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J E Parrillo

Publications and source records attributed to J E Parrillo.

At least 181 records · Page 10Linked to original sources
PubMed1985

Erysipelothrix rhusiopathiae bacteremia presenting as septic shock.

Erysipelothrix rhusiopathiae rarely causes bacteremia, and it has never been reported to cause septic shock. A 58-year-old man with fulminant hyperdynamic shock associated with E. rhusiopathiae bacteremia is described. Erysipelothrix must be considered when a patient with an appropriate history presents with septic shock.

Animals↗
PubMed1985

Quantitative analysis of polymorphonuclear leukocyte superoxide anion generation in critically ill children.

Apart from its well-known bactericidal action, superoxide anion produced by activated polymorphonuclear leukocytes is believed to be involved in pathophysiology of diffuse capillary leak syndromes, e.g., adult respiratory distress syndrome and septic shock. Neutrophil NADPH oxidoreductase, the superoxide anion synthetase, was assayed in blood samples from a variety of critically ill children. Neutrophils from patients with evidence of diffuse capillary leak syndrome had significantly depressed enzyme specific activity as compared to neutrophils from healthy controls or intensive care patients without evidence of diffuse capillary leak. These data along with additional in vitro findings support the contention that previously activated granulocytes may be refractory to subsequent activation, and that such behavior may represent an intrinsic defense mechanism to minimize inflammatory amplification autoinjury.

Adolescent↗
PubMed1985

Examination of the enzyme assay for NADPH oxidoreductase; application to polymorphonuclear leukocyte superoxide anion generation.

Superoxide anion production in intact polymorphonuclear leukocytes isolated from medically stable pediatric ICU patients was investigated by examining the initial velocity enzyme kinetics of NADPH oxidoreductase, under a variety of experimental conditions. Present findings confirm that enzyme activity requires stimulation of the respiratory burst, and that catalysis followed longitudinally reflects activation, activity, and termination phases. There was no superoxide anion production in unstimulated neutrophils, and only short-lived superoxide generation in neutrophils stimulated by phorbol myristate acetate. Moreover, the ability to activate resting neutrophils was a labile phenomenon, as reflected by an inducible enzyme half-life of 1.2 days. There were no apparent differences in enzyme activity from granulocytes isolated from venous vs. arterial blood. Enzyme activity in intact granulocytes peaked at pH 7 and 30 degrees C, where the ratio of enzyme activity to cell number was constant over the range 0.25 to 2.5 X 10(5) cells per assay. Utilizing the above strictly defined assay conditions, pediatric-derived polymorphonuclear leukocytes induced with phorbol myristate acetate were found to generate superoxide anion at rates equivalent to those in healthy adults.

Adult↗
PubMed1985

Norepinephrine alone versus norepinephrine plus low-dose dopamine: enhanced renal blood flow with combination pressor therapy.

Six normotensive, anesthetized dogs were infused intravenously with short-term, incremental infusions of norepinephrine (NE) with or without the addition of iv dopamine (DA) (4 micrograms/kg X min). The infusion of NE alone and in combination with low-dose DA produced similar, significant increases in mean arterial pressure. During the infusion of pressor doses of NE, the addition of DA resulted in significantly higher renal blood flow (p less than .001) and lower renal vascular resistance (p less than .001) than infusions of NE alone. Thus, the renal vasodilating action of low-dose DA persisted despite infusions of NE, a potent vasopressor which decreases renal blood flow. This suggests that shock patients receiving therapy with NE should be good candidates to receive low-dose DA to enhance renal blood flow.

Animals↗
PubMed1985

A circulating myocardial depressant substance in humans with septic shock. Septic shock patients with a reduced ejection fraction have a circulating factor that depresses in vitro myocardial cell performance.

We have previously described a subpopulation of patients with septic shock who had a reversible depression of radionuclide-determined left ventricular ejection fraction (EF). To investigate the mechanism of this myocardial depression, an in vitro model of mammalian myocardial cell performance was established employing primary spontaneously beating rat myocardial cells. The contraction of a single cardiac cell was quantitated by recording the changes in area occupied by the cell during contraction and relaxation. In 20 septic shock patients during the acute phase, the mean left ventricular EF was decreased (mean = 0.33, normal mean = 0.50), and serum obtained during this acute phase induced a mean (+/- standard error of the mean) 33 +/- 4% decrease in extent and 25 +/- 4% decrease in velocity of myocardial cell shortening during contraction (P less than 0.001). In contrast, serum obtained from 11 of these same patients before shock (n = 2) or after recovery (n = 9) of the left ventricular EF (mean = 0.50) showed a return toward normal in extent and velocity of shortening (P less than 0.001). Sera from 17 critically ill nonseptic patients, from 10 patients with structural heart disease as a cause for a depressed EF, and from 12 healthy laboratory personnel, induced no significant changes in in vitro myocardial cell performance. In 20 patients during the acute phase of septic shock, the decreased EF in vivo demonstrated a significant correlation (r = +0.52, P less than 0.01) with a decrease in the extent of myocardial cell shortening in vitro. The quantitative and temporal correlation between the decreased left ventricular EF and this serum myocardial depressant substance argues for a pathophysiologic role for this depressant substance in producing the reversible cardiomyopathy seen during septic shock in humans.

Adolescent↗
PubMed1985

Kaposi's sarcoma causing pulmonary infiltrates and respiratory failure in the acquired immunodeficiency syndrome.

Although an aggressive form of Kaposi's sarcoma often develops in patients with the acquired immunodeficiency syndrome, most patients die due to opportunistic infections rather than the direct effects of this tumor. Because Kaposi's sarcoma has caused pulmonary dysfunction in a number of our patients, we attempted to characterize features of pulmonary dysfunction induced by Kaposi's sarcoma. In 66 patients with Kaposi's sarcoma treated between 1982 and 1984 there were 30 episodes of pulmonary dysfunction that resulted in a biopsy. Six episodes were due to pulmonary Kaposi's sarcoma alone, and 6 additional episodes were due to Kaposi's sarcoma and associated opportunistic infections. Clinical and radiologic features of pulmonary Kaposi's sarcoma an infection were indistinguishable. Pulmonary Kaposi's sarcoma could only be documented in large tissue sections available from open-lung biopsy or autopsy samples. Because chemotherapy or radiation therapy appears to provide palliation, clinicians should recognize Kaposi's sarcoma as a cause of pulmonary disease in patients with the acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Takayasu's arteritis and its therapy.

Twenty patients with Takayasu's arteritis were followed prospectively for an average of 4.6 years. Sixteen patients with active inflammatory Takayasu's arteritis were treated with glucocorticosteroids; eight responded to therapy. Six patients had clinical or angiographic progression of their vasculitis on daily corticosteroid therapy. These patients were then given cyclophosphamide together with prednisone on alternate days. Four of these 6 patients had no progression of vascular lesions while receiving cyclophosphamide; two had progression of vascular lesions after 30 and 48 months of therapy. Vascular reconstructive surgery was successful in 7 patients who tolerated a total of 13 vascular surgical procedures without major complications. One bypass graft occluded after 13 months and was revised. With corticosteroid therapy, cytotoxic therapy, and surgery, no deaths due to Takayasu's arteritis or its treatment have occurred.

Adolescent↗
PubMed1984

Dopamine inhibition of histamine-mediated cutaneous responses.

Several patients receiving dopamine for hypotension were skin tested for possible penicillin sensitivity. Not only were the penicillin skin tests negative but also the histamine control. On the possibility that dopamine might affect cutaneous histamine responses, we examined the effect of dopamine on histamine, antigen, morphine, and compound 48/80 skin responses. Both intradermal and intravenous dopamine selectively inhibited histamine but not antigen, morphine, or compound 48/80 skin responses, and the inhibition was in a dose-related fashion. This observation indicates that histamine should not be used to demonstrate dermal reactivity in patients receiving dopamine. The results of this study also suggest that histamine may not be the sole mast cell-derived mediator involved in the wheal-and-flare reaction characteristic of immediate-type skin tests since dopamine did not affect skin reactions caused by endogenous mast cell degranulation. Finally, the possible use of dopaminergic drugs in diseases with histamine-associated symptoms is discussed.

Dopamine↗
PubMed1984

Perceptions of a critically ill patient experiencing therapeutic paralysis in an ICU.

Prolonged therapeutic paralysis with pancuronium is commonly used in ICUs to facilitate mechanical ventilation of patients with respiratory failure. Sedation is usually given concomitantly to reduce patient discomfort, but assessment of its adequacy is made difficult by the paralysis. We recently cared for a former ICU nurse who required prolonged mechanical ventilation and paralysis and received morphine as a sedative. When she recovered, she was able to relate her experiences. She stressed the need for very frequent reorientation to time and her desire for constant explanation and re-explanation of all procedures being done by the nursing and physician staff. Her experiences provide insights that allow all ICU staff to provide better care for patients requiring therapeutic paralysis.

Adult↗
PubMed1984

The results of transvenous endomyocardial biopsy can frequently be used to diagnose myocardial diseases in patients with idiopathic heart failure. Endomyocardial biopsies in 100 consecutive patients revealed a substantial incidence of myocarditis.

Transvenous endomyocardial biopsy is an accepted method to evaluate cardiac transplant rejection, but the clinical diagnostic value of the technique for other forms of cardiac disease has not been established. We performed biopsies in 100 consecutive patients without significant complications. The pathologic diagnostic information obtained was judged to be useful to the clinician in 54 and not useful in 46 patients. In 74 patients with congestive heart failure of unknown etiology and a dilated heart, useful pathologic diagnoses included myocarditis, vasculitis, doxorubicin cardiomyopathy, and congestive cardiomyopathy. In most of the patients with biopsy findings of myocarditis there were no other clinical or laboratory findings indicating the presence of this disease, and the diagnosis of myocarditis would have been overlooked without a biopsy. In 26 patients in whom there was clinical evidence of constrictive or restrictive cardiovascular physiologic characteristics, useful biopsy diagnoses included radiation-induced cardiomyopathy, endomyocardial fibrosis, amyloidosis, or no myocardial disease; in the patients without myocardial disease thoracotomies were performed for constrictive pericarditis. Transvenous endomyocardial biopsy can provide clinically useful information in the evaluation of diseases of the myocardium.

Adult↗
PubMed1984

The diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome using subsegmental bronchoalveolar lavage.

To assess the sensitivity of bronchoalveolar lavage in patients with the acquired immunodeficiency syndrome (AIDS) in diagnosing Pneumocystis carinii pneumonia (PCP), we prospectively performed 27 bronchoalveolar lavages (BAL) in 16 patients either because there was an initially high index of suspicion of PCP or in order to assess therapeutic response to anti-Pneumocystis medication in those patients who had had PCP documented. Pneumocystis organisms were demonstrated on BAL specimens in 16 of 18 procedures in patients with histologic evidence of PCP on simultaneously obtained pulmonary tissue. The diagnosis was established rapidly by BAL and there was no substantial morbidity attributable to the procedure. Subsegmental BAL may be an important and sensitive tool for early diagnosis of PCP in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Profound but reversible myocardial depression in patients with septic shock.

To characterize the role of cardiac function in septic shock, serial radionuclide cineangiographic and hemodynamic evaluations were done on 20 patients with documented septic shock. Although all patients had a normal or elevated cardiac index, 10 patients had moderate to severe depression of their ejection fraction with values below 0.40. Thirteen of twenty patients survived their episode. Paradoxically, 10 of 13 survivors, but none of the 7 nonsurvivors, had an initial ejection fraction less than 0.40 (p less than 0.005). The mean initial ejection fraction for the survivors was 0.32 +/- 0.04, and their mean end systolic and end diastolic ventricular volumes were substantially increased with a normal stroke volume. The survivors' serial scans showed a gradual return to normal ejection fraction and ventricular volume by 10 days after the onset of shock. Nonsurvivors had normal initial ejection fractions and ventricular volumes that did not change during serial studies.

Adolescent↗
PubMed1983

Unresponsiveness of Legionella bozemanii pneumonia to erythromycin administration despite in vitro sensitivity.

We report a case of Legionella bozemanii pneumonia that failed to respond clinically and microbiologically to erythromycin administration. The organism was recovered from bronchial brushings and washings and was demonstrated to be sensitive in vitro to erythromycin as well as to rifampin and sulfamethoxazole-trimethoprim. The patient received a 9-day course of erythromycin before she died. Nonetheless, postmortem lung tissue yielded Legionella bozemanii. In treating Legionella pneumonia unresponsive to erythromycin, addition of another antibiotic, based on sensitivity testing, should be considered.

Erythromycin↗