Biomedical subjects

S W Stogner

Publications and source records attributed to S W Stogner.

10 recordsLinked to original sources

PubMed1996

Anion gap in turpentine-induced pleural effusions. Correlation with pH and protein level.

Since the pleural fluid proteins and lactate are unmeasured anions, the pleural fluid anion gap (Na+K-Cl-total CO2) should vary with the protein level and should be high in acidic effusions (which have high lactate levels). The anion gap is also convenient and inexpensive to measure, and less subject to artifact than the pH measurement. To test the hypothesis that the anion gap correlates with the pH, protein level, and other traditional pleural fluid measurements, we used a well-described model of turpentine-induced effusions in nine New Zealand white rabbits. Nonacidic exudative effusions were induced by an intrapleural injection of turpentine; acidic exudative effusions were induced by a second injection. Pleural fluid and blood were obtained just before (0 h) and 9, 24, 48, and 72 h after the second injection. We found the anion gap correlated with pH, the glucose, protein, and lactate dehydrogenase levels, pleural-fluid/plasma protein and lactate dehydrogenase ratios, and WBC count (all p < 0.001). The pH and protein ratio together accounted for 95% of all anion gap variation within individual subjects. We also found the influence of the PCO2 level on pH was not significant after taking into account the influence of the anion gap. These results suggest the anion gap may be useful in the clinical evaluation of pleural effusions and could potentially replace the pH measurement.

Acid-Base Equilibrium↗

PubMed1993

Ribavirin and intravenous immune globulin therapy for measles pneumonia in HIV infection.

We have described a patient, immunocompromised from an infection with the human immunodeficiency virus, who had rapidly progressive measles complicated by measles pneumonia and respiratory failure. Rapid improvement in the patient's condition followed therapy with inhaled ribavirin and intravenous immune globulin. Patients who have measles pneumonia associated with respiratory failure may benefit from combination therapy with ribavirin and IV immune globulin.

Adult↗

PubMed1993

Chylous effusion complicating chronic lymphocytic leukemia.

We present a case of chylous effusion (CE) occurring in a patient with chronic lymphocytic leukemia (CLL), an observation which has rarely been reported. Therefore, CLL should be added to the differential diagnosis of nontraumatic chylothorax. CE in CLL can be successfully managed by irradiation of the mediastinum.

Aged↗

PubMed1992

Pleural effusion. What you can learn from the results of a 'tap'.

Pleural effusion may result from many disorders, some of them serious. Fortunately, this body fluid is easily accessible, and knowledge of its characteristics is an important tool in diagnosing the underlying disease. The authors describe radiographic and laboratory tests to use in determining the source of the problem.

Humans↗

PubMed1992

Oxygen toxicity.

OBJECTIVE: The objective of this article is to provide an overview of the biochemistry of oxygen metabolism, including the formation of free radicals and the role of endogenous antioxidants. Pathophysiologic correlates underlying the clinical manifestations of oxygen toxicity are reviewed and management strategies are outlined. DATA SOURCES: References from basic science and clinical journals were selected from the authors' files and from a search of a computerized database of the biomedical literature. STUDY SELECTION: Articles selected for review included both historical and current literature concerning the biochemistry and pathophysiology of oxygen toxicity in animals and humans. DATA SYNTHESIS: The benefits of oxygen therapy have been known for many years; however, its potential toxicity has not been recognized until the last two decades. The lungs, the eyes, and, under certain conditions, the central nervous system are the organs most affected by prolonged exposure to hyperoxic environments. Free radical formation during cellular metabolism under hyperoxic conditions is recognized as the biochemical basis of oxygen injury to cells and organs. Endogenous antioxidants are a primary means of detoxifying reactive oxygen species and preventing hyperoxia-induced cellular damage. When this defense fails or is overwhelmed by the excessive production of hyperoxia-induced free-radical species, distinctive morphologic changes occur at the cellular level. The amount of hyperoxia required to cause cellular damage and the time course of these changes vary from species to species and from individual to individual within the same species. Age, nutritional status, presence of underlying diseases, and certain drugs may influence the development of oxygen toxicity. CONCLUSIONS: There is currently no reliably effective drug for preventing or delaying the development of oxygen toxicity in humans. Use of the lowest effective oxygen concentration, the avoidance of certain drugs, and attention to nutritional and metabolic factors remain the best means currently available to avoid or minimize oxygen toxicity. Research is continuing into more effective ways to prevent, diagnose, and treat this disorder.

Animals↗

PubMed1992

Incorrect use of metered dose inhalers by medical personnel.

We administered a questionnaire and observed usage of a placebo metered dose inhaler (MDI) among 35 physicians, 14 nurses, and 12 respiratory therapists. Ninety-two percent of the respiratory therapists performed at least four of seven steps correctly, compared with 65 percent of house staff physicians, 57 percent of nurses, and 50 percent of nonpulmonary faculty. Most participants followed package insert instructions, while only 18 percent followed recent recommendations for proper MDI use. We conclude that (1) medical personnel should have additional instruction in proper MDI usage and (2) respiratory therapists and nurses can play a prominent role in instructing patients in their proper use.

Allied Health Personnel↗

PubMed1991

Cutaneous necrosis and pulse oximetry.

We report on two patients who developed cutaneous necrosis from the use of pulse oximetry monitoring. One developed digital skin necrosis from a finger sensor, while the other had a lesion of the pinna from an ear probe. Pulse oximetry monitoring is often used in the management of anesthetized and critically ill patients. Recognition of cutaneous necrosis with pulse oximetry may prevent unnecessary evaluation and prompt initiation of simple measures to protect against its occurrence.

Female↗

PubMed1990

Mycoplasmal pneumonia. Are you thinking of atypical presentations?

The presentations of mycoplasmal pneumonia can be varied and sometimes complicated. The atypical nature of this illness, as opposed to the clear pattern of findings in classic bacterial pneumonias, leads the physician to the diagnosis. Appropriate therapy then allows quick improvement as a rule, with few sequelae.

Adult↗

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↗

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↗