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J K Stoller

Publications and source records attributed to J K Stoller.

At least 91 records · Page 5Linked to original sources
PubMed1990

Ventilatory strategies in the management of the adult respiratory distress syndrome.

This article review available strategies for mechanically ventilating patients with the adult respiratory distress syndrome. The authors first present the conventional strategies of mechanical ventilation: volume-limited mechanical ventilation with positive end-expiratory pressure (PEEP) at normal inspiratory-expiratory ratios, the approach that has been the mainstay of ventilatory support since the initial description of PEEP. This discussion attempts to summarize the rationale and goals of treatment in a practical, clinically useful manner. The second section of the article reviews less conventional ventilatory approaches, including inverse ratio ventilation, extracorporeal techniques, high-frequency ventilation, prone position, and fluctuating PEEP, and attempts to review critically the available literature regarding their application.

Extracorporeal Membrane Oxygenation↗
PubMed1989

Diffuse panbronchiolitis preceding ulcerative colitis.

To expand the clinical spectrum of ulcerative colitis-associated lung disease, we describe a patient with panbronchiolitis associated with ulcerative colitis. In addition to his having a distinctive pulmonary manifestation of this bowel disease, other noteworthy aspects of this patient's course include the onset of pulmonary symptoms several years prior to bowel manifestations and the partial resolution of his pulmonary symptoms following colectomy.

Adult↗
PubMed1989

Computerized tomographic densitometry of the solitary pulmonary nodule using a nodule phantom.

The successful application of computerized tomographic density analysis for evaluating the solitary pulmonary nodule has previously been described and the technique has since been simplified by using a calcium-equivalent nodule reference phantom. Because published experience with this technique remains limited, the current research reports the Cleveland Clinic experience with the CIRS model III pulmonary nodule reference phantom. Without knowledge of the final diagnosis, the nodule phantom was used as the standard for categorizing 31 nodules in 29 patients as either benign or indeterminate. Secure diagnoses were obtained in all cases. Eleven nodules were called benign and ten proved so, whereas 20 nodules were classified as indeterminate. One lesion, an adenocarcinoma, was falsely called benign using this technique. The excellent density discrimination achieved with CT makes this a superior tool for analysis of the solitary pulmonary nodule, and the nodule reference phantom has greatly simplified the technique of CT densitometry. As demonstrated by this and prior studies, calcification is not a unique feature of the benign lesion and successful clinical application of this technique requires cautious interpretation of results.

Adult↗
PubMed1989

Alpha 1-antitrypsin deficiency and augmentation therapy in emphysema.

Since the first description of alpha 1-antitrypsin deficiency as a cause of emphysema in 1963, major strides have been made in understanding the structure and function of this important antiprotease, its role in the defense against emphysema, and in new treatment strategies. In order to elucidate the pathogenesis of alpha 1-antitrypsin-associated emphysema and recent developments in therapy for this disease, this paper considers current understanding of the pathogenesis of emphysema, recent information regarding the structure and function of the molecule, and more recent developments in augmentation therapy. The author also discusses the national registry that has been organized for better understanding of the natural history of alpha 1-antitrypsin deficiency in a relatively unselected population.

Drug Administration Schedule↗
PubMed1988

Terbutaline and diaphragm function in chronic obstructive pulmonary disease: a double-blind randomized clinical trial.

We conducted a double-blind, randomized crossover trial to evaluate whether oral terbutaline (2.5 mg orally three times daily for a week) increased the force of diaphragmatic contraction in normocapnic patients with chronic obstructive pulmonary disease. Ten patients with moderate to severe airway obstruction completed the trail. Compared with placebo, terbutaline produced a mean increase of 5.8 cmH2O in peak inspiratory mouth pressure and a mean increase of 5.0 cmH2O in transdiaphragmatic pressure during a maximal inspiratory manoeuvre. These small changes with terbutaline failed to achieve statistical significance. Also, terbutaline failed to alter flow rates (FEV1, Vmax50) or patients' dyspnoea ratings using two separate clinical scales (Pneumoconiosis Research Unit Score and the Modified Dyspnoea Index). Because all observed changes in respiratory muscle strength were small and because the trial had power to detect small changes in inspiratory mouth pressures, we suggest that oral terbutaline at the dose administered in this study has little noteworthy effect on respiratory muscle strength in normocapnic patients with chronic obstructive pulmonary disease.

Aged↗
PubMed1988

Captopril-induced cough.

Since the advent of angiotensin-converting enzyme inhibitors (captopril and enalapril), cough has been recognized sporadically as a side effect, but has received little attention in the pulmonary literature. To emphasize that angiotensin-converting enzyme (ACE) inhibitors should be considered among possible etiologies of cough, we report recent experience with two patients and review the available experience with ACE inhibitor-induced cough.

Captopril↗
PubMed1987

The impact of bronchoalveolar lavage cell analysis on clinicians' diagnostic reasoning about interstitial lung disease.

To assess the impact of bronchoalveolar lavage (BAL) on clinicians' diagnostic reasoning, we administered serial telephone questionnaires to all pulmonary physicians submitting BAL specimens to our laboratory from nonimmunocompromised patients with diffuse interstitial lung disease. Questionnaires were completed when the lavage specimens were first submitted and again after the results were reported to referring physicians. We recorded the clinicians' ordered list of likeliest diagnoses for the patient, a level of confidence in each diagnosis mentioned, and any proximate plans for further diagnostic tests. Of 78 patients in the study, information from the BAL fluid cell analysis caused clinicians to change their diagnostic thinking in 46 (59 percent). These changes were far more frequently appropriate (52 percent) than not (9 percent), and clinically impressive changes did occur but were infrequent (3 of 78 [4 percent]) in this series. Specifically, BAL permitted the unexpected diagnosis of Pneumocystis carinii in a patient not previously suspected to have acquired immune deficiency syndrome (AIDS) and appropriately encouraged clinicians to avert planned surgical biopsies in two patients subsequently found to have sarcoidosis. These findings suggest that when used to evaluate nonimmunocompromised patients, BAL fluid cell analysis can have an important impact on clinicians' diagnostic reasoning about their patients' interstitial lung diseases.

Biopsy↗
PubMed1986

Further specification and evaluation of a new clinical index for dyspnea.

When breathlessness is described in conventional clinical indexes-such as the Pneumoconiosis Research Unit score or the Medical Research Council index-the ratings depend only on the magnitude of the most taxing task that the patient can perform. No attention is given to the patient's effort in performing tasks or to the functional impairment produced by dyspnea in everyday activities. To improve the effectiveness and scope of the assessment, the patient's magnitude of effort and task, as well as functional impairment, were combined in a recently developed new index of dyspnea. In the current research, this new index has been further improved and tested. The ratings have been cited with more precise criteria, and the results of the Modified Dyspnea Index created by the new criteria have been compared with results of the conventional Pneumoconiosis Research Unit score, and with physiologic measurements of pulmonary function. For 32 patients with stable chronic obstructive pulmonary disease (COPD), the Modified Dyspnea Index had a moderate correlation with the Pneumoconiosis Research Unit score (Spearman rho = -0.62) and with the FEV1 (Pearson r = 0.71) and FVC (Pearson r = 0.69). Among patients with the same Pneumoconiosis Research Unit score, however, the Modified Dyspnea Index scores showed a substantial gradient. Ratings with both the previous and the modified new dyspnea indexes correlated most strongly with respiratory muscle strength, supporting the idea that dyspnea is mediated by alteration of respiratory muscle function.(ABSTRACT TRUNCATED AT 250 WORDS)

Dyspnea↗
PubMed1986

Enlarging, atypically located pericardial cyst. Recent experience and literature review.

Pericardial cysts frequently are recognized when they present in a cardiophrenic angle, but may not be suspected when they occur elsewhere in the chest. To highlight the unusual presentations of pericardial cysts, we present two patients with cysts in the upper mediastinum and review the reported experience with similar lesions. Our patients' cysts are particularly instructive because one cyst enlarged over 23 months and because the other did not appear cystic on a computerized tomographic scan. Because percutaneous aspiration may be an attractive alternative to surgical resection when a pericardial cyst is suspected, clinicians should include pericardial cyst in the differential diagnosis of upper mediastinal masses.

Adult↗
PubMed1985

Late recurrence of Mycobacterium bovis genitourinary tuberculosis: case report and review of literature.

A patient is described in whom Mycobacterium bovis genitourinary tuberculosis occurred initially 25 years after childhood scrofula and then recurred 29 years later despite apparently successful therapy. A review of the literature indicated that this 29-year interval between successive bouts of clinical genitourinary tuberculosis is among the longest described. This case also is a reminder that, although rare, Mycobacterium bovis infection and genitourinary tuberculosis still occur. To avoid nonrecognition of this disease and its potentially serious consequences, clinicians should remain vigilant for tuberculosis even in unusual clinical circumstances.

Antitubercular Agents↗
PubMed1984

Pulmonary artery-bronchial fistula complicating chronic lymphocytic leukemia.

A 52-year-old man with chronic lymphocytic leukemia (CLL) entered the hospital because of repetitive bouts of massive hemoptysis requiring a right pneumonectomy. A bronchus intermedius-pulmonary artery fistula was found and felt to be due to necrosis of a peribronchial lymph node which was infiltrated by chronic lymphocytic leukemia cells. This represents another pulmonary complication in the clinical course of advanced CLL.

Bronchial Fistula↗
PubMed1984

Comorbid and clinical determinants of prognosis in endometrial cancer.

In cancers of the lung, larynx, rectum, and breast, the patients' initial clinical manifestations and comorbid diseases have shown important prognostic distinctions that are not evident in the customary systems of anatomic staging. This study was done to see whether the same phenomena occurred for cancer of the endometrium. In 142 consecutive cases of endometrial carcinoma, strikingly high five-year survival rates were found in women who had no symptoms attributable to the cancer or whose only symptoms might have been caused either by concomitant uterine or cervical disease or by replacement estrogen therapy. A distinct decline in survival was associated with systemic symptoms and with major comorbid ailments. Estimation of prognosis and evaluation of therapy can be improved with a new composite staging system, formed by combining the new clinical categories and the standard morphologic stages of the International Federation of Gynecology and Obstetrics (FIGO) system.

Adenocarcinoma↗
PubMedDate not supplied

Corticosteroids in stable chronic obstructive pulmonary disease: reappraisal of efficacy.

Although systemic corticosteroids are widely used in treating stable chronic obstructive pulmonary disease (COPD), the evidence for their efficacy is still disputed. To reappraise this evidence, the authors used a new analytic strategy in which the 14 available randomized clinical trials were evaluated according to a methodologic "review of systems" and an examination of the statistical precision of the outcome results. Although none of the trials satisfied all of the methodologic criteria for both validity and clinical pertinence, the trials finding steroids efficacious were generally better designed and more statistically precise than trials failing to show efficacy. The authors propose a set of five main methodologic guidelines that require a stable baseline state, a crossover design with suitable washout, adequate doses of corticosteroids, pragmatic designs, and comprehensive choices of outcome events. Attention to these guidelines can help improve both design and evaluation for future trials of systemic steroids for stable COPD.

Adrenal Cortex Hormones↗