Biomedical subjects
F L Glauser
Publications and source records attributed to F L Glauser.
Comparative study of two hand-held respirators.
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Paraquat poisoning: an analytical toxicologic study of three cases.
Paraquat concentrations were measured in tissue, serum, urine and hemodialysate obtained from 3 patients who died 16.5 h, 22 days and 23 days after ingestion. In the patient who died 16.5 h post-ingestion, tissue paraquat levels were high. Kidney and liver had paraquat concentrations of 14 micrograms/g and 13.2 micrograms/g respectively, whereas lung tissue had a paraquat level of 3.8 micrograms/g. Low concentrations of paraquat were detectable in the tissues of the patients who died 22 and 23 days post-ingestion. Early in the poisoning, serum paraquat levels were high and large quantities of paraquat could be removed by both hemodialysis and forced diuresis. During an 8-h period, 713 mg of paraquat were removed by hemodialysis and 340 mg by forced diuresis. After the day of ingestion, little paraquat could be removed by hemodialysis or by forced diuresis; however, at all stages of the poisoning studied, hemodialysis was more effective than forced diuresis in removing paraquat from the blood.
Renal hemodynamics in drug-overdosed patients.
Effective renal plasms flow (ERPF) and glomerular filtration rate (GFR), as determined by a radioisotopic method, were evaluated in seven heroin-overdosage patients (Group I) and 7 hypnotic-sedative-analgesic overdosage patients (Group II). No patient had evidence of shock. There was no significant intergroup differences in PaO2, PaCO2, pH, blood pressure, pulse rate, respiratory rate, cardiac output, or serum creatinine levels. Group I patients had lower ERPF and GFR compared to Group II (271 +/- 182.8 vs. 580 +/- 62 cc/min and 62.4 +/- 32.6 vs. 102.9 +/- 12.8 cc/min, respectively, p less than 0.005). We conclude that compared to hypnotic-sedative-analagesic overdosed patients heroin overdosed patients heroin overdosed patients have more profoundly altered renal hemodynamics.
Post-extubation pulmonary function tests in detection of upper airway obstruction in drug-overdosed patients.
A relatively high percentage of hypnotic-sedative drug-overdosed (HSDO) patients suffer post-extubation upper airway obstruction. Since early detection and treatment of these lesions is desirable, we studied 20 recently extubated (within 24 hours) as well as 11 non-intubated HSDO patients employing flow-volume loops and spirometry. Abnormalities in tests for upper airway obstruction were common in both groups but only in the four post-extubation patients with clinically suspected upper airway obstruction was an inspiratory plateau by flow volume loops found. In addition, three of these four patients had mid-VC ratios greater than 1.25. We conclude that the Inspiratory flow volume loop and the mid-VC ratio may help in detecting post-extubation upper airway obstruction in lethargic, HSDO patients.
Hemoglobinemia in heroin overdose patients.
Four heroin-overdosed patients presented with coma, elevated serum enzymes (creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT), and increased levels of plasma free hemoglobin. In two patients marked myoglobinuria was also detected. The plasma free hemoglobin returned to normal levels by the 3rd hospital day. Since coma may eventuate in compression of muscles, we suggest that the disruption of erythrocytes occurs as they traverse these ischemic areas.
Fiberoptic bronchoscopic balloon occlusion and reexpansion of refractory unilateral atelectasis.
A new method using the flexible fiberoptic bronchoscope is described for the reexpansion of refractory unilateral lung or lobar atelectasis. The technique is well adapted for the critically ill ICU patient.
The effect of salicylate infusion on the alveolar epithelial membrane in the isolated perfused lung.
We observed two patients with aspirin (ASA) ingestion (blood levels of 87 and 56.5 mg/100 ml) who presented with noncardiogenic pulmonary edema (adult respiratory distress syndrome. To determine if ASA had a direct effect on the alveolar epithelial membrane, we established an in vitro isolated lung model and perfused it with platelet free plasma. T1/2 (in minutes), the time for 50% equilibration between the plasma and the saline filled lung, was determined before and after 500 mg salicylate infusion for various molecular weight dextrans. T1/2 decreased significantly (p less than 0.05) as follows: 3000 MW dextran, 2273 +/- 932 to 961 +/- 375; 40,000 MW dextran, 4059 +/- 1550 to 733 +/- 275; 70,000 MW dextran, 11,730 +/- 2750 to 7700 +/- 2230. Histamine levels in plasma and lung liquid did not change significantly with ASA infusion. We conclude that ASA directly increases alveolar epithelial permeability to dextrans less than 70,000 MW.
A rapid, simple technic for changing endotracheal tubes.
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Electrocardiographic abnormalities in acute heroin overdosage.
Twenty-one 25 acutely overdosed heroin addicts had abnormalities noted on their admission electrocardiograms. The most common findings were nonspecific ST-T changes in 17 patients, sinus tachycardia in 11, and left or right atrial enlargement in 8. Five patients had more serious arrhythmias (4 atrial fibrillation and 1 ventricular tachycardia). For the entire group the initial PaO2 was 74.8 +/- 48.2 torr. This degree of oxygenation was only achieved with the use of high dose supplemental oxygen. The 5 patients with the more serious arrhythmias had comparable PaO2s but this was only achieved with higher supplemental oxygen concentrations. We conclude that electrocardiographic alterations (other than arrhythmias) are very common in acute heroin overdosage and may be related to hypoxemia. The abnormal cardiac rhythms may be due to the direct effects of heroin or its metabolites. Heroin addiction is associated with a multitude of medical complications which can affect various organ systmes including the heart (1). Within the last six years several reports have appeared documenting electrocardiographic abnormalities in heroin users (2-5). These studies dealt with either a small series of patients or patients who used methadone or heroin in a chronic fashion. No one, to our knowledge, has extensively studied the electrocardiographic changes which occur in patients with acute heroin overdosage. This retrospective analysis of the electrocardiograms (ECG), arterial blood gases and selected electrolytes in 25 consecutively hospitalized patients acutely overdosed on heroin is an attempt to correct this deficiency.