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Biomedical subjects

A S Rebuck

Publications and source records attributed to A S Rebuck.

At least 73 records · Page 4Linked to original sources
PubMed1986

Range of accuracy of two wavelength oximetry.

Earlier reports of a two wavelength oximeter suggested a tendency toward overestimation of arterial oxygen saturation (SaO2) at the lowest values examined. To investigate this possible inaccuracy, we compared oximeter readings to SaO2 over a wider range of laboratory-induced steady-state hypoxia than has previously been reported. For values of SaO2 greater than 75 percent, oximeter readings were linearly related to SaO2 such that y = 0.94 SaO2 + 8.7 (r = 0.96) and the mean difference between oximeter reading and SaO2 was 0.09 percent. However, when SaO2 was less than 75 percent, the instrument readings were progressively higher than the SaO2 so that when SaO2 was approximately 50 percent, the oximeter reading was approximately 65 percent. These data show that the two wavelength oximeter displays falsely elevated readings when the arterial saturation falls below 75 percent.

Adult↗
PubMed1986

Asthma: non-responsiveness to conventional therapy.

Despite regular inhalation of beta-agonists, topical steroids and anticholinergic aerosols and the achievement of therapeutic blood levels of theophylline, some asthmatics have rapidly fluctuating levels of peak flow measurements throughout the day. Often little or no improvement is obtained with larger doses of corticosteroids. Before embarking on more intense drug therapy, attention should be paid to conscientious adherence to the prescribed regimen and avoidance of aspirin and tartrazine, as well as to exposure to allergens such as those associated with household pets. A number of newer therapeutic options are related to the use of air jet or ultrasonic nebulizers, that allow liquid forms of inhalation agents to be taken slowly in the home environment. In this regard, combination therapy with a beta-agonist and the anticholinergic ipratropium has been shown to have bronchodilating properties superior to either agent used alone. Secondly, sodium cromoglycate in its liquid form appears to have bronchodilator properties; taken on a regular basis, four times per day, it appears to have a steroid-sparing effect. Two alternatives are available for increasing the intensity of corticosteroid therapy, other than by prolonged, high-dose prednisone. The first is that of high-dose inhaled beclomethasone (up to 2000 micrograms/day) using the 250 micrograms/puff inhaler. The second is that of intravenous therapy with methylprednisolone, recently shown to have lung permeability superior to that of prednisolone. Office patients can be treated with occasional or even regular 'pulse' doses of methylprednisolone, an approach that is now finding acceptance in the management of the inflammatory alveolitides.

Adrenal Cortex Hormones↗
PubMed1986

Influence of supplemental oxygen on the physiological response to the PO2 aerobic exerciser.

Acute physiological responses to the "PO2-Aerobic Exerciser" (AE), a partial rebreathing device designed to stimulate training at altitudes, were studied in seven healthy men [mean VO2max = 56.1 +@- 10.1 (SD) ml X kg-1 X min-1] who performed cycle ergometer exercise to exhaustion in three experimental situations: a control test (C) breathing normal atmosphere: a test with the device (AE); and a test with the AE air supplemented with oxygen (AEO2'). Arterial oxygen saturation at rest for C, AE, and AEO2' studies was 97 +/- 1, 95 +/- 2, and 97 +/- 1%, respectively (P less than 0.05 for C vs AE and AE vs AEO2'), while at exhaustion it was 95 +/- 1, 87 +/- 2, and 95 +/- 1%, respectively (P less than 0.05 for C vs AE and AE vs AEO2'). Maximum work rate decreased from a control value of 1738 +/- 184 kg X min-1 to 1371 +/- 147 kg X min-1 during AE and remained below control levels during AEO2'; 1554 +/- 110 kg X min-1 (P less than 0.05). Beyond 60% of maximum work rate during AE, inspired CO2 increased to 0.026 +/- 0.005. Mouth pressure swings of up to -19.2 +/- 10.2 and 12.7 +/- 5.7 cm H2O were recorded during AE. While the PO2 aerobic exerciser induced a hypoxic stress, the pertubation imposed was not explained fully by arterial oxygen desaturation. Other factors such as hypercapnia and a flow resistive increase in the work of breathing appear to have influenced work capacity during the use of the device.

Adult↗
PubMed1986

Ventilatory patterns during hypoxia, hypercapnia, and exercise in adolescents with mild scoliosis.

Adolescents with mild, asymptomatic scoliosis (thoracic curvature less than 35 degrees) may have little or no impairment of resting lung volumes. Progression to more severe disease may, however, be accompanied by lung restriction, impaired exercise tolerance, and respiratory failure with CO2 retention. We wished to see whether adolescents with mild scoliosis and minimally abnormal resting pulmonary mechanics had impairment of their responses to hypercapnia, hypoxia, and progressive cycle exercise. Forty-four adolescents with idiopathic scoliosis were studied. The mean forced vital capacity (FVC), expressed as a percentage of the predicted value, was 94.3 +/- 2.2 (SE). The mean ventilatory response to hypercapnia (2.57 +/- 0.24 L/min/mm Hg) was within the normal range but was achieved with a tidal volume response (1.87 +/- .17% vital capacity [VC]/mm Hg) that was significantly lower than that previously reported in healthy young adults. Ventilatory responses to exercise were also within the normal range, the mean dyspnea index (VE-max/maximal voluntary ventilation) = 0.92 +/- 0.04. However, at a ventilation of 30 L/min, the tidal volume was 0.38 +/- 0.01% FVC, which was considerably lower than predicted. The tidal volume response to hypoxia was also abnormally low, the mean response being 0.52 +/- 0.059% VC/% decrease in arterial O2 saturation. These findings indicated that, even when scoliosis is asymptomatic and associated with minimal impairment of resting pulmonary function, abnormal patterns of ventilation occur during exercise or in response to chemical stimuli.

Adolescent↗
PubMed1986

Neuropsychological effects of short-term discontinuation of oxygen therapy. Observations in patients with chronic hypoxemia who are receiving long-term oxygen therapy.

Twelve patients receiving long-term oxygen therapy were assessed for possible detrimental neuropsychological effects of short-term withdrawal of oxygen. Patients served as their own controls and received either their usual oxygen prescriptions or room air, through nasal prongs, over four-hour periods on two successive days. A battery of neuropsychological tests assessing memory and learning, sustained concentration, and motor and visuomotor speed were administered. In the room-air condition, the mean arterial oxygen partial pressure fell from 86.1 +/- 25.7 to 59.1 +/- 11.7 mm Hg, and the mean oxygen saturation fell from 94.7% +/- 3.2% to 89.9% +/- 5.3%, but the mean carbon dioxide partial pressure did not change significantly. No significant differences in neuropsychological test scores were found between the two conditions, suggesting that four hours of mild hypoxemia causes no significant deficits in cognition in patients receiving long-term oxygen therapy. Paradoxically, low-order inverse correlations were found between arterial oxygen partial pressures and results of visuomotor speed and memory tests, suggesting that an improvement in performance may have taken place during oxygen withdrawal.

Aged↗
PubMed1985

Autofluorescence of alveolar macrophages: problems and potential solutions.

Despite recent advances in immunofluorescence technology, the study of alveolar macrophage cell surface proteins is hampered by the presence of autofluorescence. We suggest several approaches that might overcome this problem and enable specific immunofluorescent detection of cellular proteins and automated analysis of alveolar macrophages.

Cytophotometry↗
PubMed1985

Does serum angiotensin converting enzyme reflect intensity of alveolitis in sarcoidosis?

Serum angiotensin converting enzyme activity is increased in many patients with pulmonary sarcoidosis and has been proposed as a measure of disease activity. Assay of serum angiotensin converting enzyme, bronchoalveolar lavage, and gallium scans were performed in 27 patients with biopsy proved pulmonary sarcoidosis. There was a positive correlation between serum angiotensin converting enzyme activity and an index of pulmonary gallium uptake assessed by the National Institutes of Health method (r = 0.7, p less than 0.001). There was no significant relationship (r = 0.19) between serum angiotensin converting enzyme activity and bronchoalveolar lavage lymphocytes expressed as a proportion of cells recovered. Increase in the enzyme activity had a sensitivity of 50% as a means of detecting high intensity alveolitis but specificity was only 45%. There was no significant difference in mean angiotensin converting enzyme activity between the following groups: those with positive and those with negative gallium scans; those with bronchoalveolar lavage lymphocyte counts less than or equal to 28% and those with counts greater than 28%. Although there was a significant correlation between the enzyme activity and one component of the alveolitis of sarcoidosis, the data suggest that serum angiotensin converting enzyme activity alone is neither sensitive nor specific enough for high intensity alveolitis.

Female↗
PubMed1985

Thoracoabdominal motion during hypercapnia, hypoxia, and exercise.

We measured, in 11 healthy volunteers, the contributions of rib cage and abdomen--diaphragm compartments to increased ventilation caused by hypercapnia, hypoxia, and exercise to determine whether different stimuli produce similar or different patterns of ventilation with respect to the motion of rib cage and abdominal compartments. Progressive hyperoxic hypercapnia and progressive isocapnic hypoxia were induced by rebreathing methods and graded exercise performed on a treadmill, and compartmental tidal volume (VT) was measured by respiratory inductive plethysmography. For each stimulus, the wide range of VT responses among individuals was determined primarily by the range of rib cage contributions to VT, the abdominal compartment VT response slopes accounting for less of this range. There were no significant differences between hypercapnia and hypoxia in either rib cage or abdominal contributions to ventilation (for both, p less than 0.3). However, exercise rib cage and abdominal contributions to ventilation were significantly different from those during chemically driven breathing: for the rib cage compartment, p less than 0.0001 and for the abdominal compartment, p less than 0.05. Whereas, in 8 of 10 subjects the rib cage contribution to VT during exercise was similar to or exceeded that during rebreathing, in 7 of 10 subjects the abdomen-diaphragm contribution fell below that measured during both hypercapnia and hypoxia. There was a significant correlation between hypercapnia and hypoxia in the VT contribution of each compartment at equivalent levels of ventilation (rib cage, p less than 0.0001; abdomen, p less than 0.0005), but there was no significant correlation in the VT contribution of either compartment between exercise and hypercapnia or exercise and hypoxia.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1985

Effect of elastic loading on ventilatory pattern during progressive exercise.

Ventilatory responses to progressive exercise, with and without an inspiratory elastic load (14.0 cmH2O/l), were measured in eight healthy subjects. Mean values for unloaded ventilatory responses were 24.41 +/- 1.35 (SE) l/l CO2 and 22.17 +/- 1.07 l/l O2 and for loaded responses were 24.15 +/- 1.93 l/l CO2 and 20.41 +/- 1.66 l/l O2 (P greater than 0.10, loaded vs. unloaded). At levels of exercise up to 80% of maximum O2 consumption (VO2max), minute ventilation (VE) during inspiratory elastic loading was associated with smaller tidal volume (mean change = 0.74 +/- 0.06 ml; P less than 0.05) and higher breathing frequency (mean increase = 10.2 +/- 0.98 breaths/min; P less than 0.05). At levels of exercise greater than 80% of VO2max and at exhaustion, VE was decreased significantly by the elastic load (P less than 0.05). Increases in respiratory rate at these levels of exercise were inadequate to maintain VE at control levels. The reduction in VE at exhaustion was accompanied by significant decreases in O2 consumption and CO2 production. The changes in ventilatory pattern during extrinsic elastic loading support the notion that, in patients with fibrotic lung disease, mechanical factors may play a role in determining ventilatory pattern.

Adult↗
PubMed1985

Hemodynamic effects of inhaled ipratropium bromide, alone and combined with an inhaled beta 2-agonist.

Inhaled ipratropium bromide's reported lack of cardiovascular side effects has led to recommendations for its use as a bronchodilator in patients with coexisting cardiovascular disease and in combination regimens with adrenergic agents. To assess the hemodynamic effects of ipratropium, we monitored 10 volunteers by M-mode echocardiography following metered-dose ipratropium administered alone and with fenoterol. On 2 separate days, subjects were monitored for 90 min as they received either 160 micrograms of ipratropium or placebo in divided doses plus 400 micrograms of fenoterol at time 60 min. Following ipratropium alone, heart rate (HR) decreased 3 beats/min, a small but significant difference from placebo (p less than 0.04). Stroke volume (SV) and ejection fraction rose significantly (3 ml and 2%, respectively; p = 0.05) so that cardiac output (CO) was unchanged. By contrast, fenoterol alone (following placebo) produced marked increases in HR (13 beats/min), SV (14 ml), and CO (44%), with a marked fall in total peripheral vascular resistance (29%). Ipratropium administered before and with fenoterol had minimal additive effect. Although SV was slightly higher with the combination of drugs than with fenoterol alone (100.1 ml versus 93 ml; p = 0.05), CO was not significantly greater (6.9 L/min versus 6.4 L/min; p greater than 0.10). We conclude that metered-dose ipratropium alone has small and clinically unimportant hemodynamic effects and produces no clinically significant increases in the cardiovascular side effects of the bronchodilator regimen when given with fenoterol.

Adrenergic beta-Agonists↗
PubMed1985

Hypertrophic pulmonary osteoarthropathy in four patients with interstitial pulmonary disease.

The association between digital clubbing and idiopathic pulmonary fibrosis has been well established; however, the simultaneous occurrence of hypertrophic pulmonary osteoarthropathy and interstitial fibrosis, in the absence of neoplastic disease, has only been described in two case reports and was not mentioned in any of 336 patients described in several recent reviews. Among 70 patients referred for investigation of pulmonary infiltrates, four were found to have hypertrophic pulmonary osteoarthropathy associated with interstitial pulmonary disease, in the absence of malignant disease. We conclude that the use of bone scans and roentgenographic examination of the extremities may draw attention to an association between hypertrophic pulmonary osteoarthropathy and idiopathic pulmonary fibrosis.

Aged↗