Biomedical subjects
Publications and source records attributed to J Chalon.
A scaled-down version of a modified adult circle system capable of increasing normal humidity output 300% was constructed for pediatric use. The moisture content of the gases leaving the system was tested and found to be superior to that of any pediatric circle system commercially available that does not incorporate an electrically heated water vaporizer.
Allegedly toxic heme pigments have been described in the serum of animals bled to hemorrhagic shock (5,7). In addition, Sears et al. (9), and Braun et al. (1) have shown that the products derived from the degradation of hemoglobin following intravascular hemolysis were toxic (heme carried by hemopexin and albumin). The accumulation of metabolites, caused by the impeded circulation, degrades free hemoglobin into heme pigments and their concentration then reaches a level which exceeds the normal heme-carrying capacity of serum proteins. We have already demonstrated the presence of abnormal heme pigments in clinical cases of shock using scanning spectrophotometry (3). We have endeavored to identify these pigments by serum electrophoresis, and to relate the appearance of some of these compounds to mortality rates. There were no deaths associated with the presence of haptoglobin-hemoglobin alone in serum. As shock deepened and mortality rose, hemopexin-heme and methemalbumin appeared. The highest mortality rate (4 out of 5 cases) was found when both hemopexin-heme and methemalbumin were present. It appears, therefore, that the administration of serum proteins in shock may reduce the toxicity of the products of degradation formed in low-flow states.
Explore the source record for details and available documents.
Inverse correlations were established between the percentage of iron-laden macrophages (heart-failure cells), found in the sputum of patients with various types of heart ailment, and cardiac index. Less than 2% iron-laden macrophages were seen when cardiac index was in the region of 3 liter/min/sq mm of body surface area (BSA). This fraction increased to approximately 75% when the cardiac index attained 1 liter/min/sq mm of BSA. Since there was noticeable heterogeneity of data when the cardiac index was below 3 liters/min/sq mm of BSA and above 1 liter/min/sq mm of BSA, it was concluded that a second factor was probably at play: this was the degree of activity of the reticuloendothelial system of the subjects concerned.
Histiocytes counted in smears made from the tracheobronchial washings of 208 patients with malignant melanomas were found to be 3.12 times more numerous than in a control group comparable in sex, age (decades), and smoking habit but without any type of prediagnosed malignant lesion. The discovery of this phenomenon may lead to the development of a new method for the evaluation of therapeutic methods in patients with melanotic lesions. It may open novel pathways for the investigation of cell-mediated immunity in patients with certain forms of malignant disease.
Significantly elevated numbers of iron laden histiocytes have been shown to appear in the tracheobronchial secretions of subjects in hemorrhagic shock and in patients undergoing open heart-surgery during cardiopulmonary bypass (3,4). Abnormal heme pigments have also been demonstrated in the serum of dogs bled to hemorrhagic shock (6) and have been felt to be toxic. Because the ingestion of abnormal heme pigments by histiocytes may be part of a defense mechanism, we have attempted to correlate the percentage of iron laden histiocytes found in the tracheobronchial secretions of patients in hemorrhagic shock (Prussian blue method) with the presence of degradation of products of hemoglobin found in their serum by scanning spectrophotometry. There were, generally speaking, few iron laden histiocytes when hemoglobin degradation was advanced, and always numerous iron laden histiocytes when abnormal heme pigments were absent or spectrophotometric findings revealed minor degrees of degradation. Our findings probably reflect the process in the reticuloendothelial systems which eliminates toxic products accumulating in the circulation in low-flow states.
Explore the source record for details and available documents.
Patients with malignant disease are known to have an increased incidence of multinucleation in their tracheobronchial ciliated epithelial cells as compared with controls matched by age, sex and smoking habit. A seasonal relationship of viral inclusion bodies in the cilated epithelium of asymptomatic subjects has also been shown and is not related to age, sex and smoking habit. We have conducted an epidemiologic study to determine the possible relationships between these factors. Smears from 4,150 patients with a wide variety of pathologic conditions were examined for the presence of viral inclusions and multinucleated, ciliated epithelial cells. High degress of multinucleation were observed least frequenctly in the summer both in patients with and without known malignancy. Cytoplasmic inclusion bodies were also seen least frequently in the summer and autumn both in patients with and without know malignancy. In the presence of cancer, multinucleated epithelial cells and inclusion bodies were seen more frequently regardless of the season. When the seasonal incidence of multinucleated cells in 155 smears containing viral inclusion bodies was analyzed, it was found that patients without cancer had the lowest levels of multinucleation in the summer, whereas cancer patients had a depressed incidence of multinucleation in the winter and spring. Respiratory viruses may have a specific effect on the ciliated epithelium of cancer patients.
Explore the source record for details and available documents.
Multinucleation of noncancerous ciliated tracheobronchial epithelial cells seen in smears from 412 patients suffering from malignant tumors originating from a wide variety of organs was found to be 2.03 times more frequent than in a control group without prediagnosed malignant disease, matched by age (decades), sex, and smoking habit (p less than 0.0005). Multinucleation involving at least 3% of cells was seen four times more frequently in patients with invasive tumors without known metastases than in controls. Excessive smoking habit in control females as well as site of origin and stage of tumor influenced statistical significance, otherwise unaffected by age, sex, and smoking habit in males. A prospective study is being planned in which incidence and degree of tracheobronchial epithelial multinucleation will be used in conjunction with biochemical tests for the diagnosis of occult cancer.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Smears were made from tracheobronchial washings of patients undergoing general endotracheal anesthesia for surgery. Morphologically abnormal histiocytes were noticed in specimens obtained from subjects during hemorrhagic shock. These cells were overloaded with Papanicolaou stain (a greenish orange compound) which compressed the nucleus against the cell membrane. Cytochemical staining methods were undertaken to discover the composition of this substance. In secretions suctioned from ten patients in shock, large numbers of histiocytes were found to have ingested inorganic iron detectable by the Prussian blue method. Only two patients from a matched control group had smears in which this phenomenon was discovered. The maximum proportion of histiocytes containing Prussian blue granules was 40% for patients in shock and only 2% in normal controls. Histologic studies conducted on rats submitted to hemorrhagic shock were carried out to investigate this phenomenon. Iron-laden histiocytes were found in the kidneys, spleen, and lungs of both shocked and control animals. However, substantially more histiocytes containing Prussian blue positive granules were discovered in the lungs of rats in shock than in controls. It may, therefore, be that iron is deposited in the lungs in low flow states.
During a survey conducted for the cytodiagnosis of early bronchogenic carcinoma, cytoplasmic viral inclusion bodies were found sporadically in tracheobronchial smears of asymtomatic patients of both sexes (ages ranging from 18 to 80 years) undergoing general endotracheal anesthesia for surgery. A review of 3,049 cases performed to assess the frequency of occurrence of this phenomenon showed a 1.1 percent incidence in all smears studied. There was no relationship between smoking habit, age, or sex and the presence of inclusion bodies; however, there was a marked seasonal incidence, with 60 percent of inclusion-bearing smears being found during the months of January through March.
Smears were made from the tracheobronchial washings from 40 parturient women undergoing operative delivery while under general anesthesia administered via an endotracheal tube. There was a significantly greater incidence of epithelial multinucleation in the smears from 12 patients who had had preeclampsia for more than 24 hours than in those from 13 healthy pregnant women, from eight women with preeclampsia of less than 24 hours' duration, and from seven women with associated diseases other than preeclampsia. Although we are unable to explain this phenomenon, we have reviewed its possible causation in the face of existing theories on the cause of preeclampsia.
We previously reported (1) that tracheobronchial secretions of patients in hemorrhagic shock contained significantly more iron laden histiocytes than secretions of matched controls and demonstrated by histiologic studies in rats bled to hemorrhagic shock that these animals' lungs contained significantly more iron laden histiocytes than those of a control group. Two explanations appeared plausible: 1) abnormal hemoglobin breakdown products of systemic hypoperfusion during shock (2, 3, 5) may have accumulated in the pulmonary circulation where they were phagocytozed by pulmonary histiocytes, or 2) circulating iron laden histiocytes may have been arrested in the lung, which is well known to act as a filter during low-flow states (4). The present study reports on assay of bronchial secretions of 12 open-heart surgery patients under cardiopulmonary bypass from specimens obtained 1) immediately after onset of anesthesia; 2) during; and 3) after termination of cardiopulmonary bypass. The percentage of iron laden histiocytes rose from 15.6+/-6.0 after intubation, to 49.6+/-6.8 after 1 hour on bypass with occluded pulmonary arteries (p less than 0.0025), remaining close to the latter value after pulmonary circulation was restored. Hypoperfusion, accumulation of metabolites, or falling pH at the tissue level are probable explanations for these findings.
The patency of palmar arches must be ascertained before radial-artery cannulation is performed. A simple test in which digital pulsation is felt after proximal occlusion of the radial artery has been devised for that purpose. The method is reliable, does not require active patient cooperation, and can be carried out in all clinical situations where the radial artery can be felt.
Explore the source record for details and available documents.