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Biomedical subjects

W M Alberts

Publications and source records attributed to W M Alberts.

34 records · Page 2Linked to original sources
PubMed1991

Hepatic hydrothorax. Cause and management.

Significant pleural effusions are infrequently noted in patients with cirrhosis of the liver. A large effusion (hepatic hydrothorax) occasionally appears during the course of the disease. The fluid in the pleural space is believed to be derived from ascitic fluid that may accompany hepatic cirrhosis. Although the exact mechanism is somewhat controversial, it appears that the ascitic fluid is transported directly into the pleural space. A therapeutic thoracentesis, usually accompanied by a paracentesis, may be necessary to relieve acute symptoms. Long-term management, however, centers around eliminating or reducing the formation of ascites. When this is not successful, tube thoracostomy followed by chemical pleurodesis, primary repair of diaphragmatic defects with pleural sclerosis, or peritoneovenous shunting in conjunction with chemical pleurodesis may be attempted. These interventions may or may not be successful. Management of hepatic hydrothorax remains a clinical challenge.

Humans↗
PubMed1990

Effect of mild hypoxemia on bronchial responsiveness.

Nonspecific bronchial responsiveness may be influenced by a number of stimuli. A potentially important stimulus with significant clinical implications is hypoxemia. To investigate the effect of hypoxemia on baseline pulmonary function and bronchial responsiveness, 13 subjects (eight with mild asthma and five normal) were tested on two separate days within a 1-week period. Spirometry measured before and after breathing room air through the experimental circuit for ten minutes was not significantly different. Likewise, there was no difference in baseline spirometry during mild hypoxemia (arterial saturation of 90%) compared with air breathing. The eight asthmatic subjects underwent a methacholine bronchoprovocation challenge on each of the two test days. The PC20FEV1 measured on the "hypoxemic" day (3.7 +/- 4.5 mg/mL) was not significantly different from the measured on the "room air" day (2.5 +/- 2.4 mg/mL, P greater than .05). We conclude that mild hypoxemia does not significantly affect baseline spirometry nor bronchial responsiveness.

Adult↗
PubMed1989

Echocardiography in planned interruption of the inferior vena cava.

Interruption of the inferior vena cava by the transvenous placement of a filter or umbrella effectively prevents pulmonary embolism by acting primarily as a physical barrier to emboli. Such a device will be effective only if the site of thrombosis is distal to the planned placement site. We have presented two cases in which a preoperative echocardiogram revealed a right atrial embolus, thereby mandating either embolectomy, fibrinolytic therapy, or continued anticoagulation in addition to the filter placement. These cases suggest that an echocardiogram should be included in the evaluation preceding interruption of the inferior vena cava.

Aged↗
PubMed1989

Malignant pleural effusions: pleurodesis using a small-bore percutaneous catheter.

This study describes our experience using a percutaneously placed small-bore catheter for drainage of malignant pleural effusions and subsequent instillation of a sclerosing agent to obliterate the pleural space. We treated 15 consecutive patients with known metastatic cancer and a symptomatic pleural effusion. Twelve patients survived for more than four weeks after the procedure; 11 of these 12 patients had a successful objective clinical response. The procedure was well tolerated, with little or no discomfort during catheter placement and the maintenance period. No serious complications were encountered. We conclude that the use of a small-bore percutaneously placed "pneumothorax" catheter in the management of malignant pleural effusions is an effective and more comfortable alternative to large-bore closed-tube thoracostomy.

Adult↗
PubMed1989

Intrapleural streptokinase in management of parapneumonic effusions. Report of series and review of literature.

Noncommunicating locules of fluid may develop in the setting of a thoracic empyema or a complicated parapneumonic effusion. When this occurs a single chest tube may not provide adequate drainage. In an effort to promote drainage and thereby obviate the need for further procedures, instillation of streptokinase into the involved pleural space has been advocated. This communication reviews the literature and reports our experience with intrapleural streptokinase. In our retrospective review of nine patients, instillation of streptokinase resulted in an obvious increase in chest tube drainage in six. Of the nine patients, four with improved drainage required no further procedures. Two patients with improved drainage and the three with no change in drainage required an additional chest tube, a decortication procedure, or were lost to follow-up. None of the four patients with an empyema were benefitted. Intrapleural instillation of streptokinase may be a useful adjunct in the treatment of a complicated parapneumonic effusion but appears less likely to be of benefit in the management of an empyema.

Adult↗
PubMed1987

Corticosteroid therapy for chronic obstructive pulmonary disease. Is it worth the risks?

The majority of patients with chronic obstructive pulmonary disease (COPD) do not appear to benefit from long-term corticosteroid therapy. Nevertheless, a small minority demonstrate a response to treatment that is so dramatic that it may be worth the risk of chronic corticosteroid use. A corticosteroid trial is indicated in the patient with COPD who remains symptomatic despite adequate and aggressive routine treatment. If substantial improvement is noted in pulmonary function, chronic corticosteroid treatment should be considered. In patients without an objective response, long-term corticosteroid therapy should not be continued.

Adrenal Cortex Hormones↗
PubMed1987

Clinical use of methacholine bronchial challenge testing.

Whereas the research applications have been well established, the clinical utility of bronchial challenge testing is still being defined. In 19 of 22 patients referred for testing (86%), the results of a methacholine challenge test helped to confirm a clinical suspicion of asthma or to suggest that alternative diagnoses should be investigated. There was a discrepancy between the pretest suspicion of the referring physician and the results of the challenge test in six of these 19 patients (32%). Thus our experience suggests that bronchial challenge testing provides useful information to supplement clinical acumen in the diagnosis of asthma.

Adolescent↗
PubMed1987

Pulmonary disease caused by Mycobacterium malmoense.

Mycobacterium malmoense was isolated from pulmonary material from 4 patients. Two patients had repeatedly positive smears and cultures along with roentgenographic progression of pulmonary disease in the absence of another pathogen. These 2 patients therefore meet the criteria for diagnosis of pulmonary mycobacteriosis. Isolation of the organism may represent colonization in a third patient, and M. malmoense has been isolated from a fourth patient on 2 occasions. It is not yet definite, however, that the pulmonary process is due to mycobacterial disease. Although uncommon, pulmonary disease caused by this organism has been reported from Europe. Only 1 prior case of pulmonary disease caused by M. malmoense, however, has been reported in the United States.

Adult↗
PubMed1986

Metabolic acidosis as a presenting feature in acute asthma.

Acid-base abnormalities in adults with acute asthma are highly variable. The major abnormalities have been attributed to changes in PaCO2 secondary to altered alveolar ventilation. Primary metabolic alterations have been thought to be rare in adults. The frequency of metabolic acidosis in acute asthma was reevaluated by way of a review of the medical records of 164 hospitalizations involving 109 adults. The hydrogen ion concentration varied widely and in 27 of 164 episodes (16.5%) the arterial pH was lower than expected for the measured PaCO2. We conclude that the presenting acid-base status of adults with acute asthma is highly variable and metabolic acidosis is not an infrequent finding.

Acidosis↗
PubMed1986

Clinical implications of serum creatine kinase levels in acute asthma.

An elevated serum creatine kinase (CK) level is common in patients being treated for acute asthma, but such an elevation should not lead to further investigation unless otherwise clinically warranted. Moreover, serum CK levels need not be routinely measured in young patients with an uncomplicated exacerbation of asthma.

Acute Disease↗
PubMed1983

Preparation and handling of methacholine chloride testing solutions. Effect of the hygroscopic properties of methacholine.

Persons with hyperreactive airways differ quantitatively from normal persons in their response to bronchial provocation testing with methacholine chloride (Mch). Methacholine chloride has strong hygroscopic properties that necessitate careful dessication, preparation, and handling if accurate results are to be achieved. The rate of hydration of Mch was determined by exposing the drug to various levels of relative humidity. The rate of water uptake was directly related to the availability of water in the atmosphere. At 49% relative humidity, a 0.125%/min gain in weight was noted, which increased to 0.489%/min at 80% relative humidity. Adequate dessication time and technique were determined by noting the time required to return the drug from a hydrated to a dry state. With proper technique, dessication was virtually complete by 4 to 6 h, and 20 to 24 h assured a return to the dry state. From these data, guidelines for preparation and handling of Mch test solutions can be formulated.

Bronchial Provocation Tests↗