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Biomedical subjects

F L Glauser

Publications and source records attributed to F L Glauser.

At least 55 records · Page 3Linked to original sources
PubMed1986

Prolonged isoflurane anesthesia in status asthmaticus.

We report a case of status asthmaticus that was unresponsive to the usual agents. The use of an inhalational anesthetic agent allowed us to ventilate the patient with lower inspiratory pressures; however, lasting improvement did not occur until she mobilized large quantities of secretions. To our knowledge, this is the first clinical report on the use of isoflurane anesthesia to treat severe asthma. Despite prolonged administration, there were no significant side-effects. This case demonstrates both the benefits and limitations of such therapy.

Adult↗
PubMed1986

Role of 5-HT2 receptor inhibition in pulmonary embolization.

We examined the role of serotonin at the 5-HT2 receptor site after pulmonary embolization for changes in hemodynamics, gas exchange, and lung water. Pulmonary embolization was induced using 0.75 gm/kg autologous clot in anesthetized artificially ventilated dogs. Pulmonary vascular resistance rose by 5 min from 3.4 +/- 1.5 to 14.2 +/- 2.1 mm Hg/liter/min (p less than 0.001), arterial oxygenation decreased from 91 +/- 5 to 68 +/- 5 mm Hg (p less than 0.01), platelet count decreased from 201 +/- 64 to 141 +/- 32 ml X 10(3), and the wet to dry weight lung ratio increased from 2.59 +/- 0.34 to 4.21 +/- 0.21 (p less than 0.001). Inhibition by ketanserin, a selective serotonergic inhibitor at the 5-HT2 receptor site substantially attenuated the increase in pulmonary vascular resistance from 3.6 +/- 1.4 to 8.0 +/- 2.5 mm Hg/liter/min, ablated the hypoxemia and platelet reduction and inhibited the formation of pulmonary edema. Infusion of serotonin simulated only some of the above changes as the pulmonary vascular resistance increased from 3.16 +/- 1.6 to 13.5 +/- 4.1 mm Hg/liter/min (P less than 0.01) and the oxygenation decreased from 96 +/- 5 to 57 +/- 4 mm Hg (P less than 0.01). Serotonin infusion, however, did not cause pulmonary edema. The administration of ketanserin ablated the increase in pulmonary vascular resistance and the hypoxemia following serotonin infusion. We conclude that following pulmonary embolization, serotonin at the 5-HT2 receptor is responsible for the fall in PaO2 and partially responsible for the increased pulmonary vascular resistance. Although ketanserin inhibits the formation of pulmonary edema following pulmonary embolization, serotonin does not seem to be directly responsible.

Animals↗
PubMed1985

The pulmonary hypertension of sclerosing agents is prevented by cyclooxygenase inhibitors.

Sodium morrhuate and sodium tetradecylsulfate are injected during endoscopic sclerotherapy to control variceal bleeding. When administered to sheep they cause transient pulmonary hypertension and increase protein poor lung lymph flow. To determine the etiology of these alterations, we studied three groups of sheep after establishing acute lung lymph fistulas. In Group 1, indomethacin or ibuprofen was infused. In Group 2, 2.5 cc of sodium morrhuate was injected alone (2A) or after indomethacin or ibuprofen pretreatment (2B). In Group 3, 2.5 cc of sodium tetradecylsulfate was given intravenously either alone (3A) or after indomethacin or ibuprofen (3B). When sclerosing agents were given alone (Group 2A and 3A) pulmonary artery pressures increased three-fold at 30 seconds postinjection to 37 +/- 4.4 and 39 +/- 5.7 mmHg respectively with a slow return to baseline over two hours. Lymph flow increased significantly from 1.3 +/- 1.5 to 2.7 +/- 1.5 cc/30 minutes after sodium morrhuate and from 1.2 +/- .62 to 2.7 +/- 1.7 cc/30 mins at 30 minutes after sodium tetradecylsulfate and the lymph/plasma albumin ratio fell. Increased lymph flow persisted through 120 minutes. In those animals receiving a sclerosing agent after indomethacin or ibuprofen (2B and 3B) there was no change in pulmonary artery pressure, lymph flow, lymph plasma albumin ratio, or lung wet weight to dry weight ratios. We conclude that the pulmonary hypertension and increased protein poor lymph flow are mediated by prostaglandins.

Animals↗
PubMed1985

Intravenous nitroglycerin-induced intracranial hypertension.

Nitroglycerin therapy can cause dose-related increases in intracranial pressure. Rare cases of neurologic sequelae attributed to nitroglycerin have appeared in the literature. We report such a case, in which symptoms completely resolved after cessation of nitroglycerin therapy. Widespread use of high-dose iv nitroglycerin makes knowledge of this effect important for all practitioners.

Female↗
PubMed1985

Treatment of theophylline toxicity with oral activated charcoal.

We treated 14 patients who had an initial serum theophylline concentration greater than 30 micrograms/ml (48.3 +/- 19.4 micrograms/ml) and symptoms of theophylline toxicity with oral activated charcoal (OAC). Thirty-gram doses of OAC were administered approximately every two hours for two to four doses. Ten patients tolerated OAC and demonstrated a reduction in theophylline half-life to 5.6 +/- 2.5 hours with resolution of symptoms. Three of these ten patients were treated in the emergency department and discharged, making hospitalization unnecessary. The four patients with the highest initial theophylline concentrations (76.6 +/- 17.7 micrograms/ml) vomited all doses of OAC. Three of these four patients were treated with charcoal hemoperfusion with a reduction in the half-life to 5.2 +/- 1.0 hours. These data support the use of OAC as the primary therapeutic modality in the management of patients with theophylline toxicity. Patients with very high theophylline concentrations (greater than 50 micrograms/ml), however, usually vomit the OAC and may require charcoal hemoperfusion.

Administration, Oral↗
PubMed1985

The uncertain role of the neutrophil in increased permeability pulmonary edema.

The intrapulmonic accumulation of neutrophils is a relatively common finding in certain animal models of increased permeability pulmonary edema and in humans with the adult respiratory distress syndrome. The release of toxic oxygen radicals from these cells can result in acute lung injury. Whether these cells mediate the increased permeability in all models of increased permeability pulmonary edema remains controversial. This review will examine the role of the neutrophils in various models of increased permeability pulmonary edema.

Animals↗
PubMed1985

A comparison of physiological responses to percussive brain trauma in dogs and sheep.

Physiological variables were monitored in dogs and sheep after exposure of the brain to a pressure wave produced by a fluid-percussion device. Mean systemic arterial pressure (SAP), mean pulmonary arterial pressure (PAP), and pulmonary wedge pressure (PWP) were recorded prior to and following trauma. Lung lymph flows (QLYM) were measured prior to and for 2 hours after trauma. Plasma catecholamine levels were quantitated prior to and at 30 seconds following trauma. In 16 dogs, SAP increased from 123 +/- 14.6 to 254 +/- 60.8 mm Hg (p less than 0.0001), PAP increased from 17 +/- 4.4 to 27 +/- 10.8 mm Hg (p less than 0.05), and PWP increased from 4 +/- 2.4 to 15 +/- 8.8 mm Hg (p less than 0.0001), all at 30 seconds posttrauma. All pressures returned to near baseline values within 6 minutes. The QLYM from the right lymph duct in 12 dogs increased from 0.82 +/- 0.77 to 2.7 +/- 2.1 and 1.88 +/- 1.82 ml/30 min, respectively, at 30 and 120 minutes. In five dogs the plasma concentrations of dopamine, epinephrine, and norepinephrine increased from 234 +/- 98 to 1906 +/- 1384, 609 +/- 641 to 19,813 +/- 10,234, and 388 +/- 194 to 3223 +/- 992 pg/ml, respectively (all p less than 0.01). In sheep there were no changes in SAP, PAP, PWP, QLYM, or catecholamine levels in response to percussive wave trauma up to 10 atm. Ratios of lung tissue water to dry weight were not significantly different from control animals in either species. The authors conclude that in dogs there is a profound sympathetic discharge resulting in dramatic elevations in plasma catecholamines, systemic and pulmonary artery hypertension, and an increase in pulmonary lymph flow. Sheep fail to demonstrate changes in any of these variables after severe percussive wave brain trauma.

Animals↗
PubMed1984

Different humidification systems for high-frequency jet ventilation.

This study examined the effect of several different high-frequency jet ventilation (HFJV) humidification techniques on tracheobronchial mucosa. Six groups (2 in each group) of mongrel dogs, chronically instrumented, were cared for in an intensive care-like setting for data acquisition. Four groups received HFJV with different humidification systems during 72 h of continuous ventilation. Two groups served as controls (conventional ventilation with and without humidity). Although there was significant damage to tracheal mucosa during ventilation without humidification, there were no significant pathologic differences in bronchial mucosa between humidified and nonhumidified groups. Several techniques of HFJV humidification produced no pathologic evidence of mucosal damage and could be clinically useful.

Animals↗
PubMed1984

Methylmethacrylate induces pulmonary hypertension and increases lung vascular permeability in sheep.

Methylmethacrylate (MMA) is a bone cement used to attach prosthetic joints to raw bone surfaces. Occasional reports of pulmonary complications following total hip replacement suggest that MMA may induce pulmonary microvascular abnormalities. We studied the hemodynamic and pulmonary edemagenic effects of 2 mg/kg and 12 mg/kg MMA in 23 sheep. After the 12 mg/kg dose there was a marked fall in mean systemic blood pressure (SBP) within 30 s from 92 +/- 7 to 59 +/- 3 mmHg (p less than 0.05). The SBP returned to normal and then decreased, again becoming significantly lower than baseline at 120 min. Mean pulmonary artery pressure (PAP) increased from 16.8 +/- 1.2 to 27.0 +/- 1.5 mmHg at 0.5 min (p less than 0.01 then slowly returned to normal over 1 h. Despite the transient changes in pulmonary hemodynamics, baseline lymph flow (QL) doubled at 30 min and tripled at 120 min to 3.0 +/- 0.4 and 4.4 +/- 0.6, respectively (p less than 0.01). Lymph/plasma ratio for albumin was 0.83 +/- 0.03 at baseline and was unchanged throughout the study. Lung tissue water/blood free dry weight ratio was 5.4 +/- 0.4 compared to 3.6 +/- 0.3 for normal sheep (p less than 0.05). After the low dose there was no change in SBP or PAP, and QL only doubled (1.0 +/- 0.3 to 2.3 +/- 0.7). The L/P albumin was unchanged. We found no evidence of polymorphonuclear leukocyte (PMN) trapping in the pulmonary parenchyma by lung biopsy or by counts of PMNs in pulmonary artery and aortic blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Gamma scintigraphic analysis of albumin flux in patients with acute respiratory distress syndrome.

Computerized gamma-scintigraphy provides a new method for the analysis of albumin flux in patients with pulmonary permeability edema. In this technique, 10 mCi of 99mTc -tagged human serum albumin is administered and lung:heart radioactivity ratios are determined. This ratio remains constant unless there is a leak of albumin, when a rising ratio with time, called the "slope index" (SI), is seen. Thirty-five scintigraphic studies were obtained in 28 patients by means of a portable computerized gamma-camera. Thirteen of these patients had clinical evidence of the acute respiratory distress syndrome (ARDS) and six had or were recovering from left ventricular induced congestive heart failure (CHF). Five of the patients with CHF and pulmonary capillary wedge pressure (PCWP) below 30 mm Hg had normal scintigraphic studies. One patient in florid CHF with a PCWP of 40 mm Hg had a positive SI of 1.6 X 10(-3) U/min. The patients with ARDS were found to have significantly higher SIs than patients who did not have, or had recovered from, ARDS. The arterial:alveolar oxygen tension ratio (a/A)O2 was 0.30 +/- 0.14 in patients with positive SIs while receiving 11.0 +/- 6.8 m H2O positive end-expiratory pressure (PEEP). Both the (a/A)O2 and level of PEEP were significantly (P less than 0.01) worse in these patients than in patients with normal SIs. Positive SIs were present from 1 to 8 days following the apparent onset of ARDS in seven studies in five patients. Recovery of gas exchange was associated with a return to a normal SI in four patients. In conclusion, computerized gamma-scintigraphy was a sensitive, noninvasive tool for the detection of a pathologic increase in pulmonary protein flux. Positive scintigraphic findings were associated with significantly impaired gas exchange. The method documented that the leak of albumin in patients with ARDS may last for days but resolves with recovery.

Evaluation Studies as Topic↗
PubMed1983

Foreign body granulomatosis. Clinical and immunologic findings.

We studied the clinical and immunologic features of 10 patients with foreign body granulomatosis associated with injection of pentazocine. Five had typical micronodules on chest radiographs, 9 had abnormal 67Ga lung images, and 9 had elevated serum angiotensin-converting enzyme levels. Pulmonary function tests showed significant decreases in diffusing capacity in 8 subjects, but were otherwise normal. Bronchoalveolar lavage fluid had significantly (p less than 0.02) increased total cell numbers (13.8 +/- 7.5 x 10(7) and significantly lower percentages of lymphocytes (2 +/- 1) and neutrophils (2 +/- 1) (p less than 0.02) when compared with that from control subjects. Peripheral blood lymphocytes were normal when expressed as percentages of total leukocytes or as percent T-lymphocytes. Monoclonal antibody determinations of T-lymphocyte subsets (helper and suppressor) were similar to those in control subjects (p = NS). Lymphocyte transformation responses to a variety of antigens and skin test reactivity were normal. Foreign body granulomatosis contrasts with other interstitial lung diseases in its bronchoalveolar lavage cellular profile and in the absence of altered peripheral immunologic indexes.

Adult↗
PubMed1983

Acute respiratory failure after sodium morrhuate esophageal sclerotherapy.

Two of 30 patients with esophageal varices had respiratory distress develop within 8-24 h of esophageal sclerotherapy. Evidence of aspiration and sepsis were absent in these two patients with the clinical picture of adult respiratory distress syndrome. To investigate the possible etiologic role of sodium morrhuate in this syndrome, a sheep model was established and pulmonary hemodynamics, lung lymph flow, and albumin concentration were measured before and after the intravenous injection of 2.5-15.0 cm3 of sodium morrhuate. In all 8 animals studied, mean pulmonary artery pressures increased from 11.6 +/- 2.8 to 32.8 +/- 4.9 mmHg (p less than 0.01) 30 s after injection. These pressures returned to baseline values over 120 min. Lymph flow increased from 0.91 +/- 0.89 to 2.8 +/- 1.5 ml/30 min at 90 min postinjection (p less than 0.05) and returned to baseline values in animals monitored for 6-8 h. The lymph/plasma albumin ratio decreased from 0.856 +/- 0.08 to 0.74 +/- 0.01 (p less than 0.05) 120 min postinjection. Pulmonary edema was not evident histologically or gravimetrically (wet/dry weight ratio was 3.65 +/- 0.3 and not different from normal). It was concluded that sodium morrhuate injection in sheep causes marked but transient pulmonary hypertension associated with an increased lymph flow of relatively protein-poor lymph. Sodium morrhuate esophageal sclerotherapy may affect pulmonary hemodynamics and contribute to respiratory difficulties in patients.

Animals↗
PubMed1982

Significance of the pulmonary artery diastolic-pulmonary wedge pressure gradient in sepsis.

An initially widened pulmonary artery diastolic-pulmonary wedge pressure (PAD-PWP) gradient greater than 5 mm Hg has been reported to be associated with an 83% mortality rate in septic patients. To confirm and extend these observations, we retrospectively reviewed the charts of 47 septic patients. The patients were divided into 2 groups: group 1-12 patients who never had an abnormal gradient during their hospital course, and group 2-35 patients who had an abnormal gradient sometimes during their course. There were no hemodynamic differences. However, the mortality rate in group 2 patients was significantly higher than in group 1 patients (60% vs 25%, p less than 0.01). In patients with an initial gradient, the mortality rate was 61% which is not significantly different than the 83% previously reported. In patients with a persistent or increasing gradient before death or the resolution of sepsis, the mortality rate was 91%. We conclude that although an initial PAD-PWP gradient in patients with sepsis is associated with a high mortality, a much more sensitive indicator is whether the gradient increases or persists over time. There is a 91% mortality in patients with persisting or increasing gradients.

Adult↗
PubMed1982

Indomethacin blunts ethchlorvynol-induced pulmonary hypertension but not pulmonary edema.

Ethchlorvynol (10 mg/kg) causes transient pulmonary hypertension and an increased permeability pulmonary edema in sheep. To determine the role of cyclooxygenase and its metabolites, histamine, and catecholamines in both phenomena, we studied five groups of sheep: group I, placebo; group II, ethchlorvynol; group III, indomethacin with ethchlorvynol; group IV, diphenhydramine with ethchlorvynol; group V, phentolamine with ethchlorvynol. Indomethacin, but not diphenhydramine or phentolamine, blunted the pulmonary hypertensive response seen immediately following the ethchlorvynol injection. However, none of the drugs had any effect on the increased permeability pulmonary edema. We conclude that cyclooxygenase or its metabolites partially mediates the hypertensive response but not the increased permeability pulmonary edema seen in sheep following ethchlorvynol injection.

Animals↗
PubMed1982

Talc granulomatosis: laboratory findings similar to sarcoidosis.

We studied 6 men who had some combination of dyspnea, abnormal chest radiographs, resting increased alveolar-arterial oxygen gradients, noncaseating granuloma by lung biopsies, increased serum angiotensin-converting enzyme concentrations, positive gallium lung scans, and increased lymphocyte counts by bronchoalveolar lavage. Our patients were suffering from talc granulomatosis secondary to the intravenous injection of suspended, crushed pentazocine tablets. In addition to the above findings, bronchoalveolar lavage revealed birefringent intracellular and extracellular particles consistent with talc. We conclude that talc granulomatosis can mimic the laboratory findings of pulmonary sarcoidosis, but the findings of birefringent particles in the bronchoalveolar lavage fluid by polarized microscopy is a simple laboratory method for confirming a clinical diagnosis.

Adult↗