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Biomedical subjects

C G Elliott

Publications and source records attributed to C G Elliott.

At least 73 records · Page 4Linked to original sources
PubMed1985

Hypoxemia after gastric bypass surgery for morbid obesity.

Fifty-six patients who underwent Roux-en-Y gastrojejunostomy for morbid obesity had arterial blood gas analysis before surgery and during the first five postoperative days. Preoperatively, seven subjects were hypoxemic and three were hypercapneic. Twenty-four hours after gastric bypass, 75% of the patients had an arterial oxygen pressure (Pao2) less than 60 mm Hg. Compared with preoperative measurements, blood gas values on the first postoperative day showed a 13.7-mm Hg decrease in the mean arterial Pao2 and a 5.0-mm Hg increase in the mean arterial carbon dioxide pressure. Arterial Pao2 determinations on the third, fourth, and fifth postoperative days returned toward, but remained significantly less than, paired values obtained before surgery. Patients with hypoxemia after gastrojejunostomy were significantly older and had significantly lower preoperative arterial Pao2 measurements than patients who were not hypoxemic after surgery. Weight, body mass index, and preoperative spirometric measurements did not distinguish between those patients who did and did not become hypoxemic postoperatively. We conclude that hypoxemia commonly follows gastric bypass for morbid obesity, and thus we recommend that all patients undergoing this procedure be treated with supplemental oxygen for at least the first three postoperative days.

Adolescent↗
PubMed1985

Granulocyte aggregation in adult respiratory distress syndrome (ARDS)--serial histologic and physiologic observations.

Although a number of studies have suggested that granulocyte sequestration is an important pathophysiologic event in ARDS, histologic evidence of aggregated granulocytes in the pulmonary microvasculature is limited, and serial histologic data have not been reported with physiologic measurements. We report a patient with ARDS who demonstrated microvascular granulocyte aggregation and lung edema in sections of a lung biopsy obtained seven days after the onset of symptoms. Pulmonary vascular resistance and pulmonary capillary wedge pressure were normal immediately before the biopsy. A second biopsy performed 12 days later showed decreased lung edema and no evidence of intravascular leukostasis. This case provides histologic support for the hypothesis that granulocyte aggregates contribute to pulmonary edema associated with ARDS.

Adult↗
PubMed1985

Effect of intravenous aminophylline upon the incremental exercise performance of healthy men.

Aminophylline increases the contractile force of fatiguing muscles. The effects of aminophylline upon maximal exercise performance are not defined. 6 healthy men performed incremental bicycle ergometry before and after receiving intravenous aminophylline (6 mg/kg). Maximal oxygen uptake, maximum work rate, and maximum minute ventilation were unchanged following aminophylline. Heart rate measured at rest and at 50-watt increments of work rate was significantly increased following aminophylline (p less than 0.03). The heart rate response to incremental exercise (delta HR/delta VO2) was unchanged by aminophylline. We conclude that aminophylline does not increase maximal exercise performance of healthy men.

Adult↗
PubMed1985

Adult respiratory distress syndrome: successful support with continuous negative extrathoracic pressure.

We describe the use of continuous negative extrathoracic pressure to treat successfully the adult respiratory distress syndrome in a 19-yr-old woman who resisted the application of positive airway pressure. Arterial hypoxemia was reversed with -26 cm H2O of extrathoracic pressure, produced by a modified Emerson iron lung. Cerebral and renal functions were maintained, and barotrauma did not occur. The patient required continuous negative extrathoracic pressure for 9 days; 12 days after admission, she was discharged. This case indicates that negative extrathoracic pressure therapy can be an effective and safe alternative to positive airway pressure for the management of selected patients with adult respiratory distress syndrome.

Adult↗
PubMed1984

A prospective comparison of arterial catheter blood and catheter-tip cultures in critically ill patients.

To determine if a culture of blood obtained through an arterial catheter reflects culture of the catheter's tip, we studied 68 arterial catheters removed from 65 patients with and without suspected catheter infections. Cultures of blood obtained before catheter removal were compared to catheter-tip cultures. The arterial catheter blood culture was neither sensitive nor highly predictive of positive catheter-tip cultures. Suspicion of catheter infection was not associated with a significantly higher rate of positive catheter-tip or blood cultures.

Adult↗
PubMed1983

Prolonged mechanical ventilation for respiratory failure: a cost-benefit analysis.

To define the costs and benefits associated with prolonged mechanical ventilation, we studied retrospectively the records of 137 consecutive patients who required at least 48 h of ventilator support. The patients were physiologically unstable and required intensive care. Causes of respiratory failure included pulmonary diseases, post-operative complications, neuromuscular diseases, cardiac dysfunction, and GI disease. Forty-nine (36%) patients survived the hospitalization, and 38 (28%) patients were alive 3 yr after receiving prolonged mechanical ventilation. The mean total hospital cost was +16,930/patient (U.S. dollars, 1976-1977). The cost-benefit averaged +1826/yr of extended life. These costs varied from +460/yr of extended life for patients with respiratory failure complicating asthma to +8026/yr for patients with cardiac dysfunction. The cost-benefit ratio increased sharply for men older than 56 yr and for women older than 75 yr. These data document the importance of the basic disease process and the patient's age in the cost-benefit relationship.

Age Factors↗
PubMed1981

Pulmonary function and exercise gas exchange in survivors of adult respiratory distress syndrome.

Pulmonary function studies were performed on 13 survivors of adult respiratory distress syndrome (ARDS). Six of these 13 patients had a forced vital capacity (FVC) and total lung capacity (TLC) less than 80% of predicted within 2 months of the onset of ARDS. Seven patients followed 6 months or more showed no significant difference between measured and predicted FVC (p = 0.26) or TLC (p = 0.12). The diffusing capacity of carbon monoxide was significantly lower than predicted normal values (p less than 0.001). Although the alveolar arterial oxygen tension gradient (delta AaPO2) was within the predicted normal range for 11 nonsmokers at rest, for 7 patients who exercised (1.0 less than VO2 less than 1.5 L/min), delta AaPO2 increased. The ratio of dead space to tidal volume decreased to less than 0.25 when VCO2 exceeded 1.0 L/min. We concluded that lung mechanics return to predicted normal values within 4 to 6 months after ARDS, but abnormalities of pulmonary gas exchange persist. Pulmonary vascular obstruction does not appear to explain persistent abnormalities of gas exchange.

Adolescent↗
PubMed1979

Complications of pulmonary artery catheterization in the care of critically ill patients. A prospective study.

In order to evaluate the incidence and the significance of complications resulting from the use of flow--directed, balloon--tipped catheters to monitor critically ill patients, we made a prospective study of 116 pulmonary artery catheterizations. Indications for catheterization included shock, pulmonary edema, or hemodynamic instability following surgery. Arrhythmias, including premature atrial or ventricular depolarizations, ventricular tachycardia, and transient right--bundle branch block occurred during 90 of the 116 insertion procedures, but were unassociated with morbidity or mortality. In two cases (1.7 percent) staphylococcal bacteremia probably originated from the catheter. In addition, the pulmonary artery catheter led to two cases (1.7 percent) of subclavian vein thrombosis. Postmortem examinations revealed perforations of the pulmonic valve in one case. We conclude that although significant complications may result from pulmonary arterial catheterization and monitoring of critically ill patients, the incidence is low.

Adolescent↗
PubMed1976

Metabolism of delta7- and delta5,7-sterols by Phytophthora cactorum.

delta7- and delta5,7-Sterols are converted to the corresponding delta5-sterols by Phytophthora cactorum. When delta7-sterols were supplied to the fungus, delta5- and delta7-sterols were recovered in an acetone extract of the mycelium, the proportion of delta5-sterol being higher in the free sterol fraction than in the esters. When delta5,7-sterols were supplied, delta5-sterols were recovered. No delta5,7-sterols were found in the mycelium. The initial rate of uptake of the sterols was in the order delta5 greater than delta7 greater than delta5,7.

Esters↗