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Biomedical subjects

C E Reed

Publications and source records attributed to C E Reed.

At least 37 records · Page 2Linked to original sources
PubMed1999

Physiologic consequences of pneumonectomy. Consequences on the pulmonary function.

The cardiac sequelae following pneumonectomy should be anticipated by a thorough preoperative evaluation of cardiac risk factors, and any identified significant risk should be evaluated and corrected. The most common cardiac complication following pneumonectomy is atrial dysrhythmia. The possible causes, significant correlates, and rationale for prophylaxis are discussed. With a large portion of the pulmonary vascular bed removed by pneumonectomy, the possibility and consequences of right ventricular dysfunction are outlined. Finally, the rare but catastrophic occurrence of cardiac herniation is described.

Arrhythmias, Cardiac↗
PubMed1998

Aerosol beclomethasone dipropionate spray compared with theophylline as primary treatment for chronic mild-to-moderate asthma. The American Academy of Allergy, Asthma and Immunology Beclomethasone Dipropionate-Theophylline Study Group.

BACKGROUND: Inhaled corticosteroids and oral theophylline are effective treatments for moderate asthma. OBJECTIVE: We sought to compare the benefits and adverse reactions of theophylline and aerosol beclomethasone spray. METHODS: A multicenter, double-blind, double-placebo, randomized, controlled trial of 1-year duration was performed. Seven hundred forty-seven patients with asthma received either beclomethasone dipropionate aerosol spray (84 microg four times per day) or sustained-release theophylline twice per day in doses adjusted for optimum control of the disease. The main outcome measures were daily diary of symptoms and peak flow rates (recorded on a mark-sense computer-readable form); supplemental bronchodilator use; doctor's office or hospital visits and absence from work or school; spirometry; methacholine testing; adverse experiences; and cortisol blood measurements. RESULTS: Both treatment strategies reduced symptoms promptly and achieved low absenteeism from work or school and low rates of emergency treatment for asthma. Both maintained nearly normal pulmonary function. Beclomethasone was statistically significantly more effective in reducing symptoms, supplemental bronchodilator and systemic glucocorticoid doses, bronchial hyperresponsiveness, and eosinophilia. However, the magnitude of these differences was small. Theophylline caused more headache, nervousness, insomnia, and gastrointestinal distress, and more patients discontinued treatment because of side effects. Beclomethasone caused more oropharyngeal candidiases and hoarseness and reduced morning plasma cortisol levels before and after cosyntropin. It reduced the rate of growth in children. No new cataracts or glaucoma developed. CONCLUSION: Theophylline effectively controlled symptoms at lower than the customarily recommended blood level. The risk/ benefit profiles of these agents suggest that inhaled corticosteroids may be the preferred agent for most adult patients and for some children.

Adolescent↗
PubMed1998

Local staging of esophageal cancer using endoscopic magnetic resonance imaging: prospective comparison with endoscopic ultrasound.

BACKGROUND AND STUDY AIMS: The magnetic resonance endoscope consists of a non-ferrous endoscope with a radiofrequency receiver coil incorporated into its tip. The aim of this study was to assess the accuracy of endoscopic magnetic resonance imaging for the local staging of esophageal cancer. PATIENTS AND METHODS: Prospectively, 15 patients with biopsy-proven cancer of the esophagus (n = 9) or gastroesophageal junction (n = 6) underwent endosonography followed by imaging by the magnetic resonance endoscope. The results of endoscopic magnetic resonance imaging were assessed blindly, then compared with those of endosonography, which served as the gold standard. RESULTS: Endoscopic magnetic resonance imaging of transmural tumor invasion agreed with ultrasonography in 11/15 cases and of nodal state in 12/15 cases. Endoscopic magnetic resonance images were inadequate in four cases as a result of motion artifacts. CONCLUSIONS: Endoscopic magnetic resonance imaging of esophageal cancer diagnoses local staging that is comparable to endosonography. In future, the combination of endoscopic and conventional magnetic resonance scanning may provide comprehensive staging of esophageal cancer.

Adenocarcinoma↗
PubMed1998

Specialists achieve better outcomes than generalists for lung cancer surgery.

OBJECTIVE: A push toward care provided by generalists as opposed to specialists has occurred in the health-care marketplace despite a lack of provider specific outcome data. The objective of this study was to determine whether the outcome of patients undergoing lung cancer surgery is different between general surgeons (GSs) and thoracic surgeons (TSs). DESIGN: Examination of data from a state-wide severity-adjusted administrative hospital discharge database. SETTING/PARTICIPANTS: Patients undergoing lung cancer resection in all nonfederal acute care hospitals within South Carolina. MAIN OUTCOME MEASURES: Mortality by specialty adjusted for case mix. RESULTS: From 1991 to 1995, 1,720 resections for lung cancer were performed in South Carolina. One hundred thirty-seven cases were excluded because surgeons did not meet the predefined criteria for board certification, leaving 1,583 resections for analysis. One-half of lobectomies and nearly 60% of pneumonectomies were performed by GSs. Patients were similar in age, sex, gender, race, and the proportion in each severity of illness subclass. Mortality was significantly higher in patients who underwent lobectomy by GSs vs TSs (5.3% vs 3.0%; p<0.05) and in patients with extreme comorbidities (43.6% vs 25.4%; p=0.03) or age >65 years (7.4% vs 3.5%; p<0.05). Seventy percent of TSs performed > 10 cases in the series, whereas 75% of GSs performed <10 (p=0.05). Logistic regression analysis failed to identify any significant variable that might explain the mortality differences between TSs and GSs. CONCLUSION: Mortality is lower for lung cancer resection when the surgery is performed by a TS.

Female↗
PubMed1998

Intrathoracic aberrant thyroid: identification critical for appropriate operative approach.

True aberrant thyroid in the chest is a rarely described entity. More commonly, "aberrant" thyroid is a substernal goiter that is an extension of the cervical gland inferiorly and can be removed safely with the classic "collar" incision. Aberrant intrathoracic thyroid typically derives its blood supply from intrathoracic sources and requires an alternate surgical approach for adequate exposure. The ability to identify these rare intrathoracic thyroids is critical for safe surgical excision.

Aged↗
PubMed1997

p53 overexpression in squamous cell carcinoma of the esophagus.

BACKGROUND: Coastal South Carolina has a high incidence of squamous cell carcinoma of the esophagus (SCCE) among black residents. Overexpression and mutations of the p53 tumor suppressor gene have been noted in SCCE from other high-incidence regions. The purpose of this study was to determine the frequency of p53 overexpression in this region both in patients with SCCE and in normal subjects. METHODS: Normal and malignant tissue obtained at esophagoscopy and normal esophageal mucosa (NEM) from random autopsies were studied with monoclonal antibodies to the p53 gene product. Total cellular RNA was extracted from SCCE, reverse transcribed to complementary DNA, and a portion of the p53 gene was amplified via polymerase chain reaction and sequenced. RESULTS: Immunohistochemical studies on SCCE from nine patients showed that six (67%) were positive, two (22%) were negative, and one was indeterminate for p53 overexpression. The corresponding normal samples showed that three (33%) had p53-positive cells in the basal epithelial layer, whereas six did not. NEM from 18 random forensic cases displayed p53 overexpression in seven (39%). Eight of the nine tumors had p53 mutations. CONCLUSIONS: p53 overexpression and mutations are frequently found in SCCE from patients in coastal South Carolina. Overexpression in normal epithelium from random autopsy cases may indicate an inherited or acquired predisposition in this geographic region.

Antibodies, Monoclonal↗
PubMed1997

Attained adult height after childhood asthma: effect of glucocorticoid therapy.

BACKGROUND: Although oral and inhaled glucocorticoid therapy may impair growth in children with asthma, the effect of glucocorticoid therapy and asthma on attained adult height has not been extensively studied in representative children in the community. OBJECTIVES: The study was designed to compare the attained adult height of children with asthma with the attained adult height of nonasthmatic children and to compare the attained adult height of asthmatic children treated with glucocorticoids with the attained adult height of asthmatic children who did not receive glucocorticoids. METHODS: Residents of Rochester, Minnesota, with onset of asthma from 1964 to 1987 and age- and sex-matched non-asthmatic residents of Rochester were studied. Glucocorticoid exposure was assessed from medical records. The mean of 5 stadiometer measurements of adult height, adjusted for sex and parental height, was analyzed. RESULTS: One hundred fifty-three patients with asthma (mean age at onset, 6.1 +/- 4.8 years) and 153 age- and sex-matched nonasthmatic subjects were studied. Adult height of patients with asthma (mean age at measurement, 25.7 +/- 5.2 years) was not significantly different from the adult height of non-asthmatic subjects; the overall difference, adjusted for mid-parental height, was -0.20 cm (95% confidence interval from -0.27 to 1.64). The adult height of asthmatic children treated with glucocorticoids was not significantly different from the adult height of patients with asthma not treated with glucocorticoids; the difference after adjusting for mid-parental height was -0.2 cm (95% confidence interval from -0.1 to 0.6). CONCLUSIONS: We conclude that the attained adult height of patients with asthma is not different from the adult height of age- and sex-matched nonasthmatic subjects and that the attained adult height of asthmatic children treated with glucocorticoids is not significantly different from the adult height of children not treated with glucocorticoids.

Administration, Inhalation↗
PubMed1997

Incidence and outcomes of asthma in the elderly. A population-based study in Rochester, Minnesota.

STUDY OBJECTIVE: To estimate the incidence of asthma in an elderly population and to describe the clinical characteristics, use of health services, and long-term survival of persons with onset of asthma after age 65 years. DESIGN: Retrospective cohort study. SETTING: Rochester, Minn. PATIENTS: All Rochester, Minn, residents age 65 years or older who met criteria for onset of definite or probable asthma from 1964 through 1983. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Ninety-eight Rochester residents (52 female, 46 male) with onset of asthma at or after age 65 years were identified. The age- and sex-adjusted incidence was 95/100,000 (95% confidence interval, 76 to 115/100,000). The age-specific incidence of asthma was 103/100,000 in residents aged 65 to 74 years, 81/100,000 in those aged 75 to 84 years, and 58/100,000 in residents older than 85 years. Only 11% had allergy skin tests, 24% had at least one office peak flow measurement, and 43% had at least one spirometry measurement. After the diagnosis of asthma, 40% had unscheduled ambulatory visits, 22% had emergency department visits, and 42% had at least one hospitalization for asthma. Observed survival was not significantly different from expected survival. CONCLUSIONS: Asthma is common in the elderly. Diagnostic evaluation was less intensive than present guidelines recommend. Following the diagnosis of asthma, a substantial proportion of these individuals required unscheduled ambulatory visits, emergency department visits, or hospitalizations. Asthma with onset after age 65 years was not associated with reduced survival.

Aged↗
PubMed1997

Pitfalls and complications of esophageal prosthesis, laser therapy, and dilation.

Although often diagnosed and treated by gastroenterologists, thoracic surgeons should be skilled partners in the management of esophageal obstruction. Knowledge of pitfalls and complications of any procedure is a prerequisite to success. This article focuses on problems encountered in dilatation, laser ablation, and stenting of esophageal strictures. Dilatation of both benign and malignant strictures requires knowledge of the different types of dilators and the ability to adapt to different stricture characteristics. Although lower morbidity makes laser ablation of malignant obstruction attractive, this author finds its use to be restrictive. The advent of expandable metal stents offers the potential for fewer early complications when compared with plastic protheses but, as discussed, morbidity may be different rather than less.

Dilatation↗
PubMed1996

Ragweed immunotherapy in adult asthma.

BACKGROUND: Although allergen immunotherapy is effective for allergic rhinitis, its role in treating asthma is unclear. METHODS: We examined the efficacy of immunotherapy for asthma exacerbated by seasonal ragweed exposure. During an observation phase, adults with asthma who were sensitive to ragweed kept daily diaries and recorded peak expiratory flow rates between July and October. Those who reported seasonal asthma symptoms and medication use as well as decreased peak expiratory flow were randomly assigned to receive placebo or ragweed-extract immunotherapy in doses that increased weekly for an additional two years. RESULTS: During the observation phase, the mean (+/- SE) peak expiratory flow rate measured in the morning during the three weeks representing the height of the pollination season was 454 +/- 20 liters per minute in the immunotherapy group and 444 +/- 16 liters per minute in the placebo group. Of the 77 patients who began the treatment phase, 64 completed one year of the study treatment and 53 completed two years. During the two treatment years, the mean peak expiratory flow rate was higher in the immunotherapy group (489 +/- 16 liters per minute, vs. 453 +/- 17 in the placebo group [P = 0.06] during the first year, and 480 +/- 12 liters per minute, vs. 461 +/- 13 in the placebo group [P = 0.03] during the second). Medication use was higher in the immunotherapy group than in the placebo group during observation and lower during the first treatment year (P = 0.01) but did not differ in the two groups during the second year (P = 0.7). Asthma-symptom scores were similar in the two groups (P = 0.08 in year 1 and P = 0.3 in year 2). The immunotherapy group had reduced hay-fever symptoms, skin-test sensitivity to ragweed, and sensitivity to bronchial challenges and increased IgG antibodies to ragweed as compared with the placebo group; there was no longer a seasonal increase in IgE antibodies to ragweed allergen in the immunotherapy group after two years of treatment. Reduced medication costs were counterbalanced by the costs of immunotherapy. CONCLUSIONS: Although immunotherapy for adults with asthma exacerbated by seasonal ragweed exposure had positive effects on objective measures of asthma and allergy, the clinical effects were limited and many were not sustained for two years.

Adult↗
PubMed1996

Isolation of differentially expressed genes in carcinoma of the esophagus.

BACKGROUND: The genetic alterations that occur in the transformation of normal esophageal mucosa (NEM) to carcinoma of the esophagus (CAE) are not well understood. Differential display of mRNA is a recently described technique that uses reverse transcription and PCR to compare cDNA from paired normal and malignant tissue to determine whether there is either genetic loss (putative tumor suppressor gene) or overexpression (putative oncogene) in malignant cells. Our goal was to identify some of these genes from patients with CAE. METHODS: Specimens of NEM and corresponding CAE were obtained from patients at endoscopy or surgical resection and immediately snap frozen. Total RNA was isolated, reverse transcribed to cDNA, and PCR amplified with a predefined 10-mer oligonucleotide. The products were displayed on a polyacrylamide gel. Differential bands were isolated and sequenced and/or used as probes for Northern analysis. RESULTS: Application of the differential display method resulted in the isolation of 49 cDNA clones from three patients with CAE. Sequencing of the clones has revealed five unique sequences not previously reported and one that has been identified as histone H3.3. Northern analysis of histone H3.3 has revealed overexpression in four of six CAEs but not the paired NEM. In addition, whereas only 5 of 13 normal human cell lines of various origins overexpressed this gene, 11 of 12 human cancer cell lines (9 of 9 adenocarcinomas) overexpressed it. CONCLUSIONS: Differential display can be used to isolate potential oncogenes and tumor suppressor genes. We have identified five unique sequences and one known gene that may contribute to the development of CAE.

Adenocarcinoma↗
PubMed1996

Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer.

BACKGROUND: Esophageal endoscopic ultrasonographic (EUS) guidance for fine-needle aspiration (FNA) of mediastinal lymph nodes has been introduced only recently. The utility of EUS/FNA in diagnosing and staging bronchogenic carcinoma is unknown. METHODS: After a thoracic computed tomographic scan, 27 patients with known or suspected lung cancer underwent EUS. Accessible abnormal mediastinal lymph nodes were aspirated under EUS guidance. Patients with positive cytologic studies did not undergo further testing, whereas the remaining patients underwent mediastinal exploration. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for both chest computed tomography and EUS/FNA: RESULTS: Twenty-two of 27 patients had mediastinal adenopathy by computed tomography scan. Sixteen patients had positive findings on EUS, 15 with positive FNA (10 non-small cell lung cancer; 5 small cell lung cancer) and 1 with T4 status. Fourteen patients with positive FNA had lymph nodes sampled at level 5, level 7, or both. Of 11 patients with negative EUS/FNA, 2 had positive findings at operation (sensitivity 89%). The diagnosis of lung cancer was established in 7 patients. CONCLUSIONS: The results showed that EUS/FNA improves the accuracy of computed tomographic scan in the staging of lung cancer. By accessing lymph nodes at levels 5 and 7, EUS/FNA complements mediastinoscopy and is considered the staging modality of choice in these regions. Positive EUS/FNA can obviate the need for further invasive staging.

Biopsy, Needle↗
PubMed1996

Mechanisms of right ventricular dysfunction after pulmonary resection.

BACKGROUND: Significant right ventricular (RV) dysfunction as measured by increased end-diastolic volume and reduced ejection fraction has been documented in the postoperative period after pulmonary resection. We hypothesized that changes in RV contractile state or afterload may contribute to this RV pump dysfunction. METHODS: In part one of the study, RV preload was altered on postoperative day 2 (n = 6) by rapid infusion of Hespan to a total of 250, 500, and 1,000 mL. The relationship between RV stroke work and end-diastolic volume was plotted using linear regression. This preload recruitable stroke work relation had been previously validated as a load-insensitive index of RV contractility. The slopes of the preoperative relation (n = 35) and postoperative relation were compared. In part two of the study, RV afterload was reduced by continuous infusion of prostaglandin E1 (n = 6) through postoperative day 2 and RV pump function was assessed. RESULTS: Comparison of the slopes of the preload recruitable stroke work relation plotted preoperatively and on postoperative day 2 revealed no significant difference, indicating no change in RV contractile state. Infusion of prostaglandin E1 in the postoperative period (n = 6) significantly reduced pulmonary vascular resistance (3.67 +/- 0.19 versus baseline 5.72 +/- 0.19 dyne . s . cm-5/ m2; p < 0.05). However, RV ejection fraction remained significantly reduced (0.34 +/- 0.01 versus baseline 0.42 +/- 0.01; p < 0.05) and end-diastolic volume significantly increased (105 +/- 5 versus baseline 93 +/- 2 mL/m2; p < 0.05). Heart rate was increased compared with baseline throughout the postoperative period. CONCLUSIONS: The present study suggests that RV dysfunction after pulmonary resection is not caused by primary alterations in contractility or immediate changes in afterload. Better control of heart rate with minimal effect on inotropy may enhance RV pump function.

Alprostadil↗
PubMed1996

Pulmonary blastoma: a rare lung malignancy.

We describe a case of pulmonary blastoma, a rare lung malignancy which affects a younger population. Despite its usually indolent presentation, it is an aggressive malignancy with a prognosis similar to that for bronchogenic carcinoma.

Adult↗
PubMed1995

Cross-sectional follow-up of a flu-like respiratory illness among fiberglass manufacturing employees: endotoxin exposure associated with two distinct sequelae.

Over a period of 10 years, employees in a manufacturing plant experienced sporadic flu-like episodes after work in a basement containing a recirculated washwater mist. We report a cross-sectional study to define the flu-like illness and bioaerosol exposures. High concentrations of gram-negative bacteria (GNB) (> 10(7) cfu/ml) and endotoxin (range 34-46 micrograms/ml) were found in the water. Mist contained > 10(3) cfu/m3 of GNB, and endotoxin up to 13,900 to 27,800 ng/m3. Few fungi and thermotolerant Bacillus species and no Actinomycetes, Legionella species, or amoeba were found in washwater. Airborne levels of fungi were of the same species and magnitudes as outdoor samples. Subjects volunteered (n = 28) because of a history of flu-like symptoms or were randomly selected (n = 102) from workers with and without current exposure to the basement. No acute cases were examined. Cases did not fulfill criteria for hypersensitivity pneumonitis (HP) and high levels of IgG antibodies to water-borne antigens were not observed. However, among 20 subjects indicating a history of severe flu-like episodes (severe basement flu, SBF), diffusion capacity (DLCO) was significantly lower (p = 0.015) than among other workers. The prevalence of SBF was independent of smoking. Cases occurred in clusters, and SBF was more common among workers with intermittent exposure to the basement (19 cases) than with daily exposure (1 case). These findings suggest that SBF and associated chronically depressed DLCO resulted from toxic injury following high-level endotoxin exposure. Asthma was prevalent in the study population, particularly among employees with daily, rather than intermittent, exposure to endotoxin-containing mist (odds ratio 6.7, p = 0.02). Thus, endotoxin exposure in this study was associated with two distinct sequelae depending on the temporal pattern of exposure.

Adult↗