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Biomedical subjects

T Kelso

Publications and source records attributed to T Kelso.

4 recordsLinked to original sources
PubMed1998

Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial.

CONTEXT: No pharmacological therapeutic protocol has been found effective in modifying the clinical course of acute respiratory distress syndrome (ARDS) and mortality remains greater than 50%. OBJECTIVE: To determine the effects of prolonged methylprednisolone therapy on lung function and mortality in patients with unresolving ARDS. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Medical intensive care units of 4 medical centers. PARTICIPANTS: Twenty-four patients with severe ARDS who had failed to improve lung injury score (LIS) by the seventh day of respiratory failure. INTERVENTIONS: Sixteen patients received methylprednisolone and 8 received placebo. Methylprednisolone dose was initially 2 mg/kg per day and the duration of treatment was 32 days. Four patients whose LIS failed to improve by at least 1 point after 10 days of treatment were blindly crossed over to the alternative treatment. MAIN OUTCOME MEASURES: Primary outcome measures were improvement in lung function and mortality. Secondary outcome measures were improvement in multiple organ dysfunction syndrome (MODS) and development of nosocomial infections. RESULTS: Physiological characteristics at the onset of ARDS were similar in both groups. At study entry (day 9 [SD, 3] of ARDS), the 2 groups had similar LIS, ratios of PaO2 to fraction of inspired oxygen (FIO2), and MODS scores. Changes observed by study day 10 for methylprednisolone vs placebo were as follows: reduced LIS (mean [SEM], 1.7 [0.1] vs 3.0 [0.2]; P<.001); improved ratio of PaO2 to FIO2 (mean [SEM], 262 [19] vs 148 [35]; P<.001); decreased MODS score (mean [SEM], 0.7 [0.2] vs 1.8 [0.3]; P<.001); and successful extubation (7 vs 0; P=.05). For the treatment group vs the placebo group, mortality associated with the intensive care unit was 0 (0%) of 16 vs 5 (62%) of 8 (P=.002) and hospital-associated mortality was 2 (12%) of 16 vs 5 (62%) of 8 (P=.03). The rate of infections per day of treatment was similar in both groups, and pneumonia was frequently detected in the absence of fever. CONCLUSIONS: In this study, prolonged administration of methylprednisolone in patients with unresolving ARDS was associated with improvement in lung injury and MODS scores and reduced mortality.

Adult↗
PubMed1991

Functional restoration following anterior cruciate ligament reconstruction in active-duty military personnel.

A retrospective review was conducted of 112 active-duty military patients receiving anterior cruciate ligament reconstruction between 1985 and 1987. Mean age of these patients was 26.4 years, average follow-up was 2.35 years, and the average interval from time of injury to reconstruction was 13.6 months. The three most commonly employed surgical techniques were the Andrews' iliotibial band tenodesis, mid-third patellar tendon autograft, and a combined Andrews' and mid-third patellar tendon reconstruction. Seventy-eight patients (69.6%) returned to full duty and the ultimate disposition was not affected by the reconstructive procedure performed, chronicity of injury, or sex. A statistically higher percentage of patients over 30 years old returned to full unrestricted military service than did patients under 30. Associated posterior cruciate injury and degenerative joint disease resulted in poorer results. Our results demonstrate that functional restoration, based on the occupational criteria of return to full unrestricted duty, is likely following anterior cruciate ligament reconstruction.

Adolescent↗
PubMed1990

Laboratory values in the elderly. Are they different?

Diseases do not always show the usual or "classic" signs and symptoms in the elderly. Physiologic changes over the years of a long life seem to be responsible for impairment of regulation or function of many organ systems. Since function often is measured in clinical medicine by laboratory testing, physicians frequently face difficult clinical decisions as to the need for further evaluation of a patient based upon a laboratory test result received. For the most part, the laboratory values obtained in elderly persons seem to fall into our traditional or so-called normal ranges, and little evidence supports the need for separate sets of reference ranges for the elderly. A few patients do show abnormalities on specific tests, and a few test values can be expected more frequently than others to be out of line in healthy elderly individuals, specifically: serum alkaline phosphatase (elevations to about 2.5 times the normal) fasting blood glucose (up to 135 to 150 mg/dl) postprandial blood glucose or oral glucose tolerance test (increased above normal to 10 mg/dl per decade of age) normal serum creatinine with the existence of markedly decreased creatinine clearance higher erythrocyte sedimentation rates (up to 40 mm/hr) hemoglobin (lowest acceptable level is 11.0 gm/dl in women; 11.5 gm/dl in men) BUN (up to 28 to 35 mg/dl) The presence of multiple diseases in elderly patients, as well as the many medications often taken, will no doubt be more of a source of confusion and consternation in the clinical correlation of laboratory test results than the lack of adequate reference ranges specifically compiled for the elderly. The question "What test result is significant and raises suspicion of disease?" will remain a part of that all-important integration and correlation of the information available to the physician for the diagnosis and treatment of the patient.

Age Factors↗