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D J Gillespie

Publications and source records attributed to D J Gillespie.

At least 19 recordsLinked to original sources
PubMed1996

Post-irradiation malignant mesothelioma.

BACKGROUND: Approximately 30 patients with malignant mesothelioma following radiotherapy have been described. Population-based studies of this occurrence have not been reported. METHODS: Patients with malignant mesothelioma of the pleura were collected. All of the patients had a prior cancer and had received radiotherapy to the region in which the malignant mesothelioma developed. Data from the National Cancer Institute's Surveillance, Epidemiology and End Results Program and the Connecticut Tumor Registry were evaluated for cases of malignant mesothelioma of the pleura occurring in patients with a previous cancer. The literature on post-irradiation malignant mesotheliomas was reviewed. RESULTS: Eight patients (4 men, 4 women) with malignant mesothelioma occurring in sites of radiotherapy for a prior tumor were identified. The mean age at diagnosis of mesothelioma was 45 years (range: 22-78 years), and the average interval between radiotherapy and the mesothelioma was 21 years (range: 11-29 years). Three of the patients had also received chemotherapy. Histologically, the mesotheliomas were epithelial in five cases, biphasic in one, and sarcomatous in one. One hundred forty-two patients were identified in the epidemiologic survey. The majority were men (89%), with a mean age for all patients of 68.5 years (range: 35-86 years) and a median latency between first cancer and mesothelioma of 4.3 years (range: 2 months-29.9 years). CONCLUSIONS: Mesotheliomas rarely develop as second malignant neoplasms. Within a large, population-based survey of patients with cancer, temporal patterns and demographic features of most second primary mesotheliomas were similar to asbestos-related tumors, although the late effects of cancer treatment might have contributed to the occurrence of cancer in some patients.

Adult↗
PubMed1994

Unexplained dyspnea.

Dyspnea is a common symptom that is difficult to define and can result from a wide variety of causes. This complex sensation that arises from multiple stimuli involves both subjective perceptions and objective reactions. In the assessment of patients with dyspnea, use of a systematic approach to determine the precipitating factors and the degree of breathlessness is important. Although many diseases may produce dyspnea, two thirds of the cases result from a pulmonary or cardiac disorder. Neuromuscular and psychogenic causes should also be considered. A comprehensive history, physical examination, and basic laboratory tests are important in the initial assessment; however, the diagnosis may depend on specialized testing, the results of which may differ from the initial clinical impression. Initial testing should include electrocardiography, chest roentgenography, hemoglobin determination, thyroid function, and spirometry with use of a bronchodilator. More specialized evaluation includes detailed pulmonary function testing and echocardiography. As shown in our illustrative case, cardiopulmonary exercise testing is important for evaluation of unexplained dyspnea when initial test results are nondiagnostic. Accurate diagnostic data are critical for choosing appropriate treatment.

Adult↗
PubMed1993

Primary mediastinal neoplasms (other than thymoma).

Primary mediastinal neoplasms encompass a long list of histologically diverse lesions that can arise from a wide variety of mediastinal structures. Recent advances in diagnostic techniques have considerably enhanced the evaluation of the mediastinum with use of noninvasive or minimally invasive procedures. In adults, most primary mediastinal neoplasms can be classified in one of four categories: thymus-derived neoplasms, neurogenic tumors, lymphomas, or germ cell neoplasms. In children, neurogenic tumors (especially neuroblastomas) and lymphomas are most frequently encountered. Because of the presence of many vital structures in the confined thoracic cavity, even benign mediastinal neoplasms can cause severe symptoms from the mass effect and therefore warrant a carefully planned management strategy. With modern therapeutic and surgical interventions, associated morbidity and mortality can often be substantially decreased.

Endocrine Gland Neoplasms↗
PubMed1992

Prevention of infection in critically ill patients by selective decontamination of the digestive tract.

OBJECTIVE: To determine whether selective decontamination of the digestive tract using oral and nonabsorbable antimicrobial agents and parenteral cefotaxime prevents infection in critically ill patients. DESIGN: Randomized, controlled trial without blinding. SETTING: Surgical trauma and medical intensive care units in a tertiary referral hospital. PATIENTS: One hundred fifty patients admitted to surgical trauma and medical intensive care units during a 3-year interval, whose condition suggested a prolonged stay (greater than 3 days). INTERVENTION: Patients were randomly allocated to an experimental group (n = 75) that received cefotaxime, 1 g intravenously every 8 hours for the first 3 days only, and oral, nonabsorbable antibiotics (gentamicin, polymyxin, and nystatin by oral paste and oral liquid) for the entire stay in the intensive care unit. Control patients (n = 75) received usual care. MEASUREMENTS: The number of infections, total hospital days, and deaths, as well as the number of days in intensive care unit, were recorded. RESULTS: Control patients experienced more infections (36 compared with 12, P = 0.04), including bacteremias (14 compared with 4, P = 0.05) and pulmonary infections (14 compared with 4, P = 0.03). Although total hospital days, days in intensive care, and the overall death rate all were lower in the treatment group, these differences were not statistically significant. Clinically important complications of selective decontamination of the digestive tract were not encountered. CONCLUSIONS: Selective decontamination of the digestive tract decreases subsequent infection rates, especially by gram-negative bacilli, in selected patients during long-term stays in the intensive care unit.

Administration, Oral↗
PubMed1990

Intraoperative ultrasonographically guided biopsy in testicular sarcoidosis: a case report.

We present a case of sarcoidosis with involvement of a solitary testis that was discovered incidentally on an ultrasonogram of the scrotum. This appears to be case 8 of sarcoidosis with genitourinary involvement limited to the testis. We believe it is the second report of intraoperative ultrasonography used to locate and perform a biopsy of impalpable testicular lesions. We consider this technique to be useful in instances of solitary gonads or in cases of bilateral lesions.

Adult↗
PubMed1990

Ventilation-perfusion distribution after aortic valve replacement.

In eight patients, the ventilation-perfusion (Va/Q) relationships after uncomplicated aortic valve replacement were studied by the multiple inert gas technique. Postoperatively, all patients had a right-to-left intrapulmonary shunt (Qsp/Qt) (range 2.4% to 14.4%) and abnormal distribution of Va/Q patterns to varying degrees. No single mechanism was identified that defined gas exchange in all patients. In three patients, moving from the supine to the right lateral decubitus position resulted in improved oxygenation which occurred because of better matching of Va/Q, not because of a decrease in Qsp/Qt.

Adult↗
PubMed1989

Effect of positional change on ventilation-perfusion distribution in unilateral pleural effusion.

The effect of pleural effusion on lung function and gas exchange has not been adequately defined. We used the multiple "inert" gas technique to study gas exchange and ventilation-perfusion relationships in both the left and the right lateral decubitus positions in a patient with a moderate unilateral (left) pleural effusion. With position change, only a small change in oxygenation (3 mm Hg) and no change in carbon dioxide tension occurred. The ventilation-perfusion relationships were also nearly identical for both body positions. We conclude that a pleural effusion of moderate size has little effect on overall gas exchange and ventilation-perfusion relationships and that complex mechanisms of the respiratory system compensate for the effusion.

Aged↗
PubMed1989

Timing of tracheostomy in the critically ill patient.

The decision for timing of tracheostomy remains controversial. The relative complication rates in two retrospective series, in which 79 and 150 critically ill patients were examined, respectively, showed increased incidence of late complications with tracheostomy and led Petty's group to conclude "The value of tracheotomy when an artificial airway is required for periods as long as 3 weeks is not supported by data obtained in this study."

Critical Care↗
PubMed1988

Oxygen uptake during weaning from mechanical ventilation.

Total body oxygen uptake (VO2) increases during the transition from machine-assisted ventilation to spontaneous breathing. Since the volume of oxygen consumed by the respiratory muscles must contribute to the increase in VO2 (delta VO2), we explored whether delta VO2 and/or measurements of respiratory power output (Wresp) provide clinically useful information in the evaluation of disease state and weaning decisions in patients with respiratory failure. We determined the metabolic, ventilatory, and hemodynamic responses of ten patients during weaning from controlled mechanical ventilation, and compared delta VO2 and Wresp of patients without overt heart-lung disease (group 1) to that of patients with significant cardiopulmonary dysfunction and ventilator-dependent respiratory failure (group 2). We reasoned that for delta VO2 to be clinically useful, individual values must either clearly differ between groups, must be higher in patients with heart-lung disease, and/or correlate with weaning outcome and independent measurements of respiratory work. The VO2 increased in nine of ten patients. The differences between the groups in the values of delta VO2 (27 ml/min and 49 ml/min) and respiratory power (9.38 J/min and 11.99 J/min) were not significant. delta VO2 and Wresp were not correlated (r = 0.2), and neither predicted weaning outcome. We conclude that the sensitivity and specificity of delta VO2 and Wresp appear insufficient for evaluation of disease state and weaning decisions in individual patients.

Aged↗
PubMed1987

Human milk-derived lactoferrin inhibits mitogen and alloantigen induced human lymphocyte proliferation.

Purified lactoferrin (LF), isolated from human milk, was tested for its effect on human T-lymphocyte proliferative responses to phytohemagglutinin (PHA) and to alloantigens in mixed lymphocyte culture. LF inhibited proliferation in both assays in a dose-dependent manner. The suppressive effect was not due to LF mediated cytotoxicity since washing cells that had been pre-incubated with LF restored their proliferative activity. LF was most effective in suppressing the PHA response when added within 24 h of culture initiation. Iron saturated LF failed to inhibit PHA-induced proliferation, suggesting that the mechanisms of suppression involve the chelating property of LF. The suppressive effect of LF on T-lymphocyte proliferative response in vitro supports the notion that LF has significant immunoregulatory potential in vivo.

Female↗
PubMed1987

Body position and ventilation-perfusion relationships in unilateral pulmonary disease.

The effect of positional change (right vs left lateral decubitus) on the distribution of ventilation and perfusion ratios was determined in four patients with respiratory failure and chest roentgenographic findings of unilateral pulmonary disease. In these patients with a unilateral interstitial pattern, improvement in oxygenation which occurred when the "good" side was dependent (down) was associated with changes in the patterns of ventilation-perfusion distribution; two patients showed a predominant decrease in right-to-left intrapulmonary shunt, and two showed an improvement in ventilation-perfusion equality. Therefore, when unilateral interstitial pulmonary disease was present, positional change resulted in changes in right-to-left intrapulmonary shunt or low ventilation-perfusion ratios or both. Variability between patients can be explained by the nonhomogeneity of pulmonary disease in patients with respiratory failure.

Aged↗
PubMed1986

Oxygenation during ventilation by high-frequency oscillation in dogs with acute lung injury.

The effect of ventilation by high-frequency oscillation (HFO) on gas exchange in the abnormal lung is not well defined. In this study the efficiency of oxygenation by HFO (stroke volume 2.5 to 3.5 ml/kg, frequency 15 to 30 Hz) and by conventional mechanical ventilation (CMV) (tidal volume 15 to 20 ml/kg, frequency 8 to 15 breath/min) was compared in dogs with acute lung injury. Sixteen normal animals were studied under general anesthesia (halothane) on day 0 (control) and then injected intraperitoneally with 10 mg/kg of paraquat in divided doses over 3 consecutive days. Eight dogs were restudied on day 4 (moderate lung injury) and the other eight dogs on day 8 (more severe lung injury). With acute lung injury there was a progressive decrease in total lung capacity, decrease in lung compliance, and hypoxemia. In the moderate lung injury group, at equal alveolar ventilation, HFO resulted in a significant improvement in oxygenation (PaO2 95 to 104 torr) with a corresponding increase in mean lung volume when compared with CMV. In the severe lung injury animals, there were no significant differences in oxygenation or in mean lung volume between HFO and CMV.

Animals↗
PubMed1986

Clinical outcome of respiratory failure in patients requiring prolonged (greater than 24 hours) mechanical ventilation.

Patients requiring prolonged (greater than 24 hours) mechanical ventilation have various conditions that result in respiratory failure. All patients requiring prolonged mechanical ventilation were subdivided into the following six groups: uncomplicated acute lung injury; respiratory failure complicated by multisystem failure; previous lung disease; trauma; other medical causes; and routine postoperative ventilation. During a one-year period, 327 patients required prolonged mechanical ventilation; acute lung injury and chronic obstructive pulmonary disease were the predominant conditions. Sepsis was both the major predisposing factor for and complication of acute lung injury. Mortality for patients with acute lung injury was 40 percent in the uncomplicated group and 81 percent in patients with acute lung injury complicated by multisystem failure. Acute respiratory failure in association with acute renal failure had a mortality of 89 percent. Number of organ systems involved also correlated with mortality. In patients with chronic obstructive pulmonary disease and pneumonitis or retained secretions, mortality was lower (30 percent), but a significant percentage of these patients (43 percent) became ventilator-dependent. Ventilator dependence did not significantly increase mortality during the course of respiratory failure.

Adult↗
PubMed1985

Use of an acoustic helium analyzer and microprocessor for rapid measurement of absolute lung volume during mechanical ventilation.

A technique developed to measure functional residual capacity during mechanical ventilation uses an acoustic helium analyzer and microprocessor to perform open-circuit helium washout. The acoustic helium analyzer has acceptable linearity up to a helium concentration of 50% and is stable. The microprocessor combines output from the acoustic analyzer and a ventilator with an expiratory flow signal, to compute lung volume rapidly during mechanical ventilation. In a sample of ten patients with various lung problems, open-circuit helium washout gave results similar to those of a closed-circuit helium-dilution technique during assist control or intermittent mandatory ventilation modes, with or without positive end-expiratory pressure. This open-circuit system has an advantage over other techniques because it is small and portable and can measure lung volume quickly without complicated maneuvers.

Acoustics↗