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Biomedical subjects

M Lippmann

Publications and source records attributed to M Lippmann.

At least 145 records · Page 8Linked to original sources
PubMed1977

The clinical and physiological effect of whole-lung lavage in pulmonary alveolar proteinosis: a ten-year experience.

We have utilized whole-lung lavage in the successful treatment of 18 patients with pulmonary alveolar proteinosis. Our ten-year experience includes serial evaluations of patients with disabling lung dysfunction who had a total of 49 whole-lung lavages under general anesthesia. Clinical and physiological responses were documented both before and after each lavage. There were no complications or deaths. All patients were radiographically, physiologically, and symptomatically improved within hours after the procedures. Five patients required from two to four repeat lavages one to three years later. The treatment of this disorder has included a wide variety of techniques. We attribute our results to the use of a lung lavage technique that includes: (1) unilateral whole-lung lavages at two to three day intervals; (2) isotonic saline as the lavage solution; (3) use of a mechanical chest percussor during lavage; and (4) measuring the total thoracic compliance of each side in the immediate postlavage period as a guide for extubation. We conclude that whole-lung lavage is a safe, highly effective, repetitively applicable treatment for pulmonary alveolar proteinosis.

Adolescent↗
PubMed1977

Pulmonary reactions to drugs.

Reactions to drugs may take many forms, most commonly skin and gastrointestinal reactions. Often forgotten are the pulmonary toxic effects, which can be devastating. Unfortunately, treatment of many of these iatrogenically produced diseases is unsatisfactory. Supportive pulmonary care and corticosteroids, in some cases, are the major modalities of therapy. The physician must be aware of the serious pulmonary consequences of many commonly used agents. Judicious use of these drugs coupled with careful pulmonary monitoring will prevent serious toxicity.

Adrenal Cortex Hormones↗
PubMed1977

Tracheal cylindroma: anaesthetic management.

A tracheal cylindroma in a lady aged 56 yr was excised. The problems of tracheal and carinal resection, and an anaesthetic technique which obviates the use of cardiopulmonary bypass are described.

Anesthesia, General↗
PubMed1976

Ligation of patent ductus arteriosus in premature infants.

Twenty-four neonates at 25-34 weeks' gestation with a weight range of 570-1530 g underwent ligation of patent ductus arteriosus (PDA). The infants had mild to severe respiratory distress syndrome at birth and later developed signs of heart failure as a result of left-to-right shunting through a PDA. Surgical closure of the PDA was performed within 2-31 days after birth. In the period before operation the heart rate was monitored constantly and the arterial blood-gases were assessed frequently. The trachea was intubated and respiration was controlled with a ventilator. Surgery was performed under controlled ventilation and no anaesthesia was used. Care was taken not to overventilate the lungs. Nine infants died. Death was associated with higher peak inspiratory ventilator pressures at the time of operation and with complications occurring during or after the operation. The most common complication was tension pneumomediastinum which appears to be related to excessive ventilator pressures during surgery.

Acidosis↗
PubMed1976

Particle deposition in the trachea: in vivo and in hollow casts.

The pattern of deposition within the respiratory tract of potentially harmful particulates is a major factor in assessing any risk from individual and community exposures. Although the trachea is the most easily observed of the conductive airways, very little information concerning its particle collection characteristics is available, information which is essential for a complete and realistic description of particle deposition patterns within the entire respiratory tract. Data on tracheal deposition are also needed for development of accurate predictive models for particle deposition. The pattern of particle deposition in the trachea, and its relation to air flow, was studied in a hollow cast of the human larynx-tracheobronchial tree. Results were compared with data obtained in humans in vivo and from previous studies in hollow casts. In addition, the relevance of tracheal deposition in the hollow cast test system to deposition in vivo was examined by a direct comparison of deposition in a cast prepared from the lungs of donkeys previously studied in a series of in vivo tests. The disturbance of the air flow within the trachea caused by the larynx promoted the deposition of suspended particulates throughout the length of the trachea, and especially in proximal regions. This proximal deposition was due both to direct impaction from the air jet coming from the glottis and to effects of the tubulent flow. Turbulence produced inhomogenous deposition patterns within the trachea for particles of all sizes, although its effect was more pronounced as size decreased. Tracheal deposition in the human cast was within the range of normal in vivo tracheal depostion only when a larynx was used during cast test exposures; this emphasizes the need for the use of realistic experimental test systems for the study of particle deposition patterns. The relative patterns of deposition in casts of the donkey trachea and in the same tracheas in vivo were similar.

Aerosols↗
PubMed1976

Effect of adrenergic agents and their mode of action on mucociliary clearance in man.

The aerosolized adrenergic (ADR) agent, isoproterenol (ISO), was found markedly to accelerate mucus clearance within the human tracheobronchial tree. Mucus transport was measured by external gamma counting of aerosolized Fe2O3 particles deposited on the mucous membrane during inhalation. Aerosolized epinephrine (EPI), despite its alpha-ADR bronchial vasoconstrictor activity, increased mucus clearance to the same degree as did aerosolized ISO, with its beta-ADR bronchial vasodilator activity. The vehicle used for delivery of the ADR agents, i.e., a H2O aerosol by intermittent positive-pressure breathing (IPPB), itself increased mucus clearance slightly, but did not elicit the enormous increases produced by the ADR agents. Parenteral ISO caused increases in clearances similar to aerosolized ISO and EPI (consistent with different tissue drug levels achieved). Oral atropine delayed clearance, but atropine prior to an ADR aerosol did not alter the mucus transport effect of the ADR agent. ISO and atropine, despite opposite effects on mucus clearance, caused equal bronchodilation. Thus, increased clearance following aerosolized ISO was not dependent on bronchial vasodilation, aqueous aerosol droplets, reflex parasympathetic activation, or bronchodilation, and seems best attributable to increased ciliary beat rate.

Adult↗
PubMed1976

Effect of pretest temperature on aerosol penetration and clearance in donkeys.

Pretest temperature and humidity were correlated with tracheobronchial particle penetration and clearance data from donkeys housed in unheated outdoor facilities and tested after spending 1-2 h in a temperature- and humidity-controlled laboratory. The animals inhaled an inert insoluble radioisotope-labeled monodisperse aerosol for several minutes. Its retention was monitored continuously for 3 h by external gamma detection. Aerosol deposition pattern and bronchial clearance were linearly correlated with pretest outdoor temperature which ranged from -10 to 30 degrees C. The fraction depositing in the unciliated regions of the lung decreased 0.6% per degrees C drop in outdoor temperature. Overall bronchial transport decreased at least 1.5% per degrees C decrease. Multiple linear regression analysis and correction for the positive correlation between temperature and humidity left no significant residual humidity dependence. Acclimatization of the animals in the laboratory for 6 h before testing significantly reduced these effects.

Aerosols↗
PubMed1976

Closing volume in coal miners.

Closing volume and closing capacity were determined in 82 working Appalachian coal miners and in a comparable group of control subjects. Abnormalities of closing volume and closing capacity were related to other measurements of pulmonary function. The relationship of smoking history, dust exposure, and presence of pneumoconiosis and bronchitis to elevations of closing volume and closing capacity was determined. It was shown that nonsmoking miners had elevated closing volume and closing capacity when compared to control subjects. Miners who were smokers or ex-smokers also had elevated closing capacity when compared to control subjects. Neither bronchitic symptoms nor the radiographic presence of pneumoconiosis were associated with an elevation of closing volume or closing capacity.

Bronchitis↗
PubMed1976

Improving the results of ligation of patent ductus arteriosus in small preterm infants.

Thirty-two consecutive preterm infants with birth weights under 1,500 grams and with respiratory distress syndrome (RDS) complicated by a patent ductus arteriosus (PDA) underwent ligation of PDA. The indications for operation were massive left-to-right shunting associated with heart failure (cardiomegaly and pulmonary edema) unresponsive to medical treatment. The clinical manifestations of heart failure were related to the severity of RDS. Infants with mild-to-moderate RDS (21) often recovered and later developed typical findings of PDA (bounding pulses, hyperactive precordium, and murmur). They are now operated upon as soon as respiratory support is required. Infants with severe RDS (11) develop cardiomegaly earlier, and retrograde aortography may show massive left-to-right shunting before the presence of a murmur. Ligation is indicated when blood-gas values deteriorate despite medical treatment. Nineteen (59 per cent) of these extremely preterm infants survived to be discharged and 16 (50 per cent) are developing normally. Three have neurologic impariment. None of the survivors has clinical respiratory disease, and their radiologic findings of bronchopulmonary dysplasia are improving.

Birth Weight↗
PubMed1975

Tracheobronchial particle deposition and clearance. A study of the effects of cigarette smoking in monozygotic twins.

Particle deposition and tracheobronchial clearance were measured in six pairs of male monozygotic twins, four of which were discordant for cigarette smoking. The fraction of an inhaled aerosol that deposited on the ciliated airways showed variations within twin pairs comparable with variations in repeated tests on a single subject, and significantly smaller (P less than .001) than among tests on different subjects. Variations that did occur were consistent with differences in forced expiratory volume (FEV1.0) values. The proximal shift of aerosol deposition and reduced FEV1.0 values in smokers indicated that they had some degree of bronchoconstriction. Mucociliary clearance characteristics are qualitatively and quantitatively similar for nonsmoking and smoking concordant monozygotic twins, ie, comparable with repeated tests on a single individual, reflecting their constitutional similarity. With one exception, clearance curves for twin pairs discordant with respect to smoking were also qualitatively indistinguishable. Nonsmokers, however, had greater upper bronchial clearance rates than their smoking twins.

Aerosols↗
PubMed1975

Mortality patterns among workers exposed to chloromethyl ethers--a preliminary report.

Chloromethyl methyl ether (CMME) has been used extensively as a crosslinking agent for ion-exchange resins. Commercial grades of CMME are contaminated to the extent of 2-8% with bischloromethyl ether, an alkylating agent which has been shown to be a very potent lung carcinogen in animals. Reports by other investigators in this and other countries have implicated CMME as a lung carcinogen in chemical workers. The purpose of the study reported here was to examine the lung cancer mortality experience with respect to intensity and duration of exposure in six of the seven chemical companies that account for virtually all of the CMME use in the United States. The study included about 1800 workers who were exposed in the period 1948 to 1972 and about 8000 workers not exposed to CMME from the same plants who served as controls. Exposed workers were characterized according to job description and duration of exposure. In several plants the intensity of exposure was numerically graded for each job category with adjustment for temporal changes in the plant processes. Social Security records were used to identify deaths among workers who had left the companies and death certificates have been obtained for virtually all known deaths. The age-adjusted death rate for respiratory cancer in the CMME exposed group as a whole was 2.5 times that in the control group, whereas death rates due to other causes were comparable. There was also a gradation of lung cancer risk according to intensity and duration of exposure and the time elapsed since the onset of exposure.

Adolescent↗
PubMed1975

[Epinephrine injection with enflurane anaesthesia: incidence of cardiac arrhythmias (author's transl)].

Two hundred patients, primarily A.S.A. status I and II, were prospectively divided into two groups of 100 each. One group received nitrous oxideoxygen-enflurane anaesthesia and subcutaneous infiltration of adrenaline in lignocaine for haemostasis, while the other received enflurane but not adrenalin. Patients were continuously monitored with a cardioscope. Epinephrine dosages were limited to those recommended for safe use with halothane anaesthesia. No patient in the control group experienced an arrhythmia, and only one patient in the study group developed a burst of premature ventricular contractions following adrenaline injection. The authors conclude that adrenaline may be given subcutaneously for hemostasis in patients under enflurane anaesthesia provided the safeguards established for halothane are observed.

Adolescent↗
PubMed1975

Influence of respiratory air space dimensions on aerosol deposition.

Models used to estimate both total and regional deposition of aerosols in the human respiratory tract have been proposed by a number of individuals and groups. Although the values chosen by different investigators for dimensions of airways or other air spaces may differ significantly from each other, there is the common assumption that the normal human respiratory tract is structurally uniform and that dimensions and branching patterns may be considered as constants in the deposition equations. There has been, therefore, considerable emphasis on estimating the effects of particle size, size dispersion, tidal volume and respiratory frequency. Much less attention has been paid to the normal intersubject variability of the size of air spaces in spite of the obvious influence this would have on aerosol deposition. Work on deposition from our own laboratories, as well as published results of others on pulmonary anatomy, has lead to the conclusion that there is considerable anatomic variability among normal subjects. Aerosol deposition in individuals examined under nearly identical conditions has also shown considerable variability. This paper will discuss the similarity in range of anatomical differences and differences in deposition and the probable relationship between the two.

Aerosols↗
PubMed1975

Factors affecting tracheobronchial mucociliary transport.

In vivo mucus transport rates were studied in humans and donkeys by external measurement of the rate of clearance of insoluble monodisperse gamma-tagged aerosols. The influence of temperature, environmental toxicants and drugs which affect the autonomic nervous system were studied by determining the changes in clearance produced by them in individual subjects. In donkeys, increased pretest ambient temperature accelerated clearance by greater than 1.7%/ degrees C. Smoking 2-7 cigarettes reduced the duration of bronchial clearance by approximately 50% in both humans and donkeys. Donkeys were exposed to higher doses; with progressive slowing of tracheal and bronchial clearance for greater than 10 cigarettes. HCN, at concentrations up to 1230 ppm, produced only a mild transient slowing of clearance. In man, atropine slowed clearance, while the adrenergic stimulating drugs, isoproterenol and epinephrine, both accelerated it by greater than or equal to 4 times, as did isoproterenol when given subsequent to atropine. The cholinergic stimulating drug methacholine increased mucociliary transport in the the donkey. Administration of a tap water aerosol for 10-15 min in humans increased bronchial clearance rates by approximately 25%.

Aerosols↗