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Biomedical subjects

R M Rogers

Publications and source records attributed to R M Rogers.

At least 73 records · Page 4Linked to original sources
PubMed1985

Chest percussion and postural drainage in patients with bronchiectasis.

Patients with chronic obstructive pulmonary disease have been treated routinely with chest physical therapy for many years in spite of a lack of scientific validation of this procedure. Only recently have the indications for chest physical therapy been clarified. It is currently believed that such therapy is especially beneficial in patients with copious secretions, and that it is less effective in patients with scanty secretions. No study has specifically evaluated the efficacy of chest physical therapy in patients with bronchiectasis. We accordingly evaluated 13 patients with stable bronchiectasis to determine the effects of chest physical therapy on pulmonary function, arterial oxygenation, and sputum production and to assess whether this therapy was associated with any significant side-effects. We found that chest physical therapy was safe and well tolerated and assisted the patients in mobilization of their sputum. However, such therapy had no immediate delayed effects on pulmonary function or oxygen saturation.

Adult↗
PubMed1985

Does chest physical therapy work?

Postural drainage has usually been shown to be an effective component of chest physical therapy; there is currently no data showing a beneficial effect of percussion or vibration; directed coughing may be as efficacious as postural drainage (Table 3); the forced expiration technique may increase sputum clearance with or without postural drainage (Table 4).

Acute Disease↗
PubMed1984

The diffusing capacity as a predictor of arterial oxygen desaturation during exercise in patients with chronic obstructive pulmonary disease.

We evaluated 48 patients with chronic obstructive pulmonary disease by means of pulmonary-function and exercise testing to determine whether any tests of pulmonary function could predict the development of arterial desaturation during exercise. We found that only two indexes--diffusing capacity and forced expiratory volume in one second (FEV1)--were predictive of desaturation. The diffusing capacity was more specific and sensitive than FEV1. A diffusing capacity above 55 per cent of predicted was 100 per cent specific in excluding desaturation, as compared with an 82 per cent specificity for an FEV1 above 55 per cent of predicted. With this cutoff point, the sensitivity of the diffusing capacity was 68 per cent, as compared with 46 per cent for the FEV1. Both the frequency and the magnitude of arterial desaturation increased substantially when the diffusing capacity was below 55 per cent of predicted. Testing the diffusing capacity should be useful in identifying which patients with chronic obstructive lung disease are likely to become desaturated during exercise and may therefore benefit from oxygen therapy.

Aged↗
PubMed1984

Neutrophil alveolitis following endotoxemia. Enhancement by previous exposure to hyperoxia.

We injected Escherichia coli endotoxin, 2.5 mg/kg, intraperitoneally in rats, sequentially quantified alveolar inflammation during a 6-day period by several techniques, and observed the effect of previous exposure to hyperoxia on the intensity of alveolitis in this model. As noted in other models of endotoxemia, we found intravascular sequestration of leukocytes and an increase in the retention of 125I albumin in the lung 4 to 6 h after the injection of endotoxin. Bronchoalveolar lavage fluid (BALF) obtained at this time only slightly stimulated the migration of neutrophils in vitro, and the numbers and types of cells recovered by lavage were normal. Fifteen h after the injection of endotoxin, however, bronchoalveolar lavage fluid stimulated both random and directed migration of neutrophils in vitro, although recovery of neutrophils by lavage was increased only slightly. By 24 h, 125I albumin retention had returned to normal levels, but the chemotactic activity of BALF remained high, and the percentage and absolute number of neutrophils recovered by lung lavage were increased markedly. The recovery of neutrophils remained significantly elevated for 3 days but declined to control levels by 6 days, whereas the recovery of alveolar macrophages was increased at this time. Exposure to 100% O2 for 36 h prior to endotoxemia accelerated and intensified neutrophil influx into the lung and increased the stimulatory effect of BALF on neutrophil migration in vitro. We conclude that a single episode of endotoxemia in the rat causes a multi-phasic alveolar inflammatory response, and that this response is accelerated and intensified by prior, mild exposure to hyperoxia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Lymphocyte enumeration: a comparison between a modified avidin-biotin-immunoperoxidase system and flow cytometry.

The reliability and sensitivity of an indirect avidin-biotin-peroxidase (ABC) procedure for enumerating lymphocyte subpopulations was compared to flow cytometry (FC) employing direct immunofluorescence. Lymphocytes were enumerated by two different methods. For counting method I, which is the method of conventional FC, the number of immunostained lymphocytes was compared to the total number of lymphocytes present. The ABC procedure by method I detected a greater proportion of immunostained lymphocytes for all subsets tested than did FC. By counting method II, where the number of immunostained lymphocytes is compared to the total number of cells present, the ABC analysis still detected more total T cells than FC but the results for the two analyses were similar for T helper and T suppressor cells. Thus, the ABC technique appears to be a valid method for enumerating T lymphocyte subsets. Furthermore, as compared to FC, it offers the advantages of reduced cost, simplicity of understanding and performance, need for fewer cells, and a permanent record of lymphocyte staining. For these reasons, we feel that the ABC technique will enjoy widespread application for the identification of lymphocyte membrane antigens.

Antigens, Surface↗
PubMed1984

Progressive intrapartum respiratory insufficiency due to pulmonary alveolar proteinosis. Amelioration by therapeutic whole-lung bronchopulmonary lavage.

A 23-year-old woman became pregnant in the setting of long-standing severe pulmonary alveolar proteinosis. A previous twin gestation had resulted in low birth-weight infants. Progressive clinical and respiratory deterioration occurred, associated with exertional arterial oxygen desaturation. Because of the severity of her physiologic derangements and concern for the fetus, whole-lung bronchopulmonary lavage was performed twice under controlled conditions. This resulted in subjective and objective improvement, followed by successful term delivery.

Adult↗
PubMed1983

Nutritional status and lung function in patients with emphysema and chronic bronchitis.

This study compared the nutritional status of patients with emphysema and chronic bronchitis and examined the relationship between lung dysfunction and nutritional depletion in patients with emphysema. There was no evidence of nutritional depletion in patients with chronic bronchitis (n = 4). In contrast, patients with emphysema (n = 14) were somatically depleted. They exhibited lower values for percent ideal body weight (%IBW), arm muscle circumference (AMC), and triceps skin fold thickness (TSF) (p less than 0.05) than did patients with chronic bronchitis. The creatinine height index (CHI) was also lower in this group, but the difference was not significant (p = 0.08). In patients with emphysema, there was a good correlation between the degree of airflow obstruction and of somatic depletion (FEV1 vs %IBW, r = 0.699, p less than 0.001). The single-breath diffusing capacity (DCO) also correlated well with %IBW (r = 0.6052, p less than 0.019). These results confirm that patients with emphysema are frequently nutritionally depleted and suggest that nutritional depletion contributes to lung dysfunction in emphysema.

Aged↗
PubMed1983

Pulmonary alveolar proteinosis. Staining for surfactant apoprotein in alveolar proteinosis and in conditions simulating it.

Formalin fixed paraffin-embedded lung tissues (n = 13) or lavage material (n = 4) from 17 patients in whom alveolar proteinosis was the primary disease and ten patients with other primary diagnoses but lung morphology similar to alveolar proteinosis were examined. The tissues were stained by the periodic acid-Schiff method and by the immunoperoxidase method for surfactant specific apoprotein. The intra-alveolar material in patients with primary alveolar proteinosis stained uniformly for surfactant specific apoprotein, whereas the staining was focal in patients with other primary diseases associated with intra-alveolar accumulation of proteinacious material. In both situations, the number of inflammatory cells, especially macrophages, was small. These observations extend an earlier impression about the presence of surfactant specific apoprotein in alveolar spaces in patients with primary alveolar proteinosis and provide a distinction between primary alveolar proteinosis and morphologically similar appearance due to other causes, ie, secondary alveolar proteinosis. The lack of macrophages in the affected tissue appears to be the major pathogenetic factor in alveolar proteinosis.

Apoproteins↗
PubMed1983

A simplified computer report. Towards an understandable pulmonary function test.

We have developed a graphic format for the display of pulmonary function test results. Patient test results appear as a series of horizontal bar graphs. Each bar length is proportional to the test result and is printed over the normal ranges. This format allows rapid recognition of individually abnormal values. We have also grouped bars to create distinctive patterns characteristic of obstructive or restrictive lung disease. A computer program generates a custom form for each patient, displaying the results and ranges only for the specific test performed on that individual. No preprinting of forms is required. Written in the BASIC computer language, this program was designed to be flexible. A change of program parameters requires only minor program modification. In addition, because of its simplicity, our program can be implemented on almost any computer printer.

Computers↗
PubMed1983

Pulmonary function in progressive systemic sclerosis. Comparison of CREST syndrome variant with diffuse scleroderma.

The pulmonary function and chest roentgenograms were evaluated in 88 patients with the CREST syndrome variant of progressive systemic sclerosis (PSS or scleroderma). Seventy-two percent of the patients had abnormal pulmonary function. An isolated decrease in diffusing capacity was the most common abnormality noted, followed by restrictive abnormalities and airway obstruction. Chest roentgenograms revealed interstitial infiltrates consistent with pulmonary fibrosis in 33 percent. When compared to a contemporaneous group of 77 patients with PSS and diffuse scleroderma, patients with the CREST syndrome had similar abnormalities on pulmonary function testing and chest roentgenogram. However, patients with the CREST syndrome had a lower mean diffusing capacity despite a higher mean vital capacity; this combination of findings suggests primary pulmonary vascular disease. Calcified granulomata were identified significantly more often in PSS-CREST patients, while superior rib notching occurred exclusively in patients with PSS and diffuse scleroderma. The CREST variant of PSS is associated with frequent roentgenographic and pulmonary function abnormalities similar to those seen in PSS with diffuse scleroderma.

Adult↗
PubMed1983

Pulmonary function testing. What is 'normal'?

For many years, confusion has existed concerning the normal range for pulmonary function test results. Using statistical guidelines that have been traditionally applied to the interpretation of measured forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), we have redefined normal limits for the most common pulmonary function test values, including those for FVC, FEV1, mean forced expiratory flow during the middle half of the FVC, FEV1 as a proportion of FVC, residual volume, functional residual capacity, total lung capacity, diffusion capacity, maximum voluntary ventilation, and peak expiratory flow. Our goal is to provide a simple and consistent scheme for interpretation of pulmonary function test data. We consider the assumptions used to achieve this simplification to be reasonable, as long as their limitations are understood.

Humans↗
PubMed1983

Adult respiratory distress syndrome following intrapleural instillation of talc.

After intrapleural instillation of talc for sclerosis of malignant pleural effusions, dyspnea occurred in three patients, progressed gradually over 72 hours, and culminated in acute respiratory failure characterized by bilateral diffuse pulmonary infiltrates with normal pulmonary artery occlusion pressures. Two patients recovered and one died. The chronological similarity of the sequence of fever, dyspnea, and respiratory failure in the absence of documented infection or other conditions that predispose to the adult respiratory distress syndrome (ARDS) suggests that intrapleural talc may have induced the syndrome in these patients through unknown mechanisms. This experience emphasizes that other agents are preferable for initial attempts to promote pleural symphysis in the palliation of recurrent malignant effusions. When talc is used in patients who are unresponsive to tetracycline, we suggest clinical monitoring for respiratory compromise for 72 hours after the procedure.

Adult↗