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Biomedical subjects

R G Hooper

Publications and source records attributed to R G Hooper.

36 records · Page 2Linked to original sources
PubMed1983

Exercise testing in pulmonary sarcoidosis.

The variable natural history of sarcoidosis and the toxicity of corticosteroids result in many clinical situations where there is controversy concerning the need for treatment. Progressive incremental testing is an excellent method to identify physiologic mechanisms responsible for exercise limitation. It is therefore ideal to determine if subjective symptoms such as dyspnea are due to cardiac abnormalities, pulmonary abnormalities, or poor physical conditioning. Thirty-one patients with sarcoidosis underwent progressive incremental exercise testing. Four of 14 asymptomatic patients and eight of 17 symptomatic patients demonstrated pulmonary abnormalities which potentially limited exercise tolerance. These consisted of an abnormal respiratory pattern or gas exchange abnormalities, or both. Patients with completely normal routine pulmonary function studies almost always performed normally with exercise. Symptomatic patients with multiple abnormalities on routine pulmonary function studies invariably demonstrated a pulmonary limitation on exercise testing. Patients with one or two abnormalities on routine pulmonary function studies, regardless of the presence or absence of parenchymal infiltrates, required exercise testing to determine if symptoms were due to physiologically significant abnormalities of the respiratory system. The important variables necessary to be measured, arterial desaturation and an abnormal respiratory pattern, can be measured noninvasively with a minimum of equipment.

Adrenal Cortex Hormones↗
PubMed1982

Indications for mediastinal lymph node evaluation.

Successful surgical therapy for bronchogenic carcinoma depends upon an accurate lymph node assessment. Criteria were developed and reported to identify patients who would benefit from mediastinoscopy prior to thoracotomy. This report summarizes the prospective use of the criteria between 1974 and 1977 and the total experience from 1970 to 1977. Selection of patients for prethoracotomy mediastinal evaluation is primarily based on chest roentgenogram and cell type. Left upper lobe lesions meeting the criteria were submitted to mediastinotomy if mediastinoscopy was negative. Eighty-seven potentially resectable lesions were evaluated prospectively, and the total experience included 202 patients. Mediastinal metastasis occurred in 39 patients of the current and 82 patients of the total series. When metastases to the mediastinum were documented, roentgenographic evidence of metastasis was seen in 20 of 39 (51 percent) of the current and 44 of 82 (54 percent) of the total series. There was roentgenographic evidence of metastasis in central lesions, peripheral masses, and small peripheral lesions with mediastinal metastases in 50 percent, 25 percent, and 78 percent of the cases, respectively. Mediastinal metastases were reported 80 percent of the time before thoracotomy using these criteria. The use of mediastinotomy on left upper lobe lesions identified six of seven of the unresectable cases missed by the mediastinoscopy. The criteria will identify patients at high risk for mediastinal metastases who benefit from prethoracotomy surgical evaluation.

Adenocarcinoma↗
PubMed1980

Bullous emphysema. Progressive incremental exercise testing to evaluate candidates for bullectomy.

Various tests of both function and anatomy have been used in patients being considered for surgical resection of giant pulmonary bullae. A young patient had an excellent response to removal of a large bulla in the right lung. In addition to roentgenographic evaluation, ventilation perfusion scanning, and routine preoperative pulmonary function studies, we performed progressive incremental exercise testing to determine both preoperative and postoperative ventilatory and cardiac measurements. We feel that progressive incremental exercise pulmonary function adds another dimension to the selection and follow-up of patients being considered for operative bullectomy.

Adult↗
PubMed1980

Pulmonary infiltrates in leukemia.

We reviewed the inpatient records of 139 adult patients with leukemia to determine the incidence of opportunistic infections in immunocompromised patients and the pattern of roentgenographic involvement of such infections. There were 98 parenchymal infiltrates identified, including 43 episodes of local disease and 55 episodes of diffuse disease. The causes of the infiltrates were determined from biopsies of tissue and autopsies whenever possible. If roentgenographic resolution after therapy with an antibiotic or diuretic agent was documented, the cause was considered determined; however, this did not identify a specific bacterial or viral agent. Parenchymal infiltrates (17 episodes) appearing in the period before treatment or within 72 hours of initiating therapy were not opportunistic. Local disease during treatment was infectious in 23 (74 percent) of 31 cases and was bacterial in 20 (87 percent) of 23 cases. Opportunistic organisms caused only 13 percent of the local infectious episodes. Diffuse disease was noninfectious in 26 (65 percent) of 40 episodes; while in the 14 episodes of infectious disease identified, 13 (93 percent) were caused by opportunistic organisms. We conclude that procedures for biopsy to document opportunistic infection are of little value in local or diffuse disease before treatment, are of modest value in local disease during treatment, and are of greatest value in diffuse disease during treatment if little clinical evidence for noninfectious causes exists.

Acute Disease↗
PubMed1980

Hyperventilating the hypoventilator.

A 65-year-old man had chronic hypoventilation and was demonstrated to have primary neuromuscular disease with major involvement of the thoracic bellows. By use of accessory muscles, he was able to voluntarily hyperventilate and reduce his PCO2 to normal. Hyperventilation gases must be interpreted with care in neuromuscular disease; the ability to reduce PCO2 to normal range does not exclude neuromuscular disease as a cause of chronic respiratory failure.

Aged↗
PubMed1979

Acute poisoning from over-the-counter sleep preparations.

All cases received by the Rocky Mountain Poison Center involving over-the-counter (OTC) sleep preparations were studied during an 18-month period to elucidate 1) the range of toxicity; 2) characteristic symptoms, and 3) the time of onset of symptoms. In 155 cases reviewed retrospectively, the three most commonly ingested agents were Sominex, Nytol and Sleepeze. Multiple ingestions were also involved. Symptomatology was equally divided among no symptoms, mild symptoms and possible life-threatening symptoms. The least amount taken to produce possible life-threatening symptoms was 16 Sominex, 18 Nytol and 15 Sleepeze, although the average amount producing the same symptoms was approximately twice that. These symptoms were seen within six hours in all but three of the 39 cases presenting with these symptoms. There were no deaths.

Adolescent↗
PubMed1979

Hernia of Morgagni's foramen presenting as asymptomatic pleural mass.

An asymptomatic 64-year-old black man presented with an enlarging left pleural mass. Preoperative evaluation failed to reveal an etiology. At thoractomy omental fat was found along the diaphragm, extending to the left costophrenic angle, and protruding through a hernia of Morgagni's foramen. The omentum was replaced into the abdomen and the defect was repaired.

Diagnosis, Differential↗
PubMed1978

Diagnosis of lymphangitic carcinomatosis by transbronchial lung biopsy.

The records of patients who had transbronchial lung biopsy at Walter Reed Army Medical Center between January 1974 and September 1977 were retrospectively reviewed. Nine patients were found whose clinical and radiographic presentations were compatible with lymphangitic carcinomatosis. In five patients in lymphangitic spread of carcinoma was diagnosed from transbronchial lung biopsy specimens. A single patient had a false-negative biopsy, proven at autopsy three weeks later. The other three patients with negative biopsies are alive and receiving chemotherapy 12 months later (two patients) or are lost to follow-up (one patient). Transbronchial lung biopsy is an accurate procedure for diagnosing lymphangitic carcinomatosis. In addition, aggressive chemotherapy should not be used in these patients without a tissue diagnosis.

Biopsy↗
PubMed1978

Radioisotope scanning in the initial staging of bronchogenic carcinoma.

The use of routine radioisotope scanning to screen for subclinical metastatic disease in the initial staging of bronchogenic carcinoma was studied. To define the value of scans, liver, brain, and bone scans were studied prospectively in 111 patients and retrospectively in 114 patients. Among patients with clinical findings suggesting metastatic disease, 14.4 per cent of the liver scans, 12.3 per cent of the brain scans, and 35.7 per cent of the bone scans were positive. All patients free of clinical findings had negative liver and brain scans. Positive bone scans occurred in 8 per cent of the patients without clinical abnormalities. True-positive bone scans occurred in less than 4 per cent of the patients free of clinical abnormalities. The clinical findings noted in the patients pointed to the organ involved in only 76 per cent of the abnormal liver scans, 62 per cent of the abnormal brain scans, and 75 per cent of the abnormal bone scans. Clinical findings associated with positive liver and brain scans were multiple and significant, whereas findings with the positive bone scans could be few or subtle. Routine scanning failed to identify a significant number of patients with clinically unsuspected metastatic disease. Liver, brain, and bone scanning is indicated only in patients suspected of having metastatic disease.

Adult↗
PubMed1978

Idiopathic bronchial stenosis in a young woman.

An 18-year-old white woman presented with a severe obstructive ventilatory defect. An evaluation revealed a stenotic lesion of the right bronchus intermedius and the left mainstem bronchus. Treatment with prednisone followed by beclomethasone resulted in a marked improvement in her condition.

Adolescent↗
PubMed1978

Preoperative evaluation of patients with bronchogenic carcinoma.

The preoperative evaluation of patients with suspected or proven bronchogenic carcinoma is directed at establishing the diagnosis, the extent of disease, and the ability of the patient to withstand the removal of lung tissue. The diagnosis may not be established until thoracotomy, but sputum cytologies or specimens taken at the time of fiberoptic bronchoscopy may diagnose a malignant process preoperatively.

Biopsy↗