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Biomedical subjects

D L Schultz

Publications and source records attributed to D L Schultz.

13 recordsLinked to original sources
PubMed2001

Asphyxia due to angiotensin converting enzyme (ACE) inhibitor mediated angioedema of the tongue during the treatment of hypertensive heart disease.

This report describes seven deaths caused by angioedema of the tongue related to angiotensin converting enzyme (ACE) inhibitors. These seven cases were received in our office between 1998 and 2000. In that time frame we performed approximately 2000 autopsies. The cases involved African-American men and women, aged 51 to 65 years, all of whom had been prescribed an ACE inhibitor for the treatment of hypertensive heart disease. In each case, the external examination revealed markedly swollen tongues. The autopsies confirmed massive tongue swelling due to angioedema, and some patients also had swelling of the lips, pharynx, and larynx. Toxicologic analyses on postmortem blood samples were negative for ethanol and drugs of abuse. Although oral and pharyngeal swelling related to angioedema is well known in the clinical literature, its fatal potential has rarely been described.

Aged↗
PubMed1999

Sudden death due to a central neurocytoma.

The central neurocytoma is a common, usually intraventricular tumor with bland histologic features. We report a case of a 51-year-old man who died suddenly. At autopsy, a neurocytoma with acute hemorrhage filled the anterior left lateral ventricle. The tumor matrix and surrounding brain tissue contained accumulations of hemosiderin. Previously, 2 cases of central neurocytoma with associated hemorrhage have been reported. Hemorrhage appears to be a serious complication associated with these neoplasms.

Brain Neoplasms↗
PubMed1995

The role of the neuroscience nurse in lumbar fusion.

Lumbar spinal fusion is a major surgical procedure that joints together two or more vertebral bodies to restore stability to the lower spine. Spinal fusion may be indicated as a result of a variety of causes. Regardless of the underlying problem, if instability of the spine occurs, fusion may be necessary. In recent years there have been a number of new spinal instrumentation systems introduced that provide stabilization and immobilization of the spine while bony fusion occurs. Neuroscience nurses must be prepared to care for patients undergoing this procedure as their ability to educate, assess and intervene throughout the perioperative period can have a positive effect on the outcome of lumbar spinal fusion.

Humans↗
PubMed1994

Apolipoprotein oxidation in the absence of lipid peroxidation enhances LDL uptake by macrophages.

A characteristic of the antioxidant, probucol, is its inability to inhibit apolipoprotein B fragmentation in low density lipoprotein (LDL), despite a pronounced ability to inhibit lipid oxidation on relatively lengthy exposure to Cu(II). Here we show that a short exposure of LDL to hydrogen peroxide and Cu(II) leads to 125I-labelled apolipoprotein B fragmentation, the production of malondialdehyde and hydroperoxides and leads to increased uptake by macrophages on subsequent culture. However, pre-loading LDL with probucol protects LDL from lipid oxidation but not protein fragmentation or macrophage uptake. The use of probucol to conduct studies on apolipoprotein B oxidation without extensive lipid oxidation may prove useful when studying LDL apolipoprotein damage on exposure to an aqueous free radical insult.

Apolipoproteins B↗
PubMed1993

A 10-year experience with postpump chorea.

Postpump chorea (PPC) is the development of choreoathetoid movements within 2 weeks following cardiopulmonary bypass. Over a 10-year period, 668 children underwent open cardiac surgery, of whom 8 (1.2%) developed PPC. Age at surgery ranged from 8 to 34 months. The onset of chorea was 3 to 12 days following surgery. Computed tomography and magnetic resonance imaging showed atrophy but no focal lesions. Cerebral positron emission tomography using [18F]fluorodeoxyglucose in a patient following 12 months of chorea showed patchy areas of decreased glucose metabolism. None of the patients were developmentally normal 22 to 130 months following surgery. Three patients have had transient and 5 have persistent chorea. Neurological deficits ranged from a mild learning disability to progressive hypotonia and obtundation ending in death. One of 4 patients who received haloperidol had a decrease in the severity of chorea. We compared PPC patients with 39 randomly selected controls. During surgery, affected patients spent significantly more time on pump and at temperatures under 36 degrees C, were cooled to lower temperatures than controls, and were more likely to have had a circulatory arrest. One patient developed chorea without a history of circulatory arrest. We conclude that (1) there is a strong association between PPC, deep hypothermia, and circulatory arrest, (2) absence of characteristic macroscopic changes suggests a biochemical or microembolic etiology in some cases, (3) chorea is frequently associated with developmental delay, and (4) the prognosis for complete resolution of chorea is guarded.

Brain↗
PubMed1982

The effects of peripheral impedance and inotropic state on the power output of the left ventricle in dogs.

The power output of the left ventricle as measured by the product of the Fourier components of aortic pressure and aortic flow is linked by definition to the arterial impedance facing the heart as measured by the quotient of these components. Consequently, the use of power measurements to assess ventricular performance can be ambiguous when accompanied by afterload changes. The heart is considered to function normally between two extremes, a constant flow pump, and a constant constant pressure pump, and two power limits are defined from these. The power limits describe the extent to which impedance changes can affect the power delivered by the left ventricle. Measured power changes that are found to lie outside the two limits can be unambiguously ascribed to changes in inotropic state. The results from preliminary dog experiments designed to test this method are reported. Cardiac sympathetic stimulation and isoprenaline infusion were used to provide a pure inotropic stimulus and a mixture of inotropic and afterload changes, respectively. The technique was able to detect inotropic changes in the heart even in the presence of simultaneous changes in afterload. Eight conventional indices of cardiac performance were monitored for comparison. The extent of their afterload dependence may not be as easily quantified.

Animals↗
PubMed1981

Separate contribution of ventricular pumping and load impedance on ventricular power output.

The heart is a rather special type of fluid pump in the sense that it is an organic pump. In this paper, however, it is postulated that the heart behaves like any other mechanical pump whose power output may assume, for a primary change in load, values bounded by two limits which are power output values obtained had the pump been a pressure generator and a flow generator respectively. A power output value outside the limits would imply a definite alteration in ventricular pump function concomitant with the load change. A nomogram to illustrate the proposal is included. The hypothesis may be developed into a powerful tool for assessing the pumping capability of the left ventricle, and this has significant clinical and physiological implications.

Animals↗
PubMed1981

Assessment of myocardial performance in ischaemic heart disease: from changes in left ventricular power output produced by graded-dose isoprenaline infusion.

Current clinical indices of myocardial contractility derive from concepts of muscle mechanics developed from isolated muscle experiments. Numerous simplifying assumptions are needed to apply these concepts to contractility studies in the whole heart. An alternative is to consider the heart as a pump which generates both pressure (P) and flow (Q) and to estimate its performance from the power output of its ventricles (P X Q). A method is described for measuring peak left ventricular power output in patients during routine cardiac catheterisation. The measurements have been made at rest and following inotropic challenge with gradient infusions of isoprenaline intravenously. Results from 13 patients with coronary artery disease and severe angina pectoris, who were clinically indistinguishable from one another, are reported. The patients could be grouped according to their left ventricular peak power responses to isoprenaline, although no difference could be demonstrated between them at rest. The patients who showed no increase in left ventricular power response to isoprenaline had a poor prognosis.

Adult↗
PubMedDate not supplied

B- and T-cell gene rearrangement test: an overview of application and methodology.

OBJECTIVE: To examine the use of the B- and T-cell rearrangement test in the diagnosis of lymphoid neoplasms. DATA SOURCES: Recent texts, professional journals, and authors' experiences. STUDY SELECTION: Not specified. DATA EXTRACTION: Not specified. DATA SYNTHESIS: The B- and T-cell rearrangement test can detect a monoclonal population of B- and T-cells, strongly indicative of neoplasia. This is accomplished through the use of DNA probes. The presence of a unique band on the Southern blot signifies a monoclonal gene rearrangement, which can make or confirm a diagnosis of a lymphoproliferative disorder and classify the lineage as B- or T-cell. T-cell neoplasms generally behave more aggressively than B-cell neoplasms, which can have important implications for prognosis and therapy. The unique gene rearrangement "signature" can be followed during and after therapy to document remission or recurrence. The most commonly examined samples are from the blood, bone marrow, and lymph nodes, but any tissue or fluid suspected of harboring a lymphoid neoplasm can be examined. CONCLUSION: The test is an important diagnostic indicator in the evaluation and follow-up of patients with lymphoma or lymphoid leukemia. It is most helpful when it can be correlated to the clinical condition of the patient and other ancillary studies.

Blotting, Southern↗