson AJ, Gibson GJ, Bourke SC. Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD. Thorax 2016; 71:133-40. [PMID: 26769015 PMCID: PMC4752621 DOI: 10.1136/thoraxjnl-2015-207775] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Hospitalisation due to acute exacerbations of COPD (AECOPD) is common, and subsequent mortality high. The DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care. We aimed to validate the DECAF score, internally and externally, and to compare its performance to other predictive tools. Methods The study took place in the two hospitals within the derivation study (internal validation) and in four additional hospitals (external validation) between January 2012 and May 2014. Consecutive admissions were identified by screening admissions and searching coding records. Admission clinical data, including DECAF indices, and mortality were recorded. The prognostic value of DECAF and other scores were assessed by the area under the receiver operator characteristic (AUROC) curve. Results In the internal and external validation cohorts, 880 and 845 patients were recruited. Mean age was 73.1 (SD 10.3) years, 54.3% were female, and mean (SD) FEV1 45.5 (18.3) per cent predicted. Overall mortality was 7.7%. The DECAF AUROC curve for inhospital mortality was 0.83 (95% CI 0.78 to 0.87) in the internal cohort and 0.82 (95% CI 0.77 to 0.87) in the external cohort, and was superior to other prognostic scores for inhospital or 30-day mortality. Conclusions DECAF is a robust predictor of mortality, using indices routinely available on admission. Its generalisability is supported by consistent strong performance; it can identify low-risk patients (DECAF 0–1) potentially suitable for Hospital at Home or early supported discharge services, and high-risk patients (DECAF 3–6) for escalation planning or appropriate early palliation. Trial registration number UKCRN ID 14214.
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Affiliation(s)
- C Echevarria
- Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - J Steer
- Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK
| | - K Heslop-Marshall
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK Chest Clinic, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - S C Stenton
- Chest Clinic, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - P M Hickey
- Department of Respiratory Medicine, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - R Hughes
- Department of Respiratory Medicine, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - M Wijesinghe
- Department of Respiratory Medicine, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - R N Harrison
- Department of Respiratory Medicine, University Hospital of North Tees, Hardwick Hall, Stockton-on-Tees, Cleveland, UK
| | - N Steen
- Institute of Health and Society, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - A J Simpson
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - G J Gibson
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - S C Bourke
- Department of Respiratory Medicine, North Tyneside General Hospital, North Shields, UK Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
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Echevarria C, Steer J, Heslop-Marshall K, Stenton SC, Hickey PM, Hughes R, Wijesinghe M, Harrison RN, Steen N, Simpson AJ, Gibson GJ, Bourke SC. S58 The PEARL score predicts 90 day readmission or death following hospitalisation for an exacerbation of COPD: Abstract S58 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Harrison RN. Rise and demise of the hospital: backwards is the new forward: time for the heritage hospital. BMJ 2006; 332:52-3. [PMID: 16399752 PMCID: PMC1325182 DOI: 10.1136/bmj.332.7532.52-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Imperatori A, Harrison RN, Leitch DN, Rovera F, Lepore G, Dionigi G, Sutton P, Dominioni L. Lung cancer in Teesside (UK) and Varese (Italy): a comparison of management and survival. Thorax 2005; 61:232-9. [PMID: 16284219 PMCID: PMC2080743 DOI: 10.1136/thx.2005.040477] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The survival of lung cancer patients in the UK is lower than in other similar European countries. The reasons for this are unclear. METHODS Two areas were selected with a similar incidence of lung cancer: Teesside in Northern England and Varese in Northern Italy. Data were collected prospectively on all new cases of lung cancer diagnosed in the year 2000. Comparisons were made of basic demographic characteristics, management, and survival. RESULTS There were 268 cases of lung cancer in Teesside and 243 in Varese. Patients in Teesside were older (p<0.05), were more likely to have smoked (p<0.001), had a higher occupational risk (p<0.001), higher co-morbidity (p<0.05), and poorer performance status (p<0.001). Fewer patients in Teesside presented as an incidental finding (p<0.001) and the histological confirmation rate was lower than in Varese (p<0.01). In Teesside there were more large cell carcinomas (p<0.001), more small cell carcinomas (p<0.05), and fewer early stage non-small cell lung cancers (p<0.05). The resection rate was lower in Teesside (7% v 24%; p<0.01) and more patients received no specific anti-cancer treatment (50% v 25%; p<0.001). Overall 3 year survival was lower in Teesside (7% v 14%; p<0.001). Surgical resection was the strongest multivariate survival predictor in Varese (HR = 0.46) and Teesside (HR = 0.31). Co-morbidity in Teesside resulted in a significantly lower resection rate (p<0.001). CONCLUSIONS Patients with lung cancer in Teesside presented at a later stage, with more aggressive types of tumour, and had higher co-morbidity than patients in Varese. As a result, the resection rate was significantly lower and survival was worse.
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Affiliation(s)
- A Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Viale Borri 57, 21100Varese, Italy.
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Aithal GP, Harrison RN, Snashall PD. Is clinical examination an art? Lancet 2000; 355:501. [PMID: 10841162 DOI: 10.1016/s0140-6736(00)82061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
A two-dimensional, dynamic bioengineering model of the lower limbs was developed in order to estimate muscle and joint forces present during running at 4.5 m s-1. Data were collected from four subjects using a force platform and cine film. Individual X-rays and anthropometric data from the lower limbs were utilized to produce accurate bone models of the subjects' legs. Electromyographic verification of the model was undertaken while a runner was undergoing treadmill running at 4.5 m s-1. Results indicate that peak muscle forces of 22 times subject body weight (22 BW) could be present in the quadriceps muscle group and 7 BW in the gastrocnemius. The anterior shin muscles were found to be active for the first 9% of stance phase only, and compressive loads of 33 BW were found in the knee joint. The relationship between these high forces in the lower limbs and running related injuries is discussed.
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Harrison RN. Sarcomatous pleural mesothelioma and cerebral metastases: case report and a review of eight cases. Eur J Respir Dis 1984; 65:185-8. [PMID: 6723828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sarcomatous malignant mesothelioma have a predilection for bloodborne spread. A case with cerebral metastases is presented and the details are briefly reviewed of 8 other cases with the same histological picture.
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Abstract
For many years the development of thyrotoxicosis has been known to cause a deterioration in asthma but the mechanism is unknown. We have studied the effect of thyroid function on airway beta adrenergic responsiveness in 10 hyperthyroid and six hypothyroid subjects before and after treatment of their thyroid disease. Airway adrenergic responsiveness was assessed by measuring specific airway conductance (sGaw) after increasing doses of inhaled salbutamol (10-410 micrograms). After treatment there was no difference in resting FEV1, sGaw, or thoracic gas volume. FVC increased in the hyperthyroid subjects but did not change in the hypothyroid subjects. In the hyperthyroid subjects there was a significant increase in delta sGaw after 35, 60, 110, and 41 micrograms salbutamol; in sGaw after 60, 110, and 410 micrograms salbutamol; and in the area under the salbutamol dose response curve (AUC) after treatment of the thyroid disorder. In the hypothyroid subjects there was a significant reduction in sGaw after 10 and 60 micrograms salbutamol and in the AUC after treatment. When all subjects were considered, there was a negative correlation between the AUC and serum thyroxine values. These findings suggest that an inverse relationship exists between the level of thyroid function and airway beta adrenergic responsiveness.
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Harrison RN. Chronic lymphocytic pulmonary infiltrate and Bence-Jones proteinuria. Respiration 1984; 46:334-6. [PMID: 6333704 DOI: 10.1159/000194708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The clinical and radiological features in a 79-year-old patient with a chronic lymphocytic pulmonary infiltrate are described. The associated findings of Bence-Jones proteinuria, paraprotein bands in the plasma and a monoclonal population of circulating lymphocytes are strong evidence for a pulmonary lymphocytic lymphoma. The differential diagnosis is discussed.
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Harrison RN, Hibberd SC, Dadds JH. Malignant pleural mesothelioma at St Mary's Hospital, Portsmouth--a review of 29 fatal cases. Postgrad Med J 1983; 59:712-6. [PMID: 6647189 PMCID: PMC2417675 DOI: 10.1136/pgmj.59.697.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The clinical details are presented of 29 fatal cases of pleural mesothelioma in the majority of which there was a history of exposure to asbestos during dockyard work in Portsmouth. Chest pain, breathlessness and weight loss dominated the clinical picture. Analgesia and repeated pleural aspirations provided temporary relief but symptoms invariably progressed. The mean survival time was 39 weeks. Only one patient survived longer than 2 years from hospital presentation. At autopsy, extensive local spread was usual but a high proportion of patients also had metastases at distant sites.
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Harrison RN. Respiratory failure with normal lungs. Practitioner 1980; 224:1261-5. [PMID: 7220445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
The effect of beta-adrenoceptor antagonists on the respiratory response to carbon dioxide rebreathing was studied in eight normal subjects. Propranolol, atenolol, metoprolol, and placebo were given in random, double-blind fashion. Subjects were studied before each treatment period, after one dose, and after eight days of treatment with each drug. A rebreathing method was used to produce progressive hypercapnia and the respiratory response was assessed by measuring minute ventilation and maximum rate of change of inspiratory mouth pressure. Beta-blockade was assessed by the reduction in heart rate during steady state exercise on a cycle ergometer. There was no change in the respiratory response to carbon dioxide after a single dose or eight days treatment of any drug. All three active drugs produced a significant reduction in exercise heart rate. The forced expiratory volume in one second was not altered by any of the drugs.
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