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Biomedical subjects

W E Ruth

Publications and source records attributed to W E Ruth.

At least 19 recordsLinked to original sources
PubMed1983

Effect of location, pH, and temperature of instillate in bronchoalveolar lavage in normal volunteers.

Bronchoalveolar lavage has not been subjected to careful standardization. We examined the variables of lung lavage location and lavage fluid composition (pH and temperature) upon the percent of fluid recovered, cell count and differential, protein and pH in normal subjects. In the first part of the study, random order lavages of the right middle lobe (RML), right lower lobe (RLL), left lingula, and left lower lobe (LLL) were performed with 100-ml aliquots of normal saline (pH, 5.5) at room temperature (25 degrees C). Percent fluid recovery was greater in the RML and lingula than in the RLL (p less than 0.05). Cell count, cell differential, and protein were similar between lobes. In the second part of the study, each lobe was lavaged with 50-ml aliquots: the RML with normal saline at 37 degrees C, the RLL with normal saline buffered to a pH of 7.0 at 37 degrees C, the left lingula with normal saline at 25 degrees C, and the LLL with normal saline buffered to a pH of 7.0 at 25 degrees C. Percent fluid recovery was greater in the RML than in the lingula and greater in both the RML and lingula than in the lower lobes (p less than 0.05). Total cell count was significantly higher in the RML than in the LLL (p less than 0.05). Cell count per milliliter and protein recovered were not different between any lobe lavaged. The pH of recovered fluid was greater with buffered saline. Complications of fever and chills occurred in almost 50% of subjects in both parts of the study. Lavage location can affect fluid recovery. Alteration of lavage fluid composition did not affect cell or protein recovery. We suggest lavage of the RML to ensure larger fluid recovery and the highest total cell count.

Adult↗
PubMed1981

Prevention of pulmonary emboli in a respiratory intensive care unit: efficacy of low-dose heparin.

Ninety-eight patients admitted to our respiratory intensive care unit during a one-year period were compared retrospectively with 99 well-matched patients admitted during a second one-year period. The use of prophylactic low-dose heparin in the second year was associated with a significant decrease in pulmonary emboli documented by ventilation-perfusion scan, pulmonary angiography, and autopsy. No specific bleeding complications could be directly attributed to the use of low-dose heparin. The frequency and severity of gastrointestinal hemorrhage as determined by hemoglobin fall and transfusion requirements were not significantly affected by the prophylactic use of low-dose heparin. Low-dose heparin appears to be effective and safe in respiratory intensive care unit patients in the prevention of pulmonary emboli.

Asthma↗
PubMed1977

Triamcinolone aerosol. Treatment of aspirin-hypersensitive asthmatic patients.

The efficacy of triamcinolone acetonide aerosol in the management of asthma in six patients with aspirin hypersensitivity was evaluated during a one-year trial. Five patients were previously chronically dependent on systemic corticosteroids and had undergone unsuccessful trials with cromolyn sodium therapy. Substantial reduction in corticosteroid requirements was observed; in two patients, oral prednisone therapy was completely eliminated. Forced expiratory volume and flow were maintained at levels better than those recorded before triamcinolone therapy throughout the year of follow-up. No substantial side effects due to triamcinolone were observed.

Aerosols↗
PubMed1977

Effects of corticosteroids in the treatment of patients with gastric aspiration.

Forty-three of 88 patients suspected of having aspirated gastric contents met stringent criteria for the diagnosis of aspiration of gastric contents. One group of 25 patients was treated with corticosteroids and a second group of 18 patients was treated without corticosteroids. The two groups were clinically well matched according to all variables except that the patients who did not receive corticosteroids had greater hypoxemia and a higher incidence of infiltration on chest roentgenogram which would indicate that these patients had received greater pulmonary injury from aspiration of gastric contents. Thirty-two per cent of the patients who received steroids died compared to 28 per cent of those who did not receive steroids. Although the mortality rate difference was not statistically significant, the occurrence of gram-negative pneumonia five days after aspiration was more frequent in the patients treated with steroids.

Adrenal Cortex Hormones↗
PubMed1977

Oropharyngeal candidiasis in patients treated with triamcinolone acetonide aerosol.

Thirty asthmatic patients participating in a trial of triamcinolone acetonide aerosol were evaluated to determine the relationships among symptons of sore throat or hoarseness, the appearance of the throat on physical examination, and the presence of yeasts on pharyngeal culture. Observations were recorded prior to aerosol therapy and repeated after 2 wk, 4 wk, 6 wk, 4 mo, and 6 mo of therapy. A total of 15 patients (50%) experienced sore throat or hoarseness, 15 (50%) had yeasts cultured from the pharynx on at least one occasion, and 11 (37%) at some point had an abnormal throat examination; however, there was no predictable relationship between symptoms or abnormal physical examinations and the presence of a positive culture. The frequency of positive cultures did not change significantly during the observation period. Twelve patients had positive yeast cultures on 50% or more of their samples. The incidence of symptoms was not sigficantly increased in these chronically colonized patients. Symptoms were usually transient, and discontinuation of the aerosol or antifungal therapy was unnecessary. Triamcinolone aerosol was not associated with significantly increased pharyngeal colonization with yeasts in this 6-mo study. Existing chronic colonization is not necessarily a contraindication to triamcinolone therapy. Sore throat and hoarseness are usually unrelated to yeast infection in patients using triamcinolone acetonide aerosol.

Adult↗
PubMed1977

Contamination of a fiberoptic bronchoscope with Proteus species.

We have traced an episode of contamination of a fiberoptic bronchoscope with a Proteus species to an index patient. Bacterial cultures obtained by aspiration through the fiberoptic bronchoscope from 11 of 12 subsequent bronchoscopies in 8 additional patients grew a Proteus species with sensitivities similar to those of the initial isolate. Culture of the fiberoptic bronchoscopic specimen yielded an identical organism. There were no definitive ill effects in the patients. These findings necessitated a change in our fiberoptic bronchoscope disinfection protocol as well as development of culture surveillance mechanism to detect breaks in the cleaning procedure. The importance of this and avoiding potential outbreaks of fiberoptic bronchoscope-related infeciton is emphasized.

Bronchoscopes↗
PubMed1977

Treatment of allergic aspergillosis with triamcinolone acetonide aerosol.

The successful management of a patient with allergic asperillosis with triamcinolone acetonide for one year is reported. This patient had been maintained previously on systemic attempt to withdraw systemic corticosteroids continuously for eight years. An initial attempt to withdraw systemic steroids after initiation of aerosol therapy was unsuccessful; however, following bronchoscopic removal of mucus plugs, the transfer to maintenance therapy with triamcinolone aerosol alone was uneventful.

Adult↗
PubMed1977

Cromolyn sodium in the treatment of asthma associated with aspirin hypersensitivity and nasal polyps.

The control of asthma by therapy with cromolyn sodium was studied in 28 adults with late-onset asthma associated with hypersensitivity to aspirin and nasal polyps. Four-week periods of treatment with the drug or a placebo were compared in a double-blind crossover study. A subsequent eight-week open trial in 20 patients was compared to their period of receiving placebo. There was slight but significant improvement in the forced expiratory volume in one second (FEV1; P less than 0.05) and the mean forced expiratory flow during the middle half of the forced vital capacity (FEF25-75%; P less than 0.05) after four weeks of therapy with cromolyn sodium and in the FEV1 (P less than 0.05), the forced vital capacity (P less than 0.01), and FEF25-75% (P less than 0.01) after an additional eight weeks of therapy with cromolyn sodium. The improvement in pulmonary function was not associated with changes in the peak expiratory flow rate, the symptoms of asthma, the doses of additional medication, or the index of disability. The dosage of corticosteroids in 22 patients receiving long-term therapy with steroids was no different between the four-week periods of treatment with placebo or drug but was significantly lower (P less than 0.05) during the eight-week open trial. We conclude that administration of cromolyn sodium has a therapeutic effect in this group of asthmatic patients.

Adult↗
PubMed1977

Gastrointestinal hemorrhage in patients in a respiratory intensive care unit.

Significant gastrointestinal hemorrhage occurred in 20% (20) of the patients in a respiratory intensive care unit. Risk factors significantly associated with the development of gastrointestinal hemorrhage included (1) the principal respiratory diagnosis of adult respiratory distress syndrome; (2) increasing numbers of days on a ventilator, days in the respiratory intensive care unit, and total days of hospitalization; and (3) the development of thrombocytopenia. Factors not associated with an increased risk of gastrointestinal hemorrhage were the age and sex of the patient, the respiratory diagnosis of chronic obstructive pulmonary disease, and the use of therapy with either heparin or corticosteroids. Routine prophylactic administration of antacids was associated with a decreased incidence of hemorrhage. The mortality of bleeders was significantly greater than that of nonbleeders.

Antacids↗
PubMed1977

Pulmonary lavage in patients treated with mechanical ventilation.

Mucous plugs and secretions in smaller bronchi may be responsible for impaired exchange of gases and abnormal compliance. Conventional therapy is often insufficient for removal of these plugs and secretions, especially in patients treated with mechanical ventilation. Therefore, pulmonary lavage with 237 +/- 6 ml of physiologic saline solution infused through the flexible fiberoptic bronchoscope in patients with respiratory failure was accomplished on 43 occasions to evaluate the therapeutic benefit of this procedure on oxygenation and compliance. Eighty-one percent (35) of the 43 lavages were associated with a significant increase of the ratio of arterial to alveolar oxygen pressures (PaO2/PAO2) (11 +/- 1) hours after lavage; 63% (27) of the 43 lavages were associated with a significant increase in effective static compliance (Cst) at 8 (+/- 1) hours after lavage. There were no persistent complications other than transient decreases in PaO2/PAO2 and effective Cst soon after lavage. The results suggest that this procedure is a useful therapeutic method in selected patients with respiratory failure.

Blood Gas Analysis↗
PubMed1976

Desquamative interstitial pneumonia following long-term nitrofurantoin therapy.

Two patients with diffuse interstitial lung disease after long-term nitrofurantoin therapy were characterized clinically by exertional dyspnea and basilar rales, roentgenographically by diffuse interstitial infiltrate and physiologically by a restrictive lung defect. Pathologically, light microscopy revealed desquamative interstitial pneumonia. In one patient electron microscopy was characteristic of desquamative interstitial pneumonia. Immunofluorescent studies of one biopsy specimen showed specific fluorescence of interstitial cells with immunoglobulin E and third component of complement. In in vitro studies, nitrofurantoin therapy failed to induce lymphoblast transformation or histamine release. Treatment consisted of discontinuing the administration of nitro=furantoin and adding corticosteroids. Both patients felt better and showed clinical improvement. Our findings suggest that in some cases desquamative interstitial pneumonia may be drug related.

Adult↗
PubMed1976

Diagnosis of gastric aspiration by fiberoptic bronchoscopy.

At the time of bronchoscopic observation, 28 of 31 patients proved to have aspirated gastric contents by the presence of gastric contents in the trachea or by direct observation of gastric aspiration followed by respiratory distress and erythema of subsegmental bronchi. Since gastric aspiration is a difficult diagnosis to make and few objective data are available to make the diagnosis, the present study would indicate that early fiberoptic bronchoscopic observation of the tracheobronchial tree is a useful procedure to establish a definitive diagnosis and to allow proper planning for clinical management.

Bronchitis↗
PubMed1975

Rapid diagnosis of primary influenza pneumonia.

Primary influenza pneumonia is a disease of high mortality. Differentiation between a bacterial and viral etiology for the pulmonary infiltrates frequently presents a diagnostic dilemma. Rapid diagnosis is essential; and once established, the patient requires careful supportive therapy. This report describes two patients with primary influenza pneumonia complicated by severe respiratory failure. Early diagnosis of the pulmonary infiltrates was accomplished by obtaining bronchial secretions with fiberoptic bronchoscopy and staining them with influenza-A fluorescent conjugate. One patient died of the complications of this illness, despite maximal supportive therapy. The other patient survived the illness and at the time of hospital discharge was showing marked improvement in his exercise tolerance. There was subsequent gradual return of ventilation and gas transport function to normal values.

Female↗