Biomedical subjects

Y Y Phillips

Publications and source records attributed to Y Y Phillips.

At least 19 recordsLinked to original sources

PubMed1992

Listerial brain abscess in long-standing sarcoidosis.

A 50-year-old black man with steroid-dependent stage IV sarcoidosis and a prior seizure attributed to neurosarcoidosis had progressive disorientation, ataxia, cranial neuropathies, and increased dyspnea. Neuroradiologic evaluation showed a ring-enhancing lesion in the left basal ganglion causing a mass effect. Craniotomy yielded purulent material that grew a pure culture of Listeria monocytogenes. He responded well to antibiotic therapy.

Brain↗

PubMed1992

Sensitivity and specificity of bronchial provocation testing. An evaluation of four techniques in exercise-induced bronchospasm.

The thresholds used to define a positive result for bronchial provocation challenges (BPC) are arbitrary. Requiring smaller decrements in expired flow to define a positive study would capture more cases of reactive airways (increased sensitivity) but would include some "normal" responses (decreased specificity). To examine the relationship between threshold definition and the ability to correctly classify subjects as either normal or as having airways hyperresponsiveness (AHR), four different BPC tests were administered on different days to 20 patients with a clinical diagnosis of exercise-induced bronchospasm (EIB) and 20 control subjects. The four BPC tests were indoor exercise on a cycle ergometer, methacholine inhalation challenge (MIC), eucapnic voluntary hyperventilation (EVH) with dry gas, and EVH with cold gas. Our results indicate that the thresholds which best separate the two groups are different for each of the four BPC techniques. For methacholine inhalation (MIC), a fall in FEV1 (d%FEV1) of 15 percent or greater at 188 cumulative breath units was 100 percent specific for AHR but had a sensitivity of only 55 percent. Eucapnic voluntary hyperventilation (EVH) with room temperature dry gas was 100 percent specific at a d%FEV1 of 11 percent, but, at that threshold, sensitivity was only 50 percent. EVH with cold air was 100 percent specific at a d%FEV1 of 12 percent but sensitivity was only 35 percent. The bicycle ergometer challenge was far too insensitive to be of value in evaluating AHR. Based on their respective receiver operating characteristic curves, the best separation of the two subject groups occurred at a d%FEV1 of 5 percent and 12 percent for the two EVH techniques and MIC, respectively. An individual's response to one test was highly correlated with the response to either of the other two (r = 0.66, p less than 0.001 for dry vs cold gas EVH; r = 0.56, p less than 0.001 for dry gas EVH vs methacholine; and r = 0.69, p less than 0.001 for cold gas EVH vs methacholine). Thus, MIC and EVH techniques are equally useful in defining AHR and each has its optimal threshold for a positive test result.

Adult↗

PubMed1992

Oxygen consumption and ventilation during normal labor.

Oxygen consumption (VO2) and minute ventilation (VE) were measured breath-by-breath for 10 min periods in the third trimester of pregnancy in 16 healthy women. These measurements were repeated during the first stage of labor in eight of the women. The 10-min mean VO2 was 3.56 ml/kg/min (+/- 0.82 SD) at term and 4.28 ml/kg/min (+/- 0.93) during labor, for an average increase of 23 percent (+/- 28 percent, p = 0.04) from third trimester to labor. The mean VE was 0.15 L/kg/min (+/- 0.03) at term and increased significantly (p = 0.05) to 0.24 L/kg/min (+/- 0.11) during labor for an average increase in VE of 65 percent (+/- 78 percent). Peak VO2 and VE occurred during contractions with five-breath average peak VO2 being 86 percent (+/- 53%) above the 10-min mean value at term and VE increasing 167 percent (+/- 154 percent) from third trimester to peak values during labor. These data may be useful in identifying patients at risk for developing respiratory insufficiency during labor. We propose an algorithm for approaching the obstetric patient with respiratory disease.

Adolescent↗

PubMed1992

Outcome of cardiopulmonary resuscitation in the intensive care setting.

BACKGROUND: Although cardiopulmonary resuscitation (CPR) has been shown to be most effective in a monitored setting, previous studies have focused primarily on patients with acute cardiac events rather than chronic progressive disease. This study examined the outcome of CPR in the medical and surgical intensive care units where patients often have acute illness superimposed on chronic underlying conditions. METHODS: We present a retrospective chart review of all patients undergoing CPR in medical and surgical intensive care units during a 2-year period. RESULTS: One hundred fourteen charts were reviewed. Patient mean age was 59 years. The primary underlying disease was malignancy in 29 (25%), vascular disease in 20 (18%), chronic liver disease in eight (7%), end-stage renal disease in six (5%), chronic obstructive pulmonary disease in five (5%), and other conditions in 46 (40%) patients. Although 50 (44%) of the patients were initially resuscitated, only six (5%) ultimately survived to hospital discharge. Only one of 29 patients with malignancy and one of 39 septic patients survived. Age, sex, and Acute Physiology and Chronic Health Evaluation II scores were similar among survivors and nonsurvivors. Furthermore, four of the six survivors died within 1 year of discharge, and the two others had severe disabilities. CONCLUSIONS: Patients with chronic medical conditions undergoing CPR even in an intensive care unit setting seldom survive to hospital discharge. Even among the few survivors, the near term prognosis is poor. Therefore, the decision to perform CPR should take into account underlying chronic medical conditions and not merely the setting of the arrest.

Cardiopulmonary Resuscitation↗

PubMed1991

Urinary desmosine excretion as a marker of lung injury in the adult respiratory distress syndrome.

Desmosine, the intermolecular and intramolecular cross link between the chains of elastin polypeptide, may be useful as a marker of a lung injury in adult respiratory distress syndrome (ARDS). A radioimmunoassay for rabbit antibody developed against desmosine, conjugated to bovine serum albumin, can detect as little as 100 pg of desmosine in plasma or urine. Desmosine is not metabolically absorbed, reused, or catabolized by the body, but rather eliminated unchanged in the urine as low molecular weight peptides. The lung is relatively rich in elastin, and we reasoned that a timed collection could be used as an index of elastin degradation in vivo. A 2-h collection of urine for desmosine assay was obtained at the time of Swan-Ganz catheter insertion in 41 consecutive patients. On the basis of clinical and initial Swan-Ganz catheter data, the patients were assigned to one of three groups: an ARDS group (n = 12); a cardiogenic pulmonary edema (CPE) group (n = 12); and a critically ill, nonpulmonary edema group (NPE, n = 17). The mean urine desmosine concentration (mg/L) for the ARDS group (0.728 +/- 0.22 SE) differed from the CPE group (0.149 +/- 0.07; p less than 0.001). The total excretion (microgram/2 h) was 64.95 +/- 24.7 in the ARDS group and 24.71 +/- 11.7 in the CPE group (p less than 0.05). Urine desmosine concentration/serum creatinine index for the ARDS group (0.78 +/- 0.28) was greater than in the CPE group (0.07 +/- 0.04; p = 0.019). Desmosine excretion was increased in the NPE group compared with CPE and ARDS groups, possibly reflecting heterogeneity in this group. In the differentiation of ARDS from CPE, we conclude that substantial increases in urinary desmosine excretion favor a diagnosis of ARDS.

Adult↗

PubMed1991

Caffeine consumption decreases the response to bronchoprovocation challenge with dry gas hyperventilation.

OBJECTIVE: To determine whether caffeine consumption affects bronchoprovocation challenge (BPC). DESIGN: A prospective, double-blind, placebo-controlled, randomized, crossover trial. PATIENTS: Eleven nonsmoking men, aged 18 to 42 years, with normal baseline spirometry and evidence of exercise-induced bronchospasm. INTERVENTION: On three separate test days, each individual received, in random order, either placebo, 5 mg/kg caffeine, or 10 mg/kg caffeine, and then underwent BPC with eucapnic voluntary hyperventilation (EVH). RESULTS: Caffeine (10 mg/kg) significantly reduced bronchoconstriction compared to placebo (p = 0.02). The reduction in bronchoconstriction correlated with the serum level of caffeine (p = 0.014). CONCLUSIONS: Caffeine decreases bronchoconstriction due to EVH. Caffeine should be eliminated from diet prior to BPC.

Adolescent↗

PubMed1991

Prediction of carbon monoxide diffusing capacity of the lung in splenectomized sheep.

The steady state diffusing capacity of the lung for carbon monoxide (DLCO) was studied in 18 splenectomized adult ewes. Seven animals were anemic when studied. Weight (Wt) and, to a lesser extent, hemoglobin (Hb) level were the key predictive variables of DLCO. Sheep DLCO can be expected to range between 15 and 28 ml/min/mmHg in adult ewes which are not anemic. When DLCO measurements were repeated up to three times on the same day no significant decreases occurred. Thus, the data demonstrated no CO back-pressure caused by preceding DLCO determinations. This paper's importance is in defining a normal predictive range for this sensitive parameter of pulmonary function.

Animals↗

PubMed1991

Autologous perfusion of an isolated rabbit gastrointestinal tract.

Most perfusion techniques rely on mechanical means to provide blood flow to the isolated organ for maintaining its physiological conditions. The approach usually requires a complicated mechanical system with the associated problems of blood type matching and prevention of blood cell damage. This paper describes a gastrointestinal tract perfusion technique that uses the rabbit's own cardiopulmonary system as the autologous blood supply source. The technique allows for the removal of the complete intestinal loop from the abdominal cavity of the rabbit, and maintains its blood circulation through silastic tubing connections of the catheterized portal vein and cranial and caudal mesenteric arteries. An alternative perfusion site that uses the aorta as the arterial blood supply and the vena cava as the venous return also is described. The isolated perfused GI tract may then be placed in a separate test environment for controlled experiments. For an acute animal test, the approach was found to be a convenient alternative to conventional approaches.

Animals↗

PubMed1990

Predictive criteria for burns from brief thermal exposures.

Burns are a major cause of injury and death within the civilian and military communities. By accurately predicting the effects of brief thermal exposures, hazardous occupational situations can be identified and preventive devices and procedures can be developed. It is difficult to quantify heat transfer into skin, and calorimetry appears the best measurement method. Approximately 16.4 J/cm2 of heat transfer are necessary to cause second-degree burns. A free air temperature measurement method of predicting burns is less accurate, although, for brief exposures, a time-temperature integral of 1315 degrees C-second (2400 degrees F-second) above body temperature correlates with heat transfer causing second-degree burns. Both of these criteria apply to bare skin. When skin is covered with most types of clothing, a thermal protection factor of 2.5 (approximately 24.4 J/cm2) can be assumed.

Burns↗

PubMed1989

Computer-controlled large-animal pulmonary function system.

Breath by breath determination of lung volume and specific lung conductance is challenging, yet desirable particularly when rapid changes in lung function accompany abrupt changes in lung volume. We have developed a large-animal pulmonary function data acquisition system using two personal computers with custom-made software which continuously tracks breath by breath changes in pulmonary function and lung volume. Accurate measurement of respiratory flow signals is accomplished by collecting separate pneumotachometer-derived expiratory and inspiratory flow signals, correcting them to standard temperature pressure dry (STPD) and summing them into a single flow data array. Calibration of inspiratory and expiratory flow is software corrected by comparison of the integrated flow signals with a sinusoidal pump system. Data are collected continuously for up to 120 min at 100 Hz/channel. Subroutines which configure the system to perform functional residual capacity, dosimetry and partial expiratory flow-volume maneuvers are user selected at any time during data collection.

Animals↗

PubMed1989

Blast injuries of the ear in military operations.

Exposure to blast waves from the explosion of ordnance is a common feature of combat operations. The ear is the organ most sensitive to such strong pressure waves. Blast damage to the ear may range from minor acoustic trauma to major disruption of middle and inner ear structures. Standard hearing protectors should offer a significant degree of shielding from these injuries. Aural injury alone seldom should cause a soldier to abandon a combat mission. However, the potential for a large temporary or permanent neurosensory hearing loss does raise issues about such a soldier's effectiveness on the modern, communication-intensive battlefield. Further research is necessary on mechanisms of injury, protective measures, and the effect of hearing loss on military performance.

Blast Injuries↗

PubMed1989

Middle ear injury in animals exposed to complex blast waves inside an armored vehicle.

With greater reliance on armored vehicles of improved survivability, questions have arisen about the likelihood of the wounding of vehicle occupants from blast waves alone. In this study, we placed anesthetized animals (sheep or pigs) inside lightly armored vehicles and exposed them to the blast waves generated by one of three sizes of shaped-charge munitions. Sixty-seven animals were exposed and 15 served as controls. No difference was noted between exposed and control groups for blast injury to the respiratory or gastrointestinal tracts. In contrast, middle ear damage was observed exclusively in animals exposed to blast and was correlated strongly with the peak pressure. The ear is the organ most sensitive to blast damage, and if protectors are not used, military physicians can expect to see a high incidence of middle ear injury in modern combat. The operational consequences of such an injury are not known.

Animals↗

PubMed1989

Physical correlates of eardrum rupture.

Eardrum (tympanic membrane) rupture in humans and animals in relation to various blast pressure-time patterns was reviewed. There were few systematic studies on eardrum rupture as a consequence of blast overpressure. Most reports did not describe the area of the eardrum destroyed. The peak overpressures required to produce a 50% incidence of eardrum rupture (P50) were summarized. Most of the animal data pertained to dogs. The highest P50 for dogs, 296 kPa, was associated with smooth-rising overpressure. For complex wave patterns occurring inside open shelters subjected to nuclear blasts, the P50 was 205 kPa. For fast-rising blasts in a shock tube it was 78 kPa, and 105 kPa for statically applied pressures. The duration of the overpressure was not a factor unless it was very short. The influence of the orientation of the head to the oncoming blast was demonstrated. An ear facing the blast may receive reflected overpressures several times that for one side-on to the blast. An ear on the downstream side of the head was exposed to about the same overpressure as the side-on ear. A P50 for humans of 100 kPa and a threshold of 35 kPa has been used widely in blast criteria. A recent study suggests a threshold (P1) of about 20 kPa, and gives the overpressures required to produce minor, moderate, and major eardrum ruptures. These data were presented in the form of curves showing the overpressures as a function of duration required to inflict a P1 and a P50 of eardrum rupture of the three levels of severity.

Animals↗

PubMed1989

Treatment of lymphangioleiomyomatosis. A meta-analysis.

Lymphangioleiomyomatosis is a rare disease which afflicts young women of childbearing age. It is sufficiently uncommon that randomization or any other systematic evaluation of regimens of treatment has been difficult. Review of scattered case reports implies that a number of hormonal manipulations may be equally effective. A comprehensive review of the literature revealed 30 cases of LAM treated with eight regimens of treatment. Evaluation with predetermined criteria (meta-analysis) shows that administration of progesterone or oophorectomy or both are the most effective treatments, resulting in improvement or stabilization of the disease in the majority of cases.

Adult↗

PubMed1989

Blood volume determinations in sheep before and after splenectomy.

Using 51Cr labelled RBCs, total blood volume, red cell volume and plasma volume were measured in fifteen adult, female, domestic sheep both before and after splenectomy. Eight of the fifteen animals studied were anemic. Statistical analyses revealed no significant differences in blood volume parameters whether animals were grouped together or separated into normal and anemic groups. We observed: (a) splenectomy produced modest reductions in blood volume parameters in 12 of 15 animals, (b) preoperative variability in blood volume parameters caused by release of sequestered RBCs from the spleen was eliminated after splenectomy, and (c) equilibration of 51Cr required at least 30 minutes in intact animals, but only 10 minutes in splenectomized animals. After volume parameters were normalized to body weight, they were found to agree closely with values reported previously. This study demonstrates the dynamic function of the sheep spleen in the regulation of blood volume.

Anemia↗

PubMed1989

A steady state method of measuring carbon monoxide diffusing capacity of the lung of sheep.

A method for measuring the diffusing capacity of the lung for carbon monoxide (DLCO) in sheep was developed. The test's usefulness and reliability was studied in ten, splenectomized adult ewes. Hemoglobin concentration and weight were found to affect sheep DLCO. This article describes a method of determining DLCO in sheep, gives preliminary results of limited testing, and discusses factors affecting DLCO in sheep.

Animals↗

PubMed1988

Computer modeling of thoracic response to blast.

Primary blast injury affects the gas-containing structures of the body. Damage to the lungs with resultant respiratory insufficiency and arterial embolization of air from alveolar pulmonary venous fistulae is the predominant cause of morbidity and mortality following high-level blast exposure. In an effort to generate a widely applicable damage-risk criterion for thoracic injury from blast we are developing a complex computer finite element model (FEM) of the thorax. Taking an engineering approach, a horizontal cross-section of the thorax is divided into small discrete units (finite elements) of homogeneous structure. The necessary physical properties (density, bulk modulus, etc.) are then determined for each element. Specifying the material constants and geometry of the elements, the computer can load the surface of the structure with some force-time function (blast pressure-time history) and calculate the resultant physical events such as displacement, compression, stress, strain, etc. Computer predictions of pressure wave phenomena in the lung parenchyma are compared with trans-bronchially measured pressures in blast-exposed animals. The model should prove useful in assessing the risk of blast injury in diverse overpressure environments and may give insight into pathophysiologic mechanisms and strategies for protection.

Animals↗

PubMed1988

Cloth ballistic vest alters response to blast.

Ballistic wounds have been and will remain the principal cause of casualties in combat. Cloth ballistic vests (CBV) play an important role in limiting critical wounds from fragments and small-arms fire. There is an increased risk of primary blast injury on the modern battlefield. In a previous study, volunteers were exposed to short-duration blast waves of low peak pressure (18.6 +/- 0.8 kPa). Pressure measurements made in the distal esophagus as an estimate of intrathoracic pressure (ITP) were significantly higher (p less than 0.05) when the standard U.S. Army ballistic jacket was worn (8.7 +/- 1.2 kPa) than when fatigues alone were worn (7.4 +/- 0.7 kPa). In this study 58 sheep were exposed to nominal blast levels of 115, 230, 295, and 420 kPa peak pressure in groups of 12, 18, 16, and 12, respectively. Half of each group was fitted with a CBV. Lung weight index (LWI), lung weight expressed as a percentage of body weight, was used as a measure of blast injury. Use of the CBV was associated with a significant increase in LWI (p less than 0.05) which averaged 21% for the two middle exposure groups. At the 420 kPa level, two of six non-CBV animals died as opposed to five of six animals wearing the CBV. Intrathoracic pressure was generally higher in the CBV group. Likely mechanisms of injury enhancement include an increase in target surface area and an alteration of the effective loading function on the thorax. This information may be useful in the triage and treatment of casualties exposed to intense blast environments.

Animals↗