Search PubMed⌕ Search

Biomedical subjects

M E Whitcomb

Publications and source records attributed to M E Whitcomb.

At least 55 records · Page 3Linked to original sources
PubMed1986

Care of the ventilator-dependent patient: public policy considerations.

Because traditional cost-based reimbursement for acute hospital care has been replaced by the DRG system and other limited-payment approaches, hospital managers are seeking more cost-effective provision of care. This has shortened patient-stay periods in hospitals and increased demand for such alternatives as nursing home and private home care for chronically ill persons, including those dependent on ventilators. At the same time that hospitals seek to discharge patients earlier, patients themselves would prefer to remain in hospitals for long-term care because adequate financial coverage is not available to most of them for alternative-site care. In this setting of conflict between the financial policies of hospitals and those of Medicare and private insurance carriers, it is important to keep quality of care, not financial considerations, as the first consideration when a facility is chosen for long-term care. But the long-term patient, including the patient requiring ventilator support, is caught in the web of competing financial incentives and the fact that there is no consensus on how such care should be organized, delivered, or paid for. The only significant source of funding for long-term nursing home care is Medicaid, which requires the patient to give up his personal assets, including his home; this makes it nearly certain that he will always remain institutionalized. Private insurance carriers have not yet come to terms with the idea that long-term ventilator care can be made less expensive at sites other than hospitals--and thus many patients have no satisfactory answer to the problem of where to receive such care or how it can be financed.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Policy↗
PubMed1985

Hypoxia results in an increase in total systemic shunt flow in dogs.

There is considerable evidence to indicate that blood flow to many organs changes in response to hypoxia. However, since blood may traverse nutrient capillaries or be shunted through precapillary arteriovenous channels, measurements of total organ blood flow alone may not accurately reflect microcirculatory adaptations to hypoxia. To test this hypothesis, we determined the effect of controlled normoxic ventilation (PO2 = 86.4 +/- 2.8 Torr; N = 10) and controlled hypoxic ventilation (PO2 = 45.9 +/- 1.0 Torr; N = 5) on cardiac output, nutrient blood flow and total systemic shunt flow in dogs using radiolabelled 15 micrometers microspheres. The microspheres were injected from left heart catheters in each animal and total systemic shunt flow was estimated from the radioactivity present in pulmonary artery reference samples. Cardiac output, as well as nutrient blood flow to the heart and brain, was similar in both hypoxic animals and normoxic controls. Although we could detect no significant changes in nutrient blood flow to the remaining organs in response to hypoxia, total systemic shunt flow increased from a baseline value of 4.4% of cardiac output to a maximum value of 7.9% of cardiac output in hypoxic animals compared to 2.3% of cardiac output in normoxic animals at a similar time point (P less than 0.01). This hypoxia-induced increase in total systemic shunt flow may contribute to the overall decline in organ function often observed in this setting.

Animals↗
PubMed1984

Advances in the diagnosis and treatment of broncholithiasis.

In order to determine the present clinical spectrum of broncholithiasis and the impact that chest computed tomographic (CT) scans, laminograms , and fiberoptic bronchoscopy ( FOB ) have had on the diagnosis and treatment of this entity, we reviewed our experience between 1970 and 1982. Nineteen patients were identified with this diagnosis. Cough, hemoptysis, and obstructive pneumonia were the most common presentations. Lithoptysis occurred in only 3 patients. The chest radiographic findings were nonspecific, but in 8 of the 19 patients, laminograms or chest CT scans helped establish the diagnosis; FOB was performed on 18 patients and was abnormal in each case, with 8 intrabronchial calcifications identified. However, FOB has limited therapeutic indications in this disorder. Depending on the patient's clinical status and underlying lung disease, observation, bronchoscopic removal of the stone, or surgical resection may be indicated.

Adolescent↗
PubMed1983

Rapid diagnosis of Legionnaires' disease by bronchoalveolar lavage.

Legionella pneumophila has, in recent years, emerged as a common pulmonary pathogen in the normal and immuno-compromised patient (ICP). Making a specific etiologic diagnosis of pneumonia in the latter group is a common clinical dilemma often complicated by poor specimen availability and risks of invasive procedures. Improved staining and isolation techniques for L pneumophila would suggest that early diagnosis could be possible if adequate specimens were available. This report summarizes our experience with bronchoalveolar lavage (BAL) with which we have diagnosed L pneumophila in eight immunocompromised patients, well in advance of more traditional methods. On the basis of this experience, we would advocate early BAL in the ICP as a rapid, safe, moderately sensitive and specific diagnostic test to aid in the identification of L pneumophila.

Adult↗
PubMed1982

Progressive and transient hypoxic ventilatory drive tests in healthy subjects.

In order to ascertain the correlation between progressive and transient hypoxic ventilatory drive tests, 18 healthy subjects were tested by both methods, and the results were compared. Sudden cessation of steady-state hypoxia was done in 9 of the subjects to determine if an exaggerated central depressant effect of hypoxia might occur in some persons during progressive testing and explain a low response to progressive hypoxia. Because the progressive hypoxia test is frequently used in evaluating the effects of therapeutic interventions on ventilatory drive, the reproducibility of this test over time was also evaluated in 10 subjects. THere was a significant correlation between the results of the progressive and transient hypoxic tests when data from 17 of the 18 subjects were compared by linear regression analysis (r = 0.56, p less than 0.05). In 1 of 18 subjects, the ventilatory response to progressive hypoxia was quite low, whereas the response to transient hypoxia was high, and this can possibly be explained by an exaggerated central depressant effect of hypoxia. The progressive hypoxia test is quite reproducible (variance = 0.0092) over a 5- to 7-month period. We conclude that the use of progressive or transient hypoxic ventilatory drive tests will result in similar conclusions regarding the hypoxic ventilatory drive in most persons. In addition, the progressive hypoxia test can be reliably used to evaluate the effects of therapeutic interventions on hypoxic ventilatory drive.

Adult↗
PubMed1981

Pulmonary function after adult respiratory distress syndrome associated with Legionnaires' disease pneumonia.

Two patients with adult respiratory distress syndrome (ARDS) caused by Legionnaires' disease were treated with erythromycin lactobionate, and they survived. Sequential pulmonary function studies and chest roentgenograms were obtained in both patients. Despite previous suggestions that severe fibrosis might complicate the recovery of patients with this disease, both patients had normal lung volumes and only minimal reduction in single-breath carbon monoxide diffusing capacity ten weeks after the onset of the disease. Thus, pulmonary function after ARDS caused by Legionnaires' disease seems to be only minimally disturbed.

Adult↗
PubMed1981

Bronchiolitis fibrosa obliterans in adults.

Clinical, roentgenologic, and physiologic manifestations of three adult patients with biopsy-proved bronchiolitis fibrosa obliterans illustrate the varied clinical features of the different stages of this disease and emphasize the rapidly progressive nature of the disorder in some patients. Although the chronic stage of bronchiolitis fibrosa obliterans has not been shown previously to respond to corticosteroid therapy, both of our patients with this stage of the disease had a dramatic response to high-dose prednisone. Furthermore, our one patient with the acute stage of the disease had complete resolution of his disease with treatment. Our experience suggests that early diagnosis and treatment are important in determining the clinical course of the disease.

Adult↗
PubMed1980

Sarcoidosis.

Explore the source record for details and available documents.

Humans↗
PubMed1980

Splenomegaly in sarcoidosis.

The clinical records of 32 patients with sarcoidosis associated with splenomegaly were reviewed. The results of this study disclosed that when compared with a matched control population without splenomegaly, patients with splenomegaly had evidence of more extensive extrathoracic sarcoidosis. In contrast, there was no difference in the degree of pulmonary involvement between patients with or without splenomegaly. Of the 32 patients with splenomegaly, seven (20%) had evidence of hypersplenism and five (16%) had abdominal symptoms. These abnormalities occurred only in patients with greatly enlarged spleens. Considering splenomegaly, we suggest that corticosteroids are indicated in the management of only large spleens and not of smaller spleens, unless there are other specific indications.

Adrenal Cortex Hormones↗