Biomedical subjects

J A Meadows

Publications and source records attributed to J A Meadows.

17 recordsLinked to original sources

PubMed1988

Outcome of respiratory failure in hematologic malignancy.

We reviewed records of patients with hematologic malignancy requiring mechanical ventilation (MV) from 1976 to 1985 (excluding postoperative MV less than 48 hours). There were 119 episodes in 116 patients. In-hospital mortality was 82 percent. Of 21 (18 percent) episodes survived, median duration of survival was 12 months. Survivors did not differ from nonsurvivors in age, leukocyte count, or duration of MV. Survival for chronic lymphocytic leukemia was 42 percent, for other leukemias 16 percent, Hodgkin's disease 29 percent, and non-Hodgkin's lymphomas, 6 percent. Bronchoscopy was performed in 28 patients, resulting in a diagnosis of infection, hemorrhage, or malignancy in 19 cases. Open lung biopsy (OLB) was obtained in 23 patients, yielding a diagnosis of interstitial inflammation or fibrosis (13 cases), drug effect (three), malignancy (two), hemorrhage (one), Pneumocystis (seven), aspergillosis (two), and Legionella (one). Only two patients survived following OLB. Despite intensive management and adequate diagnosis, respiratory failure in patients with hematologic malignancy carries a high mortality. Although these data may help identify groups with a limited prognosis for long-term recovery, patient care must be individualized.

Female↗

PubMed1986

Chronic eosinophilic pneumonia. Evidence for eosinophil degranulation and release of major basic protein.

A patient with chronic eosinophilic pneumonia associated with ulcerative colitis and asthma is described. Exacerbations and remissions of these disorders paralleled each other. Pleural fluid and lung tissue contained high levels of eosinophil granule major basic protein, a substance with toxic effects on cells and tissues. The results indicate that eosinophils degranulate in the lung in eosinophilic pneumonia and point to the possibility that granule constituents damage lung tissue in the course of the disease.

Adult↗

PubMed1986

Clinical outcome of respiratory failure in patients requiring prolonged (greater than 24 hours) mechanical ventilation.

Patients requiring prolonged (greater than 24 hours) mechanical ventilation have various conditions that result in respiratory failure. All patients requiring prolonged mechanical ventilation were subdivided into the following six groups: uncomplicated acute lung injury; respiratory failure complicated by multisystem failure; previous lung disease; trauma; other medical causes; and routine postoperative ventilation. During a one-year period, 327 patients required prolonged mechanical ventilation; acute lung injury and chronic obstructive pulmonary disease were the predominant conditions. Sepsis was both the major predisposing factor for and complication of acute lung injury. Mortality for patients with acute lung injury was 40 percent in the uncomplicated group and 81 percent in patients with acute lung injury complicated by multisystem failure. Acute respiratory failure in association with acute renal failure had a mortality of 89 percent. Number of organ systems involved also correlated with mortality. In patients with chronic obstructive pulmonary disease and pneumonitis or retained secretions, mortality was lower (30 percent), but a significant percentage of these patients (43 percent) became ventilator-dependent. Ventilator dependence did not significantly increase mortality during the course of respiratory failure.

Adult↗

PubMed1985

Effect of resection of the sternum and manubrium in conjunction with muscle transposition on pulmonary function.

We recorded the changes in pulmonary function that occurred after removal of the sternum and manubrium and repair by pectoralis major muscle transposition in six patients. Of these patients, three had osteomyelitis of the manubrium and sternum, two had osteosarcoma of the sternum, and one had osteomyelitis and radionecrosis of the manubrium and sternum. Body plethysmography and the rebreathing, hypercapnic ventilatory response test with inductive plethysmographic recordings of chest-wall motion were performed preoperatively and postoperatively. Preoperatively, four of the six patients had evidence of mild to moderate chest-wall restriction. Pulmonary function was normal in the other two patients. Postoperatively, total lung capacity was unchanged but the vital capacity decreased 11.5% in the overall group. Static compliance, retractive force, and the steady-state diffusing capacity for carbon monoxide decreased modestly but significantly postoperatively. The expiratory flow rates and maximal voluntary ventilation remained unchanged. Preoperatively, the slope of the hypercapnic ventilatory response was less than that predicted. Postoperatively, the slope did not change. In three patients, however, increased dependence on the abdomen for breathing suggested a dynamic restriction of rib-cage motion. On the basis of our findings, we conclude that surgical removal of the sternum and manubrium in conjunction with muscle flap repair is a well-tolerated procedure. Any postoperative changes in pulmonary function are minor.

Adolescent↗

PubMed1980

Density dependence of maximal expiratory flow in chronic obstructive pulmonary disease.

Pulmonary mechanics were studied in 22 patients with chronic obstructive pulmonary disease (COPD) who had no evidence of asthma. Eleven of the 22 patients had a density dependence of maximal expiratory flow within the reported normal range. Patients with normal density dependence (responders) were not different from those with decreased density dependence (nonresponders) in mean age, smoking history, symptoms of cough or dyspnea, maximal expiratory flow at 75, 50, and 25% of the vital capacity during air breathing, total lung capacity, or static elastic lung recoil at 50% of the vital capacity. The nonresponders had smaller vital capacity values, larger ratios of residual volume to total lung capacity, higher resistance, and lower static recoil at total lung capacity. There was a correlation between diffusing capacity for CO and density dependence. There was an inverse relationship between the change in density dependence after inhalation of isoproterenol and initial density dependence. Dysanaptic lung growth and increased compliance of the central airways are potential mechanisms for normal density dependence in these patients. The prevalence of normal density dependence in these patients with established COPD raises serious questions concerning the usefulness of density dependence in the early detection of COPD. The differences in density dependence may indicate differences in pathogenesis of the airflow obstruction and hence may be of prognostic significance.

Airway Resistance↗

PubMed1980

Toxic shock syndrome, a newly recognized disease entity. Report of 11 cases.

The toxic shock syndrome has only recently been described. Eleven female patients aged 13 to 43 years (median 17) with toxic shock syndrome have been seen at the Mayo Clinic since August 1975. One patient died. Seven patients had one or more recurrences. As previously described, the syndrome was often life-threatening, afflicted mostly menstruating females, and was characterized by a very brief prodromal illness consisting of high fever, vomiting, diarrhea, conjunctivitis, headache, irritability, sore throat, myalgias, abdominal tenderness, and erythematous rash. The disorder can progress to hypotension or prolonged refractory shock, adult respiratory distress syndrome, diffuse intravascular coagulation with severe thrombocytopenia, and renal failure. Pancreatitis was observed in two cases. During convalescence, pronounced desquamation and peeling of the skin occurred. Numerous laboratory abnormalities are observed. In 5 of the 11 patients, Staphylococcus aureus was isolated from conjunctiva, oral cavity or nares, vagina, or stool. A recently described pyrogenic exotoxin was identified in the isolates of three patients; its etiologic role remains speculative. Therapy is mainly supportive. Antistaphylococcal therapy for the acute illness and for prevention of recurrences has not yet proved to be of any benefit. The role of vaginal tampons, if any, in the pathogenesis of this disorder remains unclear.

Adolescent↗

PubMed1979