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Biomedical subjects

D K Payne

Publications and source records attributed to D K Payne.

36 records · Page 2Linked to original sources
PubMed1992

The technique of occlusive-cuff impedance plethysmography. How to use this sensitive, noninvasive tool to detect proximal DVT.

Occlusive-cuff impedance plethysmography (IPG) is a rapid, reliable, and noninvasive method of diagnosing proximal deep venous thrombosis (DVT) in the lower extremities. The test is relatively easy to perform and carries an overall accuracy of greater than 90% when compared with venography. IPG is useful in detecting acute, symptomatic DVT and in determining the presence of recurrent DVT. In certain patients with nondiagnostic lung scans in whom pulmonary embolism is suspected, IPG may be helpful in determining appropriate therapy without use of pulmonary angiography.

Algorithms↗
PubMed1991

Respiratory syncytial virus infection among intubated adults in a university medical intensive care unit.

Respiratory syncytial virus is the major cause of lower respiratory tract infection in children. Adults who are immunocompromised, aged, institutionalized, and/or have underlying medical diseases may be at risk for severe RSV infection. Intubated adults in an MICU were evaluated for evidence of RSV infection. Respiratory secretions were analyzed by cell culture and RSV EIA. Serologic testing was obtained. Respiratory secretions from MICU personnel with acute respiratory symptoms and patients admitted for pneumonia, asthma, or COPD also were screened. Five of 11 intubated patients had evidence of RSV infection. One of seven MICU employees and four of 48 ward patients had RSV-positive respiratory secretions. During community outbreaks of RSV infection, adults admitted to an MICU already may be infected with RSV; those admitted for other reasons are at risk for nosocomial infection. Patients occupying other hospital units and personnel may be instrumental in the nosocomial dissemination of RSV.

Academic Medical Centers↗
PubMed1991

Treatment with acyclovir of varicella pneumonia in pregnancy.

Varicella pneumonia during pregnancy carries a significant mortality for both mother and fetus. The antiviral drug, acyclovir, appears to have decreased mortality in reported cases. We present a case report and review of the literature summarizing the experience to date with acyclovir in the treatment of varicella pneumonia during pregnancy.

Acyclovir↗
PubMed1990

Hypoxia/reoxygenation increases the permeability of endothelial cell monolayers: role of oxygen radicals.

We assessed the effect of hypoxia/reoxygenation on 14C-albumin flux across endothelial monolayers. Cultured bovine pulmonary artery endothelial cells were grown to confluence on nitrocellulose filters (pore size 12 microns). The endothelialized filters were mounted in Ussing-type chambers which were filled with cell culture medium (M 199). Equimolar amounts (33 nM) of 14C-labeled and unlabeled albumin were added to the "hot" and "cold" chambers, respectively. The monolayers were then exposed to successive periods (90 min) of normoxia (pO2 145 mmHg), hypoxia (pO2 20 mmHg), and reoxygenation (pO2 145 mmHg). A gas bubbling system was used to control media pO2 and to ensure adequate mixing. Four aliquots of culture media were taken during each period in order to calculate the 14C-albumin permeability across the endothelialized filter. In some experiments, either the xanthine oxidase inhibitor, oxypurinol (10 microM), or superoxide dismutase (600 U/mL), was added to the media immediately prior to the experiments. As compared to the normoxic control period, albumin permeability was 1.5 times higher during hypoxia (p less than 0.01) and 2.3 times higher during reoxygenation (p less than 0.01). The reoxygenation-induced increase in albumin permeability was prevented by either oxypurinol or superoxide dismutase. These data indicate that xanthine oxidase-derived oxygen radicals contribute to the hypoxia/reoxygenation-induced endothelial cell dysfunction. The altered endothelial barrier function induced by hypoxia/reoxygenation is consistent with the microvascular dysfunction observed following reperfusion of ischemic tissues.

Animals↗
PubMed1990

Tracheoesophageal fistula formation in intubated patients. Risk factors and treatment with high-frequency jet ventilation.

Two ventilator dependent patients developed tracheoesophageal fistulas. Their subsequent treatment using high frequency jet ventilation resulted in transient clinical improvement. Risk factors for the development of tracheoesophageal fistulas in intubated patients are discussed and preventive measures are outlined. High frequency jet ventilation may be useful in managing these patients by preventing death from respiratory failure and allows time for definitive therapy.

Adult↗
PubMed1990

Pulmonary fibrosis as the initial manifestation of scleroderma.

We report a patient who developed pulmonary fibrosis before the appearance of cutaneous scleroderma. This unusual clinical presentation has been infrequently reported in the English literature. Recognition that pulmonary disease may occur before extensive skin changes in scleroderma is important to ensure proper management.

Biopsy↗
PubMed1990

Catamenial hemoptysis: a case report and review of the literature.

A young woman with catamenial hemoptysis and pleuritic chest pain is reported. She had two living children and had undergone three abortions and a tubal ligation followed by menorrhagia and dysmenorrhea. Fiberoptic bronchoscopy revealed no abnormalities, but computed tomograms of the chest revealed bilateral lung densities, which waxed and waned during the menstrual cycle. When characteristic clinical and CT findings are present, bronchoscopy is not necessary for the diagnosis of pulmonary endometriosis.

Adult↗
PubMed1990

Esophageal perforation due to nasogastric intubation.

Esophageal perforation is a rare but catastrophic complication of nasogastric intubation. Diagnosis is frequently delayed, resulting in high mortality. We report a case of perforation due to nasogastric intubation in an otherwise normal esophagus. Patients at high risk of this complication can be identified, and special techniques can be used to avoid perforation. Percutaneous endoscopic gastrostomy is an alternative to nasogastric intubation for long-term enteral feeding. When nasogastric intubation is performed, clinical tests of tube position are not sufficient to guarantee proper tube position. The tip of the tube must be visualized radiographically in the stomach prior to initiation of tube feeding. When perforation does occur, proper management is often controversial. Therapy must be tailored to each individual case for the best possible outcome.

Aged↗
PubMed1988

Comparative permeability of canine visceral and parietal pleura.

To determine the permeability of canine pleural mesothelium, visceral and intercostal parietal pleura from mongrel dogs was carefully stripped from the underlying tissue and mounted as a planar sheet in a Ussing-type chamber. The hydraulic conductivity (Lp) was determined from the rate of volume flux in response to hydrostatic pressure gradients applied to either the mucosal or serosal surface of the pleural membrane. The diffusional permeability (Pd) of radiolabeled water, sucrose, inulin, and albumin was determined under equilibrium conditions from the unidirectional tracer flux. The Lp of the visceral pleura was 0.39 +/- 0.032 (SE) X 10(-4) ml.s-1.cmH2O-1.cm-2 and that Lp of parietal pleura was 1.93 +/- 0.93 X 10(-4) ml.s-1.cmH2O-1.cm-2 (P less than 0.001). The Pd of the visceral pleura ranged from 12.21 +/- 0.45 X 10(-4) cm/s for 3H2O to 0.34 +/- 0.03 X 10(-4) cm/s for [3H]albumin. The Pd of the parietal pleura for water and sucrose was similar to that of the visceral membrane, whereas its Pd for the larger inulin and albumin molecules was greater than that of visceral pleura (P less than 0.01). A spontaneous potential difference could not be detected across either membrane. The relatively higher parietal pleural Lp and Pd for larger solutes is probably due to the presence of stomata in this membrane. These results indicate that both the parietal and the visceral pleura are extremely permeable tissues which offer little resistance to water and solute flux.

Albumins↗
PubMed1987

Concentration dependence of protein permeability across the canine visceral pleura.

Water and protein movement across the pulmonary endothelial-visceral pleural membrane of spontaneously breathing anesthetized dogs was analyzed to determine if the protein concentration at the microvascular membrane (Cpro) influences microvascular permeability. The left lung was enclosed in a water-impermeable membrane, creating a visceral pleural space (VPS); fluid and solute fluxes were determined as the filtration or reabsorption of water and protein in the VPS. The plasma protein concentration was experimentally varied by plasmapheresis with saline replacement while the pleural fluid protein concentration was varied by introducing different concentrations of plasma mixed with saline into the VPS. Hydrostatic pressures were maintained within a physiologic range (pulmonary capillary pressure 12.1-16.1 mm Hg). The plasma protein concentration fell as low as 1.98 g/dl, and Cpro, calculated as the mean of the plasma and pleural fluid protein concentrations, ranged from 1.73 to 6.23 g/dl. The relationship between Cpro and the apparent homoporous diffusional permeability for protein (Phs), Phs(cm/sec X 10(-6] = 0.95 Cpro (g/dl) + 2.28, was highly significant (r = 0.87, P less than 0.01). In contrast, the hydraulic conductivity was not affected by a reduction in Cpro to this level (r = 0.21, P greater than 0.4). Although the solute concentration at the endothelial membrane should be considered when evaluating changes in protein permeability, under most experimental conditions the magnitude of this effect will be small.

Animals↗
PubMed1987

Unilateral absence of ventilation and perfusion associated with a bronchial mucous plug.

We have described a patient in whom loss of ventilation and perfusion of an entire lung resulted from mucous impaction of a major bronchus. Mucous plugging was associated with the combination of asthma and decreased cough effectiveness due to paraplegia. Removal of the obstruction by bronchial aspiration followed by vigorous pulmonary physical therapy resulted in return of both ventilation and perfusion to the lung and relief of dyspnea and hypoxemia.

Adult↗
PubMed1987

Influence of spirometry and chest roentgenography on the management of pulmonary outpatients.

Spirometry and chest roentgenography are frequently employed to evaluate patients with respiratory problems. To determine their impact on the management of outpatients with lung disease, both tests were performed on 100 consecutive patients (40 men and 60 women; mean age, 52 +/- 15 years) who returned for reevaluation 16 +/- 9 weeks after their previous clinic visit. Patients with obstructive (n = 45), restrictive (n = 35), and mixed (n = 20) lung diseases were initially assessed by history and physical examination and classified clinically as improved, stable, or worse. A clinical management plan (CMP) was formulated based on this initial evaluation. Changes in the proposed CMP due to spirographic or roentgenographic results were then noted. None of the 19 patients who were clinically improved and only two (3%) of the 64 clinically stable patients had a change in CMP. In contrast, five (29%) of the 17 patients whose conditions deteriorated clinically had their proposed CMP modified after review of the spirograms and roentgenograms. Therapy was intensified in three of the seven patients whose CMPs were modified, while in the other four, treatment was withheld because results of both tests were unchanged. These results indicate that routine spirograms and chest films have little influence on the CMP of clinically stable patients. However, unexpected roentgenographic and spirometric findings frequently alter the management of the individual whose condition has clinically deteriorated.

Adult↗
PubMed1985

Managing asthma and COPD in patients with cardiovascular disease.

Sideris et al followed 91 patients aged 25 to 82 (mean age 55) with respiratory failure due to severe asthma, emphysema, or chronic bronchitis. They found that patients with ventricular arrhythmias were significantly older than those without them. Although arrhythmias associated with myocardial infarction are managed primarily with drug therapy, those associated with acute respiratory failure respond best to adequate oxygenation and correction of metabolic and hemodynamic abnormalities.

Adult↗
PubMed1984

Adrenal insufficiency due to metastatic lung carcinoma and shown by abdominal CT scan.

Our patient's symptoms of adrenal insufficiency were the first evidence of recurrence of the primary tumor. The diagnosis of hypoadrenalism was established by the standard ACTH stimulation test. The elevated ACTH level provided corroborating evidence that this was primary adrenal insufficiency rather than secondary to hypothalamic-pituitary dysfunction. The CT scan of the abdomen then revealed bilateral adrenal gland enlargement as well as a less dense area in the spleen, both suggestive of metastatic disease. The CT scan has proven to be of value in diagnosing tumor involvement of the adrenal glands. The patient's response to hormonal replacement was both rapid and gratifying, and he was able to leave the hospital to resume his usual activities. The possibility of adrenal insufficiency should be considered in any patient with a history of carcinoma who has malaise, weakness, and weight loss. Adrenal insufficiency is a treatable condition, and treatment of it provides symptomatic relief that may increase the quality of life. As patients with cancer survive longer, this complication may be observed more frequently.

Adenocarcinoma↗
PubMed1984

Anticholinergics, cromolyn, and other occasionally useful drugs.

In asthmatics who are not controlled with beta-adrenergic agonists, theophylline and corticosteroids, the addition of anticholinergics may be beneficial. Cromolyn and the calcium-channel blocking agents are useful in preventing asthma attacks in some patients. Some other agents that have been proposed for the treatment of asthma are discussed briefly.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

Screening for anxiety and depression in women with breast cancer. Psychiatry and medical oncology gear up for managed care.

In this study, 275 women with breast cancer attending ambulatory breast cancer clinics in two sites were evaluated for psychological distress by using three self-report instruments: a visual analogue scale for psychological distress, the Hospital Anxiety and Depression Scale, and the Brief Symptom Inventory. Results suggest that significant psychological distress exists in ambulatory women with breast cancer; all three instruments effectively measured that level of distress. Implications for the use of these instruments in educating oncological staff members, documenting need for psychiatric services in a period of capitation, and providing quality assurance evaluations of psychiatric services are discussed.

Adaptation, Psychological↗