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Biomedical subjects

J Krikorian

Publications and source records attributed to J Krikorian.

10 recordsLinked to original sources
PubMed1999

A comparison of bronchodilator therapy delivered by nebulization and metered-dose inhaler in mechanically ventilated patients.

BACKGROUND: The optimal method of delivering bronchodilators in mechanically ventilated patients is unclear. The purpose of this study was to compare the pulmonary bioavailability of albuterol delivered by the nebulizer, the metered-dose inhaler (MDI) and spacer, and the right-angle MDI adaptor in ventilated patients using urinary analysis of drug levels. METHODS: Mechanically ventilated patients who had not received a bronchodilator in the previous 48 h and who had normal renal function were randomized to receive the following: (1) five puffs (450 microg) of albuterol delivered by the MDI with a small volume spacer; (2) five puffs of albuterol delivered by the MDI port on a right-angle adaptor; or (3) 2.5 mg albuterol delivered by a nebulizer. Urine was collected 6 h after the administration of the drug, and the amounts of albuterol and its sulfate conjugate were determined in the urine by a chromatographic assay. RESULTS: Thirty patients were studied, 10 in each group: their mean age and serum creatinine level were 62 years and 1.3 mg/dL, respectively. With the MDI and spacer, (mean +/- SD) 169+/-129 microg albuterol (38%) was recovered in the urine; with the nebulizer, 409+/-515 microg albuterol (16%) was recovered in the urine; and with the MDI port on the right-angle adaptor, 41+/-61 microg albuterol (9%) was recovered in the urine (p = 0.02 between groups). The level of albuterol in the urine was below the level of detection in four patients in whom the drug was delivered using the right-angle MDI adaptor. CONCLUSION: The three delivery systems varied markedly in their efficiency of drug delivery to the lung. As previous studies have confirmed, this study has demonstrated that using an MDI and spacer is an efficient method for delivering inhaled bronchodilators to the lung. The pulmonary bioavailability was poor with the right-angle MDI port. This port should not be used to deliver bronchodilators in mechanically ventilated patients.

Administration, Inhalation↗
PubMed1997

Pressure-controlled ventilation in ARDS: a practical approach.

Patients with ARDS typically have functionally small lungs. A growing body of clinical and experimental evidence has demonstrated that mechanical ventilation that results in high transpulmonary pressure gradients and overdistention of lung units will potentiate the acute lung injury in patients with ARDS. A relative form of "lung rest" using low tidal volume mechanical ventilation that prevents alveolar overdistention has therefore been advocated. This may be achieved with low-volume, volume-cycled ventilation with a decelerating inspiratory flow or pressure-controlled ventilation (PCV). The goal of this article is to provide a simple and practical approach to the management of PCV in patients with ARDS. Implicit in our approach is the use of a ventilator with PCV software and waveform capabilities.

Airway Resistance↗
PubMed1989

Pulmonary microvascular cytology in the diagnosis of lymphangitic carcinomatosis.

The diagnosis of lymphangitic spread of carcinoma in the lungs is sometimes difficult. We studied the cytologic characteristics of blood drawn through a wedged pulmonary-artery catheter from eight patients in whom lymphangitic carcinomatosis was confirmed by subsequent autopsy, lung biopsy, or clinical evaluation. The sites of the primary tumors were the prostate, breast, esophagus, and lung. Malignant cells were found in seven of the eight patients. Cytologic findings were normal in 16 of 17 patients with cancer but without pulmonary metastases and in 22 of 23 patients with nonmalignant pulmonary disorders. In a patient with cancer with tumor embolism to the lungs, the findings were positive, probably because of extensive intravascular tumor in large hepatic veins. One false positive finding occurred in a patient with extensive pulmonary infarction. Megakaryocytes, which are present in large numbers in the pulmonary capillary bed, are the hallmark of a satisfactory pulmonary vascular blood sample for pulmonary microvascular cytologic study. Familiarity with the cytologic characteristics of these cells in Papanicolaou preparations is essential to avoid mistakenly identifying them as malignant. Although transbronchial lung biopsy remains the diagnostic procedure of choice in this disorder, our findings suggest that the presence of malignant cells in pulmonary microvascular-cytology preparations in patients with cancer and unexplained dyspnea constitutes presumptive evidence of lymphangitic carcinomatosis. Pulmonary microvascular cytology may be particularly valuable when lung biopsy is refused or is thought to be too hazardous.

Aged↗
PubMed1983

Adjuvant chemotherapy for stage D1 adenocarcinoma of prostate.

In a series of 112 patients undergoing pelvic lymphadenectomy for clinically localized prostate cancer, 37 were found to have pelvic lymph node metastases. After prostatic irradiation, these 37 patients were divided into groups receiving adjunctive chemotherapy versus no additional treatment. The patients were followed for a period ranging from twelve to sixty-five months for evidence of disease progression. Of the 12 patients administered chemotherapy, disease progression was documented in 4 (average time to progression was fifteen months). In contrast, of the 25 patients receiving no additional treatment, 12 exhibited evidence of gross metastatic disease within an average interval of 11.6 months. One death has been recorded in the chemotherapy group at twenty-nine months after diagnosis; 4 deaths have occurred in patients receiving no systemic therapy (average time to death was eighteen months).

Adenocarcinoma↗
PubMed1983

Maytansine as a cause of acute proliferative disorder of bladder urothelium in the rat.

Male Wistar Lewis rats were injected with maytansine at a total dose of 0.425 to 0.6 mg/kg over a 3-week period. Biopsies taken at 5 weeks showed that 23% of the bladders had hyperplasia or other abnormalities. Of the bladder biopsies done for the first time at 8 weeks, 80% demonstrated papillary hyperplasia. A small number of biopsies at 13 and 19 weeks still showed hyperplasia and minimal inflammatory reaction. These results were seen regardless of prior biopsy, the presence of bladder calculi, and/or the dose level used. It is not clear from the data whether the observed changes are reversible or precarcinogenic. However, these changes closely resembled the histologic features described in the evolution of bladder cancer in rats fed N-C4-(5-nitro-2-furyl)-2-thiazolyl formamide.

Animals↗
PubMed1979

Quality control enhanced by chart review.

A long-term care facility developed, tested, and implemented criteria for documenting care, a procedure for regular review of charts, and quantitative methods of evaluating reviews.

Chicago↗
PubMed1979

Computed tomography in primary reticulum cell sarcoma of the brain.

The CT findings in 16 patients with histologically proved primary central nervous system (CNS) reticulum cell sarcoma (RCS) showed this malignancy to have predilection for the basal ganglia and thalamus, the periventricular white matter, the corpus callosum, and the vermis cerebelli. In 43% of patients with untreated tumor it presented as multifocal lesions; in each of these patients the basal ganglia were involved in conjuction with another site. In the other 57% of patients with untreated tumor presenting as solitary lesions the basal ganglia, the corpus callosum, and the frontal lobe were sites of predilection. Such solitary lesions may be indistinguishable from other tumors. Contrast enhancement of RCS was characteristically homogeneous with rare lucency, even in very large lesions.

Adolescent↗
PubMed1979

Monoclonal immunoglobulin rescue from a patient with chronic lymphocytic leukemia and autoimmune hemolytic anemia.

In order to test whether autoimmune hemolytic anemia in a patient with chronic lymphocytic leukemia was due to autoantibody production by the neoplastic clone, somatic cell hybrids were constructed between the patient's leukemic cells and a mouse myeloma line. Light-chain-restricted human immunoglobulin was secreted by 4 of 11 of the established hybrid lines. No binding of this immunoglobulin to red cell surface antigens could be detected. Thus, we conclude that the autoantibody in this patient represented a concomitant reactive response and was not the product of the malignant clone of B cells.

Aged↗
PubMed1978

Computed tomography in leptomeningeal spread of tumor.

Computed tomography proved insensitive to leptomeningeal spread of hematologic malignancies including leukemia, lymphoma, and malignant histiocytosis. In only 3% of patients did it directly demonstrate leptomeningeal tumor. In comparison, the detection rate of leptomeningeal tumor secondary to carcinoma was 44% and for melanoma, 100%. Intracranial subarachnoid seeding from primary brain gliomas was detected in each instance. The simultaneous presence of parenchymal metastases with leptomeningeal carcinomatosis occurred in 18% of patients with nonhematologic malignancies. Computed tomography evidence of communicating hydrocephalus, previously thought to be a major factor in clinical symptomatology, occurred in only 11% of patients.

Adult↗