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Biomedical subjects

D A Mahler

Publications and source records attributed to D A Mahler.

86 records · Page 5Linked to original sources
PubMed1981

Peri-emphysematous lung infection.

The difficulty in classifying pulmonary infection within areas of bullous emphysema may have contributed to the lack of appreciation of this entity. This process is important to recognize because: (1) the clinical picture is usually benign:; (2) it may be confused with tuberculosis, fungal disease, and carcinoma of the lung; and (3) radiographic resolution may be slow. For these reasons, pneumonitis which occurs within emphysematous lung may have been previously considered as slowly resolving pneumonias. The development of air-fluid levels within bullae has been called "infected emphysematous bullae." We believe that this phrase is misleading since there are no bacteriologic data to support the presence of infection within the bullae containing fluid. In fact, direct sampling of intrabullous fluid has been rarely reported and, if obtained, has been generally negative for bacteria. Furthermore, the clinical course in our patients is alos not consistent with infection within a space. Once fiberoptic bronchoscopy has excluded an obstructing endobronchial lesion, the physician may patiently follow the anticipated gradual resolution. We suggest that the phrase, "periemphysematous lung infection" best describes these related clinical-radiological conditions.

Blister↗
PubMed1981

Exercise performance in marathon runners with airway obstruction.

While evaluating lung function prior to four long-distance races (20-100 km), we found that nine of 127 marathon runners (7.1%) had airway obstruction (mean FEV1/FVC, 63.3%). Since obstruction to air flow may limit exercise performance, we compared selected cardiorespiratory parameters during exercise on a cycle ergometer in runners with airway obstruction (RAO), nine non-athletic control subjects (CON), and nine marathon runners with normal lung function (RNL). As the chemical drive to breath affects exercise hyperpnea, the ventilatory responses to hypercapnia and hypoxia were measured. All RAO were males with a mean age of 35.6 yr (range of 20-44 yr). Eight of nine RAO had a significant increase in flow rates after inhalation of isoproterenol. In the RAO and CON groups exercise ventilation was similar when oxygen consumption (VO2) was less than 2.0 l/min; as VO2 exceeded this level, significantly greater ventilation was required by the RAO. Carbon dioxide production was highest in RAO, intermediate in CON, and lowest in RNL. There was no significant difference in the mean ventilatory responses among CON, RAO, and RNL. Despite pulmonary dysfunction, the RAO achieved moderate-to-high levels of exercise performance.

Adult↗
PubMed1980

Right and left ventricular exercise performance in chronic obstructive pulmonary disease: radionuclide assessment.

Right and left ventricular pump performance was assessed at rest and during upright bicycle exercise in 30 patients with chronic obstructive pulmonary disease and in 25 normal control subjects. Right ventricular and left ventricular ejection fractions were ascertained noninvasively using first-pass quantitative radionuclide angiocardiography. The normal ventricular response to exercise was at least a 5% absolute increase in the ejection fraction of either ventricle. In patients the predominant cardiac abnormality involved performance of the right ventricle. Right ventricular ejection fraction was abnormal at rest in eight patients. Twenty-three patients demonstrated an abnormal right ventricular response to submaximal exercise. Airway obstruction and arterial hypoxemia were significantly more severe in patients with abnormal right ventricular exercise reserve than in those with normal reserve. Abnormal left ventricular performance was infrequent either at rest (four patients) or during exercise (six patients). Thus, this radionuclide technique allows noninvasive assessment of biventricular exercise reserve in chronic obstructive pulmonary disease.

Adult↗
PubMed1976

Anticholinergic poisoning from Jimson weed.

Jimson weed (Datura stramonium), is a wild growing herb that contains belladonna alkaloids. Recently there have been reports of intentional ingestion of Jimson weed by adolescents for psychedelic purposes. When seen in emergency department, these patients appear with physical signs of atropine-like poisoning, disturbances of thought and hallucinations. Diagnosis depends on a positive history, if available, and recognition of anticholinergic effects. Differentiation from lysergic acid diethylamide (LSD) ingestion and schizophrenia is important. Physostigmine, an anticholinergic agent, can reverse both central and peripheral manifestations of Jimson weed intoxication.

Belladonna Alkaloids↗
PubMedDate not supplied

Clinical applications of cardiopulmonary exercise testing.

Noninvasive measurement of metabolic and cardiorespiratory variables can be readily obtained using computerized systems as part of exercise testing of patients on a cycle ergometer or treadmill. The major indications for CPEX are: to assess exercise-related symptoms, especially dyspnea and chest pain; to measure exercise capacity including acceptability of patients with end-stage heart disease for cardiac transplantation; to evaluate for impairment/disability; to establish safety and guidelines for exercise training; and to assess response to specific therapy. As most patients with chronic cardiorespiratory disorders reduce their activities and consequently become deconditioned, CPEX should be considered as part of the initial evaluation. The results of CPEX should enable the physician to understand the reason(s) for the patient's exercise limitation and usually support the recommendation that the patient participate in a reconditioning or rehabilitation program. Should expired gases be measured as routine for all exercise tests? The use of CPEX depends on the clinical question. If the question is, "Does the patient have ischemic heart disease?", then a standard "cardiac stress test" is adequate. If the clinical question is, "Why is the individual limited in exercise ability?" or "Why is a patient breathless with activities?", then comprehensive CPEX is indicated. One important issue relating to CPEX is cost effectiveness. Do the results of CPEX justify the expense? There are little if any data to answer this question. However, if CPEX can establish a specific diagnosis, exclude significant heart disease, estimate work capacity, and/or provide guidelines for prescription of exercise intensity, this information may be invaluable to the individual patient and to the health-care provider. It is possible that CPEX may answer a specific clinical question and thereby actually eliminate the need and reduce the cost of additional expensive diagnostic tests. A prospective assessment of the cost effectiveness of CPEX will be important for select clinical problems.

Chest Pain↗
PubMedDate not supplied

Effect of exercise training on dyspnea measures in patients with chronic obstructive pulmonary disease.

PURPOSE: This study investigated the possible mechanisms for the expected improvement in dyspnea with pulmonary rehabilitation. METHODS: Lung function, clinical ratings of dyspnea, and exercise responses were studied in 44 patients with chronic obstructive pulmonary disease who participated in an outpatient program consisting of 1.5 hours per week of supervised education, breathing training, and upper/lower extremity exercise. RESULTS: After rehabilitation, there were significant increases in forced expiratory volume in 1 second (FEV1, 7%; P = .02), maximal inspiratory mouth pressure (PImax, 17%; P < .001), and the transition dyspnea index focal score (3.4; P < .001) and a significant decrease in the slope of dyspnea/power (0.12 versus 0.09; P = .001) during exercise. Patients who demonstrated > or = 0 mL of change in FEV1 or > or = 5 cm H2O of change in PImax exhibited significant decreases in the slopes for dyspnea/power. CONCLUSIONS: After pulmonary rehabilitation, there was a significant improvement in dyspnea. Although there was no evidence of a physiologic training response or enhanced mechanical efficiency, the modest increase in FEV1 and the increase in respiratory muscle strength appeared to contribute to the reduction in dyspnea.

Dyspnea↗
PubMedDate not supplied

Dyspnea relief.

Explore the source record for details and available documents.

Administration, Inhalation↗
PubMedDate not supplied

Pulmonary dysfunction in ultramarathon runners.

To assess the effects of extreme exercise on lung function we measured maximal expiratory flow volume (MEFV) curves in fifteen runners (mean age, 35.3 years; range, 26-46) before and after an 80.6 to 100 km (50-62.2 mile) road race. Mean running time for 80.6 km was 7 hr, 42 min. Post-race testing showed significant decreases of 12.4 percent in forced vital capacity (FVC), 9.5 percent in forced expiratory volume in one second (FEV1) 13.7 percent in peak expiratory flow (PF), and 28.4 percent in flow at 50 percent of FVC (MEF50). By 2.5 hours after the race lung function had improved. The reduction in flow rates after ultramarathon running may be due to airway obstruction. In contrast, the decrease in FVC with gradual recovery of lung function after rest and nourishment suggests the development of respiratory muscle fatigue.

Adult↗