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Biomedical subjects

P Terry

Publications and source records attributed to P Terry.

107 records · Page 6Linked to original sources
PubMed1987

Effects of removing oxygen from patients with chronic obstructive pulmonary disease.

To determine the acute physiologic effects of removing oxygen from patients with chronic obstructive pulmonary disease (COPD) who are receiving long-term oxygen therapy, we made serial measurements in 20 patients during and after stopping low-flow oxygen therapy. Removing oxygen caused an increase in pulmonary vascular resistance, requiring 2 to 3 h to reach a new steady state. Removing oxygen therapy increased pulmonary vascular resistance index (PVRI) by 31% during rest (8.14 +/- 0.61 versus 6.23 +/- 0.51 units, p less than 0.001) and by 29% during exercise (8.11 +/- 0.9 versus 6.31 +/- 0.7, p less than 0.001). The increase in PVRI occurred because of an increase in pulmonary arterial pressure without a change in pulmonary capillary wedge pressure or cardiac index. At rest the increase in pulmonary arterial pressure caused by stopping oxygen correlated with the decrease in arterial oxygen saturation (r = 0.70, p less than 0.01). Removing oxygen decreased stroke volume index during rest and exercise. Although removing oxygen increased pulmonary vascular resistance, it did not affect systemic arterial pressure or vascular resistance. Stopping oxygen reduced arterial and mixed venous oxygen tension and oxygen delivery during rest and exercise. In patients who had a normal PaCO2 while breathing room air, removing oxygen therapy increased their oxygen consumption; conversely, in those patients who had an elevated PaCO2 while breathing room air, stopping oxygen therapy reduced oxygen delivery and oxygen consumption.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Gas Analysis↗
PubMed1987

Categorization of hospital emergency services--developing valid criteria.

In a pilot project sponsored by the California State Emergency Medical Services Authority, validated, verifiable criteria were developed for the vertical categorization of hospital emergency services in 11 different groupings of medical and surgical emergencies. We describe the development of an assessment process and categorization criteria to identify the most appropriate receiving facility for interfacility transfer and, in selected instances, field triage of patients with different levels of severity of illness or injury. We propose that this facility assessment project be used in the critical care planning process for the eventual vertical categorization of hospital emergency services in California and as a template for similar projects in other states.

California↗
PubMed1986

Interstitial fibrosis and collateral ventilation.

Interstitial fibrosis may increase resistance to collateral flow (Rcoll) because of decreased lung volume and destruction of collateral channels or it may decrease Rcoll because of emphysematous changes around fibrotic regions. In addition, if interstitial fibrosis involves a small region of lung periphery, interdependence from surrounding unaffected lung should produce relatively large changes in volume of the fibrotic region during lung inflation. We studied the effects of interstitial fibrosis on collateral airflow by measuring Rcoll at functional residual capacity (FRC) in nine mongrel dogs before and 28 days after the local instillation of bleomycin into selected lung segments. In six of these dogs Rcoll was also measured at a higher lung volume (transpulmonary pressure = 12 cmH2O above FRC pressure). Rcoll increased in fibrotic lung segments following local treatment with bleomycin. With lung inflation (high transpulmonary pressure) Rcoll fell a similar proportion in fibrotic and nonfibrotic lung regions. These observations suggest that collateral resistance increases in fibrotic segments because lung volume decreases or because collateral pathways are involved directly in the fibrotic process. Compensatory increases in collateral communications do not occur. In addition, pulmonary interdependence does not cause disproportionate increases in volume and decreases in Rcoll of the fibrotic region during lung inflation.

Airway Resistance↗
PubMed1984

Use of oral contraceptives in women with cystic fibrosis.

Oral contraceptive pills (OCP) represent the most common contraceptive method among teenagers and young adults. Because many women with cystic fibrosis (CF) are now surviving into childbearing age and are at risk for the complications of pregnancy in CF, oral contraceptive use may be indicated. However, it has been suggested that OCP use by CF patients may be associated with deterioration in pulmonary function. Ten adolescent and young adult women with CF and moderate-to-severe obstructive lung disease were studied while taking a combination oral contraceptive pill (Ovral 28). No significant deterioration was found in clinical status or pulmonary function. Careful follow-up should nevertheless be continued to monitor for other adverse effects of oral contraceptive use in CF, such as cholelithiasis.

Adolescent↗
PubMed1983

Breast cancer in blacks, Asians and whites in Birmingham.

A retrospective study was mounted into the frequency of breast cancer in blacks, whites and Asians attending Dudley Road Hospital in the years 1970-1981 inclusive. This figure was compared with the ethnic distribution of the surrounding population and of admissions for all causes. Breast cancer was uncommon in both ethnic minorities compared with whites, but was commoner in blacks than in Asians. These trends are similar to the World Health Organization figures for Britain, Jamaica and India. Differences in parity and breast feeding do not explain the variability of breast cancer in this study.

Adult↗
PubMed1980

Metastatic pulmonary calcification in the renal transplant recipient.

An asymptomatic immunosuppressed renal transplant patient presented with diffuse alveolar infiltrates on a routine chest roentgenogram. An open lung biopsy revealed changes compatible with metastatic pulmonary calcification. The etiology, pathogenesis, and diagnostic approach to this rare disorder are discussed.

Adult↗
PubMed1979

Evaluations of continuing medical education for chronic obstructive pulmonary diseases.

A continuing medical education program which linked primary care physicians to a source of needed appropriate clinical knowledge at a relatively low cost has been demonstrated. Chronic obstructive pulmonary disease was identified as the health problem; the reference patient population was comprised of coal miner health fund beneficiaries living in a 10-county region. Primary care physicians treating beneficiaries in this region were the eligible program participants. Content of the program was based on multiple sources of information about actual practice needs. Several educational techniques were used in combination to convey the knowledge identified as appropriate in the diagnostic stage. A quasi-experimental program evaluation indicated significant changes in physician knowledge, judgment, and self-reported behavior related to diagnosis and treatment of chronic obstructive pulmonary disease.

Adult↗
PubMed1979

Collateral ventilation.

Ventilation may bypass obstructed airways through collateral channels, including interalveolar pores of Kohn, bronchiole-alveolar communications of Lambert, and interbronchiolar pathways of Martin. Resistance through these channels, like resistance through small airways, increases with decreasing lung volume and with hypocapnia. But whereas the distention of collateral channels and small airways by a variety of factors is similar, the efficiency of ventilation through collateral channels is less than the efficiency through airways. Gas inspired through collateral channels is contaminated with alveolar gas from surrounding lung so that the dead space for collateral ventilation is increased. When one part of the lung ventilates out of phase with the surrounding lung, pulmonary interdependence promotes more homogeneous ventilation. In the presence of airways obstruction, interdependence may be a primary factor governing the rate of collateral ventilation. In man, collateral ventilation is unimportant in normal lungs. However, with disease, it may be critical in producing or compensating for abnormalities. For example, the long time constant for collateral ventilation in the middle lobe may be responsible for atelectasis, which results in the middle lobe syndrome. On the other hand, the short time constant for collateral ventilation in emphysema may be essential for the distribution of ventilation beyond obstructed airways.

Airway Resistance↗
PubMed1978

Objective constructs and cognitive structure.

Some relations between objective content and concrete structure in cognitive systems are examined in repertory grids completed by 58 individuals. Predictions that systems with objective content would show less discrimination, differentiation and integration were unconfirmed, results tending in the opposite direction to that hypothesized. There was a similar outcome for six measures of cognitive style as dependent variables. It it suggested that objective-subjective constructs and their concrete-abstract use should be further investigated with the expectation of finding more complex relations in individuals' cognitive systems.

Adult↗
PubMed1978

Bronchoscopic needle aspiration biopsy of paratracheal tumors.

Primary lung carcinoma adjacent to the trachea and paratracheal nodal metastasis without evidence of the primary tumor or airway invasion require invasive surgical procedures to obtain adequate diagnostic tissues. Adequate diagnostic tissue was obtained in 3 of 5 patients with paratracheal masses by means of a bronchoscopic needle aspiration technique. There were no complications.

Adult↗
PubMed1978

Pulmonary function in young smokers: male-female differences.

To delineate the pattern of pulmonary function abnormalities and associated pathophysiologic mechanisms in young smokers, 205 volunteers between the ages of 18 and 25 were studied with a variety of pulmonary function tests. Differences between male and female smokers were observed. Pulmonary function abnormalities consistent with small airway dysfunction were noted in male smokers, but not in female smokers. Decreased forced expiratory flows at high lung volumes suggesting large airway dysfunction were noted in both male and female smokers. Decreases in diffusing capacity for CO consistent with abnormalities of the pulmonary vascular system were seen in smokers of both sexes, but were more prominent in females. Because men develop chronic obstruction pulmonary disease more frequently than do women even when adjustments for smoking are made, and because women develop primary pulmonary hypertension more frequently than do men, these chronic diseases may reflect distinct pathophysiologic response of the 2 sexes to agents such as cigarettes.

Adolescent↗
PubMedDate not supplied

How mature is your organization's prevention effort? Four stages of managed care health promotion.

Rooted in prevention since the 1973 HMO Act, managed care has weathered seasons enough to put down roots in patient education and preventive services. Now it shows a readiness for re-potting. For health promotion to reach full maturity and realize its highest calling, its roots need to spread into the community. Analysts have posited four stages of managed care market penetration; similarly, I propose four stages of maturation in managed care-based prevention initiatives (Table 1). These stages of prevention are based on an analysis of more than 100 presentations from a series of "Managed Care to Managed Health" conferences sponsored by The Institute for Research and Education, Health-System Minnesota in Minneapolis. The following descriptions of the stages of maturation illustrate the development of prevention efforts--from patient education and preventive services in early stages to improving the health of enrollees and ultimately the community in later stages.

Community Health Planning↗