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Biomedical subjects

J A Rankin

Publications and source records attributed to J A Rankin.

At least 55 records · Page 3Linked to original sources
PubMed1988

Bronchoalveolar cell activation after inhalation of a bronchoconstricting agent.

Airway inflammation is thought to be an important determinant of bronchoconstriction and bronchial hyperreactivity. We have recently demonstrated that bronchoconstriction induced by an aqueous extract of cotton bracts (CBE) is associated with bronchoalveolar complement activation, release of polymorphonuclear neutrophil (PMN) chemoattractants by pulmonary cells, and increased numbers of bronchoalveolar lavage PMN's. In the present study we performed bronchoalveolar lavage (BAL) on subjects after CBE or control (saline) challenge and examined whether BAL cells were activated in vitro to produce other inflammatory agonists. After CBE administration, cultured BAL cells released increased amounts of the reactive O2 species, superoxide (O2-.), and the cyclooxygenase products prostaglandin E2 and thromboxane B2. Although none of these in vitro parameters of BAL cell activation appeared to correlate with the degree of bronchoconstriction induced by CBE, BAL fluid levels of thromboxane B2 were also increased after CBE administration and in vivo amounts of this eicasanoid did correlate with the degree of bronchoconstriction induced by CBE (r = 0.50, P less than 0.04). Finally, although cell culture supernatants were highly chemotactic for PMN's, concentrations of leukotriene B4 were not increased, suggesting other chemotaxins were released by BAL cells in this setting. We conclude that CBE administration activates bronchoalveolar cells to release reactive O2 species and cyclooxygenase products that may be important in the bronchoconstricting response to CBE.

Adult↗
PubMed1988

Pulmonary immunology.

The lower respiratory tract of normal healthy individuals is kept sterile and disease-free by formidable local and systemic immune system defenses. In patients with AIDS, these defenses are severely compromised. Undoubtedly, alterations in both local and systemic forces make the host vulnerable to infection by opportunistic organisms. Indeed, substantial evidence suggests that at least a small percentage of macrophages, which normally function alone and in concert with other immune components, can be and are infected with HIV, and do not function normally. Abnormalities with lymphocytes in the lung may contribute to macrophage defective function. Further investigations into the role of lung macrophages and other lower respiratory tract defenses are needed if we are to comprehend fully the mechanisms that lie behind the multitude of pulmonary complications associated with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Heparin-induced thrombosis (white clot syndrome) secondary to prophylactic subcutaneous administration of heparin.

As a reminder that thrombocytopenia may occur even with very small doses of heparin, the author describes the case of a 76-year-old man who was admitted for elective hip surgery and received "mini-dose" heparin prophylactically. Profound thrombocytopenia developed, followed by deep vein thrombosis and then arterial occlusion to the lower limb. Initially, the importance of the low platelet count was not recognized and a continuous infusion of heparin (35,000 units/d) was given. It was discontinued when the limb became cold, pulseless, paralysed and anesthetic, and an emergency aortogram demonstrated occlusion of the femoral artery. Removal of the thrombus, closed fasciotomies, infusion of Rheomacrodex in dextrose and administration of warfarin resulted in the patient's recovery of sensation and movement in the limb.

Aged↗
PubMed1987

Histamine levels in bronchoalveolar lavage from patients with asthma, sarcoidosis, and idiopathic pulmonary fibrosis.

Bronchoalveolar lavage (BAL) has been used extensively as a research tool to elucidate immunologic events occurring in the lower respiratory tract of patients with numerous diseases and, most recently, to study patients with asthma. We assessed mast-basophiloid cell numbers and histamine levels with a sensitive histamine assay, lower limit of sensitivity, 25 pg/ml, in BAL fluid from normal individuals (n = 9) and compared these results to those obtained from patients with sarcoidosis (n = 31), idiopathic pulmonary fibrosis (IPF) (n = 8), and mild asthma (n = 7). Patients with sarcoidosis demonstrated a significant increase in total BAL mast-basophiloid cells, 9.6 +/- 4.1 X 10(4), compared to total cells in normal individuals, 0.0, p = 0.03, whereas only patients with IPF had significant elevations in BAL histamine levels, 1315 +/- 737 pg/ml, versus levels in normal individuals, 161 +/- 54 pg/ml, p = 0.002. A good correlation existed between histamine levels on an aliquot of lysed BAL cells and BAL histamine levels, R = 0.655 and p = 0.02, but not with either the total number or percent mast-basophiloid cells in BAL assessed on Wright's stained cytocentrifuge preparations. Subjects with asthma had both normal numbers of BAL mast-basophiloid cells and histamine levels. These data suggest that BAL histamine levels are easily quantified, the reason(s) for elevations in BAL histamine levels in IPF need further investigation, BAL histamine levels in subjects with asthma are not elevated in those with mild and stable disease, and lumenal mast-basophiloid cells are one major source of BAL histamine.

Adult↗
PubMed1987

Information system linking a medical school with practitioners and hospitals.

A recently established medical information network uses computers and telephone lines to link rural Georgia medical practitioners, Georgia hospitals, and the Mercer University School of Medicine (MUSM) in Macon, Georgia. This network, the Georgia Interactive Network for Medical Information (GaIN), provides a service and educational support system for its members. The GaIN model embodies many of the educational and information management principles endorsed by two reports by the Association of American Medical Colleges: the 1984 report of the Project Panel on the General Professional Education of the Physician and a 1982 project report called "Academic Information in the Academic Health Sciences Center." The design, services, utilization patterns, and results of the GaIN project and implications for the network's future are described. Use of the GaIN has made MUSM students more at ease with computers, has connected MUSM with remote teaching sites and rural practices, and has served as a catalyst for Georgia physicians' investigation of computer applications to support health care delivery in the state.

Computer Communication Networks↗
PubMed1987

Radiographic resolution of Pneumocystis carinii pneumonia in response to corticosteroid therapy.

Systemic corticosteroid therapy alone was administered to a patient with Pneumocystis carinii pneumonia associated with the acquired immunodeficiency syndrome. Substantial clinical improvement and almost complete chest radiographic resolution of parenchymal infiltrates occurred. Because spontaneous resolution of P. carinii pneumonia is not known to occur, corticosteroid therapy most likely was responsible for the favorable response. Given the high mortality associated with P. carinii infection in the acquired immunodeficiency syndrome, a randomized double blind study of corticosteroid therapy for P. carinii pneumonia in patients with the acquired immunodeficiency syndrome may be warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Chronic beryllium disease in a precious metal refinery. Clinical epidemiologic and immunologic evidence for continuing risk from exposure to low level beryllium fume.

Five workers at a precious metal refinery developed granulomatous lung disease between 1972 and 1985. The original diagnosis was sarcoidosis, but 4 of the workers were subsequently proved to have hypersensitivity to beryllium by in vitro proliferative responses of lymphocytes obtained by bronchoalveolar lavage. Review of medical records of coworkers and extensive industrial hygiene surveillance of the plant demonstrated that 4 cases occurred in the furnace area where air concentrations of beryllium fume were consistently below the permissible exposure limit of 2 micrograms/M3. A single case has been recognized from parts of the refinery where exposures to cold beryllium dust often exceeded the standard by as much as 20-fold. These data demonstrate that chronic beryllium disease still occurs and confirm the importance of specific immunologic testing in patients suspected of having sarcoidosis but with potential exposure to beryllium. The data raise concern about the adequacy of modern industrial controls, especially in the setting of exposure to highly respirable beryllium fume.

Adult↗
PubMed1987

Limitations of using urea to quantify epithelial lining fluid recovered by bronchoalveolar lavage.

The quantitation of substances in the epithelial lining fluid (ELF) of the lower respiratory tract, as obtained by bronchoalveolar lavage (BAL), is not precise because of the variable dilution of the ELF by the instilled lavage fluid. It has been reported that the absolute concentration of proteins in ELF can be determined by using the ratio of urea concentration in BAL fluid to that in serum as a method to calculate the volume of ELF recovered by BAL. Furthermore, it has been suggested that the error caused by diffusion of urea into the instilled lavage fluid can be minimized by instilling only 100 ml (5 X 20 ml) of saline rather than 300 ml (6 X 50 ml). We tested the validity of this method by collecting and individually analyzing aliquots from 2 different BAL protocols--a 100-ml (5 X 20 ml) BAL and a 300-ml (6 X 50 ml) BAL--performed in 6 healthy, nonsmoking subjects. Total protein, albumin, and urea were measured in each aliquot and in pooled fluid from each BAL procedure, and urea was measured in serum. In the 300-ml BAL, total protein and albumin concentrations tended to decrease progressively from the second to the sixth aliquots. In contrast, the urea concentration increased progressively from the first to the sixth aliquots. The concentration of albumin in ELF, calculated from the concentration of urea and albumin in each BAL aliquot, tended to decrease in each successive aliquot, becoming significant by the fourth aliquot.(ABSTRACT TRUNCATED AT 250 WORDS)

Albumins↗
PubMed1987

The impact of bronchoalveolar lavage cell analysis on clinicians' diagnostic reasoning about interstitial lung disease.

To assess the impact of bronchoalveolar lavage (BAL) on clinicians' diagnostic reasoning, we administered serial telephone questionnaires to all pulmonary physicians submitting BAL specimens to our laboratory from nonimmunocompromised patients with diffuse interstitial lung disease. Questionnaires were completed when the lavage specimens were first submitted and again after the results were reported to referring physicians. We recorded the clinicians' ordered list of likeliest diagnoses for the patient, a level of confidence in each diagnosis mentioned, and any proximate plans for further diagnostic tests. Of 78 patients in the study, information from the BAL fluid cell analysis caused clinicians to change their diagnostic thinking in 46 (59 percent). These changes were far more frequently appropriate (52 percent) than not (9 percent), and clinically impressive changes did occur but were infrequent (3 of 78 [4 percent]) in this series. Specifically, BAL permitted the unexpected diagnosis of Pneumocystis carinii in a patient not previously suspected to have acquired immune deficiency syndrome (AIDS) and appropriately encouraged clinicians to avert planned surgical biopsies in two patients subsequently found to have sarcoidosis. These findings suggest that when used to evaluate nonimmunocompromised patients, BAL fluid cell analysis can have an important impact on clinicians' diagnostic reasoning about their patients' interstitial lung diseases.

Biopsy↗
PubMed1986

Use of a central laboratory for analysis of bronchoalveolar lavage fluid.

The logistics and related costs were assessed for providing analysis of bronchoalveolar lavage (BAL) fluid in a central laboratory for practicing pulmonologists in the area around New Haven, Connecticut. During a 4-yr period (1981-1985) we arranged for a courier service to transport 175 BAL specimens, obtained by 22 participating physicians at the time of fiberoptic bronchoscopy, directly to our laboratory. A large battery of information was generated on each specimen, and the data were returned to the responsible physician within 24 h. Any remaining cells and the cell-free supernatants were used for additional research purposes. The primary benefits of this program included: rapid and standardized analysis of lavage fluid cell counts for the clinician to use along with historical and other more routine laboratory tests in guiding patient diagnosis and an augmented number of lavage specimens available to the academician for research purposes. The costs were judged to be reasonable but need to be factored into the overall costs of patient diagnostic evaluations.

Bronchi↗
PubMed1985

Patients' preferences for dentists' behaviors.

Unlike previous studies that examined specialized populations or were completed some years ago, this survey collected information from a cross-section of patients who were currently receiving various kinds of dental treatment. Although the study disclosed that patients' preferences and perceptions of dentists' performance might vary within and between demographic groups, a more important finding was that, in general, most patients in all demographic groups held common beliefs about how they would like to be treated by their dentists. However, according to the reports of these patients, the dentists did not always behave in ways that were congruent with the patients' preferences. The study showed that patients are sensitive to dentists' behaviors. It should also be noted that dentists are sensitive to patients' behaviors and that dentist-patient relationships may be a source of stress for both patients and dentists. Nevertheless, the responsibility for setting the tone of these relationships rests primarily with the dentist rather than with the patient. Therefore, it is important for dentists to be aware of the needs and preferences of their patients so that they can act in ways that will make patients comfortable and dental treatment a positive experience. The potential that appears to be inherent in good, satisfying dentist-patient relationships for minimizing patient stress and making dentistry a less stressful profession has yet to be fully realized. Dentistry is a two-way street: whatever benefits the patient should in turn benefit the dentist as well.

Adolescent↗
PubMed1985

Bronchoalveolar lavage cells and proteins in patients with the acquired immunodeficiency syndrome. An immunologic analysis.

Several components of cellular and humoral immunity were examined in bronchoalveolar lavage fluid and blood of 15 patients with the acquired immunodeficiency syndrome, and the results were compared to data from 25 healthy controls (including 5 asymptomatic homosexual men). Compared with that of controls, bronchoalveolar lavage fluid from patients tended to have more lymphocytes and significantly more neutrophils; a lower OKT4/OKT8 ratio, due to an increase in total OKT8 cells; and normal total OKT4 cell counts, despite a significant decrease in numbers of OKT4 cells in peripheral blood. Patients also had significantly more IgG-releasing cells and higher IgG levels than controls in lavage fluid. These data show that, in the lung lining fluid of patients with the acquired immunodeficiency syndrome, significant alterations in cellular and humoral immunity exist that differ in several important respects from immunity in controls and from corresponding changes in patients' peripheral blood.

Acquired Immunodeficiency Syndrome↗