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Biomedical subjects

G D'Alonzo

Publications and source records attributed to G D'Alonzo.

7 recordsLinked to original sources
PubMed1996

Lung volume reduction surgery in ventilator-dependent COPD patients.

BACKGROUND: Lung volume reduction surgery has been advocated recently as adjunctive surgical therapy to improve lung and chest wall mechanics in selected patients with diffuse emphysema. Although clear-cut guidelines to select candidates have not been fully established, patients decompensated with significant pulmonary artery hypertension and hypercapnic respiratory failure are currently not considered suitable subjects. Accordingly, ventilator-dependent COPD patients are not considered candidates for this procedure. However, because ventilator-dependent COPD patients have an exceptionally poor prognosis, we elected to offer them this promising, but unproved surgical intervention. Herein, we describe the outcome of these three patients. PATIENTS: The 3 patients had recurrent exacerbations of COPD precipitating respiratory failure, and following aggressive medical therapy remained mechanically ventilated for 11 to 16 weeks (1 patient had a brief period of successful weaning before returning to mechanical ventilation). Prior to surgery, the patients had severe hypercapnia and cor pulmonale. Compared with preoperative values, surgery resulted in improvements in PaO2/FIO2, 304 +/- 80 (SD) vs 229 +/- 48 mm Hg, reductions in PaCO2, 44 +/- 3 vs 60 +/- 9 mm Hg, increases in FVC, 1.63 + 0.52 vs 1.09 +/- 0.05 L, and maximum inspiratory pressure, 57 +/- 22 vs 29 +/- 12 cm H2O. Postoperative complications included persistent air leaks and one tension pneumothorax. Patients weaned from mechanical ventilation after 10 to 21 days all were discharged home and they continue to demonstrate improved gas exchange and functional status. CONCLUSIONS: Lung volume reduction surgery in select, ventilator-dependent COPD patients can result in improved gas exchange and respiratory mechanics that enable successful weaning and overall improved functional status.

Female↗
PubMed1992

Diagnosis of pulmonary tuberculosis complicating HIV infection: superiority of sputum smear over bronchoalveolar lavage.

Tuberculosis should be prominently considered in the differential diagnosis when an HIV-infected patient has respiratory symptoms. Sputum smears and culture for acid-fast organisms should always be obtained. Fiberoptic bronchoscopy to exclude other concurrent opportunistic infections is appropriate because Pneumocystis carinii complicates as many as 25% of the cases of pulmonary TB, but acid-fast sputum smears should always be obtained. It should not be assumed that bronchoalveolar lavage is superior to expectorated sputum smear for the rapid diagnosis of pulmonary tuberculosis.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Breathing pattern and metabolic behavior during anticipation of exercise.

The mechanisms responsible for the marked increase in ventilation at the onset of exercise are incompletely defined. A conditioned response to exercise anticipation has been suggested as an influencing factor, but systematic measurements have not been made during the transition from rest to the time when exercise is anticipated but has not yet commenced. We tested the hypothesis that cortical activity associated with the anticipation of exercise causes hyperpnea, which is at least partly responsible for the increased ventilation at the onset of exercise. To assess the influence of continuous cortical activity in the absence of exercise anticipation the subjects performed mental arithmetic tasks. Fifteen subjects performed the two experiments in a random order. Ventilation was measured noninvasively using a calibrated respiratory inductive plethysmograph and end-tidal CO2 concentration (FETCO2) was monitored at the nasal vestibule. Both exercise anticipation and mental arithmetic caused an increase in minute ventilation (VI) (P less than 0.01) and mean inspiratory flow (VT/TI, P less than 0.01), which reflects respiratory center drive, although the derivation differed in that the former was volume based, whereas the latter was due to alteration in timing. Despite the increase in VI, FETCO2 remained constant in both instances. In a complementary study the constant FETCO2 in the face of increased VI was shown to be due to increased CO2 output. The results show that the mere anticipation of exercise causes an increase in ventilation. The mechanism responsible for this hyperpnea cannot be due solely to respiratory center activation because of the constancy of FETCO2 and the associated alterations in cardiac and metabolic behavior.

Adult↗
PubMedDate not supplied

Comparative taste evaluation of aerosolized formulations of triamcinolone acetonide, flunisolide, and flunisolide with menthol.

The taste characteristics of aerosolized formulations of triamcinolone acetonide, flunisolide, and flunisolide with menthol flavoring were compared in 102 adult asthmatic patients. During a 2-hour test period, study participants evaluated the taste of each of the three inhaled corticosteroids, one at a time, in a randomly assigned sequence. The extent to which they liked the taste of each preparation and the taste intensity (strength of taste) of each product were rated on 100-point scales. Patients also characterized the predominant taste of each inhaled corticosteroid as "no taste," "salty," "sour," "sweet," or "bitter." Assessments were made immediately after inhalation and 2 minutes after inhalation. At both assessment times, subjects liked the taste of triamcinolone acetonide significantly more than the taste of flunisolide or flunisolide with menthol, and they liked the taste of flunisolide with menthol better than that of flunisolide without menthol. The taste intensity of triamcinolone acetonide was rated significantly less than that of the two flunisolide preparations at both evaluation times. There was no significant difference in the taste-intensity ratings for flunisolide with and without menthol. Triamcinolone acetonide was most frequently described as having no taste, whereas the taste of both flunisolide and flunisolide with menthol was most frequently described as bitter. Because of the possible adverse impact of an unpleasant taste on patient compliance with prescribed therapy, differences in the taste of inhaled corticosteroids should be an important consideration in selecting and recommending an aerosolized steroidal preparation for the control of asthma.

Administration, Inhalation↗