Search PubMed⌕ Search

Biomedical subjects

J K Stoller

Publications and source records attributed to J K Stoller.

103 records · Page 6Linked to original sources
PubMedDate not supplied

Detection and evaluation of intrapulmonary vascular shunt with "contrast Doppler" transesophageal echocardiography.

Contrast echocardiography is useful for detecting intrapulmonary right-to-left shunt lesions. In a patient with suspected pulmonary arteriovenous fistula, contrast transesophageal echocardiography was used to demonstrate the presence of a right-to-left shunt. By use of a combination of two-dimensional echocardiography, contrast injection, and pulsed Doppler echocardiography, each pulmonary vein was successfully interrogated for evidence of contrast shunting. This case demonstrates that contrast transesophageal echocardiography is useful for the detection of intrapulmonary fistulas and that it has the potential for localization of the shunt lesion.

Arteriovenous Malformations↗
PubMedDate not supplied

Reversible decerebrate posturing after profound and prolonged hypoglycemia.

Decerebrate rigidity is one of several reversible neurological abnormalities which have been observed in the setting of metabolic coma. We present the case of a patient who recovered fully from prolonged decerebrate rigidity associated with hypoglycemic coma. This case emphasizes the possibility of recovery from severe, prolonged hypoglycemia.

Adult↗
PubMedDate not supplied

Spirometry: a key diagnostic test in pulmonary medicine.

Spirometry is a simple and informative test for evaluating airflow obstruction. Measurements from a forced expiratory maneuver are conventionally displayed as volume vs time (spirogram) and flow vs volume (flow-volume loop) tracings. Spirometric measurements like the forced expiratory volume in 1 second inform about the degree of airflow obstruction, whereas the flow-volume loop helps identify the presence and anatomic location of upper airway obstruction, which may mimic symptoms of obstructive lung disease. As a simple, inexpensive, and informative test, spirometry should be used liberally in assessing patients with respiratory symptoms.

Adult↗
PubMedDate not supplied

Ordering respiratory care services for hospitalized patients: practices of overuse and underuse.

Because of recent concerns about misallocation of respiratory care services and analyses suggesting that limiting services to comply with established guidelines reduces unneeded therapies without compromising quality of care, the authors audited the records of 170 patients newly ordered to receive at least one of five respiratory therapies (oxygen therapy, incentive spirometry, bronchopulmonary hygiene, aerosolized bronchodilator therapy, or intermittent positive pressure breathing) at The Cleveland Clinic Foundation. In reviewing whether the therapies that were ordered complied with published guidelines for these services, we found that 25.2% were "not indicated." This over-ordering incurred unnecessary total charges of $11,937 ($206.16 per patient) and occupied therapist time that could have been better allocated to other services. These costs were offset by the finding that 10.5% of the patients were not ordered to receive indicated respiratory therapies. Our proposed strategy of initiating protocols for ordering and providing respiratory care services (ie, via a respiratory care consult service) is an appealing means to address this misallocation, but it requires further evaluation.

Cost Control↗
PubMedDate not supplied

Physical and social impact of alpha 1-antitrypsin deficiency: results of a survey.

BACKGROUND: Emphysema associated with alpha 1-antitrypsin deficiency can impose serious impairment. OBJECTIVE: To gather information about the impact of severe alpha 1-antitrypsin deficiency. METHODS: Mail survey, descriptive statistics. RESULTS: We sent a survey to 1730 subscribers to a national newsletter, 850 of whom had previously stated they had alpha 1-antitrypsin deficiency. A total of 414 questionnaires were returned; 398 respondents said they had alpha 1-antitrypsin deficiency, and 300 said they had the PiZZ phenotype. Sixty-six respondents who said they had the disease did not know their phenotype. Among the 304 respondents with severe deficiency, the mean age at the time symptoms first appeared was 35.0 years, but the mean age when the disease was diagnosed was 41.3 years. Overall, 75.3% of respondents with severe deficiency reported at least one adverse effect: 44.4% retired early, and 19.1% changed to a physically easier job. The duration of diagnostic delay correlated with the degree of adverse psychosocial effects. CONCLUSIONS: Alpha 1-antitrypsin deficiency frequently escapes diagnosis despite many medical encounters. Affected individuals are often unaware of basic details of their disease. Many patients report adverse psychosocial effects. Delay in diagnosing this disease is associated with adverse psychosocial effects.

Adolescent↗
PubMedDate not supplied

Postoperative pulmonary complications: risk assessment, prevention, and treatment.

Patients with pre-existing pulmonary disease and certain other conditions are at increased risk of postoperative pulmonary complications. This article surveys how internists can identify high-risk patients clinically, use pulmonary function studies, use specific therapy to reduce risk, and manage postoperative complications.

Humans↗