Biomedical subjects
Publications and source records attributed to C Gropper.
Double lip is a term used to describe a deformity of the upper or lower lip and consists of an accessory fold of redundant mucous membrane inside the vermilion border. Double lip is an uncommon congenital anomaly and is usually diagnosed and treated by a dentist or an oral surgeon. We present an unusual case of double lip--unusual because it was diagnosed and treated by a dermatologist and because of the histopathologic findings.
OBJECTIVES: To combine the patient synchrony effects of pressure-limited breath delivery strategies with the volume guarantee of volume-cycled breath delivery strategies, we designed a positive-pressure breath that incorporates both features. This breath is patient triggered and can be pressure limited. Breath termination (i.e., cycling) can either be flow- or volume-cycled, depending on whether a target volume has been attained. The pressure-limiting features are further enhanced by the capability to adjust demand-valve responsiveness at breath initiation. DESIGN: Prospective, mechanical simulation studies. SETTING: Engineering laboratory. INTERVENTIONS: A mechanical lung model that could simulate patient ventilatory efforts was used. Vigorous and weak patient efforts were studied in conjunction with use of volume assist, pressure support, and a combination pressure-limited and volume-cycled breath. MEASUREMENTS AND MAIN RESULTS: Two clinical situations were simulated by the model: a) a patient requiring total mechanical ventilatory support who had a very active ventilatory drive; and b) a patient receiving only partial ventilatory support who had an unstable ventilatory drive. A range of pressure-limiting and volume-cycling settings were given. Volume, pressure, and flow delivery were measured. Synchrony with patient effort was assessed by visual inspection of airway pressure graphics as well as by calculations of patient work during these support strategies. CONCLUSIONS: Flow dyssynchrony during fixed-flow, volume-cycled assisted breaths in patients with active ventilatory drives can be improved with this breath design while a guaranteed tidal volume is maintained. In addition, this combination breath can provide a volume "safety net" for patients in whom partial support with pressure-support ventilation is desired.
OBJECTIVE: To evaluate airway pressure release ventilation as a partial ventilatory support mode by comparing a demand-flow airway pressure release ventilation system with synchronized intermittent mandatory ventilation and pressure support ventilation. DESIGN: Prospective, nonrandomized, cross-over trial. SETTING: Medical intensive care unit in a university medical center. PATIENTS: Sixteen consecutive patients without chronic obstructive pulmonary disease with mechanical ventilatory support of 25% to 75% of total minute ventilation on synchronized intermittent mandatory ventilation, or 25% to 75% of maximal pressure support level on pressure support ventilation. INTERVENTIONS: Each mode of mechanical ventilation was supplied to patients with comparable levels of partial support for 30 mins. MEASUREMENTS AND MAIN RESULTS: Among three different modes, demand-flow airway pressure release ventilation achieved the lowest peak airway pressure (airway pressure release ventilation 9.1 +/- 2.6 cm H2O; pressure support ventilation 18.4 +/- 4.6 cm H2O; synchronized intermittent mandatory ventilation 34.8 +/- 7.7 cm H2O; p < .001). Hemodynamic status and oxygenation status were similar among these three modes. Five (31%) of the 16 patients felt that demand-flow airway pressure release ventilation was a less comfortable mode than synchronized intermittent mandatory ventilation or pressure support ventilation. This finding had no clear correlation with their duration of airway pressure release, preset machine deflation rate, or inspiratory/expiratory ratio of machine breath. Gross asynchrony of effort and ventilator cycling was noticed in two (13%) patients while they were receiving demand-flow airway pressure release ventilation. CONCLUSIONS: We conclude that for patients who do not have chronic obstructive pulmonary disease, demand-flow airway pressure release ventilation can provide effective partial ventilatory support with lower peak airway pressure when compared with pressure support ventilation and synchronized intermittent mandatory ventilation. However, this airway pressure release ventilation system may be less comfortable than the other two modes, and asynchrony may occur in some patients.
We report a clinical observation, a statistically significant decrease in peripheral blood eosinophils in patients treated with low-dose cyclosporine A for severe psoriasis 225/microliters at baseline to 114/microliters at week 12 (p = 0.04). We discuss the potential significance of this clinical finding.