Search PubMed⌕ Search

Biomedical subjects

J D Epstein

Publications and source records attributed to J D Epstein.

32 records · Page 2Linked to original sources
PubMed1985

Exercise-induced bronchodilation in asthma.

Of 34 symptomatic adult asthmatic patients (23 men) aged 51 +/- 13 years (mean +/- 1 SD) with moderately severe airways obstruction who underwent maximal exercise testing at room temperature (22 degrees C) and humidity (44 percent RH) using a bicycle ergometer, we identified seven male patients aged 56 +/- 9 years in whom forced expired volume in one second (FEV1) increased greater than or equal to 20 percent over the baseline pre-exercise value (exercise-induced bronchodilation). At maximal exercise, these patients achieved an O2 consumption of 1.4 +/- 0.4 L/min and a minute ventilation of 56 +/- 9 L/min. Baseline FEV1 was 1.3 +/- 0.5 L (SD) (43 +/- 12 percent predicted) and increased to 2.1 +/- 0.5 L at five minutes after exercise and persisted at least 20 minutes. Exercise was repeated in all seven patients on a separate day one to six months later, and results were similar in six. In these seven patients, three minutes of voluntary isocapnic hyperventilation achieving a minute ventilation comparable to that during maximal exercise led to an increase in FEV1 of 20 +/- 18 percent (range 0 to 54 percent). The Vmax50 was 22 +/- 30 percent before, and 10 +/- 21 percent after maximal exercise and 25 +/- 37 percent before, and 11 +/- 22 percent after isocapnic hyperventilation. Pre-treatment with acetylsalicylic acid (mean serum concentration 120 +/- 64 micrograms/ml) in the six patients with reproducible bronchodilation completely blocked exercise bronchodilation in one patient and blunted it in four others. Findings suggest that a subset of adult patients with symptomatic asthma may develop bronchodilation after six to eight minutes of exercise, that exercise-induced bronchodilation may in part be reproduced with isocapnic hyperventilation, and that it may be blocked completely or partially by acetylsalicylic acid, implying mediation by prostaglandins.

Aspirin↗
PubMed1985

Strong cash flow, balance sheet, management, key to capital needs. Symposium on Healthcare Directions: the capital financing imperative.

For a full day, 10 individuals representing varied health fields and viewpoints within the healthcare industry discussed a number of topics confronting health care and predicted what the environment is likely to be in three years (see accompanying sidebars for symposium participants and purpose). This article focuses on one of the symposium topics, capital availability and financing, and the implications in a time of declining utilization.

Capital Financing↗
PubMed1985

Lasers in medicine.

Explore the source record for details and available documents.

Bronchial Neoplasms↗
PubMed1984

Laser in treatment of lung cancer.

We performed treatments with a Nd-YAG laser in 27 patients (19 men) with a mean age (+/- 1 SD) of 63 +/- 15 years for incomplete obstruction of the tracheobronchial tree due to non-oat cell malignant neoplasm associated with cough, dyspnea, hemoptysis, or unresolved atelectasis or pneumonia. Sixteen patients had been previously treated with surgery, chemotherapy, or irradiation. Before surgery,, their mean values were as follows: Karnofsky score, 41 +/- 15 percent; British Medical Research Council dyspnea index, 3.7 +/- 0.6; forced vital capacity (FVC), 64 +/- 23 percent of predicted; and mean forced expiratory volume in one second (FEV1), 52 +/- 19 percent of predicted. Immediate palliative relief was achieved in 23 patients and lasted one-half to six months after a single treatment. After surgery, the mean values were as follows: FVC, 77 +/- 26 percent of predicted; FEV1, 74 +/- 27 percent of predicted; Karnofsky score, 57 +/- 18 percent (p less than 0.05); and dyspnea index, 2.8 +/- 0.7 (p less than 0.05). Complications included one death, and two patients subsequently died of massive pulmonary hemorrhage within seven days of treatment. Rigid bronchoscopy was required in seven patients. We also performed laser treatments in 19 patients (eight men) with a mean age of 64 +/- 10 years who had complete bronchial obstruction due to non-oat cell malignant neoplasm; all but one had received previous non-laser treatment. Before surgery the mean values were as follows: Karnofsky score, 30 +/- 10 percent; dyspnea index, 3.7 +/- 0.5; FVC, 46 +/- 14 percent of predicted; and FEV1, 44 +/- 13 percent of predicted. Immediate relief was achieved in six cases and lasted 0.25 to 1.5 months after a single treatment. After surgery the mean values were as follows: FVC, 59 +/- 8 percent of predicted (p less than 0.05); FEV1, 48 +/- 13 percent of predicted; Karnofsky score, 34 +/- 16 percent; and dyspnea index, 3.4 +/- 0.5. Complications included two deaths, one associated with combustion of the outer sheath of the fiberoptic bronchoscope. Rigid bronchoscopy was required in five patients. Results suggest that laser therapy is most beneficial in patients with partial and not totally occluded airways (X2, p less than 0.05).

Adenocarcinoma↗
PubMed1984

Nd-YAG laser in lung cancer.

We administered 45 Nd-YAG laser treatments in 29 patients (18 men) aged 39 to 82 years who had lung malignancy; 26 patients had primary non-oat cell lung cancer and three had metastatic airway malignancy. In all, 25 of the patients had been previously treated with combination(s) of surgical procedure, radiation therapy and chemotherapy. Indications for laser treatment included endobronchial airway obstruction with uncontrolled cough, hemoptysis, dyspnea or unresolved atelectasis-pneumonia. Of 15 patients with partially occluded tracheobronchial airway tumors, immediate palliative relief was achieved in 13 patients and lasted one to six months after a single treatment. In this group there was one postoperative death related to respiratory failure and two patients subsequently died of massive pulmonary hemorrhage. However, of 14 patients with totally obstructed airways, immediate palliative relief was achieved in only five patients and this lasted three weeks to three months after a single treatment. In this group there were two postoperative deaths related to progressive respiratory failure; in one case it was associated with endobronchial combustion of the fiberoptic bronchoscope. All three patients in both groups who died of respiratory failure were in acute respiratory distress and terminally ill before the procedure. These findings suggest that Nd-YAG laser therapy may be most beneficial in patients with partially rather than totally occluded airways due to lung malignancy.

Adenocarcinoma↗
PubMed1984

Nd-YAG laser treatment of tracheal stenosis.

We administered Nd-YAG laser treatments in four patients aged 56 to 68 years for severe tracheal stenosis, the tracheal diameters varying between 2.5 and 5 mm. These patients were all dyspneic at rest with talking or dressing and their peak flows ranged from 8% to 36% of predicted. They were not felt to be candidates for surgical excision. Immediate palliative relief was achieved in all patients and lasted two to four months after a single treatment in three patients. One patient died three weeks after laser treatment due to respiratory failure from underlying emphysema. There were no complications of laser therapy. Postlaser therapy the tracheal diameter in each patient was at least 9 mm and peak flow improved to between 25% and 76% of predicted. The results suggest that laser treatment may be beneficial in cases of severe tracheal stenosis.

Aged↗
PubMed1983

Immune complexes, gallium lung scans, and bronchoalveolar lavage in idiopathic interstitial pneumonitis-fibrosis.

We obtained results of lung immune complexes (LIC), circulating immune complexes (CIC), 48-hour gallium lung scans (scans), bronchoalveolar lavage (BAL), and pulmonary function tests in 20 patients with idiopathic interstitial pneumonitis-fibrosis. Sixteen patients had predominantly interstitial (13 cases UIP) and/or intraalveolar (3 cases DIP) cellular disease (group 1). Prior to corticosteroid therapy in group 1, scans were positive in 75 percent, CIC were elevated in 86 percent, LIC were present in 64 percent, and BAL was abnormal in 90 percent. Duration of follow-up after treatment was 3.5 +/- 1.0 year. In group 1 after treatment with corticosteroids in 13 patients and corticosteroids and penicillamine (three patients) and plasmapheresis (one patient), only four patients remain stable or improved. After corticosteroid therapy, elevated CIC returned to normal values despite progressive patient deterioration. In three patients, lung immune complexes were still detected after circulating immune complexes had returned to normal after corticosteroid therapy. In group 2 were four patients with fibrotic disease; scans and CIC were uniformly negative, LIC were weakly present in only one patient, and BAL was abnormal in all. Despite corticosteroid therapy, all have died or deteriorated. These results suggest that positive gallium lung scans, BAL, circulating immune complexes, and to a lesser extent, lung immune complexes are associated with the cellular phase of interstitial pneumonia, but do not reliably identify a corticosteroid-responsive group.

Adult↗
PubMed1978

The law your hospital might be breaking.

Recently enacted Medicare and Medicaid fraud and abuse legislation raises substantial compliance problems for hospitals, which may inadvertently be in violation of the law.

Fraud↗
PubMedDate not supplied

Comparison of fenoterol, isoproterenol, and isoetharine with phenylephrine aerosol in asthma.

The bronchodilator effect of fenoterol hydrobromide (0.5, 1.25, and 2.5 mg) was compared with either isoproterenol (2.8 mg) or isoetharine (5 mg) with phenylephrine (1.25 mg) in a double-blind placebo-controlled study. When delivered by an intermittent positive-pressure breathing device to 24 nonsmoking young adult asthmatic subjects, fenoterol produced significant improvement in forced expiratory volume at 1 second (FEV1), in maximum midexpiratory flow (FEF25-75%), and in forced expiratory flow at 25 per cent of vital capacity (FEF25%) for 6 to 8 hours, whereas isoproterenol and isoetharine with phenylephrine produced improvement for 1 and 2 hours, respectively. The lowest dosage of fenoterol was as effective as the highest but had fewer adverse effects.

Adolescent↗