Biomedical subjects
Publications and source records attributed to T F Morley.
Tussive syncope is a rare condition that often responds to treatment of the underlying cause of coughing. Therefore, the workup and diagnosis of the cause is essential. However, at times, the cough is refractory to conventional treatment. The use of nebulized lidocaine in such instances may be an important adjunctive therapy.
Noninvasive positive pressure ventilation (NIPPV) is a viable option in treating appropriately selected patients with acute respiratory failure. It is often well tolerated, and it avoids endotracheal intubation with its potential complications. Moreover, gas exchange is reportedly improved. Several issues relating to the use of NIPPV are unresolved, however. The optimal interface, best ventilator mode, and patient selection criteria have not been firmly established. Also, studies are needed to compare the efficacy, safety, and cost-effectiveness of NIPPV and standard endotracheal ventilation. Despite these unresolved issues, NIPPV clearly represents an important addition to the techniques available in managing acute respiratory failure. Except in situations in which immediate endotracheal intubation is required, it may become first-line therapy in elderly patients in whom resuscitation status is unsettled.
We present a case of bronchiolitis obliterans organizing pneumonia in a patient with acquired immune deficiency syndrome. Only three cases have previously been reported in patients infected with human immunodeficiency virus. In these four cases, bronchiolitis obliterans organizing pneumonia was similar in presentation, radiographic features and clinical course to that occurring in patients not infected with human immunodeficiency virus.
A prospective study was conducted to determine the reliability of noninvasive end-tidal CO2 (PETCO2) monitoring as a reflection of arterial CO2 tension (PaCO2) during weaning from mechanical ventilation (MV). Simultaneous PaCO2 and PETCO2 determinations were compared during MV and again during a spontaneous breathing trial just before returning the patient to MV. Three groups of patients recovering from acute respiratory failure were evaluated. Group 1 consisted of 16 patients (28 observations) without parenchymal lung disease. Group 2 consisted of 22 patients (31 observations) with alveolar filling diseases. Group 3 was composed of 13 patients (22 observations) with emphysema. Significant Pearson correlation coefficients were demonstrated between PaCO2 and PETCO2 during both MV and spontaneous breathing in all three groups. Significant correlation was also demonstrated between the change in PaCO2 and the change in PETCO2 associated with weaning for each group; however, the degree of correlation varied between groups. Our data suggest that capnography offers a reasonable estimate of PaCO2 and changes in PaCO2 during weaning in patients without parenchymal lung disease. However, PETCO2 is less sensitive to changes in PaCO2 for patients with parenchymal lung disease, particularly patients with emphysema. Interpretation of capnographic data requires a full understanding of its limitations. An approach to capnographic monitoring during weaning is discussed.
This is a case report of an asymptomatic, 65-year-old white female who was evaluated for multiple pulmonary nodules. This patient's presentation, clinical course and pathologic specimens are consistent with benign metastasizing leiomyoma. A review of this rare disorder is included in this report with emphasis on past cases, clinical overview and treatment.
Resting energy expenditure (REE) in intensive care unit patients was evaluated by three methods--indirect calorimetry (REE-IC), Fick equation (REE-F), and estimation from the Harris-Benedict equation (REE-HB). The mean REE-IC and REE-F values did not differ significantly. However, both values were significantly higher than the REE-HB. The present study indicates that a reasonably accurate estimate of the REE can be obtained from data available by Swan-Ganz catheterization. The Fick method is technically simpler to perform and less expensive than indirect calorimetry. The invasive nature of Swan-Ganz catheterization is a major disadvantage. However, right-sided heart catheterization frequently is required for the management of intensive care unit patients. For them, REE-F appears to be a reasonable alternative.
A 22-year-old black male presented with progressive dyspnea, a nonproductive cough, and new skin lesions. He was severely hypoxic, and had a severe restrictive defect on pulmonary function testing. A 2-cm lytic defect was noted on skull radiographs. A lung biopsy demonstrated pulmonary fibrosis. A biopsy of a skin lesion was consistent with a diagnosis of multifocal eosinophilic granuloma, or disseminated histiocytosis X. The case presents several unusual features of this uncommon disorder.
The present study was undertaken to determine if beta-agonists delivered by nebulizer provide better clinical responses than MDI therapy in status asthmaticus. We divided 28 hospitalized asthmatic patients into three groups. Group 1 received albuterol by MDI with InspirEase. Group 2 received nebulized albuterol. Group 3 received nebulized metaproterenol. Both nebulizer regimens resulted in significant improvements in both FVC and FEV1 by 30 min after initial hospital beta-agonist treatment. No significant improvement was noted in initial spirometry in the MDI with InspirEase group. In spite of the superiority of nebulizer therapy in the initial phase of hospitalization, the daily rates of spirometric improvement and duration of hospitalization were not significantly different among the three groups. Our results indicate that nebulizer therapy provides superior spirometric improvement in the initial phase of status asthmaticus. However, both MDI and nebulizer regimens provided similar rates of spirometric improvement and duration of hospitalization.
The present study was undertaken to evaluate the short-term effects of nitroglycerin, nifedipine, and supplemental oxygen on hemodynamics and gas exchange in 11 patients in stable condition with chronic obstructive pulmonary disease and cor pulmonale. In general, both intravenous nitroglycerin and sublingual nifedipine significantly reduced the pulmonary vascular resistance index. For the group as a whole, nifedipine decreased the pulmonary vascular resistance index by significantly increasing the cardiac index, with minimal reductions in mean pulmonary arterial pressure. Conversely, nitroglycerin decreased the pulmonary vascular resistance index by markedly reducing the mean pulmonary arterial pressure but also decreased the cardiac index in some patients. Nitroglycerin also caused a significant decrease in mixed venous oxygen tension. Administration of oxygen did not cause any clinically significant improvement in resting hemodynamics following short-term administration. During the follow-up period, eight of 11 patients who were treated with pulmonary vasodilators in addition to long-term therapy with low-flow oxygen died within a mean of six months. This rate of survival was not significantly different than an age-matched and sex-matched control group with similar severity of disease who received only long-term therapy with low-flow oxygen. Based on these data, it seems unlikely that a substantial increase in survival will be obtained by combining pulmonary vasodilators with long-term oxygen therapy in patients with stable emphysema who have cor pulmonale and carbon dioxide retention.
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Two patients developed tracheoesophageal fistula after prolonged nasotracheal intubation and tracheostomy. The use of computed tomography, a noninvasive technique, to document the size and location of tracheoesophageal fistula may be preferable to endoscopic examination in critically ill, ventilator-dependent patients.
A 52-year-old, white female developed low-grade fever, cough, and dyspnea after 8 weeks treatment with sodium aurothiomalate for rheumatoid arthritis. The patient had severe hypoxemia associated with bilateral pulmonary infiltrates. Dramatic clinical improvement followed prednisone therapy.
The nature of the protein components and their location in the sarcoplasmic reticulum membrane were studied using sarcoplasmic reticulum vesicles isolated from rat skeletal muscle and purified by a density gradient centrifugation system. On the basis of analysis by means of sodium dodecyl sulfate gel electrophoresis, the protein components appear to be similar if not identical with those reported by others for rabbit sarcoplasmic reticulum, and the relative amount of each component is also similar to that found with rabbit sarcoplasmic reticulum. Evidence is presented that radioiodine-labeled diazotized diiodosulfanilic acid is a nonpermeant labeling agent of the protein components of sarcoplasmic reticulum vesicles; this agent minimally disturbs the functional activities of these membranes. By means of this labeling agent and perturbing agents, it is concluded that the protein components with molecular weights greater than 120,000 and the (Ca2+ + Mg2+)-adenosine triphosphatase partially or totally reside on or at the external surface of the sarcoplasmic reticulum vesicles. In the case of the adenosine triphosphatase, highly controlled trypsin treatment cleaves the molecule into two products, a 65,000 molecular weight fragment and a 56,000 molecular weight fragment. The evidence indicates that the 65,000 molecular weight component of the (Ca2+ + Mg2+)-adenosine triphosphatase is located in a more exposed fashion on the external surface of the vesicles than the 56,000 molecular weight compoenet and that some adenosine triphosphatase molecules have a more exposed position on the external surface of the vesicle than others. The protein components designated by MacLennan (MacLennan, D. H. (1975) Can. J. Biochem. 53, 251-261) as "calsequestrin" and "high affinity Ca2+ binding protein" are shown not to be on the external surface of the rat sarcoplasmic reticulum vesicle but rather to reside either within the core of the membrane or on the inside surface of the vesicle. The results of this study are in agreement with the model for the organization of the protein components of the sarcoplasmic reticulum membrene recently proposed by MacLennan (MacLennan, D. H. (1975) Can. J. Biochem. 53, 251-261).
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