Migratory pulmonary infiltrates secondary to aspirated foreign body.
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Bronchography↗
Biomedical subjects
R C Bone
Publications and source records attributed to R C Bone.
Aerodynamic relationships associated with normal phonation and paralytic dysphonia.
Physiological differences between normal speakers and those with unilateral vocal cord paralysis are presented. Pressure readings taken intraorally and subglotically are compared during phonation of consonants requiring laryngeal closure and those not requiring cord approximation. From our studies, it is apparent that: (1) a significant difference in air pressure patterns exists between normal speakers and those with vocal cord paralysis, (2) the respiratory apparatus tends to alter normally constant airflow in cases of vocal fold paralysis and (3) either voice therapy or teflon cord injection will significantly alter the aerodynamic relationships from the untreated paralyzed state.
Air↗
The oxyhemoglobin dissociation curve in type A and type B COPD.
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Chronic Disease↗
Controlled oxygen administration in acute respiratory failure in chronic obstructive pulmonary disease: a reappraisal.
Controlled oxygen therapy may aggravate carbon dioxide retention during acute exacerbations of chronic obstructive pulmonary disease (COPD). Of 50 consecutive patients with COPD and acute respiratory failure, 13 required intubation because of carbon dioxide narcosis. With discriminant analysis of their arterial oxygen tension (PaO2) and pH on admission, a diagram separated patients into those at high risk and those at low risk for carbon dioxide narcosis. This diagram was then used to predict carbon dioxide narcosis in 73 patients with COPD and acute respiratory failure who were treated with controlled oxygen. In 16 of these patients carbon dioxide narcosis developed. Thirteen (81 per cent) were predicted by the diagram to be at high risk for this complication. Only two (4 per cent) patients judged by the diagram to be at low risk for carbon dioxide narcosis required mechanical ventilation. Utilizing an oxygen tension (PO2), carbon dioxide tension (PCO2) diagram a patient's ventilatory response was compared to that of ambulatory patients with COPD. These data suggest that hypoxemia and acidosis are more discriminatory for "carbon dioxide narcosis" than hypercapnia.
Acute Disease↗
Respiratory dysfunction in thrombotic thrombocytopenic purpura.
Thrombotic thrombocytopenic purpura is a rare disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurologic abnormalities, fever and renal dysfunction. in six of seven consecutive patients with thrombotic thrombocytopenic purpura seen in an eight month period, respiratory impairment was present. Respiratory dysfunction was characterized by tachypnea, hypoxemia nad infiltrates on chest roentgenogram. Five patients required mechanical ventilation. Two patients had cardiogenic pulmonary edema, but they remained hypoxemic despite treatment for pulmonary edema and maintenance of normal pulmonary capillary wedge pressure for more than 36 hours. Four patients died and autopsies revealed pulmonary edema, hemorrhage and hyaline thrombi. Pathologic examination of the heart also showed hyaline thrombi. Information from out patients with thrombotic thrombocytopenic purpura implicates respiratory dysfunction as a component of this disease as well as the classically described pentad. Cardiogenic and noncardiogenic pulmonary edema and possibly bleeding into the lung contributed to pulmonary impairment.
Adolescent↗
Lymphomatoid granulomatosis. Report of a case and review of the literature.
A 24 year old man had a nonproductive cough and chest pain. Chest roentgenogram showed a diffuse infiltrate, and pulmonary function studies showed restrictive lung disease. Extremity weakness, deteriorating mental status and neuropathy progressed as pulmonary findings diminished on corticosteroid therapy. Lung biopsy showed lymphomatoid granulomatosis. The neurologic status deteriorated despite treatment with Cytoxan, intrathecal methotrexate and brain irradiation. Autopsy showed mass lesions of lymphomatoid granulomatosis in the brain and healed lesions in the lungs. A review of the neurologic and pulmonary findings in reported cases show that diminution of pulmonary disease with progression of neurologic disease manifest by mass lesion is unusual. Since the etiology, prognosis and prevalence of this disease remains undefined, all patients with this disease should be reported on.
Adult↗
Utilization of pressure-volume curves in the pediatric patient.
Seven patients treated with continuous mechanical ventialtion were monitored with static and dynamic pressure-volume curves. Three patients developed no pulmonary complications, and mechanical ventilation was discontinued within 96 hr. In four patients, pressure-volume curves were used as a diagnostic aid in the detection of the physiologic defect resulting from bronchoconstriction, atelectasis, loculated pleural fluid, pulmonary edema, and mucous plugging. These measurements were also utilized to evaluate the effectivess of therapeutic modalities such as treatment of bronchoconstriction with bronchodilators, mucous plugging with adequate suctioning, and drainage of loculated pleural effusion. Pressure-v-lume measurements are simple, noninvasive, and require the smae equipment used in continuous mechanical ventilation. Pressure-volume monitoring of pediatric patients with curves warrants further investigation to evaluate its value.
Adolescent↗
Modern treatment of bronchial asthma.
Various biochemical mediators and autonomic events lead to symptom-causing pathological changes in asthma attacks, that is, mucosal edema, mucous gland hypersecretion, and bronchial smooth muscle contraction. The discovery of alpha and beta adrenergic receptors, and the observation that cyclic AMP is the intracellular effector in cells stimulated by various hormones, led to a better understanding of the mechanism of action of medications of asthma. Emergence evaluation, in addition to history, physical findings, and physiological status, should include prior asthma history, physical findings, and physiological status, should include prior asthma history. Initial emergency therapy in patients with a history suggesting responsiveness to simple measures includes subcutaneous epinephrine, 0.2 to 0.5 mg, or terbutaline sulfate, 0.25 mg. Also, the patient may benefit from inhalation of an aerosolized bronchodilator. Patients who do not respond to initial treatment in three to four hours or who deteriorate, should be hospitalized. Hospitalized asthma patients should be constantly observed and monitored. The emergency treatment should be continued vigorously. Corticosteroid therapy should be started upon admission. The response rate to therapy in the hospitalized asthmatic is highly variable. Outpatient management involves patient education in the nature of asthma and in the fact that multiple drugs and frequent changes in therapy may be required to bring the symptoms under control.
Adrenal Cortex Hormones↗
Noise-induced threshold shift and cochlear pathology in the Mongolian gerbil.
Groups of six mongolian gerbils were exposed to two-octave (1414-5656 Hz) band noise for 1 h at 100, 110, and 120 dB SPL. Threshold shift at several frequencies was measured 0.5, 3, 6, and 12 h, and 1-28 days after exposure. Final thresholds were determined at least two months postexposure. Extensive threshold shift was observed in all groups 0.5 h after exposure (TS0.5h). Where threshold shift increased in the initial hours after exposure, such increases were correlated with eventual permanent threshold shift (PTS). Recovery of thresholds from 1-28 days after exposure was approximately exponential, and slowest at the edges of the exposure band. PTS was seen in the 110 and 120 dB SPL groups. With TS0.5h of 50 dB or less, no PTS resulted. With TS0.5h above 50-60 dB, eventual PTS increased linearly with a slope of about 1.25 PTS/TS0.5h. Cochlear damage was evaluated by light microscopy. The relationship between hair cell loss and PTS was consistent with an inner hair cell threshold about 40 dB higher than that of outer hair cells. It is suggested that recovery from noise-induced threshold shift may involve different mechanisms in the two types of hair cells.
Animals↗
Rapid development of diffuse pulmonary infiltrates in histiocytic lymphoma.
A 24-year-old man with documented histiocytic lymphoma developed a nodular interstitial infiltrate, as shown by chest roentgenograms during a 10-day period of observation. He also developed fever, chills, and purulent sputum. Open-lung biopsy revealed histiocytic lymphoma without evidence of infection. This case demonstrates that lymphoma can cause rapid development of infiltrates observable by roentgenography. Because the infiltrate could be neoplastic or infectious, empiric therapy without an exact diagnosis is not warranted.
Adult↗
Naso-malar flap in oral cavity reconstruction.
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Cheek↗
Oat cell carcinoma of the larynx.
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Carcinoma, Small Cell↗
Adult respiratory distress syndrome. A need for comparative studies.
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Humans↗
Triamcinolone aerosol. Treatment of aspirin-hypersensitive asthmatic patients.
The efficacy of triamcinolone acetonide aerosol in the management of asthma in six patients with aspirin hypersensitivity was evaluated during a one-year trial. Five patients were previously chronically dependent on systemic corticosteroids and had undergone unsuccessful trials with cromolyn sodium therapy. Substantial reduction in corticosteroid requirements was observed; in two patients, oral prednisone therapy was completely eliminated. Forced expiratory volume and flow were maintained at levels better than those recorded before triamcinolone therapy throughout the year of follow-up. No substantial side effects due to triamcinolone were observed.
Aerosols↗
Effects of corticosteroids in the treatment of patients with gastric aspiration.
Forty-three of 88 patients suspected of having aspirated gastric contents met stringent criteria for the diagnosis of aspiration of gastric contents. One group of 25 patients was treated with corticosteroids and a second group of 18 patients was treated without corticosteroids. The two groups were clinically well matched according to all variables except that the patients who did not receive corticosteroids had greater hypoxemia and a higher incidence of infiltration on chest roentgenogram which would indicate that these patients had received greater pulmonary injury from aspiration of gastric contents. Thirty-two per cent of the patients who received steroids died compared to 28 per cent of those who did not receive steroids. Although the mortality rate difference was not statistically significant, the occurrence of gram-negative pneumonia five days after aspiration was more frequent in the patients treated with steroids.
Adrenal Cortex Hormones↗
Finding the missing information in cancer statistics.
The current cancer literature is imprecise and confusing. This hampers the ability to draw meaningful conclusions regarding diagnosis and treatment. It is suggested that all future reporting of statistics contain the following features: (1) discussion of case selection criteria; (2) use of TNM system for case classification; (3) listing of minimal treatment details; (4) explanation for length of follow-up used; (5) standardized terms for evaluation (relating these to individual TNM classification); and (6) listing of all failures by standardized terms. It is proposed that editors of journals and organizers of meetings reject all papers that do not meet these criteria.
Bibliographies as Topic↗
Oropharyngeal candidiasis in patients treated with triamcinolone acetonide aerosol.
Thirty asthmatic patients participating in a trial of triamcinolone acetonide aerosol were evaluated to determine the relationships among symptons of sore throat or hoarseness, the appearance of the throat on physical examination, and the presence of yeasts on pharyngeal culture. Observations were recorded prior to aerosol therapy and repeated after 2 wk, 4 wk, 6 wk, 4 mo, and 6 mo of therapy. A total of 15 patients (50%) experienced sore throat or hoarseness, 15 (50%) had yeasts cultured from the pharynx on at least one occasion, and 11 (37%) at some point had an abnormal throat examination; however, there was no predictable relationship between symptoms or abnormal physical examinations and the presence of a positive culture. The frequency of positive cultures did not change significantly during the observation period. Twelve patients had positive yeast cultures on 50% or more of their samples. The incidence of symptoms was not sigficantly increased in these chronically colonized patients. Symptoms were usually transient, and discontinuation of the aerosol or antifungal therapy was unnecessary. Triamcinolone aerosol was not associated with significantly increased pharyngeal colonization with yeasts in this 6-mo study. Existing chronic colonization is not necessarily a contraindication to triamcinolone therapy. Sore throat and hoarseness are usually unrelated to yeast infection in patients using triamcinolone acetonide aerosol.
Adult↗
Contamination of a fiberoptic bronchoscope with Proteus species.
We have traced an episode of contamination of a fiberoptic bronchoscope with a Proteus species to an index patient. Bacterial cultures obtained by aspiration through the fiberoptic bronchoscope from 11 of 12 subsequent bronchoscopies in 8 additional patients grew a Proteus species with sensitivities similar to those of the initial isolate. Culture of the fiberoptic bronchoscopic specimen yielded an identical organism. There were no definitive ill effects in the patients. These findings necessitated a change in our fiberoptic bronchoscope disinfection protocol as well as development of culture surveillance mechanism to detect breaks in the cleaning procedure. The importance of this and avoiding potential outbreaks of fiberoptic bronchoscope-related infeciton is emphasized.
Bronchoscopes↗