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Biomedical subjects

J R Norman

Publications and source records attributed to J R Norman.

At least 19 recordsLinked to original sources
PubMed1998

Blastomycosis as an etiology of acute lung injury.

Blastomyces dermatitidis, a dimorphic broad-based budding yeast endemic to the Mississippi River Valley region, is responsible for morbidity in humans via inhalation and dissemination. The response of acute lung injury, which produces an illness with serious morbidity and an approximately 50% mortality, uncommonly occurs. Diagnosis can be difficult, and a high index of suspicion should be maintained in endemic regions for patients with acute lung injury of uncertain etiology, especially if their condition deteriorates on broad-spectrum antimicrobial and antitubercular therapy and they have a previous insidious respiratory complaint and constitutional symptoms. Diagnosis should be aggressively pursued and treatment with amphotericin B (0.6 to 0.8 mg/kg/day) initiated as early as possible.

Acute Disease↗
PubMed1995

Unilateral hyperlucency with left lower lobe mass in a patient with bronchial asthma.

Mucoepidermoid tumors are rare bronchial adenomas whose clinical presentation can mimic that of bronchial asthma. Bronchial adenoma should be included in the differential diagnosis of a patient with a persistent radiographic abnormality and clinical features of bronchial asthma. We present an adolescent female with a history suggestive of bronchial asthma and a persistent left lower lobe atelectasis, who later was found to have a low-grade mucoepidermoid tumor.

Adenoma↗
PubMed1995

Strategies for maximizing your chances for weaning success. Limitations--and advantages--of common predictive indices.

Using indices to predict weaning outcome can avoid premature extubation and unnecessary prolongation of ventilatory support. Unfortunately, none of the indices is consistently able to predict outcome. The key to successful weaning is to assess respiratory function repeatedly with several indices, not just one. The patient should be able to sustain spontaneous breathing for at least 24 hours on minimal partial ventilatory support (a pressure support or a continuous positive airway pressure of 5 cm H2O or a T piece, for example). Indices of maximal inspiratory pressure; work of breathing; and rapid, shallow breathing are useful in evaluating a patient's respiratory muscle performance; airway occlusion pressure is helpful as well when increased neuromuscular drive is a problem.

Forecasting↗
PubMed1993

Severe COPD and acute respiratory failure. Correlates for survival at the time of tracheal intubation.

The recognition of a reversible cause for acute respiratory failure (ARF) is frequently difficult in patients with severe chronic obstructive pulmonary disease (COPD). We sought to identify clinical findings present at the time of tracheal intubation that were associated with successful weaning and short-term survival among a population of male veterans with severe COPD. Over a 5-year period (1987 to 1991), 39 episodes of ARF requiring mechanical ventilation (MV) were identified in 33 men with severe COPD. All the patients had a baseline FEV1 < 1 L. Univariate analysis suggested a higher serum albumin level and absence of pulmonary infiltrates on chest radiography distinguished survivors (weaned from MV for 72 h) from nonsurvivors (died while undergoing MV or within 72 h of weaning). Multivariate analysis revealed the absence of pulmonary infiltrates on initial chest radiography was the strongest correlate for survival. To examine the significance of these correlates in ARF complicating milder COPD, 19 patients with lesser degrees of chronic airways obstruction and ARF were also studied. Unlike patients with severe COPD, the presence or absence of pulmonary infiltrates on chest radiography was not correlated with survival in patients with milder chronic airways obstruction. Analyzing all COPD patients with ARF, the mortality risk associated with the presence of pulmonary infiltrates on chest radiography increased dramatically with declining baseline lung function. Mortality risk ratio analysis revealed the greatest likelihood for survival was predicted by a higher baseline FEV1 and the absence of pulmonary infiltrates on chest radiography. The extent of baseline airways obstruction alone was not correlated with short-term survival in either group. These observations suggest that in the subset of patients with severe COPD and ARF, the presence of pulmonary infiltrates on chest radiography at the time of tracheal intubation may be associated with less likelihood for survival. An exacerbation of COPD may infrequently be the terminal illness in these patients.

Acute Disease↗
PubMed1990

Mechanical ventilation in patients with acute severe asthma.

PURPOSE: Acute respiratory failure necessitating intubation and mechanical ventilation in patients with acute severe asthma is relatively uncommon, and there are few data available regarding positive pressure ventilation in critically ill patients with asthma. We therefore decided to evaluate our experience with the use of mechanical ventilation for acute asthma and to critically review previous reports on this subject. PATIENTS AND METHODS: A retrospective analysis of all medical records of patients who required mechanical ventilation for acute severe asthma was performed for the period of 1980 to 1988. Various clinical parameters were reviewed and examined via Fisher's exact test for association with survival. RESULTS: Twenty-seven patients who underwent ventilation for a total of 32 episodes of mechanical ventilation comprised our study group. The overall mortality was 22%. A total of 76 complications were documented, including six episodes of barotrauma. The mean duration of artificial ventilation was 114 hours for nonsurvivors and 77 hours for survivors (p less than 0.05). CONCLUSION: Although there appears to be a trend toward increased survival after mechanical ventilation for acute asthma, ventilation of critically ill asthmatic patients continues to be a potentially perilous venture associated with significant morbidity and mortality.

Acute Disease↗
PubMed1990

Communication between the PC and laboratory instruments.

In this paper we describe communications between a personal computer and any instrument with a serial port for the purpose of collecting data or controlling equipment and a program for performing this task. From a user-defined file, the software reads the communication parameters: baud rate, data bits, stop bits and parity. The communication protocol is also read: echo, acknowledge and end-of-transmission characters. The software can be used to determine the protocol, to check the integrity of the communications, and can form the basis of a program for more specific applications.

Equipment and Supplies↗
PubMed1989

Face-mask CPAP and sodium bicarbonate infusion in acute, severe asthma and metabolic acidosis.

A patient with a history of previous mechanical ventilation for asthma was hospitalized with acute, severe asthma; metabolic acidosis; and hyperlactatemia. In addition to standard therapy, she was successfully treated with face-mask CPAP and IV sodium bicarbonate infusion. This therapy may help prevent mechanical ventilation in some patients with acute, severe asthma and lactic acidosis.

Acidosis, Lactic↗
PubMed1984

Epidemiology of peptic ulcer in Australia. A study based on government statistics in four states.

A study of Pharmaceutical Benefits Scheme cimetidine prescriptions, hospital admissions, and deaths due to peptic ulcer in 13 million Australians in 1981 indicated that the annual ulcer incidence per 1000 population was 3.8 for duodenal ulcer and 0.7 for gastric ulcer. Approximately 70 000 Australians appear to receive initial treatment for a peptic ulcer each year. Two-thirds of patients were managed outside hospital. Patients with gastric ulcers were more likely to be admitted to hospital or to die from their ulcer than were patients with duodenal ulcers. Significant regional differences in ulcer frequency were found; in particular, the risk of gastric ulcer in NSW was four times that in Victoria. Gastric and duodenal ulcers were more common in New South Wales than in Victoria, Queensland or Western Australia. These differences, and other regional variations, indicate appropriate localities for further studies of the aetiology of peptic ulcer.

Adolescent↗
PubMed1978

Perioperative infarction: effects of cardiopulmonary bypass on collateral circulation in an acute canine model.

Significant intracoronary collateralization [circumflex (Cx) to anterior descending (AD)] can be established acutely by selective hypertensive perfusion of the circumflex (through left main) after acute occlusion of the AD in working canine hearts. Intracoronary collateral flow can be estimated by a collateral circulation index (CCI) = distal coronary diastolic pressure x 100/aortic diastolic pressure. The effects of 60 to 90 min of normothermic, total cardiopulmonary bypass (TCPBP) on such collaterals were evaluated in four dogs with CCI > 80%, and compared to six control dogs with CCI < 80% and without TCPBP. Three hours after AD ligation, control dogs had minimal myocardial injury despite significantly lower CCI. In contrast, the four study dogs placed on TCPBP experienced an abrupt fall of the CCI to 30% (P < 0.03), severe ischemia, and infarction in each; two became pump dependent. Thus, ventricular pressure work seems to be an important determinant of flow through collateral channels. These results suggest that preservation techniques for myocardium supplied by collaterals during coronary surgery may require considerations other than intermittent perfusion via existing coronary inflow.

Animals↗