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Biomedical subjects

A E Pitchenik

Publications and source records attributed to A E Pitchenik.

15 recordsLinked to original sources
PubMed1992

Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients.

OBJECTIVE: To describe transmission of multidrug-resistant (MDR) Mycobacterium tuberculosis infection among patients and health care workers (HCWs) in a ward and clinic for human immunodeficiency virus (HIV)-infected patients in a hospital, four studies were conducted. METHODS: Case patients and control patients were persons who had been treated in the HIV ward or clinic, whose clinical course was consistent with tuberculosis and who had at least one positive culture for M tuberculosis between January 1, 1988, and January 31, 1990, resistant to at least isoniazid and rifampin (case patients), or whose isolates were susceptible to all drugs tested (control patients). In the first study, case patients and control patients were compared to identify risk factors for MDR tuberculosis. In the second study, inpatient and outpatient days of MDR tuberculosis case patients were compared to determine whether acid-fast bacillus (AFB) smear-positivity or aerosolized pentamidine use was associated with higher numbers of subsequent MDR tuberculosis cases among exposed patients. In the third study, restriction fragment length polymorphism analysis was performed on available MDR and sensitive M tuberculosis isolates. In the fourth study, skin test conversion rates among HCWs in the HIV ward and clinic were compared with those of HCWs in another ward, and the strength of the associations between skin test conversions among HCWs on the HIV ward and the number of person-days that AFB smear-positive case patients and control patients were on this ward was estimated. RESULTS: Case patients were more likely than control patients to have been exposed on the HIV ward or clinic to an AFB smear-positive case patient (P less than .001). Inpatient and outpatient days of MDR tuberculosis case patients were associated with more subsequent cases of MDR tuberculosis if exposing case patients were smear-positive or if they received aerosolized pentamidine (P less than or equal to .01). Of 13 MDR isolates, all had one of two restriction fragment length polymorphism patterns; 10 sensitive isolates had restriction fragment length polymorphism patterns that were different from each other. The HCW skin test conversion rate was higher on the HIV ward and clinic than on the comparison ward (P less than .01). The risk of occupational acquisition of infection increased in direct proportion to the number of person-days that AFB smear-positive case patients were on the HIV ward (r = .75; P = .005), but did not increase in proportion to the number of person-days that AFB smear-positive control patients were there (r = -.36; P = NS). After isolation measures for AFB smear-positive tuberculosis patients were improved, MDR tuberculosis cases decreased to seven of 214 tuberculosis patients. CONCLUSIONS: Nosocomial transmission of MDR M tuberculosis infection to patients and HCWs occurred on the HIV ward and clinic. Infectiousness of MDR tuberculosis case patients was associated with AFB sputum-smear positivity. Case patients with MDR tuberculosis created a greater risk of skin test conversion for HCWs on the HIV ward than drug-susceptible control patients.

Adult↗
PubMed1992

Medical management of AIDS patients. Tuberculosis and nontuberculous mycobacterial disease.

AIDS has been responsible for a significant increase in mycobacterial disease, which in this setting is often extrapulmonary. In contrast to HIV-associated Mycobacterium avium complex disease, HIV-associated tuberculosis is normally transmissible between humans by the aerosol route, occurs earlier than most AIDS-related infections, and is readily treatable and preventable with conventional drugs.

HIV Infections↗
PubMed1991

Functional laryngeal obstruction relieved by panting.

A 49-year-old man presented with a two-day history of severe recurrent dyspnea and inspiratory stridor. A chest roentgenogram, computed tomographic scan of the neck, direct laryngoscopy, and bronchoscopy excluded organic upper airway obstruction. Laryngospasm occurred during the bronchoscopy. Although flow volume loops revealed severe upper airway obstruction (inspiratory and expiratory), airway resistance measured plethysmographically (during panting) was normal. Because of this observation, panting was recommended for relief of the patient's recurrent attacks of functional laryngeal obstruction. The panting maneuver immediately and completely relieved all 25 to 30 subsequent attacks. After the patient recovered clinically, a flow volume loop was repeated and was found to be normal. The marked discrepancy between severe flow limitation (as detected by flow volume loops) and normal airway resistance (measured plethysmographically) may be a diagnostic test for functional laryngeal obstruction, and panting may be an effective emergency measure for its relief. Relief by panting may also suggest the diagnosis. A second patient with an almost identical symptom complex is described, in whom the panting maneuver was also dramatically successful in promptly aborting recurrent severe attacks of airway obstruction and stridor.

Airway Obstruction↗
PubMed1989

Granulomatous vasculitides of the lung: a clinicopathologic approach to diagnosis and treatment.

The granulomatous vasculitides of the lung are uncommon. Overlap of their clinical and histopathologic features may create a confusing picture for the clinician and pathologist. This confusion is of concern because therapy differs depending on the exact diagnosis, with concomitant variations in associated drug toxicity. An integrated clinical and pathologic approach must be used to arrive at a prompt and accurate diagnosis. The true granulomatous vasculitides, a group that includes Wegener's granulomatosis, allergic granulomatosis and angiitis (Churg-Strauss syndrome), and necrotizing sarcoid granulomatosis, have various degrees of systemic involvement. Therapy is mainly immunosuppressive, and prognosis is generally good. The lymphoproliferative granulomatous vasculitides, which include benign lymphocytic angiitis and granulomatosis, lymphomatoid granulomatosis, and malignant lymphoma with angioinvasion, are progressively abnormal lymphoproliferative processes. Therapy may require combination chemotherapy, and prognosis is often poor.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Cresyl violet: a rapid, simple, easily interpretable stain for detecting Pneumocystis carinii in sputum.

Over a three-month period at the pathology laboratory of Jackson Memorial Hospital, 110 sputum samples from 62 hospitalized patients with suspected AIDS were examined for Pneumocystis carinii. Sputum specimens were either expectorated spontaneously (most patients) or expectorated after the inhalation of small amounts of nebulized normal saline. Each sputum sample was cytocentrifuged onto two slides. One slide was stained with Gomori methenamine-silver (GMS) and the other with cresyl violet (CV). Among the 62 study patients, 18 were proven to have no histologic evidence of P carinii pneumonia. Of the remaining 44 patients, P carinii organisms were found by GMS stain in 14 (32%) and by CV stain in 18 (41%). Among those with a positive CV stain, the diagnosis was made on the first sputum specimen in 14 patients and on the second specimen in the remaining four patients. CV stain is at least as sensitive as GMS in detecting P carinii cysts in the sputum of AIDS patients with P carinii pneumonia, and its diagnostic sensitivity may exceed 40% under field conditions. Further, CV stain is much simpler to prepare than GMS and much simpler to interpret than Giemsa. It could be easily adapted for general use to expedite the diagnosis and treatment of P carinii pneumonia.

Adult↗
PubMed1989

Tuberculosis in acquired immune deficiency syndrome.

The acquired immune deficiency syndrome (AIDS) epidemic has resulted in a rising incidence of tuberculosis (TB) in the United States, especially in inner cities where AIDS is prevalent and among human immunodeficiency virus (HIV) infected subpopulations with a relatively high background prevalence of tuberculous infection (ie, intravenous drug abusers, Haitians, blacks). Because M tuberculosis is a relatively virulent organism among the AIDS related infections, TB occurs early (often as a sentinel disease) in the course of progressive HIV-induced immunosuppression. In this setting, TB commonly presents in a disseminated, extrapulmonary, or "unusual" form, and when pulmonary TB occurs, the chest radiographic picture is often atypical. Further, the tuberculin test is falsely negative in more than 50% of cases. A high index of suspicion and an aggressive diagnostic approach is required to avoid missing HIV-related tuberculous disease, which is communicable to the general population and is readily treatable with conventional anti-TB drugs. In order to control the rising incidence of AIDS-related TB, tuberculin skin testing must be performed early for all patients who are either HIV infected or are in high risk groups for HIV infection (while they can still react to tuberculin), and isoniazid prophylaxis carried out for those who are tuberculous infected.

Acquired Immunodeficiency Syndrome↗
PubMed1978

PPD-tuberculin and PPD-Battey dual skin testing of hospital employees and medical students.

Tuberculin PPD and PPD-Battey skin tests were simultaneously applied to 3,882 employees of Charity Hospital and 408 medical students at Louisiana State University. The PPD was doubtful (5 to 9 mm induration) in 253 of the total 4,290 persons tested (5.9%). In 86 of these 253 persons, the reaction to PDD-Battey was greater than the reaction to PPD, presumably identifying a subpopulation with a falsely positive PPD and therefore at considerably lower risk of developing future tuberculous disease. Of the 408 medical students (average age 24 years), 80 (19.6%) were classified by the skin tests as having atypical mycobacterial sensitization as compared to six (1.45%) who were classified positive or probably positive to Mycobacterium tuberculosis (P less than .001). In the Southeastern United States, where the incidence of atypical mycobacterial infection is relatively high and occurs at a young age, dual skin testing may have its greatest applicability in identifying tuberculous infection when the PPD falls in the "doubtful" 5 to 9 mm range.

Adult↗
PubMed1978

Lingual thyroid.

After 15 years of being asymptomatic, this patient with documented lingual thyroid developed a lump in the throat, with dysphagia. Routine thyroid function tests were within normal limits, but serum TSH concentration was increased to twice normal. On thyroxine therapy TSH levels returned to normal and the symptoms were relieved. TSH determinations and suppressive thyroid hormone administration play an important role in the management of a patient with lingual thyroid.

Adult↗
PubMed1978

Superior vena cava syndrome caused by Nocardia asteroides.

A patient developed the superior vena cava syndrome from Nocardia asteroides pneumonia with mediastinitis. Specific treatment was dangerously delayed because malignancy was primarily suspected, and nocardial infection was not initially considered. The correct diagnosis was eventually made by appropriate stains and culture of a lung aspirate. Specific therapy with sulfonamide resulted in a cure of the infection, disappearance of facial swelling, and a long-term state of clinical well-being. Active nocardial pneumonia with mediastinitis is a treatable cause of the superior vena cava syndrome and should be considered in the differential diagnosis.

Adult↗
PubMedDate not supplied

Spontaneous lymphokine activated killer (LAK) activity in bronchoalveolar lavage cells from patients with bronchogenic carcinoma.

Bronchoalveolar lavage cells (BAC) are considered to be representative of cells that are in the interstitium and in patients with lung cancer, may represent, in part, cells that infiltrate cancerous tissue. We used bronchoalveolar lavage (BAL) specimens to test the hypothesis that cells within this region might be regulated locally by factors and show activities that are dependent on these growth and activation mediators. We showed previously that Natural Killer (NK) activity and IL2 titers were proportional. As compared to normal subjects, patients with all stages of bronchogenic carcinoma consistently had very high levels of IL2 in their bronchoalveolar lavage (BAL) fluid and this titer correlated with an increase in NK activity in the BAC both in absolute level and in relative level to the blood. Now, we report results that show that spontaneous lymphokine activated killer (LAK) activity also can be measured in most patients, but not all patients, that express IL2 titers. These findings support the hypotheses that different types of nonspecific cytotoxic cells are present and active in cancerous lung specimens secondary to the secretion of lymphokines from activated T lymphocytes in that region and that LAK activity is a physiological phenomenon that may be expressed in regional rather than systemic areas of the body.

Bronchoalveolar Lavage Fluid↗