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Biomedical subjects

G A Salzman

Publications and source records attributed to G A Salzman.

16 recordsLinked to original sources
PubMed2000

Reevaluation of continuous oxygen therapy after initial prescription in patients with chronic obstructive pulmonary disease.

BACKGROUND: Long-term oxygen therapy improves survival and quality of life in hypoxemic patients with chronic obstructive pulmonary disease (COPD). The need for long-term oxygen therapy should be determined when patients are medically stable. The Third Oxygen Consensus Conference recommended reevaluating patients 1-3 months after continuous oxygen therapy (COT) is initiated, if initiated when the patient is medically unstable. METHODS: A cross-sectional study was performed to examine how often orders for COT are reevaluated pursuant to the guidelines promulgated by the Third Oxygen Therapy Consensus Conference, and to assess the impact that following these guidelines would have on the cost of COT. RESULTS: Of 226 patients prescribed home oxygen therapy, 92 had COPD as a primary diagnosis and 57 were prescribed COT. Only 19 (35%) of 55 patients who returned to the clinics were appropriately reevaluated. The rate of appropriate reevaluation was significantly higher among pulmonary physicians than among primary care physicians (65% vs 17%; odds ratio: 9.0; 95% confidence interval: 2.5-32). Of 19 patients who were appropriately reevaluated, 11 (58%) were discontinued from COT. The patients who were discontinued from COT had a significantly higher percent of predicted forced expiratory volume in the first second than those who were not (34 +/- 8.6% vs 25 +/- 8.8%; p = 0.04). CONCLUSIONS: In our study, most patients were clinically unstable when COT was prescribed, and a significant number of patients remained on COT without reevaluation. Up to 60% of those patients could potentially be discontinued from COT if appropriately reevaluated. Referring a patient initiated on COT to a pulmonary specialist for the proper use of oxygen is strongly recommended. Reevaluating such patients in a timely fashion and discontinuing unnecessary oxygen concentrators could possibly save $106-153 million per year in the United States.

Aged↗
PubMed1999

Much ado about doing nothing.

Negative stereotypes about certain kinds of medical specialists are commonly expressed by physicians in the presence of medical students. The authors of this brief essay, an academic pathologist and an academic internist, suggest that these sorts of remarks may have a range of deleterious effects on students. We wish to sensitize medical school faculty to this problem. Moreover, we propose that in an era in which a team approach to patient care is often required, the promotion of positive doctor-doctor relationships is critical and should be an integral part of medical education.

Education, Medical↗
PubMed1997

Evaluation of dyspnea.

The differential diagnosis of dyspnea includes a wide range of diseases and disorders with differing causes and symptoms. A thorough evaluation, with particular attention to the patient's history, is important in determining an effective course of treatment.

Acute Disease↗
PubMed1997

Continuously nebulized albuterol in severe exacerbations of asthma in adults: a case-controlled study.

A retrospective, case-controlled analysis comparing patients admitted to a medical intensive care unit with severe exacerbations of asthma who received continuously nebulized albuterol (CNA) versus intermittent albuterol (INA) treatments is reported. Forty matched pairs of patients with asthma are compared. CNA was administered for a mean of 11 +/- 10 hr. The incidence of cardiac dysrhythmias was similar between groups. Symptomatic hypokalemia did not occur. CNA patients had higher heart rates during treatment, which may reflect severity of illness. The incidence of intubation was similar. We conclude that CNA and INA demonstrated similar profiles with regard to safety, morbidity, and mortality.

Administration, Inhalation↗
PubMed1992

Empyema thoracis.

Explore the source record for details and available documents.

Empyema, Pleural↗
PubMed1992

Sarcoidosis masquerading as eosinophilic pneumonia.

A 29-year-old woman presented with progressive dyspnea, fever, cough, and weight loss. A chest roentgenogram revealed bilateral peripheral infiltrates suggestive of chronic eosinophilic pneumonia. Bronchoscopic evaluation, as well as a therapeutic trial of corticosteroids, was nondiagnostic. Open lung biopsy revealed findings consistent with a diagnosis of sarcoidosis. Roentgenographically, differentiating between sarcoidosis and chronic eosinophilic pneumonia can be difficult. A diagnostic approach, as well as the differential diagnosis of bilateral peripheral pulmonary infiltrates, is discussed.

Adult↗
PubMed1989

Hemodynamic and respiratory effects of thyrotropin-releasing hormone and epinephrine in anaphylactic shock.

Thyrotropin-releasing hormone (TRH) has been shown to increase mean arterial pressure during anaphylactic shock. The hemodynamic mechanism of action and the effect of TRH on the respiratory system during anaphylactic shock are not known. A rabbit model of anaphylaxis was used to determine the effect of TRH, epinephrine (EPI), and normal saline (NS) on various cardiovascular and respiratory parameters during anaphylactic shock. Anaphylactic shock was induced by antigen challenge in 31 sensitized animals. After a 25% decrease in mean arterial pressure, they were randomly treated with TRH (2 mg/kg), EPI (0.005 mg/kg), or NS (10 mL/kg). Blood was drawn at baseline and at the end of the experiment for laboratory analysis. Cardiac and respiratory parameters were monitored continuously and measured at baseline, at onset of shock (time zero), and at time intervals for 30 minutes. Animals were treated with repeated doses during the first 15 minutes as needed to maintain mean arterial pressure above shock level. Five of ten TRH-, five of 11 EPI-, and six of ten NS-treated animals survived. The TRH-treated group required fewer doses than the other groups and had increased heart rate, mean arterial pressure, peripheral vascular resistance, respiratory rate, and minute ventilation as well as decreased stroke volume index and lung compliance compared with the NS-treated group. EPI treatment resulted in increased minute ventilation and decreased pulmonary airway resistance compared with NS treatment. The EPI group also had a higher postsurvival epinephrine level than the other groups. No difference in right atrial pressure, cardiac index, acid-base status, pO2, A- a gradient, lung weight, lactate, or norepinephrine levels was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗
PubMed1989

Aerosolized metaproterenol in the treatment of asthmatics with severe airflow obstruction. Comparison of two delivery methods.

The bronchodilator response to metaproterenol delivered by metered-dose inhaler (MDI) with a spacer device (Aerochamber [A]) and by jet nebulizer was studied in 44 asthmatic patients who presented to the emergency department with acute severe (FEV1 less than 50 percent predicted) airflow obstruction. The delivery method was randomized, double-blinded and placebo controlled. The A group received one puff of metaproterenol every five minutes for a total of three puffs (1.95 mg). The jet nebulizer group received 15 mg of metaproterenol by continuous nebulization over ten minutes. Only about 2.75 mg of the original 15 mg delivered by jet nebulizer was calculated to be available for inhalation due to the inefficiencies of the delivery system. The mean percentage of improvement in FVC and FEV1 in the A group was 33.5 and 49.0 percent, respectively. The mean percentage of improvement in FVC and FEV1 in the jet nebulizer group was 22.8 and 33.0 percent, respectively. There was no significant difference in the mean percentage of improvement values between the two groups. We were unable to demonstrate a difference in bronchodilator response to metaproterenol delivered by MDI-A and jet nebulizer in emergency department asthmatics with acute severe airflow obstruction.

Adult↗
PubMed1989

Prolonged survival in pulmonary veno-occlusive disease treated with nifedipine.

A case of pulmonary veno-occlusive disease diagnosed by open lung biopsy is presented. The patient had a clinical and hemodynamic response to therapy with nifedipine with a significant reduction in pulmonary vascular resistance. This is the first reported case of prolonged survival in this disease resulting from vasodilator therapy with nifedipine.

Adult↗
PubMed1988

Oropharyngeal candidiasis in patients treated with beclomethasone dipropionate delivered by metered-dose inhaler alone and with Aerochamber.

We compared the incidence of Candida infection, Candida colonization, and reduction in oral prednisone dose in patients with asthma treated with beclomethasone dipropionate delivered by metered-dose inhaler (MDI) alone and MDI plus Aerochamber. Group M contained 18 patients treated with beclomethasone, four actuations four times a day (672 micrograms/day), delivered by MDI alone. Group A contained 18 patients treated with the same dose of beclomethasone delivered by MDI plus Aerochamber. In group M, four of 18 patients had Candida infection, 12 of 18 patients had Candida colonization, and six of 18 patients were completely removed from oral prednisone. In group A, 0 of 18 patients had Candida infection (p = 0.05), six of 18 patients had Candida colonization (p less than 0.05), and 12 of 18 patients were completely removed from oral prednisone (p less than 0.05). We conclude that beclomethasone delivered by MDI plus Aerochamber is more efficacious in reducing oral prednisone dependency and produces less Candida infection and colonization than beclomethasone delivered by MDI alone.

Administration, Oral↗
PubMed1987

Pneumomediastinum after cocaine smoking.

We have reported two cases of pneumomediastinum occurring in previously healthy young men after smoking cocaine and performing the Valsalva maneuver to intensify the euphoria. Pneumomediastinum is thought to result from increased intrathoracic pressure produced by the Valsalva maneuver, with resultant rupture of marginal alveoli. With the increasing popularity of inhaling free-base cocaine, physicians should be aware of this complication.

Adolescent↗
PubMed1986

A comparison of two delivery methods for aerosolized metaproterenol sulfate.

The bronchodilator response to metaproterenol sulfate delivered by metered-dose inhaler (MDI) with a spacer device (Aerochamber) and by jet nebulizer was studied in 15 asthmatic patients. The mean percent increase in absolute forced expiratory volume in 1 second (FEV1) with an MDI plus Aerochamber was 28.6%, and 28.8% with jet nebulization. There were no significant differences in the mean percent increases in FEV1, forced vital capacity (FVC), maximum midflow rate (MMFR), and peak expiratory flow rate (PEFR) with the two delivery methods. It is concluded that there is no difference in the bronchodilator responses to metaproterenol sulfate delivered by MDI plus Aerochamber or by jet nebulizer. The MDI plus Aerochamber has the advantage of being less expensive and more convenient to use.

Aerosols↗