Search PubMed⌕ Search

Biomedical subjects

J E Thompson

Publications and source records attributed to J E Thompson.

At least 73 records · Page 4Linked to original sources
PubMed1997

Carotid endarterectomy in patients less than 50 years old.

PURPOSE: The purpose of this study was to compare the results of carotid endarterectomy (CEA) in a young population with premature atherosclerosis with the results of an older control group, examining perioperative morbidity and mortality data, recurrent stenosis and symptoms, late stroke, and survival data. METHODS: We retrospectively studied 26 patients less than 50 years old (mean, 43.2 +/- 3.8 years) and 30 patients greater than 55 years old (mean, 69.1 +/- 7.4 years) who underwent CEA during the same time period. Data were obtained regarding demographics, atherosclerotic risk factors, indication for CEA, perioperative complications, recurrent stenosis and symptoms, late stroke, and survival. RESULTS: Smoking was more prevalent among young patients who underwent CEA (92% vs 70%; p = 0.036). Young patients were also more likely to be symptomatic at presentation (92% vs 57%; p = 0.003). The perioperative mortality rate (0% vs 0%) and neurologic morbidity rate (0% vs 3%; p = 1.000) were low for the study patients. During a mean follow-up of 67 +/- 42.7 months, there was no significant difference in survival rate (5-year survival rate, 93% vs 81%; p = 0.373), rate of late ipsilateral (4% vs 3%) and contralateral (4% vs 3%) stroke, restenosis and occlusion (26.9% vs 14.3%), recurrent symptoms (22% vs 17%), reoperation (11.5% vs 5.7%), or contralateral disease (17% vs 23%) development that required surgery for the study or the control cohorts. CONCLUSIONS: Our data show that there is a high incidence of smoking and symptomatic presentation among young patients in whom carotid occlusive disease develops. CEA may be performed in young patients with low perioperative morbidity and mortality rates. Recurrent disease, late stroke, and survival rates are not significantly different than for older patients. Follow-up with serial duplex ultrasound and reoperation for symptomatic and high-grade asymptomatic restenosis may decrease the risk of late stroke.

Adult↗
PubMed1997

Noninvasive determination of cardiac output in a model of acute lung injury.

OBJECTIVE: To examine the utility of single breath CO2 analysis as a noninvasive measure of cardiac output in a model of acute lung injury. SETTING: An animal laboratory in a university-affiliated medical center. DESIGN: A prospective, animal cohort study comparing 21 parameters derived from single breath CO2 analysis with cardiac output determined by an ultrasonic flow probe. SUBJECTS: Six adult sheep with saline lavage-induced acute lung injury. INTERVENTIONS: Animals were treated with repetitive saline lavage to achieve a uniform degree of acute lung injury (PaO2 of < 100 torr [< 13.32 kPa] on an FIO2 of 1.0). Cardiac output was manipulated by successive injections of an hydraulic constrictor placed around the inferior vena cava and measured using an ultrasonic flow probe. Twenty-one derived components of the CO2 expirogram were evaluated as predictors of cardiac output. MEASUREMENTS AND MAIN RESULTS: Thirty-eight measurements of cardiac output were available for comparison with derived variables from the CO2 expirogam. Stepwise linear regression identified four variables for the equation predicting cardiac output: a) PaO2/FIO2 ratio; b) the angle between the slope lines for phases II and III divided by the tidal volume; c) mixed expired CO2 tension; and d) physiologic deadspace to tidal volume ratio. The multivariate equation was highly statistically significant and explained 80% of the variance (adjusted R2 = .80, p < .0001). The blas and precision of the calculated cardiac output were .00 and .38, respectively. The mean percent difference for the cardiac output estimates derived from the single breath CO2 analysis station was -0.01%. CONCLUSIONS: Our results indicate that changes in cardiac output can be determined using components of the CO2 expirogram with a high degree of reliability in animals with induced acute lung injury. Specifically, the use of four parameters derived from a plot of expired CO2 concentration vs. expired volume predict changes in cardiac output in adult sheep with induced lung injury with an adjusted coefficient of determination of .80. Prospective application of this technology in the clinical setting with the rapidly changing physiology that is characteristic of the acutely ill patient will be essential in determining the clinical usefulness of single breath CO2 analysis as a noninvasive measure of cardiac output.

Acute Disease↗
PubMed1997

Comparison of self-inflating bags with anesthesia bags for bag-mask ventilation in the pediatric emergency department.

OBJECTIVE: To compare bag-mask ventilation performed by emergency department (ED) personnel using anesthesia bags (AB) and self-inflating bags (SIB). SETTING: ED in a teaching children's hospital where the AB is the device used during resuscitations. DESIGN: Experimental study. Bag-mask ventilation was evaluated with an infant resuscitation mannequin equipped to measure airway volumes and pressures. Pediatric residents, ED nurses, and pediatric emergency medicine fellows performed bag-mask ventilation with AB and SIB and rated their confidence using each device. MAIN OUTCOME MEASURE: Ventilation failure rates. RESULTS: Seventy subjects participated (17 interns, 16 junior residents, 13 senior residents, 10 fellows, and 14 nurses). There were 13 failures with the AB (18.6%) versus 1 (1.4%) with the SIB (P < 0.01) [95% confidence interval: 5-29%], with a significant difference even after excluding the least experienced subjects. There was no difference in high pressure breaths delivered (SIB 19% vs AB 15%, P = 0.4) and a higher incidence of hyperventilation with the SIB (67 vs 25%, P < 0.01). While using the SIB, 19 (27%) of the subjects did not turn on the O2 flow. There was no difference in pretest confidence rating, but the posttest confidence rating was higher for the SIB (P < 0.05). CONCLUSIONS: Compared to SIB use for bag-mask ventilation in an ED, AB use resulted in more ventilation failures, no advantage in preventing excessive airway pressures, and less confidence among operators. The SIB should be the first choice for bag-mask ventilation in the ED, with attention to maximize oxygen delivery.

Anesthesiology↗
PubMed1997

Accidental strangulation by a motor vehicle window.

OBJECTIVE: To describe a child who was asphyxiated by a motor vehicle window and to review the relevant literature. DESIGN: Case report. SETTING: A 402-bed tertiary care medical center in La Crosse, WI. PATIENT: Four-year-old girl. INTERVENTIONS: Supportive pediatric critical care. MAIN OUTCOME MEASURES: None. RESULTS: The patient did not survive. CONCLUSIONS: Parents must assume responsibility for restraining their children in motor vehicles. Parents must not leave children alone in motor vehicles. Parents must become "more injury literate."

Accident Prevention↗
PubMed1997

Community acquired pneumonia in north eastern Australia--a hospital based study of aboriginal and non-aboriginal patients.

BACKGROUND: Although the most important organism causing community acquired pneumonia continues to be Streptococcus pneumoniae, the frequency of other pathogens varies considerably across the world. AIMS: To look for the causes of community acquired pneumonia (CAP) in north east Australia. To examine the differences between Aboriginal and non-Aboriginal subjects with emphasis on prevalence, risk factors, causative organisms and prognosis. METHODS: The records of 200 consecutive patients admitted to Cairns Hospital during 1992 with a diagnosis of pneumonia were studied. RESULTS: Aboriginal patients made up half the numbers admitted, but only 13% of the population. More Aboriginal adults died than non-Aboriginal adults, but no child died. Heavy alcohol use, chronic lung disease and diabetes mellitus were the commonest risk factors for Aborigines (alcohol, chronic lung disease and cancer for non-Aboriginal subjects). S. pneumoniae, followed by Haemophilus influenzae were the most common pathogens found. Both were sensitive to amoxycillin. The yield of definite pathogens was low. Staphylococcal and melioidosis pneumonia were confined to Aboriginal patients. Chlamydia, legionella and Mycoplasma pneumoniae were not identified.

Adult↗
PubMed1997

'Normal' lung function in rural Australian aborigines.

BACKGROUND: Although lung diseases are a leading cause of premature mortality in Australian Aborigines, little is known about normal lung function in these people. AIM: To develop models for 'normal' spirometric function in rural Australian Aborigines. METHOD: A cross-sectional population-based study of four rural Aboriginal communities was performed in Queensland, Northern Territory and South Australia, Australia. We studied 261 children aged seven-19 years and 332 adults aged 20-80 years who were free of symptoms and had no clinical signs of chronic lung disease. The outcome measures were forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Multiple linear regression was used to develop models for FEV1 and FVC and comparisons were made with Caucasians and indigenous people from other countries. RESULTS: The Aboriginal people studied had FEV1 and FVC values that were lower (20% and 30% respectively) than those found in Caucasians of the same height, age and gender. As a consequence, they had relatively high FEV1/FVC ratios. Those studied also had forced expiratory volumes that were lower than those found in African Americans and other indigenous peoples. CONCLUSIONS: Apparently healthy rural Aboriginal people have low forced expiratory volumes when contrasted with Caucasians and indigenous peoples such as African Americans. More research is required to determine if this is 'normal' or a product of the suboptimal environment into which many Aboriginal people are born.

Adolescent↗
PubMed1997

Improved oxygenation in a randomized trial of inhaled nitric oxide for persistent pulmonary hypertension of the newborn.

OBJECTIVE: To determine the effect of inhaled nitric oxide (NO) on clinical outcome in newborns with persistent pulmonary hypertension (PPHN). DESIGN: A prospective, randomized trial of patients referred to a level 3 nursery in a single large center. Clinicians were not masked to group assignment. Crossover of patients from control to NO treatment was not permitted. METHODS: We randomized 49 mechanically ventilated newborns, transferred to our center with clinical and echocardiographic evidence of severe PPHN (arterial oxygen tension [PaO2] <100; fractional inspired oxygen = 1) to treatment with or without NO. Patients with gestational age <34 weeks or with congenital heart disease or diaphragmatic hernia were excluded. High-frequency oscillatory ventilation was used but not allowed concomitantly with NO. Primary outcome variables were oxygenation, mortality, and use of extracorporeal membrane oxygenation (ECMO). RESULTS: Meconium aspiration syndrome and isolated PPHN were the most common diagnoses (32/49) and were distributed equally between groups. The median age at the time of entry into the study was similar between groups, 25 hours for control patients and 18 hours for NO patients. Median baseline oxygenation index (OI) was similar in 23 control (OI = 29) and 26 NO (OI = 30) patients. Mortality (8%), use of ECMO (33%), median days on mechanical ventilation (9 days), and duration of supplemental oxygen (13 days) were not different between treatment groups. PaO2, oxygen saturation, and OI improved in the NO group compared with baseline and to control patients at 15 minutes. The median percent change in OI (-31%) in the NO group was significantly different from baseline and from the control group. The difference in oxygenation between treatment groups was still apparent 12 hours after baseline. Before cannulation for ECMO, oxygenation was better in the NO group compared with control patients. Among patients who were placed on ECMO, the median time from baseline to ECMO cannulation was 2.4 hours (range, 1 to 12 hours) among control patients and 3.3 hours (range, 2 to 68 hours) for those randomized to receive NO. There was a tendency to observe fewer adverse neurologic events (seizure and intracranial hemorrhage) in the NO group (4/26 vs 8/23). One child with alveolar capillary dysplasia confirmed by postmortem examination could not be weaned from 80 parts per million of NO and transiently developed methemoglobinemia (peak methemoglobin level = 17%). No other side effects were observed. CONCLUSIONS: Although mortality and ECMO use were similar for both treatment groups using this study size and design, sustained improvement in oxygenation with NO and better oxygenation at initiation of ECMO may have important clinical benefits. We speculate that modification of treatment to include specific lung expansion strategies with NO treatment and recognition that early improvement of oxygenation may be sustained with NO may lead to reduced use of ECMO in NO treated patients compared with controls.

Administration, Inhalation↗
PubMed1997

Choristomas of the seventh and eighth cranial nerves.

Choristomas, masses of normal tissues in aberrant locations, contain smooth muscle fibers and fibrous tissues. We describe the MR imaging features of two choristomas located in the internal auditory canals and arising from the facial and vestibulocochlear nerves. Both lesions enhanced with contrast material. In one case, enhancement was seen in the geniculate ganglion and greater superficial petrosal nerve. In the other, a medial component enhanced less than the lateral component did.

Adult↗
PubMed1997

Immunolocalization of bFGF in pterygia: association with mast cells.

PURPOSE: To examine the expression of basic fibroblast growth factor in pterygia and determine whether mast cells contain basic fibroblast growth factor (bFGF) in this disease process. METHODS: Formalin-fixed paraffin-embedded tissue samples of pterygia (n = 14) were used to study the expression of bFGF with immunohistochemistry. Seven samples were also double labeled with specific antibodies to bFGF and tryptase (a specific mast cell marker). RESULTS: In all tissue samples examined, bFGF was specifically localized in blood vessels, epithelium, and a subset of connective tissue cells. The majority of bFGF-positive connective tissue cells were also tryptase positive (90.4 +/- 3.6%). Nearly all the tryptase-positive cells (mast cells) in the pterygia tissues coexpressed bFGF (98 +/- 1.5%). CONCLUSIONS: These findings suggest that bFGF may have biologic effects on the epithelium and blood vessels in pterygia, with epithelial and endothelial cells as a possible source. In addition, mast cells contain bFGF in the pterygia tissues examined in this study. The mast cells may serve as an additional source of bFGF, possibly modulating a variety of cell types as well as the extracellular matrix in pterygia.

Adult↗
PubMed1997

Emergent ileocecectomy for infection and inflammation.

The role of right colectomy in controlling inflammatory conditions and intra-abdominal sepsis remains controversial. The objective of this study was to define the outcome following emergency ileocecal resection for infectious and inflammatory causes. Retrospective analysis of 83 consecutive patients who underwent such treatment in a university-affiliated public hospital over a 7-year period was performed. Preoperative diagnosis was correct in 54 per cent of patients; CT scan (29 patients) did not improve this rate (59%). Free perforation was noted in 16 per cent of patients, and a defined abscess was found in 39 per cent. Common pathologic diagnoses included appendicitis (39%), diverticulitis (23%), cancer (14%), and Crohn's disease (8%). Primary ileocolic anastomosis was performed in 74 patients (89%); 9 patients (11%) required an ileostomy. Mean postoperative stay was 10 days, and there was no mortality. Complications occurred in 15 patients (18%), and 2 required reoperation (2%). Preoperative presence of an abscess was not associated with an increased complication rate (16%), but free perforation was associated with a 31 per cent complication rate. Definitive emergency treatment of infectious and inflammatory disease of the ileocecum can be safely accomplished by resection with primary anastomosis in the majority of patients, obviating the need for ileostomy and a second operation.

Abdominal Abscess↗
PubMed1997

The etiology of the adult indirect inguinal hernia: revisited.

It has generally been historically stated that indirect inguinal hernias develop only in patients who have a patient processus vaginalis that enlarges to become a hernia sac. Occasionally, this theory has been challenged but without any objective evidence. Herniography was performed by placing 50 mL of nonionic contrast material into the peritoneal cavity. The patient was then placed in a prone position with the head of the table elevated. Films of the inguinal fossae were obtained with the patient straining. The herniogram revealed a right indirect inguinal hernia. There was no left inguinal hernia, nor was there a patent processus vaginalis on the left side. Two years later, the patient developed left inguinal discomfort and swelling and was found to have a moderate-sized left inguinal hernia. At the time of operation, an indirect sac of moderate size was present. A mesh plug repair was performed. This case report is the first published objective evidence that, contrary to common thought, a patent processus vaginalis is not a necessary prerequisite to the development of an indirect inguinal hernia.

Hernia, Inguinal↗
PubMed1996

Asthma and atopy in four rural Australian aboriginal communities.

OBJECTIVE: To determine the prevalence and nature of asthma in four rural Australian Aboriginal communities. DESIGN: Cross-sectional population study. SETTING: Four Aboriginal communities in Queensland, the Northern Territory and South Australia, Australia. SUBJECTS: Data were collected from 1252 subjects aged 5-84 years in August 1990 and August/September 1991. MAIN OUTCOME MEASURES: Respiratory symptoms, measured by interview-administered questionnaire; airway hyperresponsiveness (AHR), measured by histamine challenge; and allergy, measured by skin-pick tests. AHR was a PD20FEV1 of histamine of less than or equal to 3.9 mumol. RESULTS: The prevalence of AHR in the four communities ranged from 2.2% to 7.5% and significantly increased with age (chi 2 trend test: P < 0.05). The prevalence of current asthma was 0.5% among 8-12 year old children and 3.3% among adults. The overall prevalence of atopy in the four communities ranged from 21% to 34%. Allergy to cats, house dust mites or cigarette smoking was a risk factor for AHR, and cat allergy was a risk factor for current asthma. CONCLUSIONS: The prevalence of asthma in rural Aboriginal adults is low in comparison with the prevalence among non-Aboriginal Australians, and asthma in Aboriginal children is almost non-existent. The low prevalence of asthma is possibly due to environmental factors that influence the acquisition of atopy and AHR.

Adolescent↗
PubMed1996

ECMO in evolution: the impact of changing patient demographics and alternative therapies on ECMO.

The incidence of neonatal extracorporeal membrane oxygenation (ECMO) is decreasing nationally. This decrease is presumed to be a result of the emergence of alternative technologies such as high-frequency oscillatory ventilation (HFOV), nitric oxide (NO), and surfactant therapy as well as others. The purposes of the present report were to determine just how rapidly the demographics of ECMO are changing and to determine the impact of competing technologies on ECMO use. The authors reviewed their entire ECMO experience of 455 cases (370 neonatal, 38 pediatric, and 47 cardiac). The neonatal cases also were separated into diagnostic groups: MAS (meconium aspiration syndrome), PPHN (persistent pulmonary hypertension of the newborn), RDS (respiratory distress syndrome), and sepsis. To allow statistical comparison, the patients were divided into four chronological groups, of equal 3-year duration, spanning the 12 years that ECMO has been available. The results of the analysis demonstrated four principle findings. (1) The total number of patients receiving ECMO per year was declining (P = .0001). This decline was attributable to a reduction in the total number of neonatal patients, with the exception of cases of congenital diaphragmatic hernia. (2) The complexity of each ECMO run was increasing, as evidenced by substantial increases in mean ECMO duration per patient and an increase in the incidence of patient complications on ECMO (P = .0001). (3) There has been a significant decrease in the overall survival rate for patients treated with ECMO (P = .0001). (4) The ECMO population mix has shifted away from straightforward neonatal cases and toward the more complex pediatric and cardiac cases. This demographic shift has occurred as a result of improvements in pre-ECMO management of neonatal patients, and is primarily responsible for the findings noted above. However, there also has been a worsening of condition severity within each diagnostic group, which also is partly responsible for the changes noted. If these trends continue, pediatric, cardiac, and CDH patients will likely account for the majority of ECMO patients. Consequently, existing ECMO centers must be prepared to adapt to the changing demographics by evolving programs that support pediatric, cardiac, and adult patients, in addition to neonates. Furthermore, the complexity associated with transporting these unstable older patients and the likelihood that the number of active ECMO centers will decline may require remaining ECMO centers to develop long-distance ECMO transport capabilities.

Adult↗