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Biomedical subjects

R F Grossman

Publications and source records attributed to R F Grossman.

At least 19 recordsLinked to original sources
PubMed1992

Infectious complications following isolated lung transplantation.

STUDY OBJECTIVE: To ascertain the incidence, types, morbidity, and mortality of infectious episodes in isolated lung transplant recipients. DESIGN: Retrospective chart review of patients who have undergone transplants over a six-year period in one institution. PATIENTS: Twenty-three single and 17 double lung transplants followed up between 2 and 68 months. RESULTS: Fifty-one episodes of infection occurred in the group with a slight predominance in the double lung transplants. The 32 episodes of bacterial infection constituted the largest group of infection and more than half of these were pneumonias. Organisms identified were predominantly Gram negative. While bacterial processes made up the bulk of infections, fatalities were rare. Viral and fungal infections were less common, but more often fatal. Of six cases of viral pneumonitis, two were fatal; two of five cases of invasive fungal infection were also fatal. Overall, six patients died of infection. CONCLUSION: Our findings support previous reports from heart-lung centers documenting a high rate of infectious complications, particularly pneumonia, in recipients of lung grafts. In our experience, bacterial infections are the most common (two of three infections), but have the lowest mortality. Efforts should be directed toward establishing effective prophylaxis programs and early detection of infection.

Bacteria↗
PubMed1992

Cefaclor AF versus cefaclor in acute exacerbations of chronic bronchitis.

The effectiveness and safety of cefaclor advanced formula (AF) compared with cefaclor in the treatment of acute exacerbations of chronic bronchitis were evaluated in multicentre trials in the United States and Europe. In the US study, patients were randomized to receive either cefaclor AF 375 mg twice daily or 500 mg twice daily or 250 mg cefaclor three times daily. Three dose levels of cefaclor AF were used in the European study: 375 mg, 500 mg and 750 mg twice daily; the comparative agent was cefaclor 250 mg three times daily in the 375 mg and 500 mg strata, and cefaclor 500 mg three times daily in the 750 mg stratum. The total number of patients receiving cefaclor AF was 667 versus 357 patients receiving cefaclor. Results showed that cefaclor AF administered twice daily at 375, 500 or 750 mg was as effective as cefaclor 250 mg three times daily for the treatment of acute exacerbations of chronic bronchitis. Evaluable patients receiving cefaclor AF in the US study had a clinical response rate of over 90% and a bacteriological response rate of over 85%. In the European study, patients receiving cefaclor AF had clinical response rates over 85% and bacteriological response rates ranging from 50% to 85%. The safety profile for cefaclor AF was similar to that reported for other beta-lactam antibiotics.

Adolescent↗
PubMed1991

An experimental study on the effect of rigid fixation on the developing craniofacial skeleton.

Rigid fixation of the craniofacial skeleton has proven of great value in adult orthognathic and traumatic reconstructive surgical procedures. This technique has gained increased acceptance in the surgical treatment of infants and young children with congenital malformations, despite the fact that its effects on subsequent craniofacial growth are unknown. To examine this question, an experimental model using 25 young kittens was developed to compare rigid fixation with conventional wire fixation, with and without osteotomy. Our findings demonstrate a regional restriction of growth in the developing craniofacial skeleton when both wire and plate and screw fixation are utilized in concert with osteotomy. Further, a compensatory growth was observed in individual animals when plate fixation was utilized that was not seen in the wire-treated group. This suggests that there is a dynamic growth interaction between restriction and compensation in this setting.

Animals↗
PubMed1990

Results of single-lung transplantation for bilateral pulmonary fibrosis. The Toronto Lung Transplant Group.

Between November 1983 and August 1989, we performed single-lung transplantation for end-stage pulmonary fibrosis in 20 patients. Nine patients (45 percent) who survived for more than one year form the basis of this report. Before surgery, the nine survivors had severe restrictive lung disease, with a mean (+/- SD) vital capacity (VC) of 43 +/- 9 percent, a forced expiratory volume in one second (FEV1) of 50 +/- 9 percent, and a single-breath diffusing capacity (DLCO) of 36 +/- 9 percent of predicted values. One year after transplantation, the patients' VC had reached 69 +/- 10 percent, FEV1 79 +/- 15 percent, and DLCO 62 +/- 16 percent of predicted values. Relative perfusion to the transplanted lung rose from 63 +/- 14 percent (three days after surgery) to 77 +/- 7 percent within three months and stayed constant or increased slightly thereafter. Before surgery, despite supplemental oxygen at flow rates varying from 1 to 9 liters per minute, none of the patients could exercise beyond stage 1/2 (2.7 km [1.7 miles] per hour, 5 percent grade) on a modified Bruce treadmill-exercise protocol. All eight patients tested one year or more after transplantation achieved at least stage 1 (2.7 km [1.7 miles] per hour, 10 percent grade), and usually a higher stage, without supplemental oxygen. Arterial oxygen tension returned to normal values in most patients (87 +/- 13 mm Hg), and supplemental oxygen, which all patients required before surgery, was no longer needed by any patient after transplantation. We conclude that in carefully selected patients with end-stage pulmonary fibrosis, single-lung transplantation is an effective treatment.

Adolescent↗
PubMed1990

Historical estimates of external gamma exposure and collective external gamma exposure from testing at the Nevada Test Site. II. Test series after Hardtack II, 1958, and summary.

The historical data on the cumulative individual external gamma exposures are tabulated for communities around the Nevada Test Site for the time periods of 1961 to the signing of the Limited Test Ban Treaty on 5 August 1963, and from then until 1975. The collective exposures during the two time periods are calculated to be 610 and 320 person-R, respectively. The total collective external gamma exposure from 1951 through 1975 for these communities s calculated to be 86,000 person-R. The area considered includes the countries of Clark, Lincoln, Nye, and White Pine in Nevada and the countries of Iron and Washington in Utah; inclusion of Salt Lake City would have substantially increased the calculated collective exposure because of the large population. The methods of calculation are reviewed. Also, the historical data on the assessment of dose via ingestion are reviewed with emphasis on the dose to the thyroid of infants living in St. George, UT, at the time of fallout from event HARRY on 19 May 1953.

Environmental Exposure↗
PubMed1990

The effect of rigid fixation on the survival of onlay bone grafts: an experimental study.

Much attention has recently been focused on rigid fixation as a method of improving fracture healing. Whether such fixation, when applied to onlay grafting, improves graft take and volume is unknown. To examine this question, we compared survival of both endochondral and membranous grafts fixed rigidly and nonrigidly in areas of low motion (snout) and high motion (femur) in a rabbit model. Gross morphology, histologic analysis, and graft volume kinetics were evaluated. Findings demonstrate that in areas of high motion, the application of rigid fixation improves graft survival, whereas in a low-motion region, no differences in graft volume retention as a function of fixation were observed. Histologically, no differences with the method of fixation employed were seen, and similar revascularization patterns were noted. By kinetic analysis, rigid fixation appears to exert its most profound effect early in the postgraft period. Membranous bone grafts remain superior to endochondral grafts under all circumstances. From these studies, we conclude that rigid fixation is the method of choice in all circumstances where onlay bone grafts may be exposed to motion, shear, and torsional forces.

Analysis of Variance↗
PubMed1990

Preoperative assessment for lung transplantation.

Lung transplantation has evolved from an intellectual curiosity to a viable therapeutic option in a selected number of patients with end-stage lung disease. The indications for single lung, double lung, or heart-lung transplantation at major North American transplant centers are presented, the selection criteria are discussed, and the standard preoperative evaluation is outlined. Utilizing these guidelines, a 1-year actuarial survival following each of these procedures of greater than 60% can be expected.

Adult↗
PubMed1990

Long-term functional follow-up of lung transplant recipients.

Transplantation is now a treatment option in patients with end-stage pulmonary and pulmonary vascular disease. This article describes the outcome of single and double lung transplants performed by the Toronto Lung Transplant Group. Specifically reported are mortality, cause of death, pulmonary physiology, arterial blood gases, and exercise performance. Where possible, these results are compared with results of heart-lung transplantation from other centers.

Adult↗
PubMed1989

Airway hyperreactivity in patients undergoing lung and heart/lung transplantation.

To assess airway reactivity in lung transplant patients, three heart/lung, three double lung, and eight single lung transplant patients underwent airway challenge tests. All patients were assessed by methacholine aerosol challenge and thirteen were also assessed by histamine aerosol challenge at least three months after transplant surgery. The airways of patients with bilaterally denervated lungs (heart/lung and double lung transplants) were significantly more reactive to both methacholine and histamine (p less than 0.01) than were the airways of patients with unilaterally denervated (single lung transplants) lungs. Inflammatory changes in the airway mucosal biopsies were minimal in three patients and absent in all others. These studies raise questions about the role of central innervation in the maintenance of normal airway function as well as the mechanisms of action of both methacholine and histamine in causing bronchoconstriction.

Adolescent↗
PubMed1988

Clinical features of sarcoidosis in elderly patients.

We reviewed 17 cases of biopsy-proven sarcoidosis occurring in patients who were 65 years of age or older at the time of diagnosis in order to determine the clinical features of sarcoidosis in this group of elderly patients. A female preponderance (76%) was noted, as well as significant respiratory and cutaneous symptoms. There were no characteristic diagnostic features of sarcoidosis in this group; therefore, we suggest that tissue biopsy is needed to exclude pulmonary diseases such as neoplasm or tuberculosis. Most elderly patients having sarcoidosis remained clinically stable during the period of follow-up and did not require therapy for sarcoidosis. We propose that sarcoidosis should be considered in the differential diagnosis of elderly patients presenting with pulmonary or multisystem disease.

Aged↗
PubMed1986

Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea.

We measured pharyngeal cross-sectional area and its change with alterations in lung volume in 10 subjects who snored and had obstructive sleep apnea, 6 subjects who snored and did not have obstructive sleep apnea, and 9 subjects who did not snore. Pharyngeal area was measured with use of an acoustic-reflection technique. We found that snorers with and without sleep apnea had a significantly smaller mean (+/- SE) pharyngeal cross-sectional area (4.1 +/- 0.2 and 3.7 +/- 0.9 cm2, respectively) at functional residual capacity than nonsnorers (5.4 +/- 0.5 cm2, P less than 0.025). When lung volume decreased from functional residual capacity to residual volume, both nonsnorers and snorers with sleep apnea had a decrease in pharyngeal area (from 5.4 +/- 0.5 to 4.5 +/- 0.4 cm2 and 4.1 +/- 0.2 to 3.4 +/- 0.2 cm2, respectively), whereas snorers without sleep apnea had no such decrease, suggesting that their pharynxes were less collapsible at low lung volumes. We conclude that snorers with and without sleep apnea have smaller pharyngeal cross-sectional areas than nonsnorers and that snorers with sleep apnea have a further decrease as lung volume falls.

Adult↗
PubMed1986

Pulmonary manifestations of familial dysautonomia in an adult.

A patient with familial dysautonomia (Riley-Day syndrome) who illustrates the multiple and varied pulmonary manifestations of this disorder is described. Since many of these patients are now surviving well into adulthood, knowledge of this condition among physicians should be propagated.

Adult↗
PubMed1986

Role of diffuse airway obstruction in the hypercapnia of obstructive sleep apnea.

The mechanisms responsible for the development of chronic hypercapnia in patients with obstructive sleep apnea (OSA) are not well defined. Therefore, we tested the hypothesis that diffuse airway obstruction may be involved by studying 50 patients with a well-documented OSA syndrome. Seven patients had daytime hypercapnia with a mean PaCO2 of 51 +/- 2 (SEM) mm Hg, compared to a PaCO2 of 35 +/- 1 in the other 43 patients. There were no differences between the 2 groups in the number or duration of nocturnal obstructive events. In contrast, the hypercapnic patients were significantly heavier than the normocapnic patients (body weight, 189 +/- 11 versus 148 +/- 6% of ideal; p less than 0.005) and had evidence of diffuse airway obstruction, as indicated by an increased residual volume and a reduction in all expiratory flow rates. When the hypercapnic patients were compared with a weight-matched group of 9 normocapnic patients (body weight, 196 +/- 8% of ideal), there were still no differences in nocturnal obstructive events, but the differences in tests of airway mechanics persisted. Multiple regression analysis of PaCO2 against several anthropometric, respiratory physiologic, and polysomnographic variables revealed that only 2 variables (expiratory reserve volume and FEV1/FVC), both of which are influenced by airway mechanics, were significantly correlated with PaCO2 (multiple r = 0.78; p = 0.0001). The findings suggest that OSA alone does not produce daytime hypercapnia even in obese patients, and that the presence of diffuse airway obstruction is an important predisposing factor to the development of chronic CO2 retention in such patients.

Adult↗
PubMed1986

Nalbuphine-induced pulmonary edema.

We report the occurrence of acute pulmonary edema in a patient receiving therapy with nalbuphine, a synthetic narcotic analgesic. Other potential causes of acute pulmonary edema were excluded. It is likely that all opiate drugs share the propensity to produce acute pulmonary edema, and nalbuphine resembles other opiates in this regard.

Adult↗