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Biomedical subjects

C Franklin

Publications and source records attributed to C Franklin.

At least 73 records · Page 4Linked to original sources
PubMed1993

The technique of percutaneous tracheostomy. Using serial dilation to secure an airway with minimal risk.

Percutaneous tracheostomy is the procedure of choice for most patients who require prolonged use of an artificial airway; it can be performed rapidly at the bedside and is associated with fewer complications than is the standard procedure. The serial dilational technique involves the insertion of prelubricated dilators that gradually enlarge the diameter of a tract made by a guidewire and guiding catheter, facilitating placement of a standard double-cannula tracheostomy tube. The most dangerous complication, paratracheal insertion, occurs only rarely. The small skin incision and resulting tight fit of the tracheostomy tube in the stoma help prevent bleeding and infection.

Contraindications↗
PubMed1992

DNR in the OR.

Explore the source record for details and available documents.

Humans↗
PubMed1992

Extreme hypercapnia in a fully alert patient.

A patient is described with decompensated chronic obstructive lung disease (COLD) and extreme hypercapnia. Despite an arterial CO2 level of 160 mm Hg, the patient remained awake and alert. This indicates that CO2 narcosis is not an invariable finding in severe hypercapnia.

Aged↗
PubMed1991

Long-term survival of patients with AIDS, Pneumocystis carinii pneumonia, and respiratory failure.

OBJECTIVE: --To evaluate the long-term survival of patients admitted to the medical intensive care unit, Cook County Hospital, Chicago, Ill, with Pneumocystis carinii pneumonia and acute respiratory failure. DESIGN: --Cohort study over a 4-year period. SETTING: --Municipal teaching hospital. PATIENTS: --Seventy-three consecutive patients who had 75 episodes of P carinii pneumonia and acute respiratory failure were followed up from the time of hospital admission until their deaths or the termination of the study. OUTCOME MEASURES: --Duration of survival from the time of initial hospital admission with diagnoses of P carinii pneumonia and acute respiratory failure. RESULTS: --Consistent with recent reports of improved short-term outcome, the immediate hospital survival was 47% (35/75). The 1-year survival was 37% (95% confidence interval, 26% to 49%). Two patients have survived for 40 months. Almost three quarters of the patients who survived hospitalization lived for at least 1 year. CONCLUSIONS: --The long-term prognosis for patients with the acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure is now substantially better than anticipated. Respiratory failure due to P carinii pneumonia does not necessarily signify the terminal phase of human immunodeficiency virus infection. Accordingly, patients with the acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure can be appropriate candidates for life support in medical intensive care units.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Membranes of high- and low-metastatic L tumor cell variants.

A model system of metastasis, L-929 fibroblasts and a derivative cell line, A-9 cells, was developed in order to compare the membrane properties of high- and low-metastatic cells cultured in chemically defined medium. The metastatic ability of L-929 and A-9 cells in athymic (nude) mice was examined. Both cell lines produced local tumors, but only L-929 fibroblasts metastasized to the lung. The plasma membranes of L-929 cells had lower sterol/phospholipid ratios and their phospholipids were more unsaturated than those of A-9 cells. The fluorescence probe 1,6-diphenyl-1,3,5-hexatriene and multifrequency phase and modulation fluorometry indicated that the plasma membranes of L-929 cells were less rigid (lower polarization and limiting anisotropy; shorter rotational relaxation time and lifetime) than those of A-9 cells. Thus, the membranes of highly metastatic cells had more unsaturated fatty acids, a lower sterol/phospholipid ratio and were consequently less ordered than those of their less malignant counterparts that formed only local tumors.

Animals↗
PubMed1990

Ethanol increases extracellular adenosine by inhibiting adenosine uptake via the nucleoside transporter.

Chronic exposure to ethanol results in heterologous desensitization of receptors coupled to adenylyl cyclase via Gs, the stimulatory guanine nucleotide regulatory protein. Ethanol-induced accumulation of extracellular adenosine is required for the development of heterologous desensitization (Nagy, L. E., Diamond, I., Collier, K., Lopez, L., Ullman, B., and Gordon, A. S., Mol. Pharmacol., in press). To understand the mechanism underlying ethanol-induced increases in extracellular adenosine, we examined the interaction of ethanol with the adenosine transport system in S49 lymphoma cells. We found that ethanol inhibited nucleoside uptake without affecting deoxyglucose or isoleucine transport. Inhibition of adenosine uptake was due to decreased influx via the nucleoside transporter. Thus, ethanol-induced increases in extracellular adenosine appear to be due to inhibition of adenosine influx. After chronic exposure to ethanol, cells became tolerant to the acute effects of ethanol, i.e. ethanol no longer inhibited uptake. Consequently, ethanol no longer increased extracellular adenosine concentrations. Taken together with our previous studies, these results suggest that ethanol inhibition of adenosine influx leads to an increase in extracellular adenosine which causes an initial increase in intracellular cAMP levels and subsequent development of heterologous desensitization of cAMP signal transduction.

Adenosine↗
PubMed1990

Triage considerations in medical intensive care.

As an initial step toward improving admission criteria to the medical intensive care unit (MICU), we examined Acute Physiologic and Chronic Health Evaluation scores and the diagnosis-adjusted mortality rates of 2419 medical patients, including those who received MICU consultation over a 6-month period. There was considerable overlap in the physiologic scores and the predicted mortality rates between those patients who were admitted to the MICU and those who were not. There was no discrete score or mortality rate at which triage to the MICU would have included most MICU patients but excluded most patients who survived without admission to the MICU. While uniform MICU admission criteria would be desirable, current scoring systems may not have the desired sensitivity or specificity to establish such criteria. Using a receiver operating characteristic curve, we demonstrated that diagnosis-adjusted mortality rates could predict as well as Acute Physiologic and Chronic Health Evaluation scores which patients would receive MICU admission and intervention. This suggests that, for different diagnoses, specific clinical variables and laboratory tests may have different predictive importance for MICU admission. Prospective models of clinical variables using receiver operating characteristic curves in various medical diseases may improve triage procedures.

Diagnosis-Related Groups↗
PubMed1989

Improved survival in patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure.

Pneumocystis carinii pneumonia (PCP) causing acute respiratory failure (ARF) in patients with acquired immunodeficiency syndrome (AIDS) has been reported in several studies to have a mortality of 84 to 100 percent. A recent report found a 42 percent survival rate. We followed 58 patients with AIDS who required positive pressure ventilation and identified 33 patients with PCP and ARF who had a PaO2/FIo2 level less than 150 mmHg. We report the survival of 12 of these 33 (36 percent). The mean duration of survival after discharge from the hospital was 7.9 +/- 1.8 months, which is an improvement over previous reports. These data suggest that we should reevaluate the reported recommendations that patients with AIDS, PCP and ARF should not receive intensive care or mechanical ventilation.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Clinical characteristics and resource utilization of ICU patients: implications for organization of intensive care.

We reviewed the clinical characteristics and resource utilization of 391 medical (M) and 315 surgical (S) ICU patients. In general, MICU patients had more physiologic derangement, as determined by the admission, maximal, and average acute physiology scores (APS). SICU patients had more frequent therapeutic interventions as measured by admission, maximal, and average therapeutic intervention scoring system values. Notably, 40% of MICU and 30% of SICU patients never received any active interventions and were admitted strictly for monitoring purposes. Patients on admission with APS less than or equal to 10 had markedly shorter ICU stays, with almost 50% less treatment than patients with APS over 10. Fifty-six percent of patients with APS less than or equal to 10 did not require any active intervention. In contrast, 83% of patients with APS greater than 10 had considerable intensive interventions. These patients required mechanical ventilation, invasive monitoring, and vasoactive drugs more than twice as often as patients with lower APS scores. Consideration should be given, therefore, to the organization of ICUs according to the patient's severity of illness.

Adult↗