Biomedical subjects

D S Pratt

Publications and source records attributed to D S Pratt.

49 records · Page 3Linked to original sources

PubMed1985

A role for the respiratory therapist in flexible fiberoptic bronchoscopy.

UNLABELLED: All bronchoscopies in our institution are performed by physician-respiratory therapist teams. The therapist instructs the patient, anesthetizes him, does the biopsies, and prepares specimens for laboratory testing. METHODS: We undertook a retrospective study of our performance to evaluate the safety, yield, and cost of this system. RESULTS: Of 216 procedures evaluated, therapist-performed biopsies provided a specific diagnosis in 55%. When a tumor-like mass was seen directly, biopsies were positive 95.7% of the time. No procedure was associated with death. Complications included fever in about 9%, hoarseness in 2%, hemoptysis in 1%, and pneumothorax in one procedure (0.5%). Our institutional costs for flexible fiberoptic bronchoscopy by a physician-respiratory therapist team were only 34% of what they would have been if the same procedures had been performed in the operating room. RESULTS performed were comparable to all others reported in the literature. CONCLUSION: This study clearly demonstrates that respiratory therapists can provide high quality, low cost, safe bronchoscopic assistance to pulmonary internists.

Bronchoscopy↗

PubMed1984

Prolonged high-frequency jet ventilation.

A 26-yr-old woman with bilateral staphylococcal pneumonia developed respiratory failure. Conventional ventilation failed and high-frequency jet ventilation (HFJV) was successfully instituted. Bronchopleural fistulas required prolonged (73 days) support with HFJV. A bronchoscopy performed after 37 days of mechanical support showed no abnormalities. Computed tomography (CT) of the chest demonstrated severe cystic abnormalities. Pulmonary function tests performed 1 and 6 months after recovery showed small-airway dysfunction. HFJV proved safe for prolonged use.

Adult↗

PubMed1984

Foreign body aspiration associated with the use of an aerosol inhaler.

A 51-yr-old asthmatic carpenter aspirated a penny using a hand-held, self-pressurized aerosol device. The penny was extracted using a fiberoptic bronchoscope. Because no similar instances are reported in the medical literature, experimental systems were designed to test the likelihood of this event happening with a variety of nebulizers. Nickels , dimes , and pennies were tested for ejection potential and for aspiration likelihood. All inhalers, excepting that designed for Intal, were capable of accommodating dimes and pennies and ejecting them down simulated airways during inspiration. Nickels were accommodated by several inhalers but were not ejected during conventional inspiratory volumes and pressures.

Aerosols↗

PubMed1980

Enhanced thrombin and plasmin activity with exercise in man.

We measured products of thrombin and plasmin action and of the platelet release reaction during exercise to determine if the well-known effect of exercise on in vitro coagulation and fibrinolytic tests reflects activity of these systems in vivo. Plasma fibrinopeptide A, produced by thrombin-mediated proteolysis of fibrinogen, increased with graded treadmill and cycle exercise to postexercise levels of 20--30 times resting values. Fibrin/fibrinogen-related D antigen increased in a similar fashion with peak levels at maximal O2 uptake. Plasma-activated partial thromboplastin times fell as fibrinopeptide A levels increased. Unheated fibrin plate lysis areas increased as D antigen concentrations rose, indicating increased release of plasminogen activator. In contrast to activation of the soluble coagulation and fibrinolytic systems, platelet counts and plasma levels of beta-thromboglobulin, a platelet release protein, did not change significantly with exercise. The effect of exercise on thrombin and plasmin was not influenced by prior physical training, but appeared to be less with cycle exercise than with treadmill exercise.

Blood Coagulation↗

PubMed1979

The use of fluorescent labeled antigen to follow the fate of instilled immune complexes in the rabbit lung.

To follow the fate of exogenously introduced immune complexes in the rabbit lung, a direct labeling method was devised. Bovine serum albumin was incubated with fluorescein isothiocyanate, washed and then bound at equivalence with antibovine serum albumin. Immune complexes thus prepared are injected into a rabbit airway and the animal was sacrificed. Using chilled alcohol fixative and paraffin embedding 4 micrometer sections were prepared for light and fluorescent microscopy. This technique readily verifies that labeled antigen is taken up by alveolar macrophages. Electron microscopy using ferritin-antiferritin complexes corroborate these light findings.

Animals↗

PubMed1979

Exercise-induced anaphylactic reaction to shellfish.

The syndrome of immediate type I food hypersensitivity, mediated by tissue-bound IgE antibody and mast cell histamine release, is well recorded in the medical literature. This case study represents a previously undescribed late food hypersensitivity, induced only by strenuous exercise. Identification of this new syndrome illustrates classical epidemiologic analysis, improves medical advice for the allergic and athletically inclined, and raises new questions in the areas of allergy and immunology.

Adult↗

PubMed1979

Rapidly fatal pulmonary fibrosis: the accelerated variant of interstitial pneumonitis.

We sought to explore immunological factors in patients who died with rapidly fatal fibrosing lung diseases (Hamman-Rich syndrome). A retrospective review of cases of interstitial lung disease showed 12 recent deaths from Hamman-Rich syndrome. The mean age was 62, men outnumbering women 3 : 1. Five patients had proved collagen vascular disease (rheumatoid arthritis three, lupus two). Four others had a history of allergic disorders, syphilis, chronic eosinophilia, or hypersensitivity reactions. One patient showed disappearance of immunofluorescence as fibrosis advanced, which has not previously been reported. The study suggests a possible aetiological link between disorders of immunity and Hamman-Rich syndrome. The evidence also supports the notion that Hamman-Rich syndrome is an accelerated variant of the more indolent interstitial pneumonias.

Adult↗

PubMed1979

Circulating immune complexes in pulmonary eosinophilic granuloma.

We analyzed serum from six patients with pulmonary eosinophilic granuloma for the presence of circulating immune complexes. These levels were correlated with the pulmonary histopathology and immunofluorescence findings. Levels of circulating immune complexes were elevated in five subjects. All of the subjects had an active cellular histology. Immunofluorescent studies showed granular deposits of IgG and complement (C3) in alveolar walls and blood vessels in all five patients. One subject had no detectable circulating immune complexes and showed a predominantly fibrotic pattern by light microscopy. In addition, immunofluorescence in this patient also showed no immunoglobulin or complement deposition within the lung tissue. These findings show that circulating immune complexlike activity is present in patients with cellular disease and suggest that their formation or deposition, or both, may contribute to the pathogenesis of pulmonary eosinophilic granuloma.

Adult↗

PubMed1978

Successful treatment of Brucella melitensis end-carditis.

Brucella endocarditis is a rare, but often fatal, complication of brucellosis. A 32 year old man acquired brucellosis while on a visit to his former home in Greece and presented six months later with malaise, fever and aortic regurgitation. Blood cultures grew Brucella melitensis biotype 1. Combined chemotherapy with streptomycin, tetracycline and rifampin sterilized his blood; however, his aortic valve was replaced owing to recurrent emboli and cardiac failure. Over the next 18 months the patient's antibody titer to Brucella fell and his blood reamined sterile. Cure was achieved by resection of the infected aortic valve and 10 weeks of bactericidal therapy for B. melitensis.

Adult↗

PubMed1978

Diagnosis of a thoracic inlet tumour by transbronchial biopsy.

A 67-year-old man presented to the pulmonary service with left shoulder and arm pain. Examination disclosed a left Horner's syndrome. Supraclavicular exploration at another hospital was not helpful. Transbronchial biopsy through a flexible fibreoptic bronchoscope retrieved tissues showing poorly differentiated carcinoma. There are no previous reports of the use of the technique in the diagnosis of a Pancoast tumour with a normal standard chest radiograph.

Aged↗

PubMed1978

Immunofluorescent patterns in the idiopathic interstitial pneumonias.

Immunologic mechanisms have been implicated in the pathogenesis of the IIP's. Thirty five patients with IIP were divided into three groups: group I, seven subjects with DIP; group II, thirteen with UIP; and group III, fifteen with mural fibrosis. Lung biopsies were exposed to fluorescein-conjugated antisera to IgG, IgA, IgE, IgM, C3, fibrinogen, and albumin. In group I, all patients demonstrated IgG and C3 in a granular pattern lining alveolar walls. Similarly, in group II, all had IgG and 10 had C3 within alveolar walls. In contrast, only two group III subjects demonstrated IgG and none C3. Only one of 19 control subjects hav alveolar wall immunoglobulin and C3 deposition. The incidence of positive rheumatoid and antinuclear factors was similar in all three study groups. These data suggest that immune complex deposition may play a role in the pathogenesis of the cellular interstitial pneumonias and that once mural fibrosis supervenes, these complexes are no longer present.

Adult↗

PubMedDate not supplied

Feed-associated respiratory illness in farmers.

A variety of respiratory hazards are present in the farm environment. Disorders such as Silo Filler's Disease and Farmer's Lung Disease have been detailed in the literature. A retrospective study of hospital visits for farm-associated lung injury in rural Otsego County, New York during an 11-yr period is reported herein. Twenty-two males and 1 female experienced a total of 26 episodes of illness. Eighty-four percent of the episodes occurred between July 1 and October 31. Four of the 23 individuals died, 2 acutely and 2 after a slowly progressive, debilitating disease. One patient died of suffocation in a silo; 2 patients had Silo Filler's Disease, 1 dying acutely. Of 6 patients with Farmer's Lung Disease, 2 died of progressive fibrosis. The remaining 14 patients suffered an acute febrile illness typified by short duration, clear chest radiograph, and negative serologies. We refer to this as "Silo Unloader's Syndrome" and conclude that it is a more common occurrence in the farm environment than some of the more known disorders. This study demonstrates that occupational lung injury is a problem affecting a young (average age 36 yr) vigorous population with potentially fatal consequences.

Adolescent↗

PubMedDate not supplied

Reported frequency of dairy farm-associated health hazards, Otsego County, New York, 1982-1983.

We surveyed a self-selected sample of dairy farm owners/residents to determine the feasibility of establishing a surveillance system that would identify health risks common to this type of farming activity. Data obtained included demographic characteristics of the farm families, number of milk cows, prevalence of selected respiratory diseases, and farm-related injuries among farm owners. Despite a low overall response rate (45 percent), farm owners/residents reported a higher prevalence of respiratory conditions than that of the United States as a whole. Male farm owners were less likely to smoke than U.S. white males as a whole. The number of farm owners reporting farm-related injuries during a one-year period (9 percent) was similar to previous reports.

Animals↗