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Biomedical subjects

A Bouchama

Publications and source records attributed to A Bouchama.

At least 37 records · Page 2Linked to original sources
PubMed1995

Open lung biopsy provides a higher and more specific diagnostic yield compared to broncho-alveolar lavage in immunocompromised patients. Fungal Study Group.

In order to examine the feasibility and safety of undertaking a larger prospective study to compare the diagnostic yield from concurrent open lung biopsy (OLB) and bronchoalveolar lavage (BAL) in febrile neutropenic patients with pulmonary infiltrates and the impact of such knowledge on clinical outcome, a pilot exploratory study was performed. 13 immunocompromised patients (mainly with haematological malignancy or bone marrow transplantation recipients) were investigated. At least one diagnostic finding in 12 of 13 patients was provided by OLB compared to 4 of 13 patients by BAL. BAL provided 7 specific diagnoses (pneumocystis 1, fungal infection 3, bacterial pneumonia 1, pulmonary haemorrhage 2) whilst OLB provided 12 specific diagnosis (CMV 2, pneumocystis 3, fungal infection 1, bacterial pneumonia 1, pulmonary haemorrhage 4, pulmonary embolism 1). Five patients with nonspecific interstitial/alveolar inflammation were diagnosed only by OLB. The concordance that the exact same specific diagnoses present in the OLB were found in the BAL was zero. There were 2 minor complications (1 wound infection by OLB, 1 moderate haemorrhage by BAL). Mortality at 28 days was 8 of 13 patients which in no case was related to either procedure. We suggest that OLB is a safe procedure in such patients, provides superior and more complete diagnostic information compared to BAL and a larger controlled study to investigate the impact of early OLB on the outcome of these patients appears to be justified.

Adolescent↗
PubMed1994

CT-guided fine needle aspiration biopsy in the diagnosis of mediastinal tuberculosis.

Twenty-two patients with mediastinal tuberculosis were reviewed. The most common symptoms were chest pain, cough, fever, and weight loss. Results of the physical examination were unremarkable. The chest radiographs of all 22 patients showed abnormal mediastinum with no evidence of extramediastinal disease. Most (62%) had right-sided paratracheal lymphadenopathy. Mantoux skin test was positive (> 15 mm) in all patients, whereas sputum smears and cultures for acid-fast bacilli were negative. Computed tomographic (CT) guided fine needle aspiration biopsies (FNAB) were performed in 12 patients using 22- to 25-gauge needles. Ten patients had fiberoptic bronchoscopic (FOB) examination with brushings and biopsies. Mediastinoscopy (n = 8) or thoracotomy (n = 6) was performed in patients where either FNAB or FOB was not diagnostic or where lymphoma was suspected clinically. The rates of true-positive diagnoses were 20%, 66%, 75%, and 100% for FOB, FNAB, mediastinoscopy, and thoracotomy, respectively. The rate of false-negative for FNAB was 34%. Only one patient developed nonsignificant pneumothorax after FNAB. These findings suggest that CT-guided FNAB is a useful and safe procedure and should be considered in the initial evaluation of patients suspected of having mediastinal tuberculosis.

Adolescent↗
PubMed1993

Impaired elimination of atenolol in a nephropathic patient with self-medication overdose.

A case of intoxication with atenolol (plasma concentration of 2.71 mg/L) caused by an improper self-medication combined with impaired renal function is presented. The patient was supported with atropine, isoproterenol, dopamine, and dobutamine, and a thorough pharmacokinetic monitoring of atenolol was conducted. As the serum creatinine concentration returned slowly to baseline with good diuresis, the concentration of atenolol decreased (biologic half-life = 2.95 days) and the blood pressure gradually recovered. The patient improved and was subsequently discharged in good health. Had pharmacokinetic monitoring of atenolol not been performed, hemodialysis would have been indicated.

Atenolol↗
PubMed1993

Alteration of taurine homeostasis in acute heatstroke.

OBJECTIVE: To investigate the potential role of taurine as a hypothermic modulator during heatstroke. DESIGN: Prospective analyses. SETTING: Heatstroke Center in makkah, Saudi Arabia. PATIENTS: Twenty-nine adult patients with heatstroke. INTERVENTIONS: High-performance liquid chromatography was used to measure plasma and urine taurine concentrations in heatstroke patients on admission (precooling) and 24 hrs after complete cooling (postcooling). MEASUREMENTS AND MAIN RESULTS: There were 18 males and 11 females with a mean rectal temperature of 42.2 +/- 0.14 degrees C. At the precooling time period, the taurine concentrations were increased (plasma 180 +/- 14 mumol/L; urine 4142 +/- 720 mumol/L [normal ranges 45.5 to 138.2 and 168 to 1890 mumol/L, respectively]). At the postcooling time period, taurine concentrations were significantly (p < .0001) decreased (54 +/- 6 and 802 +/- 160 mumol/L for plasma and urine, respectively). No correlation was found between taurine and creatine kinase activity, or between precooling temperature and taurinemia or taurinuria. CONCLUSIONS: The source and clinical significance of the increased taurine concentrations are to be determined. The involvement of taurine in the regulation of core body temperature suggests that it may have an adaptive role in heatstroke.

Acute Disease↗
PubMed1993

Elevated pyrogenic cytokines in heatstroke.

STUDY OBJECTIVES: Heatstroke, characterized by hyperthermia and neurologic abnormalities, can cause shock, adult respiratory distress syndrome, and multiorgan failure culminating in death. The mediation of metabolic changes and tissue damage is not fully understood. Recent evidence suggests the involvement of endotoxin, tumor necrosis factor alpha (TNF-alpha), and interleukin 1 alpha (IL-1 alpha) and we hypothesized that other pyrogenic cytokines may be implicated. DESIGN: Prospective analysis. SETTING: Heatstroke Center in Makkah (Mecca), Saudi Arabia. MEASUREMENTS AND RESULTS: We measured plasma IL-1 beta, IL-6, and interferon gamma (INF-gamma) concentrations by enzyme-linked immunosorbent assay in 28 heatstroke patients at the time of hospital admission (precooling) and after complete cooling (postcooling), and in 10 normal control subjects. We measured C-reactive protein (CRP) as a marker of acute phase response and calculated severity of illness using the simplified acute physiology score. Twenty-five male and 3 female subjects had mean (+/- SEM) rectal temperature of 41.2 +/- 0.2 degrees C. IL-6, IL-1 beta, and INF-gamma concentrations were elevated in 100 percent, 39 percent, and 50 percent of patients to (mean +/- SEM) 220 +/- 44 pg/ml, 42 +/- 14 pg/ml, and 1,180 +/- 879 pg/ml, respectively (normal control values: < 3.5 pg/ml, < 4.5 pg/ml, < 20 pg/ml). The CRP value was elevated in 72 percent of patients to 152 +/- 40 mg/L (control value: 0 to 17 mg/L). The IL-6 concentrations correlated with severity of illness (r = 0.516, p = 0.03); two patients with the highest concentrations died. There was no significant correlation between circulating levels of IL-6, IL-1 beta, INF-gamma, and temperature, or between IL-6, IL-1 beta, and CRP. Postcooling, IL-6, and IL-1 beta were still above normal control values; INF-gamma could be detected in one patient only. CONCLUSION: Our findings of elevated circulating IL-6, IL-1 beta, and INF-gamma in the presence of acute phase response, and correlation with severity of illness, suggest that these cytokines have a role in the pathogenesis of heatstroke, which could lead to new therapeutic strategies.

Body Temperature↗
PubMed1992

Distribution of peripheral blood leukocytes in acute heatstroke.

We examined 11 heatstroke patients (mean rectal temperature 41.4 +/- 0.3 degrees C) and 40 healthy subjects to determine the effects of hyperthermia on peripheral blood leukocyte distribution. Precooling samples were taken on admission. Whole blood was incubated with conjugated monoclonal antibodies, and erythrocytes were eliminated by FACS lysing solution. Lymphocyte subsets were detected by specific mouse monoclonal antibodies: Leu-4/CD3+ (T-cells), Leu-3a/CD4+ (T-helper cells), Leu-2a/CD8+ (T-suppressor-cytotoxic cells), Leu-11/19/CD16+/CD56+ (natural killer cells), and Leu-12/CD19+ (B-cells). Immunofluorescence was measured with a flow cytometer. The number of circulating leukocytes and lymphocytes was significantly increased in heatstroke patients. This lymphocytosis was mainly due to an increase in T-suppressor-cytotoxic cells and natural killer cells. The absolute number of lymphocytes and T-suppressor-cytotoxic cells significantly correlated with the degree of hyperthermia (r = 0.62, P = 0.04; r = 0.751, P = 0.007, respectively). There was a significant decrease in the percentages of T-, B-, and T-helper cells and increase in T-suppressor-cytotoxic and natural killer cells, giving a marked decrease in the ratio of T-helper to T-suppressor-cytotoxic cells. We conclude that heatstroke is associated with leukocytosis and significant alteration in absolute number and percentage of circulating lymphocyte subpopulations.

Acute Disease↗
PubMed1992

Spontaneous esophageal perforation in herpes simplex esophagitis.

A 32-yr-old, previously healthy man with severe chest pain of sudden onset was found to have purulent pericarditis and pleural effusions. Several days later, an esophagogram revealed a perforation of the thoracic esophagus. Endoscopy showed a picture highly suggestive of a late stage of an extensive herpes simplex virus (HSV) esophagitis. Biopsies revealed evidence of massive HSV infection, confirmed by immune microscopy and virus culture. At surgery, a mediastinal abscess was found, and an esophageal perforation was identified. These findings suggest that the etiology of the perforation was an unusually severe herpetic infection. To our knowledge, HSV esophagitis has not previously been implicated as the cause of spontaneous esophageal perforation.

Adult↗
PubMed1991

Ineffectiveness of dantrolene sodium in the treatment of heatstroke.

STUDY OBJECTIVE: To determine the efficacy of dantrolene sodium in the treatment of heatstroke. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Heatstroke center in Makkah, Saudi Arabia. PATIENTS: Fifty-two adult patients with heatstroke. INTERVENTIONS: Patients were assigned to receive either dantrolene sodium (2 mg/kg body weight iv) or placebo. Conventional cooling therapy was initiated in all. MEASUREMENTS AND MAIN RESULTS: There was no significant difference in the mean cooling times for the treatment and control groups (67.9 vs. 69 min). There was only one death in the control group. Complications were seen in six (23%) patients receiving dantrolene sodium and seven (27%) patients receiving placebo; the difference was not statistically significant. There was no significant difference in the mean number of hospital days (4.7 +/- 2.0 vs. 2.9 +/- 0.9 days). CONCLUSION: Treatment with dantrolene sodium at the dose used, did not prove beneficial to patients with heatstroke.

Dantrolene↗
PubMed1991

Endotoxemia and release of tumor necrosis factor and interleukin 1 alpha in acute heatstroke.

To determine whether endotoxemia and release of tumor necrosis factor (TNF-alpha) and/or interleukin 1 alpha (IL-1 alpha) are involved in the pathogenesis of heatstroke, 17 adult patients with a mean rectal temperature of 42.1 +/- 0.2 degrees C were studied. Blood samples were taken on admission and after cooling was completed. TNF-alpha and IL-1 alpha levels were measured by enzyme-linked immunosorbent assay, and lipopolysaccharide (LPS) content was measured by the chromogenic substrate modification of the Limulus amebocyte lysate. TNF-alpha, IL-1 alpha, and LPS were elevated in all patients [199 +/- 25 (SE) pg/ml, 480.5 +/- 68.3 pg/ml, and 8.60 +/- 1.19 ng/ml, respectively, compared with normal control values of 31.4 +/- 8.4 pg/ml, 53.7 +/- 5.32 pg/ml, and less than 9 pg/ml]. There was no significant correlation between temperature and the circulating concentration of TNF-alpha, IL-1 alpha, and LPS. Postcooling TNF-alpha, IL-1 alpha, and LPS concentrations were significantly decreased but still above normal control values. The findings suggest that these mediators may have a role in the pathogenesis of heatstroke that could change the strategy of management.

Endotoxins↗
PubMed1991

Mechanisms of hypophosphatemia in humans with heatstroke.

Hypophosphatemia is common in heatstroke, but little is known about its mechanism. We investigated 10 consecutive patients with heatstroke (mean age 58 +/- 2 yr) whose mean rectal temperature at admission was 42.3 +/- 0.2 degrees C. Eight patients presented with hypophosphatemia [0.48 +/- 0.08 mmol/l, normal range (NR) 0.8-1.4 mmol/l], associated with increased fractional excretion of phosphate (19.8 +/- 6.4%, NR 6-20%) relative to plasma phosphate levels and reduced renal threshold for phosphate (0.55 +/- 0.08 mmol/l glomerular filtrate, NR 0.8-1.4 mmol/l). Plasma parathyroid hormone (75.0 +/- 5 pmol/l) and calcium (2.24 +/- 0.02 mmol/l) levels and fractional excretion of calcium were normal (1.66 +/- 0.27%). There was no evidence of uricosuria or aminoaciduria, and only one patient had glucosuria. Arterial carbon dioxide was decreased in eight patients (28 +/- 1.1 Torr); however, none had elevated blood pH (7.35 +/- 0.02). The results suggest that heatstroke-related hypophosphatemia is associated with abnormal phosphaturia independent of the parathyroid hormone level, and there is no evidence of tubular dysfunction.

Aged↗
PubMed1991

Brain biopsy in tuberculoma: the risks and benefits.

In developing countries, 5 to 8% of the space-occupying lesions of the central nervous system are tuberculomas. Diagnosis can be difficult in the absence of extracranial tuberculosis; computed tomography is suggestive only. To assess the value of brain biopsies in tuberculomas, the records of 15 patients aged 6 to 80 years were reviewed. Histological confirmation was obtained in 15 patients, and acid-fast bacilli were cultured from 12 patients. Intracranial hypertension was the principal sign in 11 patients; other neurological signs were related to the location of the tuberculoma. One patient had evidence of extracranial tuberculosis. Biopsy-related complications consisted of an epidural hematoma in 1 patient and hydrocephalus in another; both required additional surgery. One case of tuberculous meningitis was probably related to surgery and poor drug compliance. There was no postoperative mortality. Thirteen patients (2 were lost to follow-up) were cured after an average of 16 months of antituberculous therapy. It was concluded that the brain biopsy is useful in diagnosing tuberculoma but that there is some associated risk.

Adolescent↗
PubMed1987

Ultralow doses of vasopressin in the management of diabetes insipidus.

Management of postoperative diabetes insipidus (DI) frequently requires intermittent treatment with multiple subcutaneous injections of pituitrin or vasopressin, in doses averaging 20 IU/24 h. Use of a syringe pump for a continuous infusion of ultralow doses of pituitrin produced uniform, constant, and sustained reduction of urinary output, thus facilitating regular fluid replacement. Twelve patients with postoperative DI received iv pituitrin at a dose of 1.6 +/- 0.26 mIU/kg X h (1 to 2 IU/24 h). The antidiuretic effect began at the third hour of treatment, peaked by the sixth hour (diuresis of 37 ml/h, specific gravity of 1.018 +/- 0.002), and was sustained throughout infusion. Polyuria recurred 3 h after the infusion was discontinued; this rapid reversibility is highly advantageous when excessive fluid intake causes overhydration. Pressor effects were not observed during the treatment period.

Adolescent↗
PubMed1986

[Urinary tract obstruction by Candida bezoars, or fungus balls].

Two patients admitted to an intensive care unit for severe bacterial infection develops Candida albicans superinfection with obstruction of the urinary canals by "fungus balls". The development of medico-surgical techniques using antibiotics and immunosuppressive drugs accounts for the increasing incidence of disseminated candidiasis. The kidneys are particularly sensitive to Candida infections. Fungus balls are conglomerates of mycelium which may result in obstruction of the urinary tract. Their clinical, radiological and ultrasonic features, as well as the microbiological and serological diagnostic problems they raise are described. Ultrasonically guided percutaneous nephrostomy is a very interesting technique for the diagnosis of the condition and its local treatment by drainage and lavage with amphotericin B. This antifungal, combined with flucytosine is still used for the systemic treatment of candidiasis.

Aged↗
PubMed1984

Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients.

To determine the relative cultural accuracy of the bronchoscopic protected specimen brush (PSB) in ventilated patients, we compared this method in the same area of the lung with histologic and bacteriologic examinations of pulmonary specimens. The procedures were concluded just after death when the ventilator was still functioning. Samples via the PSB were taken from a branch of the anterior basal bronchus of the left lower lobe, and immediate left thoracotomy was performed to obtain peripheral specimens from the corresponding segment for quantitative cultures. Twenty-six patients were studied; 6 had histologically proved pneumonia. Using quantitative cultures, a correlation was evidenced between PSB and lung cultures, especially in the subgroup of patients who received no antibiotic during the week preceding their death. No pneumonia was observed when PSB cultures isolated no organisms in concentrations greater than 10(3) colony-forming units (cfu) per ml. The PSB cultures at a level of 10(3) cfu/ml identified every patient with histologically proved pneumonia and every microorganism present in concentrations of 10(4) cfu/g or greater in the lungs. Moreover, in the subgroup of patients receiving no antibiotic, only 4 microorganisms were isolated by the PSB in concentrations greater than 10(3) cfu/ml and not found in the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Acute pneumonitis with bilateral pleural effusion after talc pleurodesis.

We describe a patient who developed acute pulmonary distress with bilateral interstitial infiltrates and pleural effusion following talc pleurodesis. Talc particles, obtained by bronchoalveolar lavage, were identified by transmission electron microscopy and chemical analysis. The patient improved with corticosteroid therapy. Acute respiratory failure can be a potential hazard of talc pleurodesis.

Adult↗