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Biomedical subjects

J Engle

Publications and source records attributed to J Engle.

13 recordsLinked to original sources
PubMed1999

The impact of diaphragm management on prolonged ventilator support after thoracoabdominal aortic repair.

PURPOSE: The relationship of the division of the diaphragm during thoracoabdominal aortic repair to prolonged ventilator support has not been studied. The purpose of this study was (1) to determine whether preservation of diaphragm integrity has a significant effect on postoperative ventilator duration and (2) to elucidate other pulmonary risk factors related to thoracoabdominal aortic surgery and to study the relationship of these factors to the intact diaphragm technique. METHODS: Between February 1991 and January 1997, we repaired 397 descending and thoracoabdominal aortic aneurysms. Descending thoracic aneurysms were not included in the study because their repair does not include the diaphragm. A total of 256 patients participated in this study. The diaphragm was divided in 150 patients and left intact in 106 patients. Examined as potential risk factors were patient demographics, history and physical findings, aneurysm extent, urgency of the procedure, acute dissection, cross-clamp time, homologous and autologous blood product consumption, and adjunctive operative techniques. FEV1 also was considered in the 197 patients for whom preoperative spirometry was available. Prolonged mechanical ventilation was defined as ventilator support for >72 hours. Data were analyzed by univariate contingency table and multiple logistic regression methods. RESULTS: Increasing age (odds ratio [OR], 1.02/y; P <.02), current smoking (OR, 2.6; P <.0008), total cross-clamp time (OR, 1.0/min; P <.008), units packed red blood cells transfused (OR, 1.06/unit; P <.008), and division of the diaphragm (OR, 2.03; P <.02) were significant, independent predictors of prolonged ventilation. Sixty-seven percent of patients (71 of 106) whose diaphragms were preserved were extubated in <72 hours compared with 52% of patients (78 of 150) who underwent diaphragm division (OR, 0.53; P <.02). CONCLUSION: Independently of well known pulmonary risk factors, an intact diaphragm during thoracoabdominal aortic repair results in a higher probability of early ventilator weaning.

Adolescent↗
PubMed1998

Effect of gliotoxin on human polymorphonuclear neutrophils.

OBJECTIVES: Candida albicans is known to produce gliotoxin, which has several prominent biological effects, including immunosuppression. Interference with host defenses may arise from the effects of this toxin on leukocyte structure and function. METHODS: Flow cytometric analysis revealed that polymorphonuclear leukocytes (PMN) were more sensitive to gliotoxin than were mononuclear cells. Structural and various functional aspects of PMN exposed to gliotoxin were studied. RESULTS: Gliotoxin at (1 microgram/mL) did not affect the viability but did diminish PMN chemotaxis and reduced their ability to ingest particles. Other functional aberrations included decreased nitroblue tetrazolium dye reduction, decreased superoxide production, and release of lactoferrin suggesting by degranulation. Gliotoxin also affected the ability of PMN to kill Escherichia coli. CONCLUSIONS: This study suggests a previously unrecognized potential virulence factor of C. albicans that could contribute to persistence of yeast colonization or recurrence of symptomatic infection through diminished host resistance.

Candida albicans↗
PubMed1997

Mucopolysaccharidosis presenting as pediatric multiple aortic aneurysm: first reported case.

Within the pediatric population, the rare aortic aneurysm is most often brought on by congenital cardiovascular malformation or connective tissue disorder, trauma, inflammatory disease, or infection. Thus our 8-year-old patient who had multiple aortic aneurysms and evidence of mucopolysaccharidosis presented a doubly unique case. Three and one-half months after the patient underwent emergency aortic valve replacement, we performed resection and graft replacement of both her descending thoracic aorta and thoracoabdominal aorta. Histologic analysis of the aneurysm wall displayed severe medial degeneration with large deposits of acid mucopolysaccharides. Subsequent evaluation, although negative for connective tissue disorders, showed glycosaminoglycans, chondroitin sulfate, and heparan sulfate in the patient's urine. These findings are diagnostic for a heterogeneous group of storage diseases termed mucopolysaccharidoses, although testing of the patient's cultured fibroblasts failed to reveal any specific previously described enzymatic defect. After reviewing the literature, we believe that this is the first known successfully treated pediatric aortic aneurysm associated with mucopolysaccharidosis.

Aorta↗
PubMed1996

Immune-based therapy for HIV.

Even if there were antiretrovirals developed that could completely eliminate HIV from the body, it is thought that immune-based therapy would still be necessary. Pervasive damage occurs in the immune system even in early stages of the disease, and this damage would not be corrected by antiretrovirals. Several different types of immune-based therapies are presented in this article; some have been successful, and some have not been successful. All have been important, however, in increasing the knowledge base of HIV pathogenesis and in narrowing the options that might rebuild the immune system and, thereby, reverse this pathology.

Bone Marrow Transplantation↗
PubMed1995

Evaluation of five in-line hematocrit monitors.

Monitoring the hematocrit is essential during cardiopulmonary bypass for efficacious administration of blood products. The purpose of this study was to evaluate five cardiopulmonary bypass in-line monitors designed to display continuous hematocrit or hemoglobin values. The devices were evaluated for accuracy using an in vitro circuit primed with human blood while randomizing hematocrit, blood flow rate, and temperature. Hematocrits correlated significantly with the error in all the devices (p < 0.01). Over evaluation time, the error of the CDI, Gish, IBC, and MX2 increased significantly (p < 0.05). Temperature correlated significantly with the error of the Gish device (r = -0.49, p < 0.01). Blood flow correlated significantly with the Gish error (r = -0.24, p < 0.01). The Cobe device had a significantly smaller overall error than the other devices (p < 0.001). Device evaluation, based on a low mean error, a low percent error, a high correlation with the actual hematocrit, low correlations between mean error, blood flow, and temperature, and insignificant correlation between time and error, suggests that the Cobe device is more accurate for the continuous monitoring of hematocrit during cardiopulmonary bypass.

Blood Circulation↗
PubMed1990

Occlusive vascular stapling in a canine inferior vena cava model.

A canine model for inferior vena cava resection was devised to study the biomechanical and clinical applications of the cartridge stapler, which applies a triple staggered staple line. Eighteen mongrel dogs were subjected to subhepatic, suprarenal inferior vena cava occlusion with excision of the excluded segment. At 1 hour, six dogs were killed and inferior vena cava sizes and pressures were measured. All staple lines were intact. The inferior vena cava bursting pressure was 150 to 300 mm Hg. Ten dogs survived to 6 weeks and underwent repeat laparotomy with excision and measurement of the remaining inferior vena cava. Mean diameter was 1.9 cm. No evidence of staple line leakage was found despite chronic pressures to 39 cm H2O: median static bursting pressures were 250 mm Hg. Vein wall thickness of greater than 0.24 mm were all satisfactorily stapled. Histologic examination revealed normal reendothelialization, with improved healing at higher chronic pressures. No evidence of inflammation at the staple line or foreign body reaction was found. We conclude that a triple staple line provides secure, rapid venous occlusion that can withstand supraphysiologic stresses immediately and at 6 weeks.

Animals↗
PubMed1988

Treatment of neuroleptic malignant syndrome with diphenhydramine.

A case report of a patient with neuroleptic malignant syndrome is described. Of note is the fact that both central and peripheral manifestations of the syndrome responded to diphenhydramine and suportive therapy alone. A brief review of therapy is also discussed.

Adult↗
PubMed1984

Neuromagnetic evidence of spatially distributed sources underlying epileptiform spikes in the human brain.

Neuromagnetic measurements were performed on 17 subjects with focal seizure disorders. In all of the subjects, the interictal spike in the scalp electroencephalogram was associated with an orderly extracranial magnetic field pattern. In eight of these subjects, multiple current sources underlay the magnetic spike complex. The multiple sources within a given subject displayed a fixed chronological sequence of discharge, demonstrating a high degree of spatial and temporal organization within the interictal focus.

Brain↗
PubMed1979

Ultrasound detection of a carcinoid tumor.

The intraluminal component of symptomatic malignant carcinoid tumors of the small bowel is typically small relative to the extension in the mesentery, and barium examinations are occasionally normal. This case report illustrates the diagnostic value of abdominal ultrasonography in the detection of extraluminal component of a carcinoid tumor.

Carcinoid Tumor↗
PubMed1979

The evolution of a public health nursing performance evaluation tool.

A tool was developed to evaluate the performance of nurses in a large public health department. Nursing staff were involved in the development process and received inservice education in some aspects of performance that would be measured by the tool. The evaluation tool is used to assess performance in four areas: clinical practice, supervision and management, professional growth and research. The authors wish to express their appreciation to the following individuals in the Chicago Department of Health who worked so diligently in the development of the Performance Evaluation Tool and the inservice education program described in this paper: Elizabeth Velten, Lee Gross, JoAnn Macon, Mitchi Oki, Carol Corcoran, Hazel Barclay, Carrie Manley, Evelyn Ribic, Etherlene Palmer, Zettie Richardson. The authors also acknowledge the guidance of Ms. Claudie Leckeisik during the preparation of this manuscript.

Chicago↗
PubMed1976

Acute interstitial nephritis.

Acute allergic interstitial nephritis is manifested clinically by rash, fever, eosinophilia, hematuria, oliguria and azotemia. Histologically a monocytic inflammatory process in the renal interstitium is seen. The clinical course of a patient after excessive sodium cephalothin administration suggested allergic interstitial nephritis and implicates this drug as an etiologic agent.

Acute Disease↗