Suctioning the left bronchial tree in the intubated adult.
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Biomedical subjects
Publications and source records attributed to L Goodman.
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On computed tomographic scans of the upper abdomen the interface sign can help distinguish pleural and intra-abdominal fluid readily and accurately. A hazy interface between the fluid and liver or spleen is characteristic of pleural fluid. A sharp interface is characteristic of ascites. The interface sign has proved to be accurate in 30 consecutive cases.
In a survey of 45 men aged 40 or over who had worked five years or more in an asbestos manufacturing plant, the prevalence of pleural plaques was studied with respect to age, duration of asbestos exposure, estimated cumulative asbestos dose, and smoking habit. Plaques were found in 38 to 53% of the men, depending on the interpretation of the chest film reader. Cigarette habit appeared to be the most important factor; the prevalence was lowest in non-smokers, intermediate in current smokers, and particularly high in exsmokers. There was some confounding of this relationship by estimated cumulative asbestos dose but such confounding did not seem to be sufficient to explain fully the relationship between the prevalence of plaques and smoking habit. Both factors must be considered in studies of the risk of pleural plaques in asbestos workers.
Magnetopneumography was used to measure non-invasively the concentration of the ferrimagnetic fraction of retained welding fume in the thoraces of steel arc welders. This was done by measuring the remanent magnetic fields due to ferrimagnetic particles. The 11 welders studied had concentrations of thoracic ferrimagnetic mineral several orders of magnitude greater than three machinists, 16 former asbestos insulators and 24 control subjects. These concentrations correlated well with total years welding (p less than 0.01) and radiographic evidence of small rounded densities (p less than 0.05), but not with smoking history. There was a higher concentration of ferrimagnetic mineral over the hilar regions. Magnetopneumography offers a non-invasive indicator of the accumulation of welding fume in the thorax.
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Malignant fibrous histiocytoma is a recently accepted member of the mesenchymal group of tumors. Hypertrophic pulmonary osteoarthropathy is rarely seen with metastatic lung disease but when it occurs it is most frequently described with sarcomatous tumor metastases. In the case reported here, this phenomenon developed with pulmonary metastases from a malignant fibrous histiocytoma, indicating that this tumor resembles other sarcomas in giving rise to this unusual clinical syndrome.
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Carroll et al. reported that an abnormal dexamethasone suppression test (DST) may identify approximately 50% of endogenous depressives and that normalization of the test occurs with clinical recovery. Brown et al. and Schlesser et al. have confirmed the diagnostic utility of the test. A preliminary study suggested that when the DST failed to normalize at discharge, patients were at high risk for early relapse. In this study, we compared ten unipolar or bipolar endogenous depressives who had an abnormal DST on admission and a normal DST at discharge, with four patients whose abnormal DST on admission failed to convert at discharge. On all measures, those whose DST fail to convert showed substantially less improvement. Patients whose DST fail to normalize may have incomplete resolution of their underlying depressive process. Despite clinical judgment that discharge may be appropriate these patients may require further active treatment. Use of the DST prior to discharge may help discriminate between patients whose remaining symptoms reflect situational or psychosocial problems and those with a continuing endogenomorphic process.
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