Expiratory flow patterns in amyotrophic lateral sclerosis.
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Amyotrophic Lateral Sclerosis↗
Biomedical subjects
B B Brach
Publications and source records attributed to B B Brach.
Papillomatosis of the respiratory tract. Upper airway obstruction and carcinoma.
Metastasizing squamous cell carcinoma of the lung developed in a patient who had juvenile papillomatosis but had had no previous radiation therapy. At the same time, a significant upper airway obstruction was present. All endobronchial lesions rapidly resolved with radiation therapy, and the carcinoma was resected.
Adolescent↗
Functional residual capacity and body position in the dog.
Resting lung volumes in the supine position (FRCs) were determined by N2 washout method in 67 dogs under pentobarbital anesthesia and computed in ml/kg body weight (BW). In 21 other dogs, FRCs and the change in FRC from the supine to upright positions (deltaFRC) were determined; these lung volumes were expressed in ml/kg BW and in percentage of TLC40 (lung volume at 40 cmH2O positive-pressure inflation). It was found that a) FRCs averaged 38.6 plus or minus 8.2 and 42 plus or minus 5.9 ml/kg BW in the two groups of dogs; b) deltaFRC averaged 23 plus or minus 4 ml/kg BW resulted in large data dispersion, a large coefficient of variation (CV) and a poor correlation (r) of lung volume to BW; D) on the contrary, marked uniformity of FRCs and FRCu (upright FRC) was obtained by expressing the resting lung volumes in %TLC40, allowing an accurate prediction of FRC from the inspiratory capacity (IC). Relationship of FRCu to TLC was comparable to human data reported in the literature. FRCs (%TLC40) was smaller than values previously reported for awake human subjects, probably due to the FRCs reduction in our dogs by anesthesia.
Animals↗
Clinically suspected deep venous thrombosis of the lower extremities. A comparison of venography, impedance plethysmography, and radiolabeled fibrinogen.
To define the utility of new diagnostic approaches in patients with clinically suspected deep venous thrombosis of the lower extremities, 42 legs of 33 patients were studied by fibrinogen labeled with radioactivie iodine (125I) impedance plethysmography (IPG), and contrast venography. The clinical diagnosis was confirmed in approximately two thirds of the legs and patients. In venogram-positive legs, fibrinogen 125I was positive in 70%, IPG in 61%, and one of the two in 78%. In venogram-negative legs, fibrinogen 125I was positive in four (21%) and IPG was negative in all. It was found that the size, age, and location of the thrombus, collateral vein development, heparin sodium therapy, and technical-interpretive choices can influence both IPG and fibrinogen 125I results. The data demonstrate that the fibrinogen 125I and IPG procedures can assist physicians in the diagnosis of clinically suspected deep venous thrombosis of the lower extremities.
False Negative Reactions↗
Venous thrombosis in acute spinal cord paralysis.
Radiolabeled fibrinogen, impedance phlebography and venogram surveillance were carried out in ten consecutive acute spinal cord paralysis patients. Nine patients had evidence of deep venous thrombosis by radiolabeled fibrinogen technique. Venogram confirmed the presence of venous thrombosis in seven. Impedance phlebography was positive in only four. Eight patients developed a positive radiolabeled fibrinogen test after a surgical procedure. One patient with extensive venous thrombosis had multiple pulmonary emboli.
Adolescent↗
Light sources as a means of reproducing patient positioning.
A simple method to insure the reproducibility of patient positioning is described. The system uses an adjustable frame fastened to the camera head and two light sources. The light sources project two circles of light on the patient. These reference points are marked on the patient's skin with a felt pen. If the patient moves or requires a follow-up study, these two reference points can be used to reposition the patient exactly. Comparison of the light-sources method with the persistence-scope method showed a significant improvement in accuracy with the former.
Light↗
Diaphragmatic function during immersion.
Diaphragmatic function during immersion to midneck level was studied in upright mongrel dogs, using constant electrophrenic stimulation. Effectiveness of diaphragmatic contraction was analyzed in terms of inspired volume (VT) (with airways open), and change in intrathoracic pressure (Pmus) (with the respiratory system occluded). Hydrostatic compression of the immersed body decreased functional residual capacity (FRC) to 55% base-line value (FRCO), resulting in a 2.8-fold increase in Pmus. In spite of this Pmus increase, VT often decreased during immersion, averaging only 83% VTO (base-line value in air). Hence, immersion was associated with a marked stiffening of the respiratory system. The Pmus increase during immersion persisted after restoration of FRC to FRCO, and was related to diaphragmatic length being greater in water than in air under condition of iso-lung volume. In all, there were three factors affecting diaphragmatic function during immersion: FRC reduction, change in thoracic configuration, and stiffening of the respiratory system.
Animals↗
133Xenon washout patterns during diaphragmatic breathing. Studies in normal subjects and patients with chronic obstructive pulmonary disease.
Studies of the washout of radioactive 133xenon were performed in six normal subjects and six patients with chronic obstructive pulmonary disease during normal and diaphragmatic breathing. Subjects were unable to change the distribution of ventilation with diaphragmatic breathing. In all normal subjects and in three of the six subjects with chronic obstructive pulmonary disease, overall washout improved with diaphragmatic breathing. It is suggested that this change was related to the slower, deeper tidal volumes used by these subjects during diaphragmatic breathing.
Breathing Exercises↗
Alveolar proteinosis. Lobar lavage by fiberoptic bronchoscopic technique.
Lavage limited to an isolated lobe was performed on multiple occasions using a cuffed fiberoptic bronchoscope in a patient with alveolar proteinosis. Sequential ventilation-perfusion scintiphotoscans were used to preselect and follow the functional behavior of the lavaged lobe. Lavage led to functional improvement. The technique of fiber-optic bronchoscopic lobar lavage is simple and may find application in patients in whom lavage of an entire lung may be hazardous.
Adult↗
Ventilation-perfusion alterations induced by fiberoptic bronchoscopy.
Pulmonary perfusion (Q) and ventilation (V) scintiphotography was performed in 16 patients undergoing diagnostic fiberoptic bronchoscopic examinations. Regional V/Q did not change in the majority of the patients who developed hypoxemia after bronchoscopic studies. An improvement in V/Q was detectable in the patients with a rise in arterial oxygen pressure (PaO2) after bronchoscopic examination, and this rise was associated in most with the removal of mucous plugs or extensive secretions. The data indicate that the behavior of PaO2 after bronchoscopic study is dependent upon both the extent of lavage and the yield of the procedure in terms of secretions and plugs. The results also indicate that the removal of secretions or plugs can be associated with rapid return of regional V and Q.
Bronchoscopy↗
A review of deaths due to suspected lactic acidosis at a large metropolitan hospital.
A review of 2,647 consecutive deaths over a 19-month period at a large metropolitan hospital revealed 27 cases (1%) to be coded as metabolic acidosis. In ten of these deaths, a presumptive diagnosis of lactic acidosis could be made. Eight of the ten were diabetic, and all eight were treated with phenformin at the time of their last admission. Although phenformin could not be incriminated as the sole cause of lactic acidosis in these cases, a contributory role of the drug seems probable. The indiscriminate use of phenformin in diabetic patients should be discouraged and the contraindications to the use of phenformin should be stressed.
Acidosis↗
Reduced inspiratory effort during intermittent mandatory ventilation with PEEP.
The use of intermittent mandatory ventilation (IMV) and positive and expiratory pressure (PEEP) may demand the patient mount an inspiratory pressure equivalent to the pressure level of the PEEP for spontaneous breathing. During respiratory failure, ineffective inspiratory muscles may be unable to consistently meet such demands, especially if high levels of PEEP are used. A technique which reduces the required inspiratory effort was devised for use in patients being treated with IMV and PEEP. Using this technique, isovolume inspiratory time was dramatically reduced and less inspiratory effort was required. This maneuver may assist spontaneous breathing in patients with respiratory failure on high levels of PEEP.
Humans↗