Biomedical subjects
Publications and source records attributed to T H Johnson.
A cardiac transplant patient died of severe left ventricular dysfunction 2 weeks after coronary angiography demonstrated normal coronary arteries. Post mortem examination showed significant and diffuse allograft vasculopathy. Coronary angiography may have limited sensitivity in detecting allograft vasculopathy.
PURPOSE: The overall prognosis for patients with congestive heart failure is poor. Defining specific populations that might demonstrate improved survival has been difficult. We therefore examined our patient database for patients with congestive heart failure who demonstrated sustained improvement in left ventricular function and associated resolution of signs and symptoms of congestive heart failure. PATIENTS AND METHODS: We identified 11 patients with severe congestive heart failure (average ejection fraction 21.9 +/- 4.23% (+/- SD) who developed spontaneous, marked improvement over a period of follow-up lasting 4.25 +/- 1.49 years. All 11 patients were initially symptomatic with exertional dyspnea and fatigue for a minimum duration of 3 months. They form a subset of a larger group of 97 patients with chronic congestive heart failure that we have followed with sequential ejection fraction measurements. All 11 patients were treated with digitalis diuretics, and either converting-enzyme inhibitors or a combination of isosorbide dinitrate and hydralazine. Ten of the 11 patients had a history consistent with chronic alcoholism, and each reportedly abstained from alcohol during follow-up. RESULTS: During the follow-up period, the average ejection fraction improved in 11 patients from 21.9 +/- 4.23% to 56.64 +/- 10.22%. Late follow-up indicates an average ejection fraction of 52.6 +/- 8.55% for the group. Congestive heart failure resolved in each case. CONCLUSIONS: We conclude that selected patients with severe congestive heart failure can markedly improve their left ventricular function in association with complete resolution of heart failure. This appears to be particularly evident in those patients with chronic alcoholism who subsequently abstain.
Dietary treatments providing three levels of added Al (0, .196, or .392%) as aluminum sulfate and of available phosphorus (Pav) .45, .68, or .78%) in a factorial arrangement were administered to day-old chicks in Experiment 1. Plasma inorganic phosphorus (Pi) was significantly (P less than .05) elevated by increasing Pav and was decreased by Al. Body weight gain, feed intake, and the gain:feed ratio at Day 21 were significantly decreased by increased concentrations of Al, but were unaffected by the Pav concentrations. Decreases of 39 and 73% in weight gain and of 34 and 66% in feed intake resulted from feeding .196 and .392% Al, respectively. In Experiment 2, day-old chicks were fed diets supplemented with 0 or .392% Al in combination with .9% Ca plus .45% Pav, .9% Ca plus .78% Pav, 1.8% Ca plus .45% Pav, or 1.8% Ca plus .9% Pav. After 21 days, the supplemental Al resulted in: 1) significantly poorer growth performance; 2) decreased plasma Pi, total Ca, Zn, and Mg; and 3) decreased tibia weight and breaking strength. Elevating Pav improved growth performance, plasma Pi, and tibia weight and strength, and decreased plasma total Ca. Increasing dietary Ca significantly decreased plasma Pi and increased plasma total Ca without affecting other parameters. Increasing Pav alleviated the negative effect of Al on plasma Pi without correcting the negative effect of Al on growth performance.
The effect of dietary aluminum sulfate on Ca and P metabolism was studied using 1-day-old male broiler chicks. In Experiment 1, practical diets providing .90% Ca plus .45% available P (Pav), .90% Ca plus .78% Pav, 1.80% Ca plus .45% Pav, or 1.80% Ca plus .90% Pav were fed with 0 or .392% A1 as aluminum sulfate for 21 days. The control diet (.90% Ca plus .45% Pav) without added A1 was fed to all chicks during Days 22 to 49. In general, A1 significantly (P less than .05) decreased BW gain, feed intake, gain:feed ratio, plasma inorganic P (Pi), tibia breaking strength, tibia weight, percentage of tibia ash, and plasma Zn, measured at Day 21. Elevating Pav increased BW gain, feed intake, gain:feed ratio, tibia weight and plasma Zn, and decreased plasma total Ca in the presence of .392% A1 plus 1.80% Ca. Plasma Pi, tibia breaking strength, and percentage of tibia ash were increased by raising dietary Pav in the presence of .392% A1 with either level of Ca. Negative effects of dietary A1 on feed intake and BW persisted through Day 49. In Experiment 2, a control diet (.90% Ca, .45% Pav) was fed for ad libitum access either alone or supplemented with .2% A1 as aluminum sulfate or with an equivalent amount of sulfate provided by potassium sulfate. The control diet was also pair-fed to chicks given .2% A1. Dietary A1 significantly depressed weight gain, feed intake, gain:feed ratio, and plasma Pi.(ABSTRACT TRUNCATED AT 250 WORDS)
The effect was studied of feeding dietary Al as aluminum sulfate on calcium and phosphorus metabolism and performance of Single Comb White Leghorn laying hens. In Trial 1, graded levels of Al (0, .05, .10, or .15%) were added to a corn-soybean meal layer diet containing 3.3% Ca and .5% available P. Each diet was fed for 28 days to six groups of six individually caged hens. Adding .15% Al to the diet significantly (P less than .05) reduced feed intake, egg production, body weight, tibia breaking strength, and plasma inorganic P. In Trial 2, graded levels of Al (0, .1, .2, or .3%) were added to the basal diet. Each diet was fed to five or six individually caged hens for 42 days. Feeding .3% Al significantly (P less than .05) decreased plasma inorganic P in samples collected immediately following oviposition after 10 and 42 days of treatment. Plasma total Ca, tibia weight, and tibia breaking strength were unaffected by dietary treatments. Egg production and feed intake during Days 1 through 21, but not during Days 22 through 42, were significantly reduced by .3% Al. The results indicated that the addition of .3% Al to a laying hen diet has a negative effect on P metabolism and egg production.
Patients receiving positive end-expiratory pressure (PEEP) therapy should be considered at risk for pneumoperitoneum. In the four patients described, chest roentgenographic demonstration of pulmonary interstitial gas and pneumomediastinum, frequently but not always associated with pneumothorax, preceded the dissection of gas into the abdominal cavity. Neither prompt intubation of the pleural space with reexpansion of the lung in the event of pneumothorax nor decrease in the PEEP applied precluded dissection of gas from the mediastinum into the retroperitoneal and peritoneal spaces. This sequence of roentgenographic events should strongly suggest pneumoretroperitoneum and pneumoperitoneum as a sequela to PEEP therapy rather than a ruptured viscus.
Radiographic identification of pulmonary interstitial gas is a prime indicator of possible further complications in patients treated with PEEP therapy for severe respiratory failure. Records and chest radiographs of 89 adult patients treated with PEEP in a 40-month period were reviewed. Data of 7 were incomplete, 82 cases were analyzed. Of 17 patients who developed interstitial gas, 9 progressed to further barotrauma complications of pneumomediastinum, pneumothorax, and extrathoracic dissection. Interstitial gas is manifested radiographically by vesicular rarefactions (cystic changes), linear streaks along the bronchi and vessels, halos of gas around vessels, and subpleural gas.
The noninvasive diagnosis of impaired mechanical integrity or compliance of the trachea is most accurately made by fluoroscopic observation recorded on video tape or cineradiography, with or without benefit of artificial contrast media (contrast tracheography). In particular, localized buckling, collapse or dilatation indicative of focal tracheomalacia may thus be diagnosed in vivo and correlated with diseases of the central airways. Congenital tracheomalacia is a rare, bu, well described entity. Cases of acquired tracheomalacia occur with increasing frequency, but are often not clearly recognized. We contrast the dynamic behavior of the normal trachea with the abnormal dynamics characteristic of focal tracheomalacia. Such lesions may result from trauma, surgical procedures, chronic irritation, inflammation, mechanical changes, or malignancy.
Chicks from lines genetically selected for high or low heat tolerance were compared to lines selected for high or low oxygen consumption. Oxygen consumption, survival time, respiration rate, lung capacity and body weight were determined. Selection for high oxygen consumption ahd high heat tolerance resulted in birds with similar characteristics. The high line birds for both heat tolerance and oxygen consumption had greater oxygen consumption, survival time and lung capacity but lower body weight.
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We reviewed serial chest roentgenograms of 82 patients treated with positive end-expiratory pressure (PEEP) therapy for morbid pulmonary failure. No change was identified in the appearance of the chest roentgenograms in 49 patients. Thirty-three patients showed pulmonary hyperinflation, varying degrees of apparent clearing of alveolar or interstitial disease, and resorption of interstitial and pleural fluid. Lung hyperinflation and interstitial gas generally preceded pneumomediastinum and pneumothorax. These pulmonary complications were identified roentgenographically, often before they became clinically apparent. No consistent correlation was observed between these roentgenographic changes and the ventilatory pressures employed. The radiologist should be informed that a patient is receiving PEEP therapy, as the earliest signs of alveolar rupture--interstitial emphysema--are frequently subtle.
The standard Colcher-Sussman pelvimetry technique does not adequately visualize the interischial distance on a significant number of patients. A twenty-degree angulation modification has been developed to solve this problem.