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Biomedical subjects

J Hansen-Flaschen

Publications and source records attributed to J Hansen-Flaschen.

32 records · Page 2Linked to original sources
PubMed1991

The Patient Self-Determination Act and the future of advance directives.

Living wills and other advance directives currently play a limited role in medical decision making. A new federal law, the Patient Self-Determination Act, will require health care providers in hospitals, nursing homes, and other facilities to inquire about the presence of advance directives, to record patient preferences in the medical record, and to develop institutional policies regarding the implementation of these directives. Unfortunately, the law does little to promote discussion or preparation of advance directives before hospitalization. Additional efforts to promote the use of advance directives can take place in the outpatient medical care system, in attorneys' offices, or through health insurers. Because most people have not yet prepared an advance directive, we suggest that institutions develop treatment policies for situations in which the wishes of patients who lack decisional capacity are not known. These policies should be designed to promote the patients' best interests, as defined by the consensus of the institutions' staff and members of the surrounding community.

Advance Directives↗
PubMed1990

Localized leukemic pulmonary infiltrates. Diagnosis by bronchoscopy and resolution with therapy.

Although commonly found at autopsy, leukemic infiltration of the lung is rarely recognized as a cause of respiratory symptoms or roentgenographic densities. Previously reported cases of patients who had symptomatic or roentgenographic acute leukemic lung diseases invariably presented with diffuse pulmonary infiltrates. We describe three patients with leukemic involvement of the lung who presented with cough, fever, and localized roentgenographic infiltrates suggestive of bacterial pneumonia. In each case, the diagnosis was made by transbronchial biopsy specimen and confirmed by complete response to chemotherapy. In common with the other reported cases, all of our patients had peripheral blast counts above 40 percent (greater than 6,000 blasts per ml3) at the time the pulmonary diagnosis was made. Leukemic invasion of the lung should be considered in patients with acute leukemia who develop lung infiltrates--whether diffuse or focal--in association with a high peripheral blast count.

Adult↗
PubMed1989

Severe methaemoglobinaemia after flexible fibreoptic bronchoscopy.

A patient with the acquired immunodeficiency syndrome (AIDS) developed severe cyanosis after bronchoscopy (oxygen saturation 34%) from methaemoglobinaemia. This was thought to be due to enhanced absorption of local anaesthetic from the nasopharynx or trachea as a result of candidiasis. The patient responded dramatically to intravenous methylene blue.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Clubbing and hypertrophic osteoarthropathy.

Acquired clubbing of the digits and hypertrophic osteoarthropathy are closely related disorders of unknown etiology that derive special significance from their frequent association with serious underlying diseases of the thorax or abdomen. Most importantly, clubbing or HOA may provide the first clinical indication of a chronic infection or an intrathoracic neoplasm. However, clubbing is easily overlooked on physical examination, and hypertrophic osteoarthropathy is often mistaken for some other disorder. The diagnosis of clubbing is based on the finding of an increase in the soft tissue at the base of the finger or toenails. Of the several objective criteria that have been proposed for the diagnosis of digital clubbing, the best documented and most practical is an increase in the ratio of the distal phalangeal depth (DPD) to the interphalangeal depth (IDP) of the index finger to 1.0 or greater. Hypertrophic osteoarthropathy is characterized in advance cases by the combination of digital clubbing, periostitis of the long bones, arthritis-like changes in the knees, elbows, ankles, and wrists, and swelling of the soft tissues in the distal extremities. Bone scintigraphy has emerged as the most sensitive test for HOA; in fact, a bone scan may show evidence of periostitis in patients with no other signs, symptoms, or radiographic abnormalities of the disorder. The symptoms of HOA respond to anti-inflammatory agents, and to ablation or cure of the underlying disorder.

Diagnosis, Differential↗
PubMed1985

Normobaric hyperoxia in vivo inhibits fatty acid incorporation into sheep erythrocyte phospholipid in vitro.

Oxygen toxicity is a major complication of normobaric hyperoxia in therapeutic settings. Because alterations in membrane function occurring as a consequence of peroxidation of membrane phospholipid fatty acids may be an early event in the pathogenesis of oxygen-induced injury, we studied the effects of hyperoxia on the ability of the membrane to repair itself by incorporating fatty acid via the pathway for deacylation and reacylation in situ. Although the lung is the major site of clinically significant injury, the erythrocyte is also directly exposed to elevated PO2 in vivo. In this study, incorporation of [9,10(-3)H]-oleic acid into phospholipid has been measured in sheep erythrocytes in vitro after exposure of four animals to normobaric hyperoxia in vivo. [9,10(-3)H]-Oleic acid incorporation into erythrocyte phospholipid decreased within 24 hours and reached 50% of pre-exposure levels after 70 hours of exposure to 100% O2. No significant change in the fatty acid composition of membrane phospholipid was detected under these conditions. In contrast to the results with intact cells, incorporation of [9,10(-3)H]-oleic acid into phospholipid by isolated erythrocyte membranes prepared from the cells of two animals increased after 70 hours of exposure to 100% O2, indicating that the inhibition of fatty acid incorporation in intact erythrocytes does not result from irreversible inactivation of the enzymes involved in acylation of endogenous lysophospholipid. Because the ability of cells to replace membrane phospholipid fatty acids via deacylation and reacylation in situ could be important in the maintenance of membrane integrity during oxidative stress, the decrease in fatty acid incorporation by erythrocytes in vitro may reflect an early event in the pathogenesis of oxygen-induced cellular injury.

Animals↗
PubMed1983

Transcapillary movement of cationized ferritin in the isolated perfused rat lung.

We have identified the ultrastructural localization of anionic sites on the luminal surface of the pulmonary microvascular endothelium by perfusing isolated rat lungs with polycationized ferritin (CF). The ligand decorated preferentially the luminal plasmalemma, coated pits, intercellular clefts, and about half of the plasmalemmal vesicles open to the lumen. Decoration of the plasmalemma was not uniform particularly in the nonvesiculated regions of the endothelium. Perfusion of the lung with high salt solution completely abolished binding of CF to the plasmalemma, coated pits, and intercellular clefts but did not significantly decrease binding of CF to the diaphragm of the luminal plasmalemmal vesicles. This indicates the presence of highly charged anionic sites on these regions of the endothelium. CF was taken up by vesicles and discharged on the capillary membrane. Perfusion of the lungs at 4 degrees C completely abolished transport of CF across the endothelium but did not modify the pattern of binding to the luminal endothelial surface. These findings are regarded as evidence for a functional subspecialization of plasmalemmal vesicles in the pulmonary microvascular endothelium.

Animals↗
PubMedDate not supplied

A comprehensive educational program improves clinical outcome measures in inner-city patients with asthma.

BACKGROUND: Despite improved understanding of the pathophysiology of asthma, morbidity and mortality continue to rise, with disproportionate increases occurring among urban, indigent minorities. New approaches in the management of asthma are therefore necessary to reverse these dramatic and costly trends. OBJECTIVE: To determine if patients who are admitted to the hospital with acute asthma and receive inpatient education will have improved outpatient follow-up and clinical outcome measures compared with those receiving conventional care. METHODS: Patients enrolled in the study had a primary admission diagnosis of asthma and were between ages 18 and 45 years. Exclusion criteria included comorbid disease, inability to speak English, absence of a telephone in the primary residence, or pregnancy. Seventy-seven patients admitted from the emergency department with asthma were randomized to either the inpatient educational program (IEP) or routine care (control group). Patients in the IEP received asthma education, bedside spirometry, a telephone call 24 hours after discharge, and scheduled follow-up in an outpatient asthma program within 1 week of discharge. Those individuals randomized to the routine management group received conventional inpatient asthma care and routine follow-up. RESULTS: The patients enrolled in the IEP had a markedly higher follow-up rate compared with outpatient appointments (60% vs. 27%; P = .01) and significantly fewer emergency department visits (P = .04) and hospitalizations (P = .04) for asthma in the 6 months following IEP intervention, as compared with control patients. This represented a substantial cost savings to the managed care organization. CONCLUSION: Our study suggests that an IEP in the treatment of indigent, inner-city patients hospitalized with asthma reduces the need for subsequent emergent care and improves outpatient follow-up in a cost-effective manner.

Acute Disease↗
PubMedDate not supplied

Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill?

BACKGROUND: Recognizing that many Americans draw on religious or spiritual beliefs when confronted by serious illness, some medical educators have recommended that physicians routinely ask about spirituality or religion when conducting a medical history. The most appropriate wording for such an inquiry remains unknown. OBJECTIVE: To examine patient acceptance of including the following question in the medical history of ambulatory outpatients: "Do you have spiritual or religious beliefs that would influence your medical decisions if you become gravely ill?" METHODS: Self-administered questionnaires were completed by 177 ambulatory adult patients visiting a pulmonary faculty office practice at a university teaching hospital in 1997 (83% response rate). RESULTS: Fifty-one percent of the study patients described themselves as religious and 90% believe that prayer may sometimes influence recovery from an illness. Forty-five percent reported that religious beliefs would influence their medical decisions if they become gravely ill. Ninety-four percent of individuals with such beliefs agreed or strongly agreed that physicians should ask them whether they have such beliefs if they become gravely ill. Forty-five percent of the respondents who denied having such beliefs also agreed that physicians should ask about them. Altogether, two thirds of the respondents indicated that they would welcome the study question in a medical history, whereas 16% reported that they would not. Only 15% of the study group recalled having been asked whether spiritual or religious beliefs would influence their medical decisions. CONCLUSION: Many but not all patients surveyed in a pulmonary outpatient practice welcome a carefully worded inquiry about their spiritual or religious beliefs in the event that they become gravely ill.

Adult↗