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Biomedical subjects

D Nunley

Publications and source records attributed to D Nunley.

12 recordsLinked to original sources
PubMed1999

Unopposed neutrophil elastase in bronchoalveolar lavage from transplant recipients with cystic fibrosis.

Large numbers of neutrophils with unopposed neutrophil elastase (NE) proteolytic activity are found in lower respiratory tract secretions from most patients with advanced cystic fibrosis (CF). To determine whether antielastase defenses may be overwhelmed in epithelial lining fluid after lung transplantation, we measured NE activity (cleavage of the specific substrate, MeO-Suc-Ala-Ala-Pro-Val-pNA) in bronchoalveolar lavage fluids (BALF) obtained for surveillance or diagnostic purposes at various intervals (1 mo to 7 yr after transplantation) from 52 recipients who had undergone double or bilateral lung transplantation for end-stage CF. Unopposed NE activity was found in BALF from 14 recipients, most of whom also had >= 10(5) colony forming units (cfu) of Pseudomonas aeruginosa in BALF. Ten of the 14 recipients with unopposed NE in bronchoalveolar lavage (BAL) had developed obliterative bronchiolitis (OB), but only 8 of the 38 subjects without unopposed NE activity had OB (p = 0. 002; Fisher exact test). We conclude that antiprotease defenses in lower respiratory tract secretions of CF patients receiving lung allografts are sufficient in the majority of patients to prevent unopposed NE activity. However, the presence of unopposed NE activity in BAL from lung allografts of patients with CF is associated with progressive, irreversible OB and graft failure.

Adolescent↗
PubMed1992

Aspergillus fumigatus sternal wound infections in patients undergoing open heart surgery.

During a 21-month period (July 1986-April 1988), six patients who underwent open heart surgery at Holston Valley Hospital and Medical Center in Kingsport, Tennessee, developed sternal would infections caused by Aspergillus fumigatus. All patients required sternectomy, reconstructive surgery, and long term amphotericin B therapy; no patient died. By univariate analysis, the following were significantly associated with A. fumigatus sternal would infection: chronic lung disease, a recent history of pneumonia, a greater mean number of admission diagnoses, and a particular surgeon. However, multivariate analysis identified chronic lung disease as the only independent risk factor and the best predictor of A. fumigatus sternal wound infections. No factors related to the surgical procedure or operating room personnel were associated with infection. A review of the characteristics of the patients undergoing open heart surgery showed that since 1985, there had been a trend for these patients at Holston Valley Hospital and Medical Center to be older and sicker, which may have contributed to the occurrence of infections never observed before. Despite an extensive investigation, no environmental source for A. fumigatus was identified. A. fumigatus, however, grew from the bronchial washing of one patient at the time the sternal wound infection was diagnosed, and a prospective study showed that the rate of A. fumigatus colonization among open heart surgery patients was the same as the rate of sternal wound infections caused by A. fumigatus. These data suggest that patients with chronic lung disease and respiratory colonization with A. fumigatus are at increased risk for A. fumigatus sternal wound infections after open heart surgery.

Aged↗
PubMed1992

Percutaneous endoscopic gastrostomy as an unrecognized source of methicillin-resistant Staphylococcus aureus colonization.

Methicillin-resistant Staphylococcus aureus (MRSA) caused colonization or infection around the gastrostomy site of seven hospitalized patients, five of whom were in the long-term care unit. All cultures of gastrostomy sites were retrospectively reviewed, and 28% had MRSA. The gastrostomy site was responsible for 6.3% of all MRSA cultures, and 12.5% of all MRSA-positive patients with gastrostomy site cultures had involvement at that site. The implications of MRSA and gastrostomy tubes are discussed.

Aged↗
PubMed1991

Human neutrophil elastase and elastase/alpha 1-antiprotease complex in cystic fibrosis. Comparison with interstitial lung disease and evaluation of the effect of intravenously administered antibiotic therapy.

In cystic fibrosis (CF), extracellular lung matrix is progressively damaged, neutrophils invade the air spaces, and activated neutrophils may release large amounts of neutrophil elastase (NE). Although alpha 1-antiprotease (alpha 1-AP) binds and inactivates NE and is the major antielastase of the lower respiratory tract, antielastase defenses may be overwhelmed in CF, leading to progressive lung damage. To determine whether the ability of alpha 1-AP to neutralize NE is impaired in CF, we compared NE activity in bronchoalveolar lavage (BAL) fluid and human neutrophil elastase/alpha 1-antiprotease (NE/alpha 1-AP) complex in both BAL fluid and peripheral blood serum from patients with CF, normal volunteers, and patients with interstitial lung disease. We detected a considerable amount of NE activity in BAL fluid from all but one patient with CF but none in that from normal volunteers or from patients with interstitial lung disease. Although in interstitial lung disease there was a significant correlation between increased NE/alpha 1-AP complex in BAL or peripheral blood and the degree of neutrophil influx, NE/alpha 1-AP complex was disproportionately low in CF BAL compared with significantly elevated values in serum. These data suggest that in CF, alpha 1-AP-mediated defense against free NE in the lower respiratory tract is significantly impaired, and high levels of uncomplexed, enzymatically active, NE are present in CF respiratory secretions. To determine whether intravenously administered antipseudomonal antibiotic therapy for exacerbations of CF lung disease diminished the amount of free NE in respiratory secretions, we used BAL to investigate the effect of such therapy on neutrophils and NE in patients with CF colonized with pseudomonads.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Selective medium with DNase test agar and a modified toluidine blue O technique for primary isolation of Branhamella catarrhalis in sputum.

A selective medium with DNase test agar and incorporating vancomycin (10 micrograms/ml), trimethoprim (8 micrograms/ml), and amphotericin B (2 micrograms/ml) supported the growth of 305 Branhamella catarrhalis isolates. A modified toluidine blue O technique was used after 48 h of incubation in CO2 to overlay suspected B. catarrhalis colonies. A metachromatic color change was observed in 15 min, indicating DNase production. In 200 unselected sputum samples of hospitalized patients, this method was compared with routine microbiologic procedures; 31 B. catarrhalis isolates were recovered with the method, compared with 22 isolated from the clinical laboratory. This medium will be particularly useful for culture of sputum, which shows inflammatory cells and gram-negative diplococci on Gram-stained smears.

Amphotericin B↗
PubMed1988

Diagnosis of pulmonary strongyloidiasis by bronchoalveolar lavage.

Bronchoalveolar lavage was performed on a patient with disseminated strongyloidiasis and 4.5 X 10(7) cells/65 ml of lavage fluid were recovered. Eighty-five percent of cells were polymorphonuclear leukocytes; 15 percent were pulmonary alveolar macrophages. Rhabditiform larvae (1 X 10(4)) were recovered in 65 ml of lavage fluid. This is the first report of bronchoalveolar lavage used in diagnosing disseminated strongyloidiasis.

Bronchoalveolar Lavage Fluid↗
PubMed1988

Listeria monocytogenes peritonitis.

Listeria monocytogenes peritonitis in a patient with cirrhosis and simultaneous soft tissue infection is reported. Six previously documented cases are reviewed. All seven patients were bacteremic, suggesting hematogenous seeding to the peritoneum as the pathogenic mechanism. Clinical and laboratory characteristics of L. monocytogenes peritonitis are compared with peritonitis of other bacterial etiologies.

Female↗
PubMed1984

Enhanced late survival following coronary artery bypass graft operation for unstable versus chronic angina.

Late survival following coronary artery bypass operation is time-frame dependent, with a major improvement occurring by 1974. In the cohort of patients undergoing operation between 1974 and mid-1982, subsets were present with further enhanced survival. In this study of 3,575 patients, the urgency of clinical presentation is examined as a survival determinant, and the results are seemingly paradoxical. Among the 1,404 patients with chronic angina, survival at 1 month was 98.3%; at 5 years, 88%; and at 8 years, 79%. Among the 1,008 patients with progressive angina, survival at 1 month was 97.8%; at 5 years, 90%; and at 8 years, 80%. Among the 1,163 patients with unstable angina, 1-month survival was 98.3%; 5-year survival, 92%; and 8-year survival, 89%. The best long-term results were obtained in patients with an acute clinical presentation. Ventricular function was an important determinant of late survival for the groups with chronic (p less than 0.001) and progressive (p less than 0.001) angina, but it had no effect in the group with unstable angina (p = 0.803). For the patients with chronic angina and good left ventricular (LV) function, survival was 99.5% at 1 month; 92% at 5 years; and 86% at 8 years. For those with poor LV function, the respective survival was 96%, 84%, and 71%. For the patients with progressive angina and good LV function, 1-month survival was 98.9%; 5-year survival, 94%; and 8-year survival, 83%. For those with poor LV function, the respective figures were 96.3%, 85%, and 76%. For the patients with unstable angina and good LV function, survival at 1 month was 97.8%; at 5 years, 92%; and at 8 years, 89%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Superior vena cava obstruction after Mustard repair of d-transposition of the great arteries.

Superior vena caval obstruction following Mustard repair of d-transposition of the great arteries is usually relieved by partial or complete revision of the intra-atrial repair. We employed a different approach in a patient with isolated total obstruction of the superior vena caval pathway, who suffered from fatigue, venous congestion in the upper part of the body and mild hydrocephalus. A 12 mm polytetrafluoroethylene tube was interposed between the left innominate vein and the left (functionally right) atrial appendage. Early and medium-term relief was demonstrated by repeat catheterization of the right heart and computed tomography brain scan three months postoperatively. The rationale for use of prosthetic material in the venous system is discussed and the need for long-term follow-up is stressed.

Blood Vessel Prosthesis↗
PubMed1983

Ten-year survival after coronary bypass surgery for unstable angina.

We have assessed the long-term results of coronary bypass surgery performed for unstable angina in 1282 patients from 1970 to 1982. The operative mortality was 1.8 per cent; in the first 4 years it was 2.5 per cent, and in the last 8 1/2 years it was 1.7 per cent. Using actuarial techniques, we determined that the 5-year and 10-year survival rates (mean +/- S.E.) were 92 +/- 1 per cent and 83 +/- 2 per cent, respectively, for the whole group. For patients with "normal" left ventricular function, they were 92 +/- 2 per cent and 86 +/- 3 per cent, and for patients with "abnormal" left ventricular function 91 +/- 2 per cent and 79 +/- 4 per cent (P = 0.14). No significant differences were observed in the long-term survival for any of the three clinical subgroups of patients with unstable angina--angina at rest, angina after recovery from acute myocardial infarction, and progressive angina of recent onset (P = 0.49). The reoperation rates at 5 and 10 years were 6 +/- per cent and 17 +/- 3 per cent. Currently, 61 per cent of the survivors have no angina; angina occurs on severe exertion in 20 per cent, on ordinary exertion in 14 per cent, and on mild exertion in 5 per cent. We conclude that coronary bypass surgery is an effective form of therapy (for up to 10 years) in patients with unstable angina.

Actuarial Analysis↗
PubMedDate not supplied

Ten-year survival following aortic valve replacement: A multivariate analysis of coronary bypass as a risk factor.

The additional risk of coronary bypass surgery was analysed in 664 patients over 40 years of age undergoing aortic valve replacement between 1969 and 1981. Four hundred sixty-seven patients underwent aortic valve replacement alone, while 197 patients with coronary artery disease underwent combined aortic valve replacement and coronary bypass surgery. There were no significant differences in the preoperative hemodynamic characteristics of the two groups of patients. There were 41 (9%) operative deaths following aortic valve replacement alone and 20 (10%) following aortic valve replacement with coronary bypass surgery. Since 1976, operative mortality has fallen to 5% and perioperative myocardial infarction to 2% following the combined procedure. Ten-year actuarial survival (standard error) was 56 (3%) following aortic valve replacement and 49 (6%) following aortic valve replacement and coronary bypass surgery. A multivariate analysis including both groups of patients revealed that age, functional class and year of operation significantly affected ten-year survival (p less than 0.05). The same analysis showed that coronary artery disease requiring coronary bypass surgery also decreased ten year survival in patients undergoing aortic valve replacement (p = 0.06).

Aged↗