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Biomedical subjects

L McKeever

Publications and source records attributed to L McKeever.

9 recordsLinked to original sources
PubMed1988

A system approach to intravenous thrombolysis in acute myocardial infarction in community hospitals: the influence of paramedics.

UNLABELLED: During a 3-year period, intravenous streptokinase (IV STK) was given to 110 consecutive patients ages 34-78 in the course of acute myocardial infarction (AMI) in three community hospitals served by the same paramedic system. 1.5 million units of IV STK was given over 30 minutes. Half of the patients were brought to the hospital by paramedics. The average time from onset of pain to administration of IV STK was 107 minutes in the paramedic group and 182 minutes for the others. Of 110 patients, 98 (89%) showed clinical evidence of reperfusion and 94 of 106 patients (89%) showed angiographic reperfusion. Angiography was performed from 1 to 10 days post-AMI. Mean time to angiography was 6 days for the first 58 patients and 2 days for the last 52 patients. In-hospital mortality was 2 of 110 patients and there was 1 late death at 8 months for an overall 3-year mortality 2.7%. Of 86 patients, 83 (96%) working before their infarct are working now. Of 107 survivors, 96 (90%) are Functional Class I. CONCLUSIONS: (1) IV STK is safely administered in a high percentage of AMI patients. (2) IV STK is safely administered in community hospitals. (3) Paramedics act as an early warning system and allow for earlier treatment than patients presenting without paramedic involvement. (4) Successful coronary reperfusion with IV STK results in low mortality rates and minimizes functional disability. (5) A system-wide approach to reducing time to treatment in AMI may be the most influential factor in affecting morbidity and mortality.

Adult↗
PubMed1982

Ocular lesions in free-living raptors.

In a retrospective study, records of 931 raptors admitted to the Avian Clinic at the New York State College of Veterinary Medicine and to the Owl Rehabilitation Research Foundation were evaluated to determine the prevalence, cause, and distribution of ocular lesions. Some form of ocular lesion was identified in 135 (14.5%) birds. Of these, 90% were the result of physical injury. Collisions accounted for 33% of ocular lesions; gunshot wounds accounted for 11%. Unilateral lesions were more common than bilateral lesions, with the anterior segment being most frequently involved. Hyphema was the most common clinical finding. In a prospective study involving raptors admitted to the Avian Clinic from 1980-1982, it was found that 17 of 61 birds (28%) had some form of ocular lesion. The higher prevalence in this study was attributed to a lower proportion of juvenile cases and to increased detection of subtle lesions, especially those involving the posterior segment.

Animals↗
PubMed1977

Comparative responses to dobutamine and nitroprusside in patients with chronic low output cardiac failure.

The acute hemodynamic effects of dobutamine and nitroprusside were compared in 19 patients with low output cardiac failure. At dosage levels yielding similar increases in cardiac index (12 patients), nitroprusside resulted in significantly lower arterial systolic and wedge pressures and did not increase heart rate suggesting advantages over dobutamine when reduction in myocardial oxygen requirement or pulmonary congestion is a major goal. Systemic arterial mean and diastolic pressures were minimally changed with dobutamine, but fell significantly with nitroprusside suggesting advantages of dobutamine over nitroprusside in patients where hypotension could limit coronary blood flow or perfusion of other vital organs. Reduction in pulmonary arteriolar resistance occurred only with nitroprusside. Arterial hypoxemia developed in three patients during nitroprusside infusion suggesting the possibility of increased right-to-left intrapulmonary shunting resulting from a direct vasodilating effect of nitroprusside on pulmonary arteriole smooth muscle. Although both inotropic and vasodilator drugs can result in hemodynamic improvement when administered to patients with chronic low output cardiac failure, significant differences of potential clinical importance exist between these two modes of therapy.

Adult↗
PubMed1975

Perinatal reactions of the rabbit lung to maternal endotoxemia.

The reactions of the fetal and newborn lung to in utero injury were investigated in rabbits using as a model maternal administration of Escherichia coli endotoxin, 2 to 4 mug per kg. of body weight, injected intravenously at the 29th gestational day. At 6 hours after endotoxin injection, the lung revealed diffuse alveolar damage-sparing type II cells which appeared resistant to injury but more mature than type II cells from control lungs. These changes were followed by a reparative phase which over a 2-day period resulted in increased interstitial cellularity, replacement of the damaged type I cells by proliferated type II cells, and marked intraalveolar accumulation of myelin figures. The above reactions were associated with an average increase of 100 per cent in the phospholipid content of the surfactant fraction isolated from lung washing. Postnatally, the lungs showed structural changes resembling those seen in hyaline membrane disease of the newborn. The findings suggest that the response of the alveolar epithelim to injury inudced late in gestation follows a pattern similar to that described previously in adult lung, and is assoicated with in utero increased release of surfactant. It is proposed that alveolar injury and repair, including reduction of the intracellular surfactant reservoir occurring prior to breathing, may interfere postnatally with formation and maintenance of a normal surfactant layer, thereby predisposing to respiratory distress.

Animals↗