Biomedical subjects

K H Weisiger

Publications and source records attributed to K H Weisiger.

5 recordsLinked to original sources

PubMed1995

Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase.

STUDY OBJECTIVE: We report the results of image-guided catheter drainage with adjunctive enzymatic pleural debridement in the treatment of empyemas and other complicated pleural fluid collections. DESIGN: Retrospective review. PATIENTS: One hundred eighteen patients with complicated pleural fluid collections were treated with image-guided drainage. There were 79 empyemas, 27 sterile loculated parapneumonic effusions, 10 sterile hemothoraces, and 2 sterile postoperative exudative effusions. Forty-one patients had failed prior large-bore thoracostomy drainage. The estimated age of the effusions at the time of image-guided drainage ranged from 1 to 175 days with a mean estimated age of 13 days. INTERVENTIONS: Patients were treated with image-guided placement of one or more 12F to 16F chest drains. Adjunctive urokinase instillation was used in 98 cases. Urokinase (100,000 to 250,000 U/mL) was instilled in 20 to 240-mL aliquots and reaspirated in 1 to 4 h. One to four instillations were performed per day until drainage was complete. MEASUREMENTS AND RESULTS: Drainage was successful in 111 cases (94%). Two patients died of sepsis with incomplete drainage. Five patients underwent decortication (three recovered and two died postoperatively). Fifty-three patients (45%) required placement of more than one drain. The mean duration of drainage was 6.3 days. Patients treated with pleurolysis required a mean of five instillations of urokinase. The mean total dose of urokinase used per case was 466,000 U. There were no complications. CONCLUSION: Image-guided drainage with adjunctive pleural urokinase therapy is a safe and effective method of closed thoracostomy drainage of complicated pleural fluid collections and can obviate surgery in most cases.

Adolescent↗

PubMed1987

Blood lactate concentration increases as a continuous function in progressive exercise.

The relationship between arterialized blood lactate concentration [( La-]) and O2 uptake (VO2) was examined during a total of 23 tests by eight subjects. Exercise was on a cycle ergometer with work rate incremented from loadless pedaling to exhaustion as a 50-W/min ramp function. Two different mathematical models were studied. One model employed a log-log transformation of [La-] and VO2 to yield [La-] threshold as proposed by Beaver et al. (J. Appl. Physiol. 59: 1936-1940, 1985). The other model was a continuous exponential plus constant of the form La- = a + b[exp(cVO2)]. In 21 of 23 data sets, the mean square error (MSE) of the continuous model was less than that of the log-log model (P less than 0.001). The MSE was on average 3.5 times greater in the log-log model than in the continuous model. The residuals were randomly distributed about the line of best fit for the continuous model. In contrast, the log-log model showed a nonrandom pattern indicating an inappropriate model. As an index of the position of the [La-]-VO2 continuous model, the VO2 at which the rate of increase of [La-] equaled the rate of increase of VO2 (d[La-]/dVO2 = 1) was determined. This VO2 was 2.241 +/- 0.081 l/min, which averaged 64.6% of maximal VO2. It is proposed that this lactate slope index could be used as a relative indicator of fitness instead of the previously applied threshold concept. The change in [La-] could be better described mathematically by a continuous model rather than the threshold model of Beaver et al.

Adolescent↗

PubMed1987

Estimate of mean tissue O2 consumption at onset of exercise in males.

A mathematical model has been developed that permitted the calculation of the flow-weighted mean tissue O2 consumption (VO2T) at the onset of a step increase in work rate. From breath-by-breath measurements of alveolar O2 consumption (VO2A) and cardiac output (Q) by impedance cardiography and assumptions about the site of depletion of O2 stores, the rate of change in O2 stores (VO2s) was determined. The sum of VO2A + VO2s = VO2T. Six very fit males performed six repetitions of each of two step increases in work rate. STlo was a transition from rest to 100-W cycling; SThi was a transition from 100- to 200-W cycling. For each work rate transition, the responses of VO2A and Q were averaged over the six repetitions of each subject and the model was solved to yield VO2T. The responses of VO2A, VO2T, and Q after the increase in work rate were fit with a monoexponential function. This function included a time constant and time delay, the sum of which gave the mean response time (MRT). In the STlo test, the MRT of VO2A (24.9 +/- 1.1 s, mean +/- SE) was longer than that of VO2T (15.3 +/- 1.3 s) and of Q (16.5 +/- 6.5 s) (P less than 0.05). The MRT of VO2T and Q did not differ significantly. Also for SThi, the MRT of VO2A (34.4 +/- 3.3 s) was significantly longer than that of VO2T (30.0 +/- 3.4 s) (P less than 0.05). The MRT of VO2T and Q (30.3 +/- 5.5 s) were not significantly different at this work rate either.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

Computerized estimation of lactate threshold.

Traditional approaches to estimating a lactate threshold during a progressive exercise test have utilized visual inspection of the data. We describe a computerized approach which utilizes a log-log transformation to yield two approximately linear segments. Linear regression lines are fit to these segments and the intersection of the two lines yields an estimate of the lactate threshold. An approximate 95% confidence interval is also generated.

Algorithms↗

PubMed1986

Importance of oscillations in alveolar gas concentrations in the analysis of rebreathing data.

Cyclic rebreathing of a soluble inert gas can be used to estimate lung tissue volume (Vt) and pulmonary blood flow (Qc). A recently proposed method for analyzing such cyclic data (Respir. Physiol. 48: 255-279, 1982) mathematically assumes that ventilation is a continuous process. However, neglecting the cyclic nature of ventilation may prevent the accurate estimation of Vt and Qc. We evaluated this possibility by simulating the uptake of soluble inert gases during rebreathing using a cyclic model of gas exchange. Under cyclic uptake conditions alveolar gases follow an oscillating time course, because gas concentrations tend to increase during inspiration and to decrease during expiration. We found that neglecting these alveolar gas oscillations leads to the underestimation of soluble gas uptake by blood, particularly during the early rebreathing breaths. When continuous ventilation is assumed Vt and Qc are overestimated unless rapid rebreathing rates, large tidal volumes, and gases of moderately low solubility are used. Under these conditions the amplitude of the cyclic oscillations is minimized, the alveolar time course more closely resembles that expected from continuous ventilation, and the resulting errors are minimized. Alternatively, when the effect of oscillating alveolar gas concentrations on mass transfer are considered, these estimation errors can be eliminated without restricting rebreathing rate or gas solubility. We conclude that failure to consider the effect of cyclic rebreathing on the time course of alveolar gas concentrations may result in significant errors when evaluating rebreathing data for Vt and Qc.

Lung Volume Measurements↗