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Biomedical subjects

A E Rubin

Publications and source records attributed to A E Rubin.

At least 19 recordsLinked to original sources
PubMed2004

Elimination of central sleep apnoea by mitral valvuloplasty: the role of feedback delay in periodic breathing.

Central sleep apnoea is a form of periodic breathing which resembles Cheyne-Stokes respiration but occurs only during sleep. One mechanism in the pathogenesis is a delay in chemical feedback from the lungs to the medullary respiratory centre. We explored the relationship between circulatory feedback delay in a patient with central sleep apnoea and Cheyne-Stokes respiration before and after mitral valve repair. Preoperatively the patient had severe central sleep apnoea and an increased circulation time. Following mitral valvuloplasty the circulation time was decreased with resolution of central sleep apnoea. This case demonstrates the role of feedback delay in central sleep apnoea and suggests that similar haemodynamic mechanisms may lead to central sleep apnoea and Cheyne-Stokes respiration.

Cheyne-Stokes Respiration↗
PubMed1999

Incidence of bacteraemia following fibreoptic bronchoscopy.

Guidelines for antibiotic prophylaxis of infective endocarditis prior to fibreoptic bronchoscopy, are based on only five studies, which showed a bacteraemia rate of <1% among 291 patients studied. T his study was designed to expand the current data regarding the frequency of bacteraemia following fibreoptic bronchoscopy. Aerobic and anaerobic cultures of venous blood and of lavage fluid were drawn from 200 consecutive patients undergoing fibreoptic bronchoscopy without respiratory infection or antibiotic treatment prior to the procedure. The true bacteraemia rate was calculated after excluding probable "contaminated" blood cultures. A possible correlation between type of procedure performed during the bronchoscopy and occurrence of bacteraemia was investigated. Positive blood cultures were noted following 26 bronchoscopy examinations. Coagulase negative Staphylococcus was found in the cultures of 18 patients, coagulase positive Staphylococcus in 3 patients, nonhaemolytic streptococci and a Klebsiella species in 2 patients each, and beta haemolytic streptococcus in one patient. After exclusion of 13 "contaminated" specimens the bacteraemia rate was 6.5% (13/200 patients). This study showed a bacteraemia rate of 6.5%, significantly higher than previously recognized in a cohort of patients undergoing fibreoptic bronchoscopy without either pulmonary infection or an unusually high rate of invasive procedures. These findings should be taken into account in future evaluations of recommendations for antibiotic prophylaxis of endocarditis.

Adolescent↗
PubMed1999

Pleural empyema: An unusual presentation of esophageal perforation.

A 67-year-old patient presented with pleural empyema as the sole manifestation of thoracic esophageal perforation, 2 weeks after accidental fish bone ingestion. Nonspecific chest pain and general deterioration, unusual presenting symptoms in themselves, accounted for the extreme delay in the diagnosis. The empyema was treated surgically, and the esophageal perforation conservatively. Despite the poor prognostic factors, the patient recovered completely after 50 days in hospital.

Aged↗
PubMed1997

A controlled trial of fluoxetine in nondepressed patients with Huntington's disease.

To examine the antidepressant specificity of fluoxetine in Huntington's disease (HD), we carried out a randomized, double-blind, placebo-controlled trial of this medication in nondepressed HD patients. Thirty patients with early HD who were depressed (Hamilton Depression Inventory < 16) were randomized to placebo (N = 13) or fluoxetine 20 mg/day (N = 17) and were followed up for 4 months. Outcome measures included changes in total functional capacity (TFC) and in standardized neurological, cognitive, and behavioral ratings. After adjustment for the higher education level found in the placebo group at baseline, no differences between the treatment groups were found in TFC, neurological, or cognitive ratings. Fluoxetine-treated patients did show a slight reduction in agitation and in the need for routine. Although fluoxetine may be a useful antidepressant in depressed HD patients, it failed to exert substantial clinical benefits in nondepressed HD patients.

Adult↗
PubMed1994

[Pulmonary alveolar proteinosis].

Pulmonary alveolar proteinosis is a rare disease of unknown etiology characterized by alveoli filled with PAS-positive material high in protein and lipid. A 30-year-old man was referred because of respiratory failure. 2 years previously exertional dyspnea and productive cough appeared and gradually worsened. A year later he sought medical advice but defaulted on follow-up. After further deterioration he returned for treatment. On examination he had tachypnea and cyanosis. Diffuse crackles were audible in both lungs. X-ray revealed diffuse bilateral airspace consolidation. Arterial blood gases on air showed PaO2 41 mm Hg, PaCO2 35 mm Hg, and pH 7.46. There was a restrictive pattern on pulmonary function testing. Fiberoptic bronchoscopy with broncho-alveolar lavage and transbronchial biopsy established the diagnosis of pulmonary alveolar proteinosis. Whole lung lavage lead to gradual improvement over the next few weeks. However, chest X-ray, arterial blood gases and pulmonary function tests failed to revert completely to normal. Such severe manifestations and such an aggressive course as in this case might have been prevented had the diagnosis been made and treatment instituted earlier in the course of the disease.

Adult↗
PubMed1992

Obstructive airway disease associated with occupational sodium hydroxide inhalation.

Sodium hydroxide (NaOH) is well known for its corrosive properties and its ability to generate heat on contact with water. The respiratory effects of industrial exposure to NaOH have, however, never been reported. A 63 year old man worked daily for 20 years cleaning large industrial jam containers by boiling lye (NaOH) solution without using respiratory protective equipment. Physical examination, chest x ray film, pulmonary function tests, and arterial blood gases were all compatible with severe obstructive airway disease with significant air trapping. It is probable that this massive and prolonged occupational exposure to the corrosive effect of NaOH mists induced irritation and burns to the respiratory system, eventually leading to severe obstructive airway disease.

Humans↗
PubMed1990

[A respiratory health questionnaire for occupational screening].

A Hebrew pulmonary health questionnaire was designed for occupational screening, based on the American Thoracic Society questionnaire but adjusted to conditions in Israel. It was designed for assisted completion using a computer, but can easily be modified to become self-administered. We propose that it be used here as the standard, occupational, pulmonary health questionnaire and as the basis for a standard, general purpose, respiratory health questionnaire.

Humans↗
PubMed1988

The effect of gravity on the response of ventilation to abrupt change in FICO2.

Recently, Arieli and Farhi (1987) formulated a model for a previous suggestion made by their group that an increased ventilation as gravity increases is due to reduced perfusion of the respiratory center which causes an elevation of tissue PCO2. Extending the model to the dynamic response, we predict a slower ventilatory response to CO2 breathing as gravity increases. To test this prediction, ventilatory response to 5% CO2 was studied in 11 seated subjects at +1 and +2 Gz in a human centrifuge. Five of these subjects were studied at +3 Gz as well. In addition, ventilatory response to 5% CO2, using breath-by-breath analysis, was measured in three subjects in supine and upright postures. The ventilatory response (mainly through tidal volume) was faster as gravity increased from +1 to +2 and to +3 Gz, and from supine to the upright position. These findings disagree with the model prediction. Therefore, an alternative explanation is suggested based on the response of CO2 sensitive stretch receptors in the lung. Increased gravity causes increased ventilation, reduction of cardiac output and increased VA/Q mismatch; all enlarge the part of the lung with low CO2 where responsiveness of the CO2 sensitive stretch receptors is large.

Adult↗
PubMed1984

Prevalence of sleep apnea syndrome among patients with essential hypertension.

The purpose of this study was to investigate the prevalence of sleep apnea syndrome (SAS) among patients with essential hypertension. Sixteen of 50 patients with essential hypertension were suspected of having SAS based on their responses to a sleep questionnaire. Whole-night polysomnographic recordings revealed that 11 of the 16 patients, which is 22% of the initial sample, had SAS as defined by the occurrence of at least 10 apneas lasting 10 seconds each per hour of polygraphically defined sleep. The preponderant finding of SAS in this group indicates that the possibility of the syndrome should be taken into consideration in the clinical evaluation of these patients.

Adult↗
PubMed1983

The treatment of asthma in adults using sodium cromoglycate pressurized aerosol: a double-blind controlled trial.

Sodium cromoglycate formulated as a pressurized aerosol (2 mg 4-times daily) and placebo were compared in 31 adult asthmatic patients in a double-blind crossover trial lasting 12 weeks. Sodium cromoglycate was superior to placebo in improving breathlessness at rest (p less than 0.001), breathlessness on exertion (p less than 0.05) and the quality of sleep (p less than 0.001), and also in improving the morning peak expiratory flow rate value (p less than 0.05). Both the patients' (p less than 0.05) and the clinicians' (p less than 0.01) treatment opinions, and their treatment preferences (p less than 0.05), favoured sodium cromoglycate. Moreover, usage of bronchodilators (theophylline and aerosol beta-stimulants combined) declined significantly (p less than 0.001) during sodium cromoglycate treatment compared to placebo. No side-effects were reported. The results of this study show that sodium cromoglycate delivered by pressurized aerosol was significantly superior to placebo, not only in improving asthmatic symptoms, but also in reducing the amount of concomitant bronchodilator therapy required.

Adolescent↗
PubMed1976

Postpartum haemolytic-uraemic syndrome.

In a young woman a twin pregnancy and uneventful labour were complicated by the development of the postpartum haemolytic-uraemic syndrome. A number of unusual features of this syndrome were present, including early onset, accompanying hepatocellular necrosis, hepatic encephalopathy and bleeding diathesis. Early institution of heparin therapy combined with coagulation factor replacement was followed by cessation of haemorrhage and complete recovery from acute renal failure.

Adult↗