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Biomedical subjects

D R Gracey

Publications and source records attributed to D R Gracey.

At least 37 records · Page 2Linked to original sources
PubMed1987

Respiratory failure in Lambert-Eaton myasthenic syndrome.

Five patients with the Lambert-Eaton myasthenic syndrome who required more than 48 hours of mechanical ventilation for respiratory failure are described. All five had small cell bronchogenic carcinoma. In one patient with associated chronic bronchitis, one with interstitial pulmonary fibrosis, and one other, respiratory failure requiring mechanical ventilation developed as a result of the Lambert-Eaton myasthenic syndrome. The two other patients had received muscle relaxant drugs, but the acute respiratory failure episode in one of the two was not clearly related to their administration. One patient had an initial response to plasmapheresis, which allowed assisted mechanical ventilation to be discontinued. This improvement was not sustained, and the patient subsequently died in respiratory failure. Three patients survived to be dismissed from the hospital after they were weaned from mechanical ventilation.

Aged↗
PubMed1985

Arterial oxygen values achieved by COPD patients breathing oxygen alternately via nasal mask and nasal cannula.

Ten patients with known but clinically stable chronic obstructive pulmonary disease (COPD) were studied while breathing low-flow (1-2 L/min) supplemental oxygen by nasal cannula and by biflow nasal mask. Although the increase in inspired oxygen when breathing with the cannula has been documented, the nasal mask has not been tested by measurement of PaO2 change. The mean age of the group was 64.6 years, and their mean PaO2 was 54 +/- 10.5 torr while they were at rest and breathing room air. Patients were each given oxygen alternately with the mask and cannula, with no change in flowrate; time was allowed between the two for equilibration and return to baseline values. PaO2 values were compared by t test for nonindependent samples, which provided a t value of 1.893, with P = 0.09. Differences in measured arterial saturation (SaO2) and PaCO2 also proved to be insignificant when patients breathed via the two devices. The conclude that the nasal cannula and the biflow nasal mask produce comparable PaO2 in patients who may need low-flow supplemental oxygen at rest. The mask can be considered an alternative oxygen appliance if preferred by patients because of comfort.

Masks↗
PubMed1984

Differential mechanical ventilation in respiratory failure due to severe unilateral lung disease.

Severe unilateral lung disease that produces respiratory failure may necessitate mechanical ventilatory support to sustain gas exchange. This article describes the successful use of differential lung ventilation in the management of one patient with diffuse unilateral pneumonia and another with a postoperative bronchopleural fistula after standard methods of mechanical ventilation failed to provide adequate gas exchange for these patients.

Adult↗
PubMed1984

Plasmapheresis in the treatment of ventilator-dependent myasthenia gravis patients. Report of four cases.

During a 42-month period, we used plasmapheresis to treat four cases of myasthenia gravis with refractory respiratory failure. All four patients were ventilator dependent for prolonged periods and were not responding to management with cholinesterase inhibitors and corticosteroids. All four patients rapidly responded to the plasmapheresis; respiratory muscle strength returned sufficiently to allow discontinuation of assisted mechanical ventilation and removal of the artificial airway. In our experience, plasmapheresis is indicated in the treatment of the myasthenia gravis patient with respiratory failure which is refractory to conventional drug therapy.

Adult↗
PubMed1984

Postoperative respiratory care after transsternal thymectomy in myasthenia gravis. A 3-year experience in 53 patients.

During a three-year period, 53 patients with myasthenia gravis underwent transsternal thymectomy by a partial sternum-splitting technique at our institution. This procedure was carried out (1) because an x-ray film or a computed tomography scan had suggested the presence of a thymoma or (2) to manage symptoms of myasthenia gravis. In 41 patients the endotracheal tube was removed in the post-anesthesia recovery room. The remaining 12 patients were extubated in the Respiratory Care Unit--in five, after prolonged mechanical ventilation. From our experience, the only factor useful for predicting the probable need for prolonged postoperative mechanical ventilation is the degree of bulbar involvement. Patients in Osserman classification groups 3 and 4 have an extremely high incidence of postoperative respiratory failure. Consideration should be given to the use of preoperative plasmapheresis in myasthenia gravis patients who have significant bulbar symptoms.

Adolescent↗
PubMed1983

Mechanical ventilation for respiratory failure in myasthenia gravis. Two-year experience with 22 patients.

We evaluated a 2-year experience involving 22 patients who required prolonged mechanical ventilation for respiratory failure associated with myasthenia gravis. The most frequent cause of respiratory failure was operation, and the most common type of procedure was thymectomy. Next in frequency as exacerbating factors were myasthenic crisis and cholinergic crisis. Of the 22 patients, 21 survived and were weaned from the ventilator after 1 to 32 days of respiratory support.

Adolescent↗
PubMed1982

Unexplained diaphragmatic paralysis: a harbinger of malignant disease?

The records of 103 male and 39 female patients with unexplained diaphragmatic paralysis were reviewed. A probable cause of the paralysis was not revealed by the initial history, physical examination, or review of plain chest roentgenograms. Paralysis occurred on the left in 82 patients (58%), on the right in 58 (41%), and bilaterally in two (1%). Initially, 64 patients (45%) had symptoms; dyspnea, cough, and chest wall pain were the most common. Long-term follow-up showed the best prognosis to be for patients with chest wall pain and cough (improvement in 82% and 78%, respectively); dyspnea improved in only 34% of patients with this complaint. Intrathoracic malignant lesions with phrenic nerve involvement were subsequently diagnosed in five patients (3.5%) and progressive neurogenic atrophy in one (0.7%). Roentgenographic follow-up showed return of normal diaphragmatic position in only 12 instances (9.2%). Patients with unexplained diaphragmatic paralysis are unlikely to have an underlying occult malignant or neurologic process, but recovery of diaphragmatic function is also unlikely and subsidence of related symptoms is variable.

Adolescent↗
PubMed1982

Respiratory failure in Guillain-Barré syndrome: a 6-year experience.

Seventy-nine patients with acute Guillain-Barré syndrome were seen during a 6-year period. Twenty-one were admitted to a respiratory intensive care unit, where they remained for 58 +/- 26 days (range 14 to 105 days). Thirteen patients required nasotracheal intubation followed by tracheostomy and mechanical ventilation. The tracheostomy tube was in place for an average of 50 +/- 27 days (range 10 to 104 days). Four patients had complications of tracheostomy; two of these were significant, and one of them led directly to the patient's death. There were no complications due to mechanical ventilation, from which 11 patients were successfully weaned after a mean period of 37 +/- 29 days (range 7 to 93 days). Three of the 79 patients (3.8%) died of complications of their disease or its treatment. Respiratory failure in this condition is protracted and its complications are mainly those of prolonged endotracheal intubation with a tracheostomy tube.

Adolescent↗
PubMed1981

Spontaneous rupture of the esophagus.

The records of all patients with spontaneous esophageal perforations who were examined between August 1966 and December 1978 were reviewed. Eleven patients (six men and five women) whose mean age was 62.8 years were treated during this period. Precipitating factors that contributed to perforation were identified in all patients. Ten patients had epigastric or low sternal pain. Chest roentgenograms were abnormal for all patients. Two patients were treated conservatively, and both died. Of the nine patients treated by thoracotomy, the two who were treated within 24 hours of perforation survived. Of the seven patients treated later than 24 hours, only three survived. Late treatment consisted of either primary closure or esophageal exclusion. Prompt surgical intervention remains the treatment of choice.

Adult↗
PubMed1979

Experimental squamous cell lung tumors in Sprague-Dawley and murine pneumonitis-free rats.

Squamous cell bronchogenic carcinoma was produced in 34% of a group of specific pathogen-free rats in a mean time of 139 days by the use of point-source irradiation. In a group of Sprague-Dawley rats, identical tumors developed in 54% of animals after an average exposure time of 147 days. This study was undertaken to clarify whether the bronchogenic squamous cell carcinomas produced by this method are due to the effects of the point source of irradiation alone or to the additive effects of irradiation and chronic murine pneumonitis. The results of this study in specific pathogen-free rats indicate that murine pneumonitis is not a prerequisite for the development of neoplasia by this method. The electron microscopic findings presented support the histologic diagnosis of a well-differentiated squamous cell bronchogenic carcinoma, similar in appearance to the tumor found in humans.

Animals↗
PubMed1979

Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease: a prospective study.

A group of 157 patients with chronic obstructive pulmonary disease who were treated before surgery using a standardized pulmonary preparation underwent physiologic assessment both before and after the prophylactic program. The postoperative course of each patient also was evaluated to assess the incidence of respiratory morbidity and mortality. Although many physiologic values were statistically improved after the pulmonary preparation, most of the changes are of doubtful functional significance. It is difficult to determine which patients will develop pulmonary complications not requiring mechanical ventilation, but the group requiring this type of support appears to be predictable on the basis of the severity of their pulmonary functional impairment and their lack of response to the standard pulmonary preparation used. The single most reliable test for this purpose was the mean forced expiratory flow during the middle half of the forced vital capacity. The frequency of postoperative respiratory complications was related to the type of operation, with the highest incidence occurring in the group that had extensive upper-abdominal surgery. While the occurrence of these complications was significantly reduced in patients undergoing a standard preoperative pulmonary preparation, the explanation for the beneficial effect of this procedure is not apparent.

Aged↗
PubMed1979

Electrophrenic respiration: report of six cases.

The development of electrophrenic respiration has permitted freedom from mechanical ventilation for patients who have irreversible respiratory failure in association with high-cervical spinal cord or brainstem lesions. There are three basic criteria for successful diaphragm pacing: (1) the need for long-term mechanical ventilatory assistance, (2) a functionally intact phrenic nerve-diaphragm axis, and (3) chest wall stability. Inability to achieve satisfactory pacing can be due to malfunction of equipment, instability of the chest wall, or inadequate neuromuscular responsiveness. These features of diaphragm pacing are exemplified in a series of six patients. Three achieved independence from mechanical ventilatory assistance with full-time phrenic pacing. In one patient, only limited electrophrenic respiration was achieved, and in another the method was entirely unsuccessful. Although functioning well, pacing systems were removed from the sixth patient because of infection. Diaphragm pacing can be a valuable form of respiratory support for carefully selected patients.

Adolescent↗
PubMed1978

Aspiration of intrathoracic abscess. Resultant acute ventilatory failure.

Three cases illustrate that acute respiratory failure may be precipitated by spontaneous drainage of lung abscess or pleural empyema intrabronchially with diffuse aspiration of the contents bilaterally. This condition is especially hazardous if the cavity is large and the patient is debilitated or obtunded. The acute onset may mimic aspiration of gastric contents. Immediate studies of tracheal aspirate and roentgenograms of the chest should define the aspiration of intrathoracic abscess contents as the cause of acute respiratory failure.

Acute Disease↗
PubMed1977

Right atrial myxoma with right to left shunting and mitral valve prolapse.

A 58 year old black man presented with progressive dyspnea and persistent systemic arterial hypoxemia. Initial hemodynamic evaluation revealed mitral valve prolapse and evidence for isolated right to left shunting, presumed to be extracardiac. A detailed pulmonary evaluation disclosed normal volume and flow parameters with a mild reduction of the single breath carbon monoxide diffusing capacity. An open lung biopsy disclosed no abnormalities. Radionuclide studies of the heart, however, suggested the possibility of a filling defect in the right atrium, and echocardiography enforced the impression of a mass in the right atrium, subsequently demonstrated by superior vena cava angiography. Our report outlines the use of multiple diagnostic tools in difficult situations and stresses the importance of right atrial myxoma in the differential diagnosis of isolated right to left shunting

Echocardiography↗