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Biomedical subjects

R Foust

Publications and source records attributed to R Foust.

9 recordsLinked to original sources

Meconium aspiration injury: Uncoupling between the in vivo physiologic and in vitro inflammatory responses.

OBJECTIVE: To correlate the in vivo physiologic changes that occur with meconium aspiration injury to an associated in vitro cellular response to meconium. DESIGN: Experimental, prospective, randomized, controlled study. SETTING: University research laboratory. SUBJECTS: Eighteen adult Sprague-Dawley rats with meconium aspiration injury. INTERVENTIONS: Rats were given 3 mL/kg of a 25% meconium solution and were treated with conventional gas ventilation; nine rats were given exogenous surfactant therapy (Survanta, 4 mL/kg), and nine rats were not treated (control). Bronchoalveolar lavages were collected for total cell counts. Histologic samples also were taken for analysis. In addition, the in vitro effect of meconium on granulocytic elastase release from human neutrophils was determined. MEASUREMENTS AND MAIN RESULTS: Meconium caused significant morbidity in vivo, including poor oxygenation, elevated Paco(2), diminished compliance, and elevated white cell count in the bronchial lavages. Lung white cell count was significantly less in the surfactant group (p <.01). Meconium did not cause elastase release from human neutrophils in vitro. CONCLUSIONS: This study demonstrated uncoupling between in vivo physiologic responses to meconium injury in rats and the in vitro effect of meconium on human neutrophils. Surfactant therapy alleviated some of the perturbations associated with meconium injury, including a reduction in the inflammatory cell count in lung lavages. The absence of direct neutrophil activation by meconium suggests the requirement of an intermediary in the pathogenesis of meconium aspiration injury.

Journal Article↗

Immunohistochemical localization of protein 3-nitrotyrosine and S-nitrosocysteine in a murine model of inhaled nitric oxide therapy.

Inhaled nitric oxide (INO) therapy is currently used clinically to selectively dilate the pulmonary vasculature and to help treat persistent pulmonary hypertension and bronchopulmonary dysplasia in the neonate. However, in the presence of oxygen or superoxide, nitric oxide forms potentially harmful reactive nitrogen species. Using an experimental mice model, we examined the effects of concurrent hyperoxia and INO on protein tyrosine nitration and cysteine S-nitrosylation in pulmonary tissue. Data showed enhanced 3-nitrotyrosine staining within the airway epithelium and alveolar interstitium of mice lungs treated with hyperoxia, which did not increase significantly with INO administration. Within the alveolar interstitium, 3-nitrotyrosine staining was localized to macrophages. S-Nitrosocysteine staining in airway epithelium was significantly enhanced with INO administration regardless of oxygen content. These data suggest that the formation of protein S-nitrosocysteine is the major protein modification during administration of INO.

Administration, Inhalation↗

Analysis of perfluorochemical elimination from the respiratory system.

We describe a simple apparatus for analysis of perfluorochemicals (PFC) in expired gas and thus a means for determining PFC vapor and liquid elimination from the respiratory system. The apparatus and data analysis are based on thermal conduction and mass transfer principles of gases. In vitro studies were conducted with the PFC vapor analyzer to determine calibration curves for output voltage as a function of individual respiratory gases, respiratory gases saturated with PFC vapor, and volume percent standards for percent PFC saturation (%PFC-Sat) in air. Voltage-concentration data for %PFC-Sat of the vapor from the in vitro tests were accurate to within 2.0% from 0 to 100% PFC-Sat, linear (r = 0.99, P < 0.001), and highly reproducible. Calculated volume loss of PFC liquid over time correlated well with actual loss by weight (r = 0.99, P < 0. 001). In vivo studies with neonatal lambs demonstrated that PFC volume loss and evaporation rates decreased nonlinearly as a function of time. These relationships were modulated by changes in PFC physical properties, minute ventilation, and postural repositioning. The results of this study demonstrate the sensitivity and accuracy of an on-line method for PFC analysis of expired gas and describe how it may be useful in liquid-assisted ventilation procedures for determining PFC volume loss, evaporation rate, and optimum dosing and ventilation strategy.

Animals↗

Liquid assisted ventilation: an alternative ventilatory strategy for acute meconium aspiration injury.

Evidence of surfactant inactivation by meconium has led to the use of exogenous surfactant therapy in the management of meconium aspiration syndrome (MAS). Liquid assisted ventilation has been shown to improve the cardiopulmonary function in lungs with high surface tension. We compared exogenous surfactant therapy with liquid assisted ventilation in the management of experimental acute meconium aspiration injury. Thirty-two newborn lambs were ventilated at peak inspiratory pressures of 13-16 cm H2O, positive end expiratory pressure of 3-4 cm H2O, fractional inspired oxygen concentration (FiO2) of 1.0, and a respiratory frequency range between 30 and 35 breaths/min. Baseline arterial blood gases, pulmonary function, and arterial blood pressure measurements were taken. All lambs were given 2-3 ml/kg of an unfiltered 25% meconium solution. Lambs were then randomized into either gas-ventilated meconium control, or one of three treatment groups: 1) surfactant; 2) partial liquid ventilation (PLV); or 3) total liquid ventilation (TLV) for 4 hours after meconium injury. All treated groups demonstrated a significant increase in arterial oxygenation (P < 0.05); surfactant and PLV-treated lambs demonstrated significantly decreased arterial PCO2 (P < 0.05). Compliance in all groups increased compared with injury values; compliance of the TLV group increased more than in all other treatment groups (P < 0.05). In addition, lung histology of the TLV group demonstrated clear, intact alveolar epithelium and homogeneously expanded alveoli, while no such improvement was evident in the other groups. These data suggest roles for both exogenous surfactant therapy and liquid assisted ventilation techniques in the management of MAS.

Animals↗

Comparison of natural surfactant and brief liquid ventilation rescue treatment in very immature lambs. Clinical and physiological correlates.

We studied the effect of rescue therapy with modified porcine surfactant (Curosurf) or brief perfluorocarbon liquid ventilation on pulmonary gas exchange, mechanics and structure in very immature lambs. Both rescue strategies produced an improvement in arterial oxygenation and were able to support CO2 elimination. Histology showed unevenly inflated lungs in all but tidal-liquid-ventilated lambs. We speculate that due to immature lung architecture and relatively high permeability, previous exposure to gas ventilation impeded full effectiveness of both rescue modalities, perhaps prophylactic surfactant or liquid ventilation could be a better alternative.

Animals↗

Three-dimensional human pattern visual evoked potentials. II. Multiple sclerosis patients.

Pattern visual evoked potentials were obtained from 46 patients with definite relapsing/remitting multiple sclerosis, using both a conventional 5-channel occipital array and a 3-D recording technique consisting of three bipolar derivations approximating the three dimensions of space. These three orthogonal wave forms were displayed as a 3-D Lissajous trajectory for each subject. Two of the 15 patients with completely normal conventional pattern VEPs had abnormalities of the orientation of the B-C curvilinear segment of the 3-D pattern VEPs. Delays in the first major occipital positive component (P100) were evident using both techniques; the correlation between P100 latency and the latency of the corresponding trajectory apex was r = 0.99 (P less than 0.01). Post-chiasmal MRI abnormalities were associated with 3-D VEP orientation abnormalities. Three-dimensional pattern VEPs are moderately more sensitive than conventional pattern VEPs at detecting dysfunction posterior to the optic chiasm in demyelinating disease and do not require the use of eccentric fixation to do so.

Adult↗

The use of two new coagulation probes for control of hemorrhage in laparoscopic liver biopsy.

Two new prototype probes, BICAP and Heater, were assessed to determine their effectiveness in controlling post-biopsy bleeding during laparoscopy. A total of 88 patients with a wide spectrum of liver diseases were studied. Both probes were equally effective in stopping bleeding in all patients. We recommend the use of either of these devices in controlling post-biopsy bleeding.

Adolescent↗

Computed tomography of gliomatosis cerebri.

Gliomatosis cerebri, a rare diffusely infiltrating astrocytoma, was discovered on the postmortem examination of a 22-year-old woman with a 13 year history of seizures. Computed tomography of the brain revealed bifrontal white matter low density changes that were most consistent with a demyelinating or dysmyelinating disorder.

Adult↗