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Biomedical subjects

T Bartter

Publications and source records attributed to T Bartter.

At least 19 recordsLinked to original sources
PubMed1999

The role of sinus imaging in the treatment of chronic cough in adults.

PRIMARY STUDY OBJECTIVE: To determine the appropriate role and timing of sinus imaging studies in the evaluation and treatment of chronic cough. DESIGN: Prospective study of chronic cough. All patients underwent sinus imaging, the results of which identified prospectively the following: (1) fluid in sinuses, with or without opacification, and (2) mucosal thickening. Patients then were treated using an algorithm that sequentially addresses the etiologies of chronic cough. Patients whose sinus imaging studies had demonstrated fluid were treated initially for sinusitis, but mucosal abnormalities alone were not considered an indication to change the algorithm. After workup, relationships between abnormalities on sinus imaging studies and diagnoses were determined. SETTING: University hospital pulmonary outpatient clinic. PATIENTS: Thirty-six patients (31 women, 5 men; mean age, 58.4 years). Cough duration averaged 5.2 years (range, 4 weeks to 30 years). RESULTS: Diagnoses were made in 100% of patients, and cough resolved in 86%. Mucosal thickening correlated with sinusitis as a cause of cough in only 29% of cases. CONCLUSIONS: Mucosal thickening is not diagnostic of sinusitis as a cause of chronic cough; in most patients, cough will resolve without treatment for sinusitis. Given this lack of specificity, it is reasonable to delay sinus imaging until after efforts at treating rhinitis have failed and, in the absence of complaint or findings of postnasal drip, until after completion of evaluation for asthma. The principles of diagnosis and treatment of chronic cough remain simple: go sequentially from the most common to the least common cause; use tools that begin with the most available and least expensive and invasive modality; then move as needed to tools that are more expensive and invasive.

Adult↗
PubMed1996

Asthma: better outcome at lower cost? The role of the expert in the care system.

Asthma is a common disease for which morbidity and mortality have been increasing. This despite advances in the scientific understanding of asthma and in the pharmacologic armamentarium available to treat it. The dichotomy between knowledge and outcomes led us to review asthma from a systems perspective. We have presented data first to document failure in the current system of care and then to examine factors associated with improved outcomes. We found a disparity in outcome and costs when care given by experts was contrasted with care given by generalists. We conclude that "expert-based" care systems are superior from the perspective both of the patient and of the insurer; medical outcomes are better at lower overall cost. Managed care companies are in a unique position to identify asthmatics and to shift them from generalist to expert-based care when appropriate.

Asthma↗
PubMed1996

Rapid opiate detoxification.

We report on clinical and practical aspects of treatment of opiate addiction with a relatively new approach, rapid opiate detoxification (ROD). The goal is to induce rapid narcotic withdrawal in a controlled environment using narcotic antagonists while suppressing withdrawal symptoms with sedative drugs, thus effecting a dramatic abbreviation of the traditional withdrawal schedule. Twenty-five consecutive heroin-addicted patients presenting for detoxification were treated at a university hospital. There were 14 women and 11 men, with a mean age 32.6 years (range, 24-48). They underwent 29 separate detoxifications over a 4-month period. All but 3 of the detoxifications were effected with ROD. Several different techniques were used over the 4-month period, ranging from intramuscular and oral sedation to intravenous sedation, paralysis, and intubation. Efficacy of detoxification was demonstrated for all patients undergoing ROD; all were given 50 mg of naltrexone PO prior to discharge, and none had withdrawal symptoms. (The three patients treated with abstinence were not so tested.) We derive three conclusions from this early clinical experience: First, ROD appears to be a valuable tool in the treatment of heroin addiction. ROD is an efficient, effective technique that can play an important role in an integrated rehabilitation program. Second, the optimal method of ROD is yet to be determined; a continuum of approaches is available. Third, ROD is probably most suited to designated outpatient centers.

Adult↗
PubMed1995

Music improves patient comfort level during outpatient bronchoscopy.

STUDY OBJECTIVE: To determine the effect of music during bronchoscopy on patient perception of the procedure. DESIGN: Prospective randomized trial. SETTING: University-based bronchoscopy suite. PATIENTS: Twenty-one patients received music (M+), and 28 patients served as controls (M-). MEASUREMENTS AND RESULTS: Physiologic responses, subjective patient perceptions, and administered medications were monitored. After the procedure, the technician and the physician both rated their impression of the patients' comfort levels to see how accurately they correlated with actual patient reports. There was no difference in physiologic responses between the M+ and M- groups. The M+ patients reported significantly greater comfort (p = 0.02) and less cough (p = 0.03) than the M- group, while there was no difference in reported dyspnea P = 0.21). Both physicians and technicians were very inaccurate in their assessments of patient level of comfort. Medications given did not differ for the two groups. CONCLUSION: Music during bronchoscopy is a simple and inexpensive nonpharmacologic way to improve patient comfort.

Adult↗
PubMed1995

The physiologic effects of inhaled amphotericin B.

Our institution used an experimental protocol for the use of inhaled amphotericin B as a prophylactic measure to prevent fungal disease in severely immunocompromised patients. We did a prospective study of the physiologic effects of amphotericin B administration. We looked specifically at oxygen saturation levels, peak flow values, and symptoms of patients given amphotericin B. We collected data on a series of 18 patients and of 132 amphotericin B administrations. Four (22%) of the patients stopped treatments because of nausea and vomiting which were believed to be due to the inhaled amphotericin B. For the remaining patients, no treatment was stopped because of symptoms or physiologic changes caused by amphotericin B, although there were 9 instances of clinically significant bronchospasm as defined by a drop in peak flow of 20% or more, 9 clinically relevant increases in cough, and 3 clinically relevant increases in dyspnea. Forty-eight percent of the clinically relevant changes occurred in patient 8. Another 16% occurred in asthmatic subjects who were significantly more likely (p = 0.03) to experience a 20% or more drop in peak flow than were patients without asthma. The physiologic profile of the response to inhaled amphotericin B is acceptable.

Administration, Inhalation↗
PubMed1993

An algorithmic approach to chronic cough.

OBJECTIVES: To evaluate a stepwise approach to chronic cough that emphasized initial treatment of all patients with an antihistamine-decongestant for postnasal drip and to determine the value of routine bronchoprovocation challenge in the evaluation of chronic cough. DESIGN: Prospective trial using an algorithm for chronic cough in immunocompetent nonsmoking out-patients. SETTING: University-based pulmonary practice. PATIENTS: Forty-five patients met the inclusion criteria. The mean duration of cough was 140 weeks (range, 3 to 2080 weeks), and the mean severity of cough as assessed by patients on a four-point scale was "severe." RESULTS: Marked improvement and resolution (mean, 3.1 and 7.1 weeks, respectively), with resolution in 96% of patients. Antihistamine-decongestant therapy was beneficial in 39 of 45 patients and was the only therapy needed for 16 patients. Bronchoprovocation challenge had a negative predictive value of 100% and a positive predictive value of 74% for cough caused by asthma. No significant relationship was found between the time to cough resolution and duration or severity of cough. Eighteen percent of patients experienced a recurrence of cough at a follow-up interval of 3 months. CONCLUSIONS: A sequential approach to chronic cough that emphasizes initial treatment with an antihistamine-decongestant is effective. Bronchoprovocation challenge is useful in evaluating patients with chronic cough but can be delayed until the initial response to antihistamine-decongestant therapy has been assessed. The 18% incidence of recurrence highlights the fact that cough often is the manifestation of a chronic or recurring process that requires chronic or episodic therapy.

Adolescent↗
PubMed1992

ARDS following acute lithium carbonate intoxication.

Lithium is a two-edged sword; it is on the one hand a unique drug with invaluable psychoactive potential and on the other a drug which can cause multisystem toxicity and even death. We present a case of severe lithium intoxication with multiple organ involvement. Our patient developed the adult respiratory distress syndrome (ARDS), nephrogenic diabetes insipidus (DI), distinctive neurological abnormalities, and hyperglycemia. We believe that this is a case of ARDS due to lithium toxicity in which elevated left atrial pressures were excluded by right heart catheterization and suggest a causal relationship between lithium and ARDS.

Adult↗
PubMed1992

Inpatient management of status asthmaticus.

We examined physician management of patients hospitalized for status asthmaticus at a university hospital. A retrospective review of consecutive admissions for status asthmaticus covering a 13-month period yielded 130 charts for review. We found that practice patterns with respect to documentation of severity of illness, medications, and documentation of efficacy of therapy fell short of the current state of knowledge with respect to treatment of asthma. Asthma is a treatable disease, and physician education needs to bridge the gap between current practice patterns and standards of optimal therapy as defined in the literature.

Adult↗
PubMed1991

Zirconium compound-induced pulmonary fibrosis.

Despite suspicion that inhalation of zirconium should be capable of causing human pulmonary disease, documentation of zirconium pneumoconiosis in humans has been lacking. We studied a likely case of zirconium compound-induced pulmonary fibrosis. The diagnosis was based on the following: (1) a history of gradual increase in symptoms and slowly progressing pulmonary fibrosis by chest roentgenogram compatible with a pneumoconiosis; (2) an appropriate history of exposure and a latency period of about 15 years before the onset of dyspnea and of roentgenographic changes; (3) analysis of open lung biopsy material revealing end-stage fibrosis and honeycombing, a moderate number of birefringent particles, and extremely high levels of a variety of zirconium compounds; and (4) no other potential cause of fibrosis. We conclude that zirconium should be considered a likely cause of pneumoconiosis and that appropriate precautions should be taken in the workplace.

Humans↗
PubMed1990

Complications associated with thoracentesis. A prospective, randomized study comparing three different methods.

To determine what role the technique plays in complications associated with thoracentesis performed by physicians in training, we undertook a prospective study of thoracentesis in the medical service at our institution in which the sampling method was randomized among needle, needle with catheter, and needle with direct sonographic guidance. Fifty-two spontaneously breathing, cooperative patients with free-flowing effusions obliterating more than half of the hemidiaphragm on an upright, posteroanterior chest roentgenogram were randomized. When we analyzed those complications that were potentially life-threatening (eg, pneumothorax) and/or placed patients at increased risk for further morbidity (eg, pneumothorax, dry tap, inadequate tap), the sonography-guided method was associated with significantly fewer serious complications (0 of 19) than the needle-catheter (9 of 18) or needle-only methods (5 of 15). The sonography-guided method was associated with fewer pneumothoraces (0 of 19) than the needle-catheter (7 of 18) or needle-only methods (3 of 15). The difference between needle-catheter and needle-only methods was not significant. From our results, we conclude that the method by which thoracentesis was performed significantly influenced the spectrum and frequency of complications, and the sonography-guided method was the safest.

Catheterization↗
PubMed1989

Idiopathic bronchiolitis obliterans organizing pneumonia with peripheral infiltrates on chest roentgenogram.

We report five patients with chest roentgenograms showing peripheral infiltrates similar to that described for chronic eosinophilic pneumonia (CEP). While lung biopsy specimens (transbronchial and open in two and transbronchial only in three cases) revealed typical changes of bronchiolitis obliterans organizing pneumonia (BOOP) as the predominant finding in all cases, two cases had changes consistent with a resolving CEP. We speculate that (1) it may be common for BOOP to present with peripheral infiltrates, (2) chest roentgenograms showing peripheral infiltrates are not diagnostic of any specific entity, (3) idiopathic BOOP may represent the evolution of untreated CEP, (4) a lung biopsy may be a more appropriate initial approach than the therapeutic trial of corticosteroids when peripheral infiltrates of unknown origin are present, and (5) transbronchial biopsy may be adequate to establish a working clinical diagnosis of BOOP.

Adult↗
PubMed1988

'Toxic strep syndrome'. A manifestation of group A streptococcal infection.

Three patients presented with multisystem disease that shared many of the features of toxic shock syndrome. Bacteriologic and serologic evidence strongly suggested that group A beta-hemolytic Streptococcus had caused the illnesses. Group A streptococcal infection may be an underdiagnosed cause of a toxic streptococcal syndrome, a syndrome of multisystem disease apparently mediated by toxins.

Acute Kidney Injury↗