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Biomedical subjects

J M Luce

Publications and source records attributed to J M Luce.

At least 73 records · Page 4Linked to original sources
PubMed1989

Aerosolized pentamidine as second line therapy in patients with AIDS and Pneumocystis carinii pneumonia.

The use of aerosolized pentamidine was investigated in ten patients with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) who had previous or concurrent severe adverse reactions or contraindications to trimethoprim-sulfamethoxazole or parenteral pentamidine. A dose of 600 mg pentamidine in 6 ml sterile water, aerosolized in a small-particle producing jet nebulizer was administered for 25 minutes once daily for an average of 10.5 days to these ten patients. All patients improved their arterial O2 saturation and showed clinical and roentgenographic improvement within six to 21 days of aerosol pentamidine therapy. No adverse systemic reactions occurred. The results of this small open trial indicate that aerosolized pentamidine is effective and can be given safely to AIDS patients with PCP who have had adverse reactions to trimethoprim-sulfamethoxazole or parenteral pentamidine.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Rational approach to the management of multiple systems organ failure.

MSOF is a complicated disorder that can involve every organ system in the body. Whatever causes or perpetuates the syndrome, its management involves the prevention and treatment of infection, the maintenance of tissue oxygenation, nutritional and metabolic support, and the support of individual organ systems. Unfortunately, this therapy often is nonspecific and of little proven efficacy. It also is potentially harmful in that measures used to benefit some organ systems may be detrimental to others. Further research is needed both to understand MSOF and to improve its management.

Humans↗
PubMed1989

Pulmonary diagnostic evaluation in patients suspected of having an HIV-related disease.

The wide range of pulmonary infections associated with human immunodeficiency virus (HIV)-seropositivity, coupled with the possible presence of HIV-related neoplasms and non-HIV-related pulmonary processes, requires that most patients who are known to be or suspected of being HIV-seropositive should undergo a thorough diagnostic evaluation. This usually should include a screening evaluation that includes history, physical examination, screening laboratory tests, chest radiography, and arterial blood gas measurements. Pulmonary function testing and lung scanning also may be sensitive in screening, although these and the other procedures are nonspecific. Specific infectious organisms, particularly Pneumocystis carinii, may be identified through examination of induced sputum and by bronchoscopic procedures, including bronchoalveolar lavage and transbronchial biopsy. Open lung biopsy is not a routine part of the diagnostic evaluation. Although detection of recurrent episodes of pneumonia due to P carinii is difficult, empiric diagnosis and treatment of this disorder should be employed primarily when specific diagnostic techniques are unavailable or are refused.

AIDS Serodiagnosis↗
PubMed1988

Selective delivery of pentamidine to the lung by aerosol.

In 8 patients with diffuse infiltrates on chest radiograph undergoing fiberoptic bronchoscopy for suspected Pneumocystis carinii pneumonia, bronchoalveolar lavage sediment and supernatant concentrations of pentamidine were compared 18 to 24 h after administration of 4 mg/kg intravenous (n = 3) and aerosolized (n = 5) pentamidine isethionate. Aerosol was inhaled for 35 to 40 min with 300 mg of pentamidine isethionate in a jet nebulizer, baffled to decrease the particle size to 1.42 micron +/- 1.88 (mass median aerodynamic diameter +/- geometric standard deviation). Bronchoalveolar pentamidine concentrations were: In sediment, 9.34 +/- 1.74 postintravenous versus 705 +/- 242 ng/ml postaerosol (mean +/- SEM, p less than 0.05); supernatant, 2.64 +/- 0.73 postintravenous versus 23.2 +/- 7.75 ng/ml postaerosol (mean +/- SEM, p less than 0.05). Serum pentamidine levels were low or undetectable after aerosolization. Aerosol administration delivers significantly higher concentrations of pentamidine to the air spaces than does intravenous delivery in patients with diffuse alveolar infiltrates.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Transbronchial biopsy without fluoroscopy in patients with diffuse roentgenographic infiltrates and the acquired immunodeficiency syndrome.

Transbronchial biopsy with the flexible fiberoptic bronchoscope is usually performed with the assistance of fluoroscopy in order to increase diagnostic yield and decrease the incidence of pneumothorax. We have compared the results of transbronchial biopsy performed with or without fluoroscopic guidance in patients with diffuse roentgenographic infiltrates who had or were suspected of having the acquired immunodeficiency syndrome. Neither the sensitivity for Pneumocystis carinii (88.5 versus 92%) nor the percentage of patients developing pneumothoraces after transbronchial biopsy (8.6 versus 11.1%) was significantly different in those patients who had the procedure without fluoroscopic guidance compared with those in whom fluoroscopy was used. There were no patients with significant hemorrhage or deaths in either group. This complication rate compares favorably with other reports of transbronchial biopsy in immunocompromised patients in which fluoroscopy was used. "Blind" transbronchial biopsy is a safe and effective diagnostic procedure in this patient population.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Ineffectiveness of high-dose methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock.

We conducted a prospective, randomized, double-blind study to determine whether high-dose methylprednisolone could prevent parenchymal lung injury, including the adult respiratory distress syndrome (ARDS), or improve mortality when administered early in septic shock. All patients already hospitalized in or newly admitted to the medical and surgical intensive care units at San Francisco General Hospital between September 1, 1983 and August 29, 1986 were eligible for admission to the study if they had either (1) an increase in temperature of 1.5 degrees C and a decrease in systolic blood pressure of 20 mm Hg or more from baseline values (in already hospitalized patients), or (2) a temperature greater than 38.5 degrees C or less than 35.5 degrees C and a systolic blood pressure of less than 90 mm Hg (in newly admitted patients). Patients meeting these criteria were excluded if they (1) had severe immunodeficiency, (2) were less than 18 or greater than 76 yr of age, (3) had multilobar roentgenographic infiltrates, or (4) were already receiving corticosteroids. Eighty-seven patients enrolled in the study received either methylprednisolone, 30 mg/kg per dose, or mannitol placebo for a total of 4 doses every 6 h, following the presumptive diagnosis of septic shock. Of these patients, 75 ultimately were determined on the basis of culture results to have actually had septic shock at the time of entry. Thirteen of the patients who received methylprednisolone developed ARDS, compared to 14 patients who received placebo. Lesser degrees of parenchymal lung injury did not differ between the 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Diagnosis of pulmonary diseases.

A broad spectrum of lung disease occurs in association with HIV infection. Included are both infectious and neoplastic processes and idiopathic disorders. To insure prompt, accurate, and efficient diagnosis, a logical, staged sequence of tests should be applied. Chest films and, in some instances, pulmonary function tests and gallium-67 citrate lung scans serve to provide objective indications of lung disease. Each of these tests is sensitive but nonspecific. Specific infecting organisms, particularly P. carinii, can be identified by examining sputum induced by inhalation of 3 per cent saline. Bronchoscopic procedures, including BAL and TBB, are highly sensitive and should be performed in patients having nondiagnostic sputum examinations. Tests involving antigen and antibody detection are of little use in the evaluation of individual patients. Detection of recurrent episodes of PCP is difficult because abnormalities in the usual screening tests may be residual from previous episodes. Finding P. carinii in sputum or bronchoscopic specimens soon (within 2 to 3 months) after a confirmed episode of PCP likely represents residual organisms rather than recrudescence of the infection. Empiric diagnosis of P. carinii should be employed only in limited circumstances when specific diagnostic studies are not available, are contraindicated, or are refused.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Attitudes of medical residents regarding intensive care for patients with the acquired immunodeficiency syndrome.

We recently surveyed the medical house staff at the University of California, San Francisco, and found that residents had a good understanding of the poor prognosis of patients with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia who require intensive care for respiratory failure, and tended to favor early discussions with patients regarding resuscitation and intensive care. We used the same questionnaire to survey the house staffs of four other programs varying in geography and exposure to patients with AIDS. We found a striking correlation between the number of patients with AIDS cared for by the residents, the assessment of the prognosis of patients with AIDS with P carinii pneumonia, and house-staff attitudes toward discussions about resuscitation and intensive care. The results of this study suggest that the intensity of exposure to patients with AIDS determines the assessment of prognosis, and that one or both of these factors strongly influences attitudes toward intensive care. Regardless of these attitudes, early discussion of resuscitation and intensive care between physicians and patients with AIDS and P carinii pneumonia seems warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1987

High-dose corticosteroids in patients with the adult respiratory distress syndrome.

Corticosteroids are widely used as therapy for the adult respiratory distress syndrome (ARDS) without proof of efficacy. We conducted a prospective, randomized, double-blind, placebo-controlled trial of methylprednisolone therapy in 99 patients with refractory hypoxemia, diffuse bilateral infiltrates on chest radiography and absence of congestive heart failure documented by pulmonary-artery catheterization. The causes of ARDS included sepsis (27 percent), aspiration pneumonia (18 percent), pancreatitis (4 percent), shock (2 percent), fat emboli (1 percent), and miscellaneous causes or more than one cause (42 percent). Fifty patients received methylprednisolone (30 mg per kilogram of body weight every six hours for 24 hours), and 49 received placebo according to the same schedule. Serial measurements were made of pulmonary shunting, the ratio of partial pressure of arterial oxygen to partial pressure of alveolar oxygen, the chest radiograph severity score, total thoracic compliance, and pulmonary-artery pressure. We observed no statistical differences between groups in these characteristics upon entry or during the five days after entry. Forty-five days after entry there were no differences between the methylprednisolone and placebo groups in mortality (respectively, 30 of 50 [60 percent; 95 percent confidence interval, 46 to 74] and 31 of 49 [63 percent; 95 percent confidence interval, 49 to 77]; P = 0.74) or in the reversal of ARDS (18 of 50 [36 percent] vs. 19 of 49 [39 percent]; P = 0.77). However, the relatively wide confidence intervals in the mortality data make it impossible to exclude a small effect of treatment. Infectious complications were similar in the methylprednisolone group (8 of 50 [16 percent]) and the placebo group (5 of 49 [10 percent]; P = 0.60). Our data suggest that in patients with established ARDS due to sepsis, aspiration, or a mixed cause, high-dose methylprednisolone does not affect outcome.

Clinical Trials as Topic↗
PubMed1987

Aerosolised pentamidine as sole therapy for Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome.

15 patients with first episodes of Pneumocystis carinii pneumonia and the acquired immunodeficiency syndrome were treated with only aerosolised pentamidine, which they inhaled for 20 minutes every day for 21 days. 13 of the 15 responded to therapy. Mean PaO2 (mm Hg) and vital capacity (% predicted) were 67.9 and 50.8 before therapy and 80.1 and 67.9 after therapy in patients successfully treated. No systemic side-effects occurred and serum pentamidine concentrations were low in all patients. The only local adverse reaction was cough in 12 patients. Aerosolised pentamidine may be an effective non-toxic treatment for P carinii pneumonia.

Acquired Immunodeficiency Syndrome↗