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Biomedical subjects

H G Colt

Publications and source records attributed to H G Colt.

51 records · Page 3Linked to original sources
PubMed1990

Fiberoptic bronchoscopy without premedication. A retrospective study.

The objective of this study was to determine if flexible FOB could be performed safely without premedication other than topical anesthesia. A total of 281 procedures performed during a 12-month period at a VA medical center were reviewed. Ninety-one procedures performed without premedication were compared with 190 procedures performed with premedication. Complications occurred in 5 percent of patients in each group. Statistical analysis revealed no significant differences in age, spirometry, P(A-a)O2 or SaO2 between both groups. Despite the proven safety of outpatient FOB without sedation, many bronchoscopists administer complicated premedication regimens and employ ambulatory surgery beds or recovery rooms to monitor patients before and after procedures. These results support a simplified approach to routine FOB which would include no premedications and greater use of outpatient facilities resulting in decreased expenditures without compromising patient care, safety or comfort.

Adult↗
PubMed1989

Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department.

To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED.

Attitude↗
PubMed1989

Drug-induced illness as a cause for admission to a community hospital.

To assess the rate of occurrence of drug-induced illness as a cause for admission to the general medicine service of a community hospital, charts were reviewed retrospectively of all patients admitted to the service over two randomly selected one-month periods. Statistical analysis was performed on patients over and under the age of 65, and on iatrogenic and noniatrogenic admissions. Twenty-three of 244 patients (9.4%) were admitted with drug-induced illness. Patients with drug-induced illness had 5.7 medications as compared to 3.2 medications per patient admitted for other reasons (P less than .05). A single drug was responsible for 61% of all drug-induced illness admissions. Aspirin and other nonsteroidal anti-inflammatory agents were most often implicated. Eighteen of 155 elderly patients (11.7%) were admitted with drug-induced illness. These patients were on an average of 6.3 medications as compared with 3.8 medications per elderly patient admitted for other causes (P less than .005). Polypharmacy and a preponderantly elderly population may explain the substantial number of admissions caused by adverse drug reactions. Further research to assess the role of patient age and the number and type of medications involved in the event of drug-induced illness requires standardization of definition and diagnostic criteria.

Adult↗
PubMed1988

Cholesterol emboli after cardiac catheterization. Eight cases and a review of the literature.

Cholesterol embolization is a puzzling event that may be increasingly iatrogenic in origin. Diagnosis is difficult and requires a high index of suspicion, an appropriate clinical picture, and usually, confirmation by biopsy. Certain laboratory abnormalities may be helpful; the elevated sedimentation rate and relative eosinophilia found in our patients concurs with other cases reported in the literature. Prognosis is related to the extent of systemic involvement, but renal disease is particularly threatening and gangrene and infection can be lethal. Multiple therapeutic regimens have been generally unsuccessful in altering the course of the disease process. The most significant impact on the disease can be made by its prevention. Cholesterol emboli occur spontaneously, but also after invasive aortic procedures such as diagnostic angiography or cardiovascular surgery. In addition, cardiac catheterization and percutaneous transluminal coronary angioplasty have the potential for arterial trauma and consequent cholesterol embolization. Although the apparent increasing numbers of cholesterol emboli may be a reflection of the increased use of arterial invasive procedures, they are being performed on an older, more severely ill population, with other risk factors for the development of embolic phenomena, i.e., age, smoking history, diabetes mellitus, hypertension, and peripheral vascular disease. Our observed cases and review of the literature do not furnish information concerning the comparative incidences of embolization as related to the suggested etiologies. Careful documentation of the clinical situation preceding the event, the type of procedure, the site of arterial entry, and the duration, difficulty, and extent of the intravascular invasion (i.e., above or below the left subclavian artery) are necessary for this purpose. Such data should help to develop guidelines for patient and procedure selection in order to minimize the possibility of cholesterol embolization.

Aged↗
PubMed1988

Bilateral renal cell carcinoma.

Renal carcinoma is frequently detected incidentally during abdominal ultrasound studies or computed tomographic scanning. Although clinical studies report bilateral tumors in fewer than 4 percent of patients with renal carcinoma, an autopsy study has shown a much higher incidence. Various surgical approaches are available.

Carcinoma, Renal Cell↗
PubMedDate not supplied

Double stents for carcinoma of the esophagus invading the tracheo-bronchial tree.

Extrinsic compression, neoplastic involvement of the trachea or left main bronchus, and esophago-airway fistula may cause airway obstruction and infection in patients with esophageal carcinoma. Further reduction of airway lumen may result from palliative treatment of dysphagia by radiation or esophageal stent insertion. In order to evaluate the extent of airway compromise, bronchoscopy was systematically performed in 39 consecutive patients with advanced carcinoma of the esophagus requiring esophageal endoprostheses. Airway obstruction observed in 10 patients (mean age, 60 years) resulted in the additional placement of a silicone stent in the trachea (five patients) or left main bronchus (five patients). Esophageal and airway procedures were performed under general anesthesia. All had squamous cell carcinoma of the middle third of the esophagus. Severe dyspnea at rest was documented in five patients prior to intervention. Esophago-tracheal fistula was present in five. Eight patients with associated, neoplastic invasion of the tracheo-bronchial tree required airway Nd:YAG laser therapy. The esophageal prosthesis contributed significantly to airway compromise in four patients. Symptomatic relief of dysphagia and dyspnea was obtained in all individuals. Mean survival was 121 days (range, 12 to 350 days). Complications were not serious, but included esophageal or tracheal stent migration in three patients.

Bronchial Diseases↗
PubMedDate not supplied

Necrotizing tracheitis caused by Corynebacterium pseudodiphtheriticum: unique case and review.

The occasional pathogenicity of nondiphtheria corynebacteria in both immunocompetent and immunocompromised individuals is now well established. Previously described sites of infection include heart valves, wounds, urinary tract, and lungs. This report of necrotizing tracheitis caused by Corynebacterium pseudodiphtheriticum illustrates the widening spectrum of infections caused by these organisms. A 54-year-old man developed respiratory distress and symptoms of upper airway obstruction unresponsive to inhaled bronchodilators, systemic corticosteroids, or intravenous erythromycin. A spirometry flow-volume loop demonstrated fixed upper airway obstruction. Fiberoptic bronchoscopic examination revealed a circumferential inflammatory process partially occluding the tracheal lumen. Gram staining revealed gram-positive rods typical of corynebacteria, and cultures of tracheal tissue yielded C. pseudodiphtheriticum resistant to erythromycin and clindamycin. There was no clinical or laboratory evidence for exotoxin or cell-associated toxins. Treatment with intravenous penicillin resulted in resolution of the inflammatory process and eradication of the organisms, as assessed by subsequent cultures.

Airway Obstruction↗
PubMedDate not supplied

Analysis of chronic obstructive pulmonary disease referrals for lung volume reduction surgery. The University of California San Diego Emphysema Treatment Group.

BACKGROUND: Preliminary results of lung volume reduction surgery (LVRS) for patients with severe emphysema are promising, although many issues regarding the selection process for LVRS are still unaddressed. For example, it is unclear which patients should be referred for pulmonary rehabilitation, lung transplantation, or LVRS, and whether health-care providers are optimizing conservative treatment options before referral for surgical intervention. The purpose of this analysis is to describe preliminary results of the evaluation process for LVRS implemented as part of an integrated, programmatic approach to the evaluation, treatment, and rehabilitation of patients with advanced emphysema. METHODS: The records of 105 consecutive patients with chronic obstructive pulmonary disease (COPD) referred for consideration for LVRS at the University of California San Diego Medical Center were reviewed. Results of prospective data collection pertaining to patient demographic, baseline dyspnea scores, and history of prior treatment, including pulmonary rehabilitation, were extracted. Patient disposition after the evaluation was noted. RESULTS: One hundred five patients (mean age 65 years, range 40 to 84 years) completed evaluation. Fifty-eight had never before participated in pulmonary rehabilitation, and 47 of these patients were eventually referred to a rehabilitation program. Fourteen patients were referred for consideration of lung transplantation, 25 were considered eligible for LVRS, 13 were still undergoing rehabilitation and surgical eligibility had not yet been determined, and 53 were ineligible for LVRS because patients had other illnesses (n = 34), did not meet radiological or physiologic criteria (n = 5), were considered too ill (n = 5), or were too healthy (n = 9) after rehabilitation to warrant surgical intervention. CONCLUSIONS: Lung volume reduction surgery is a surgical option to be considered within the framework of an integrated medical evaluation program that includes pulmonary rehabilitation. Pulmonary rehabilitation remains an often underused therapeutic alternative in patients with severe COPD. It has become the central component of our comprehensive management program for patients with severe dyspnea and deteriorating quality of life.

Adult↗
PubMedDate not supplied

Size matching in lung transplantation.

Volume concordance between donor lungs and the chest cavities of transplant recipients has important perioperative and postoperative implications. Between December 1987 and August 1991, 90 patients underwent lung transplantation in the Joint Marseilles-Montreal Lung Transplantation Program: 51 patients had double lung transplants, 19 patients had single lung transplants, and 20 patients had heart-lung transplants. There were 18 children (age range, 7 to 17 years) and 72 adults (age range, 18 to 58 years). Size matching was based on measurement of the submammary thoracic perimeter. Patient age (+/- 2 years) was also taken into consideration in children. Airway anastomoses were bronchial except for all heart-lung transplant patients and two double lung transplant patients, who had tracheal anastomoses. Occasional differences between donor and receiver bronchial diameters in children (greater donor size twice and smaller donor size once) required bronchoplasty in three instances. Healing was normal in these three instances, and no bronchial stenoses were noted. Performance of separate sutures rather than continuous running sutures on the cartilaginous anterior portion facilitated correction of airway diameter inequalities in adults. Excess volume was noted in three patients during closure of the thorax. In one patient, donor and recipient thoracic perimeters were similar. In two patients, however, donor size was greater by more than 20%. This was corrected by pneumoreduction with a surgical stapler. Lung size was decreased by 10% to 40% with use of this technique. Thoracic closure was facilitated and hemodynamic instability was thus corrected. No functional abnormalities were noted after surgery once the differences in lung size were corrected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

A "patient-like" nude mouse model of parietal pleural human lung adenocarcinoma.

Histologically intact human adenocarcinoma of the lung maintained in nude mice by serial subcutaneous transplantations (4 generations) was harvested and transplanted to the parietal pleura of 11 other nude mice via a novel thoracotomy procedure. Local and regional tumor growth of transplanted tumors occurred in all cases within 31 days, resulting in weight loss, decreased physical activity and death. This rapid-growth "patient-like" model of direct transplantation of a human neoplasm to the parietal pleura may facilitate basic research of pleural malignancies, and stimulate studies of pleural tumor response to cytotoxic treatment, biologic modifiers, and other modalities of treatment. and other modalities of treatment.

Adenocarcinoma↗
PubMedDate not supplied

Metastatic human pleural ovarian cancer model constructed by orthotopic implantation of fresh histologically-intact patient carcinoma in nude mice.

Pleural cancer is a frequently-occurring tumor that is generally refractory to therapy. Clinically-relevant animal models of human pleural cancer are greatly needed for testing experimental and standard treatments, as well as for understanding the clinical features of this disease. We report the first orthotopic transplant model for human patient pleural cancer. Fresh histologically-intact patient specimens of human pleural ovarian adenocarcinoma were implanted onto the visceral and parietal pleura of nude mouse. The human tumors grew locally and regionally mimicking the usual human clinical features of this disease. Moreover, only visceral pleural implantation subsequently involved mediastinal lymph nodes corroborating clinical observations suggesting that visceral pleural involvement in pleural cancer represents an advanced-stage disease. This model should facilitate basic research of pleural malignancies, and stimulate studies of pleural-tumor response to cytotoxic treatment, biologic modifiers, and other modalities of therapy.

Adenocarcinoma↗
PubMedDate not supplied

Clinical course of human epithelial-type malignant pleural mesothelioma replicated in an orthotopic-transplant nude mouse model.

Malignant pleural mesothelioma is an aggressive tumor that is essentially unresponsive to standard medical and surgical therapies. Little is actually known about its biologic response to therapeutic interventions, in part because of a lack of a "patient-like" animal tumor model. Most experimental models thus far have been derived from inhalation or inoculation of asbestos fibers into animal subjects or by subcutaneous transplantation of human mesothelial cell lines into nude mice. These models are not representative of clinical malignant pleural mesothelioma. In this report, an animal model of human pleural malignant mesothelioma obtained by orthotopic transplantation of intact pleural tumor tissue into athymic nude mice is described. Pleural tumor obtained by thoracolscopy from a patient with epithelial-type malignant pleural mesothelioma was implanted as intact tissue by surgical orthotopic implantation (SOI) into the right pleural cavity of nude mice. Animals were sacrificed when moribund or 6 months after implantation. Tumor growth and regional spread in the mice evaluated at post-mortem examination mimicked the clinical pattern of progression of human disease. Histologic findings and the immunohistochemical profile were similar to those demonstrated on examination of thoracoscopic parietal pleural biopsy specimens and post-mortem examination of the original patient's tumor. This "patient-like" nude mouse model of epithelial-type malignant pleural mesothelioma, phenotypically similar to the original human tumor, should facilitate future investigation of tumorigenesis and metastatic potential of this neoplasm. The model should serve as a basis for assessing the impact of experimental and existing therapy on malignant mesothelioma.

Adult↗
PubMedDate not supplied

Thoracoscopy: nursing implications for optimal patient outcomes.

Many patients who once were considered for open chest procedures now benefit from examination and treatment of pleural disease via thoracoscopy. The thoracoscopist enters the chest cavity through small incisions through the chest wall. Procedures are performed through a video assisted thoracoscope (much like a bronchoscope or endoscope). Wound care, maintenance of the chest drainage system, pain management and vigilant assessment of the cardiorespiratory system following the procedure are integral nursing interventions when caring for these patients.

Adult↗