Biomedical subjects
D M Goodenberger
Publications and source records attributed to D M Goodenberger.
Herpes simplex virus from respiratory tract secretions: epidemiology, clinical characteristics, and outcome in immunocompromised and nonimmunocompromised hosts.
PURPOSE: The purpose of this study was to review the course of patients with herpes simplex virus (HSV) recovered from respiratory tract secretions, and to compare the demographics, clinical characteristics, and outcomes of immunocompromised versus nonimmunocompromised patients. PATIENTS AND METHODS: Retrospective review of medical records of 42 consecutive patients who had respiratory tract cultures positive for HSV-1 between May 1988 and August 1990 at a major university-affiliated hospital. RESULTS: Twenty-seven patients (64%) were not immunocompromised. On the average, the nonimmunocompromised patients were 20 years older (mean age: 67 +/- 15, p = 0.001), had a higher incidence of tobacco smoking (p = 0.04), and were more frequently endotracheally intubated prior to HSV isolation (p = 0.002). Nonimmunocompromised patients more frequently had bronchospasm (44% versus 7%, p = 0.01), leukocytosis (16,400 versus 6,900/mm3, p = 0.001), and difficulty weaning from mechanical ventilation (63% versus 13%, p = 0.002). Mortality was also greater in the nonimmunocompromised group (70% versus 33%, p = 0.02). In addition, for survivors, days of mechanical ventilation (8 +/- 7 versus 2 +/- 4, p = 0.03), length of stay in the intensive care unit (10 +/- 8 versus 2 +/- 4 days, p = 0.004), and length of stay in the hospital (37 +/- 23 versus 16 +/- 14 days, p = 0.04) were all significantly longer for the nonimmunocompromised patients. CONCLUSION: These data suggest that HSV isolation from lower respiratory secretions is associated with a more severe presentation and a worse outcome in immunocompetent patients than in immunosuppressed patients.
A protocol for initiation of nasal positive pressure ventilation.
BACKGROUND: Respiratory failure related to neuromuscular weakness has commonly been managed with long-term ventilation by tracheostomy. Currently, nasal positive pressure ventilation is being used with success in this patient population. It has been suggested that initiation of nasal positive pressure ventilation is best done in an intensive care setting. METHOD: Nine patients were placed on nasal ventilation during a brief admission to a medical floor staffed by nurses trained in respiratory care. This process was facilitated by use of a standardized protocol for nursing staff that identified treatment objectives. RESULTS: Following the initiation of nasal positive pressure ventilation, this group of patients experienced near normalization of daytime measurements of partial pressure of arterial carbon dioxide, reported increases in daytime energy levels, and relief of nighttime signs and symptoms. These objectives were accomplished with no significant complications. Use of this protocol may also decrease length and cost of hospitalization and improve patient acceptance of noninvasive ventilatory assistance.
Successful discontinuation of ventilation via tracheostomy by substitution of nasal positive pressure ventilation.
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Use of indium 111-labeled white blood cell scan in the diagnosis of cytomegalovirus pneumonia in a renal transplant recipient with a normal chest roentgenogram.
Opportunistic infections are common in patients after renal transplantation. This report describes a case of cytomegalovirus pneumonia in a renal transplant recipient with a normal chest roentgenogram and normal arterial oxygenation. An abnormal 111In-white blood cell scan led to the discovery of a pulmonary source of his recurrent fevers.
Critical-care training for emergency medicine residency graduates.
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Early prehospital cardiopulmonary resuscitation.
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Cardiovascular collapse and pulseless idioventricular rhythm.
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Necrolytic migratory erythema without glucagonoma.
Two patients with clinical and histologic findings consistent with necrolytic migratory erythema are presented. Unlike previously described patients with this disorder, neither patient had substantially elevated glucagon levels nor an associated pancreatic islet cell tumor. The cause of the skin disease in these patients remains unknown but may be related to the underlying small-bowel disorder present in both.