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Biomedical subjects

R B George

Publications and source records attributed to R B George.

At least 91 records · Page 5Linked to original sources
PubMed1980

Parapneumonic effusions.

In this study the incidence and course of pleural effusions (parapneumonic effusions) in patients with acute bacterial pneumonia were prospectively evaluated. Bilateral decubitus chest x-ray films were obtained within 72 hours of admission in 203 patients with an acute febrile illness, purulent sputum and an infiltrate evident on the chest film. Ninety of the 203 patients (44 percent) had pleural effusions. Parapneumonic effusions, which required chest tubes for resolution and/or on which the pleural fluid cultures were positive, were classified as complicated parapneumonic effusions. The 10 patients with complicated parapneumonic effusions had clinical characteristics similar to the remainder of the group and could be separated from the 80 with uncomplicated effusions only by pleural fluid analysis. A pleural fluid pH below 7.00 and/or a glucose level below 40 mg/100 ml are indications for immediate tube thoracostomy. In patients with pleural fluid pH between 7.00 and 7.20 or lactic dehydrogenase (LDH) above 1,000 IU/1,000 ml, tube thoracostomy should be considered, but each case should be individualized; serial studies of the pleural fluid are useful in some of these cases. Patients with pleural fluid pH above 7.20 and pleural fluid LDH below 1,000 mg/100 ml rarely have complicated parapneumonic effusions and do not require serial therapeutic thoracenteses.

Adult↗
PubMed1980

A new method for analyzing multiple-breath nitrogen washout curves.

Multiple-breath nitrogen washout (MBNW) curves from 39 normal and 45 patients with varying degrees of airway obstruction were analyzed with the following equation: log log [(F0N2 - F infinity N2)/(FN2 - F infinity N2)] = B log (V/FRC) +A, where F0N2 is the initial, F infinity N2 is the equilibrium, and FN2 is the end-tidal fractional nitrogen concentration after a volume (V) of air in liters have been exchanged, and FRC is the measured functional residual capacity of the individual. All 84 curves were well described with the equation when all points corresponding to FN2 below 0.40 were used. The coefficient of determination (r2) exceeded 0.990 in 56/84 (67%) of the transformed curves and the lowest coefficient of determination was 0.946. This suggests that the MBNW can be described by two numbers, B called the index of uniformity, and A the index of efficiency. The ability of these two indices and the lung clearance index (LCI) to identify individuals as abnormal and to separate groups with varying degrees of airway obstruction was compared. B identified more individuals (33/45) as abnormal than did A(15/45) or LCI (19/45). B was also superior to A or LCI in separating groups with varying degrees of airway obstruction. This analysis allows the complex MBNW curve to be described by two numbers that vary depending on the degree of airway obstruction.

Adult↗
PubMed1980

Observations on pleural fluid pressures as fluid is withdrawn during thoracentesis.

In 52 patients with pleural effusions, pleural pressures were measured initially and serially as pleural fluid was withdrawn. Pleural fluid aspiration was continued until the pleural pressure fell below -20 cmH2O, or the patient developed excessive symptoms, or no more fluid could be obtained. The initial pleural pressure ranged from +8 to -21 cmH2O. The rate of pleural pressure change as fluid was withdrawn was highly variable. In 13 of 52 procedures (25%), thoracentesis was terminated because the pressure fell below -20 cmH2O. Negative initial pleural pressures and/or rapid changes in the pressures as fluid was withdrawn were suggestive of malignancy or trapped lung. The measurement of pleural pressures in patients with pleural effusions may be useful diagnostically. More importantly, because large changes in pleural pressures are not readily detectable by the operator, pleural pressures should be monitored when large amounts (> 1,000 ml) of pleural fluid are removed to increase the safety of the procedure.

Drainage↗
PubMed1980

Acute histoplasmosis. Description of an outbreak in northern Louisiana.

An outbreak of acute histoplasmosis occurred in northern Louisiana in September 1977. All six men who cleared a field of bamboo cane known to be a blackbird roosting site were affected. All had clinical and roentgenographic findings of acute pulmonary histoplasmosis, and all recovered. Seroconversion or fourfold rise in antibody to Histoplasma capsulatum yeast--or mycelial-form antigens were demonstrated in five. Immunodiffusion testing showed that all six patients developed H capsulatum M bands, and two developed H bands specific for active infection. The H capsulatum was isolated from the soil in the cane field. This is the first report of an outbreak of histoplasmosis in Louisiana and the first known isolation of H capsulatum from Louisiana soil.

Adult↗
PubMed1980

Serial pulmonary function studies in survivors of near drowning.

Determinations of standard lung volumes, mechanics of breathing, and single breath carbon monoxide diffusing capacity (DLCO) were obtained serially in two young patients who survived near drowning in fresh water. These patients were nonsmokers and neither had a past history of lung disease. Pulmonary function studies in both patients revealed a restrictive ventilatory defect with a decreased forced vital capacity and total lung capacity. One patient also exhibited a markedly decreased DLCO. No obstructive lung disease was found in either case. All pulmonary function abnormalities returned to normal during the 16 week follow-up period. Near drowning in fresh water did not cause permanent pulmonary dysfunction in these two young patients.

Adolescent↗
PubMed1979

Cefazolin vs penicillin. Treatment of uncomplicated pneumococcal pneumonia.

Cefazolin sodium, 500 mg intramuscularly twice daily, was compared with penicillin G procaine, 600,000 units intramuscularly twice daily, in the treatment of 82 patients with pneumococcal pneumonia. Patients were randomly assigned except when there was a history of penicillin allergy. The patients received treatment for five days or until they were afebrile for 48 hours. No patients experienced side effects or allergic reactions. All patients recovered satisfactorily without relapses. Cefazolin in the previously described dosage is as effective as penicillin in the treatment of pneumococcal pneumonia.

Cefazolin↗
PubMed1979

Albuterol and isoproterenol in bronchial asthma. Efficacy and toxicity of drugs administered via intermittent positive pressure breathing.

This study compared the efficacy and side effects of 1.25, 2.5, 5, 10, and 15 mg of albuterol and isoproterenol hydrochloride administered by intermittent positive pressure breathing (IPPB) to 12 patients with reversible airway obstruction. Equal doses of the two medications induced similar peak increases in pulmonary function, but the increase following albuterol persisted longer. The degree of bronchodilation was impressive; 15 mg of albuterol induced a mean increase over six hours of 82% in the forced expiratory volume in one second. Significant cardiovascular side effects were more common after isoproterenol than after albuterol. Albuterol is superior to isoproterenol as a bronchodilator when administered by IPPB because, for a given peak bronchodilation, cardiovascular side effects are fewer and bronchodilation persists longer with albuterol. The optimal dose of isoproterenol hydrochloride is 2.5 to 5.0 mg and the optimal dose of albuterol is 10 mg when these drugs are given by IPPB.

Adult↗
PubMed1979

Alpha1-antitrypsin quantitation and Pi typing of stored postmortem blood.

Correlation of necropsy findings with protease inhibitor levels and phenotype is sometimes desirable. This study was designed to determine the feasibility of postmortem protease inhibitor assessment. One hundred fifteen consecutive postmortem samples, stored at -20 C for 24 to 53 months, were analyzed. The time from death to necropsy, storage time, and the pH values of the sera were correlated with alpha1-antitrypsin levels, trypsin inhibitory capacity, and Pi typability. The alpha1-antrypsin level and trypsin inhibitory capacity were not significantly correlated with morgue time, serum storage time, or pH, and mean values were within the expected ranges. A significant decrease in Pi typability occurred when pH was less than 7.0. Moreover, while most (86%) of the sera stored for 2 to 2 1/2 years were typable, only 30% of those stored for more than four years were typable. Determination of alpha1-antitrypsin and trypsin inhibitory capacity are possible with the use of stored postmortem blood. Pi typing is usually possible, provided sera are not acidic and are examined within 2 1/2 years.

Female↗
PubMed1977

Oral atropine in the treatment of chronic asthma.

Six adult patients with chronic asthma were treated with oral atropine sulfate 0.5 mg or placebo four times a day in a double-blind, crossover trial lasting eight weeks. Subjects returned at weekly intervals for spirometry and clinical evaluation. The baseline pulmonary functions did not differ significantly between the atropine and placebo periods. The only side effects noted were slight dryness of the mouth in three patients. The three patients who complained of mouth dryness felt that they were better while they were taking oral atropine in that they had fewer acute episodes of asthma. The administration of 0.5 mg oral atropine four times a day is ineffective in improving baseline pulmonary functions in chronic asthmatics, although it may decrease the incidence and severity of acute asthmatic episodes.

Administration, Oral↗
PubMed1977

Comparison of albuterol and isoproterenol aerosols in bronchial asthma.

Albuterol and isoproterenol aerosols were compared with placebo in a double-blind manner in 18 patients with bronchial asthma. Both drugs elicited significant improvement in flow rates and vital capacity. Duration of action was longer with albuterol than with isoproterenol. Neither was associated with significant increases in heart rate or blood pressure.

Adolescent↗