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Biomedical subjects

D M O'Donnell

Publications and source records attributed to D M O'Donnell.

15 recordsLinked to original sources
PubMed2000

Pulmonary complications in neuromuscular disease.

Pulmonary compromise can result from primarily peripheral or central neuropathic disease (including neurodegenerative diseases) or diseases of the muscle or neuromuscular junction. Some diseases present with a combination of nervous system and muscle tissue involvement (due to secondary changes like atrophy or primary pathology, as in mitochondrial diseases). While clinically different in pathophysiology, these diseases may progress to produce and ìshareî common pulmonary pathology by the time the patient reaches the adolescent years. This article presents a review of the categories of neurologic disease that may lead to respiratory compromise, followed by thorough description of the pulmonary complications that can result from these types of diseases. Finally, a review of currently accepted treatment options that may aid in improving the quality of life of these patients is offered.

Adolescent↗
PubMed1999

The significance of excessive rhythmic alpha and/or theta frequency activity in the EEG of the neonate.

OBJECTIVE: The goal of this study was to determine the significance of excessive rhythmic alpha and/or theta frequency activity in neonatal EEGs. METHODS: The EEGs of 963 neonates, 26-44 weeks conceptional age (CA), performed during the years 1992-1994 at the Texas Children's Hospital, Houston, Texas, were reviewed for the presence of excessive rhythmic alpha and/or theta frequency activity. Cases in which such activity was identified were further characterized by the presence or absence of other EEG abnormalities. The medical records of these patients and a group of control infants with normal EEGs were reviewed to identify associated pathological conditions. RESULTS: Forty patients were identified whose EEGs revealed such activity. The CA of these patients ranged from 37 to 44 weeks. A variety of pathological conditions were seen in these patients, most commonly congenital heart disease, congenital brain anomalies and hypoxia. These conditions were not seen in the control group of infants. Twenty patients had received CNS-active drugs. The EEGs of 32 patients revealed additional abnormalities, most commonly multifocal sharp waves and episodes of voltage attenuation during slow-wave sleep. CONCLUSIONS: The results indicate that excessive rhythmic alpha and/or theta frequency activity is an abnormal finding in the newborn's EEG.

Brain↗
PubMed1997

Exhaled nitric oxide and bronchoalveolar lavage nitrite/nitrate in active pulmonary sarcoidosis.

Increased exhaled nitric oxide (NO) may reflect respiratory tract inflammation in untreated asthmatics. We compared exhaled NO and bronchoalveolar lavage (BAL) nitrate/nitrite (NO3-/NO2-) in 10 patients who had untreated, active pulmonary sarcoidosis with those of normal control subjects. Exhaled NO concentrations, determined by chemiluminescence, were similar in patients and control subjects (peak NO concentration of patients [mean +/- SD]: 13.6 +/- 5.9 parts per billion [ppb], peak NO concentration of control subjects: 11.2 +/- 5.7 ppb, p = 0.32; mean alveolar NO concentration of patients: 7.8 +/- 4.4 ppb, mean alveolar NO concentration of control subjects: 7.1 +/- 4.2 ppb, p = 0.70; end-tidal NO concentration of patients: 6.9 +/- 4.5 ppb, end-tidal NO concentration of control subjects: 6.6 +/- 4.0 ppb, p = 0.60). BAL NO2- was assayed using a modified Griess reaction after reduction of NO3- to NO2-. There was no significant difference in mean BAL NO2- concentrations, expressed as nanomoles per milliliter of epithelial lining fluid (patients: 544 nmol/ml, control subjects: 579 nmol/ml, p = 0.81) or as nanomoles per milliliter of BAL fluid (patients: 6.7 nmol/ml, control subjects: 5.7 nmol/ml, p = 0.41). These data suggest that excess NO generation does not accompany the respiratory tract inflammation of pulmonary sarcoidosis.

Adult↗
PubMed1995

Trinucleotide repeat disorders in pediatrics.

The relationship between the expansion of trinucleotide repeat sequences and human disease hs been the subject of a significant volume of study since the identification of a CGG repeat sequence in the mutated gene responsible for the fragile X syndrome. Six other neurologic diseases are now known to result from a triplet repeat expansion of either CTG or CAG nucleotides. Of particular interest to the pediatrician or pediatric subspecialist is the phenomenon of "anticipation," now clarified by mechanisms inherent to trinucleotide repeat expansions. The progressive enlargement of repeat sequences in successive generations of affected kindreds correlates inversely with the age of onset and, in some cases, the severity of the disease. The presentation of a young patient with symptoms ranging from developmental delay to movement disorders and ataxia requires that the physician involved in the child's care be aware of these diseases, their phenotypic variability, and their effects in previous generations. In this manner, pertinent history, including family history, may be obtained, relevant diagnostic testing initiated, and appropriate referrals facilitated.

Child↗
PubMed1992

Staging lung carcinoma with a Tc-99m labeled monoclonal antibody.

Thirty-three patients with biopsy-proven lung cancer and a total of 150 lesions diagnosed by conventional staging procedures were imaged using a Tc-99m labeled monoclonal Fab fragment of an IgG2B murine monoclonal antibody (MoAb) (NR-LU-10, NeoRx Corporation). Immunoscintigraphy demonstrated 100% of primary and 78% of metastatic lesions. MoAb imaging detected 88% of lesions in 12 small cell lung cancer (SCLC) patients and 77% of lesions in 21 non-small cell lung cancer (NSCLC) patients. Based on initial evaluation by other methods, 29 sites of MoAb activity were not associated with evidence of disease. Eleven of these were subsequently shown to represent sites of metastases; 18 remain unconfirmed. Four of ten patients studied with limited NSCLC had eight unsuspected lesions on MoAb imaging. Confirmation of unsuspected lesions in two patients altered initial clinical staging, and surgical therapy was abandoned. This study demonstrates that Tc-99m labeled NR-LU-10 can accurately stage patients with lung cancer.

Carcinoma, Non-Small-Cell Lung↗
PubMed1991

Clinical implications of combined hypogastric and profunda femoral artery occlusion.

From 1983 to 1990, nine patients with combined hypogastric (HA) and profunda femoral arterial (PFA) occlusive disease presented with five nonhealing hip disarticulations, three nonhealing above-the-knee amputations, perineal necrosis in six patients, buttock necrosis in four patients, visceral ischemia in two patients, and lumbosacral spinal ischemia in one patient. Obviously some patients had more than one regional complication. Five patients died from complications of HA/PFA ischemia. Survivors included two patients who required a hemipelvectomy, one patient who required an axillary-to-hypogastric artery bypass graft for stump salvage, and one patient who survived despite lumbosacral paralysis and complete cystectomy. The 56% mortality and 100% morbidity emphasize the critical significance of combined hypogastric/profunda femoral artery circulatory compromise. Efforts should be made to preserve or re-establish the HA and/or PFA circulation whenever possible. A hemipelvectomy may be required to allow the wounds to finally heal. Furthermore, the certainty of an above-the-knee amputation healing is not present in these patients; therefore, a hemodynamic assessment of the healing potential of an above-the-knee amputation is required.

Aged↗
PubMed1990

Multicenter evaluation of the hemodynamic effects of bisoprolol in patients with mild to moderate hypertension.

Twenty-six patients with mild-to-moderate essential hypertension participated in a 6-week outpatient, multicenter, randomized, double-blind, placebo-controlled two-way crossover study to assess the hemodynamic effects of bisoprolol (20 mg QD) at steady state. Hemodynamic assessments included sitting blood pressure, heart rate, and left-ventricular ejection fraction by radionuclide ventriculography after 7 days of bisoprolol or placebo at trough (24 h post-dose) and peak (3 h post-dose) values. The group adjusted mean ejection fraction was not significantly different in patients receiving bisoprolol compared with the placebo group at either peak or trough measurements; in fact, means in patients taking bisoprolol were slightly higher than in the placebo group. No symptomatic hypotension was documented. Blood pressure, measured 24 hours after dosing, was significantly lower in those receiving bisoprolol when compared with the placebo group, by 7.7 mm Hg and 9 mm Hg for diastolic and systolic blood pressure, respectively. Similarly, mean values of heart rate were 10 beats/min lower in the bisoprolol patients than in the placebo group. Only headache and insomnia occurred as adverse events. Bisoprolol (20 mg QD) effectively lowered blood pressure over a 24-hour period without significantly reducing ejection fraction or causing adverse clinical or biochemical events.

Adrenergic beta-Antagonists↗
PubMed1982

Vesicular lung sound amplitude mapping by automated flow-gated phonopneumography.

A recently developed automated apparatus capable of determining vesicular lung sound amplitude rapidly and accurately was used to construct detailed inspiratory vesicular sound amplitude maps in eight healthy male subjects to determine the normal amplitude patterns on the chest wall. The sounds were recorded in 2-cm steps along the following lines bilaterally: A, vertically, clavicle to abdomen, 6 cm from the sternal border; B, vertically, from the level of T1 to the lung bases, 6 cm from the spine; and C, horizontally, from the sternal border to the spine at the level of the nipple. Sound amplitude was measured at an airflow rate of 1.3 l/s. The resulting amplitude maps revealed considerable intra- and intersubject variation with frequent amplitude heterophony. Th patterns for the subjects as a group were as follows: series A, amplitude decreasing with distance from the clavicle; series B, amplitude increasing with distance from T1 with a peak at the bases; and series C, approximately equal amplitude at all positions. The findings in series B and C are, in general, consistent with an explanation of ventilation following hydrostatic gradients. The series A pattern and the intersubject variability in amplitude are inconsistent with this explanation and suggest that the inspiratory vesicular sound amplitude is not simply a result of ventilation distribution but involves other as yet undefined factors.

Adult↗
PubMedDate not supplied

Enuresis: current concepts.

Incontinence disorders are an important group of problems that clinicians manage in children and adolescents. This paper reviews the physiology of micturition, the epidemiology of enuresis, etiologic concepts of incontinence disorders, a general clinical approach to enuretic patients, laboratory evaluation and general principles of management. Neurological and nephrological concepts of enuresis are emphasized in this discussion.

Adolescent↗
PubMedDate not supplied

Effect of pulmonary edema on tracheal diameter.

BACKGROUND: Though it is well known that cardiogenic and noncardiogenic pulmonary edema can cause changes in lung mechanics, actual alterations in tracheal diameter have not been described. OBJECTIVE: To evaluate the effects of pulmonary edema induced by increased left atrial pressure (cardiogenic) and Perilla ketone (PK; noncardiogenic) on tracheal diameter in chronically instrumented awake sheep. METHODS: We investigated the effects of two mechanistically distinct types of pulmonary edema on tracheal diameter in chronically instrumented awake sheep. Cardiogenic pulmonary edema (analogous to congestive heart failure in humans) was induced by increasing left atrial pressure ( upward arrowP(LA)) by inflating the balloon on a Foley catheter positioned in the mitral valve annulus to cause partial obstruction to flow across the valve (n = 18). Noncardiogenic pulmonary edema (increased pulmonary microvascular permeability pulmonary edema analogous to the acute respiratory distress syndrome in humans) was produced by the intravenous administration of PK (n = 11). Lateral chest radiographs (CXRs) were scored by a standardized 5-point scoring system for the severity of pulmonary edema, and tracheal diameter was measured at a fixed location in the carina. Three radiologists, blinded to sheep identification number and experimental protocol, evaluated the radiographs independently at different points in time for edema severity and tracheal diameter. The sheep were sacrificed immediately after the final CXR, and wet/dry lung weight ratio (W/D ratio) was determined. RESULTS: Both upward arrowP(LA) and PK were associated with statistically significant tracheal narrowing ( upward arrowP(LA): 20.3 +/- 0.6 to 15.1 +/- 0.9 mm; PK: 20.2 +/- 0.6 to 14.1 +/- 1.4 mm). Tracheal narrowing correlated with the severity of the pulmonary edema determined radiographically ( upward arrowP(LA): r = -0.69, p < 0.01; PK: r = -0.62, p < 0.01) and by W/D ratio ( upward arrowP(LA): r = -0.64, p < 0.05; PK: r = -0.54, p < 0. 05). CONCLUSIONS: We conclude that tracheal narrowing occurs in sheep models of both cardiogenic and noncardiogenic pulmonary edema and that the degree of narrowing correlates with the severity of the edema.

Animals↗