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Biomedical subjects

C E Reed

Publications and source records attributed to C E Reed.

At least 55 records · Page 3Linked to original sources
PubMed1995

Pneumonectomy for chronic infection: fraught with danger?

Pneumonectomy for chronic lung infections has been avoided because of potential intraoperative and postoperative complications. A retrospective review of 13 cases requiring pneumonectomy for aspergillus (8), Mycobacterium tuberculosis (2), actinomycosis, Pseudomonas aeruginosa, and bronchiectasis revealed increased operating time, blood loss, and transfusion requirements. Operative records documented problems with dense adhesions, lack of an extrapleural plane, and distortion of hilar structures. Although mortality was acceptable (8%), early and late morbidity (total, 38%), especially bronchopleural fistula (23%), was significant. It is concluded that when justified, pneumonectomy for complete resection of chronic infection can be performed with acceptable risk. However, specific problems should be anticipated. This review has led to modifications in operative technique.

Adult↗
PubMed1995

Thoracoscopic staging of esophageal cancer: a prospective, multiinstitutional trial. Cancer and Leukemia Group B Thoracic Surgeons.

BACKGROUND: Lymph node metastasis has been shown to be an important prognosticator in esophageal cancer. A prospective, multiinstitutional study of thoracoscopic lymph node staging in patients with biopsy-proven esophageal cancer was undertaken at University of Maryland, Medical University of South Carolina, and Brigham and Women's Hospital. METHODS: Forty-nine patients underwent thoracoscopic staging between September 1991 and August 1993. Five procedures were incomplete due to adhesions. Preoperative computed tomography, magnetic resonance imaging, esophageal ultrasound, and bronchoscopy were performed. After our initial experience with the left side of the chest, thoracoscopic staging was done through the right side of the chest unless specific indications dictated otherwise. Beginning in January 1993 routine laparoscopic/mini-laparotomy lympho node staging of the celiac axis was performed. RESULTS: Satisfactory thoracoscopic lymph node staging was achieved in 44 patients (95%). Of 33 patients undergoing esophageal resection, 29 were correctly staged (88%). Since initiating concomitant laparoscopic lymph node staging, we have correctly staged all of the last 9 patients with regard to celiac lymph nodes as well. Information regarding T status obtained at thoracoscopy was as follows: 3 patients were correctly "downstaged" to T3 despite preoperative noninvasive tests suggesting T4. In 2 patients thoracoscopy correctly predicted T4 invasion, whereas in 2 patients, thoracoscopy missed T4 lesions. CONCLUSIONS: Thoracoscopy is a valuable tool for staging intrathoracic tumors. Preoperative staging of esophageal cancer may allow better allocation of adjuvant therapy. This pilot study suggests that thoracoscopic staging can correctly predict thoracic lymph node status with high accuracy and aid in better defining T status.

Adenocarcinoma↗
PubMed1995

Diagnosis of soybean-induced asthma.

BACKGROUND: The role of soybean dust as a causal agent of asthma has been clearly established since the Barcelona asthma epidemics in the 1980s. The large number of patients who were first seen with asthma symptoms during those epidemics provided an excellent opportunity to study the possibilities of different diagnostic tests. OBJECTIVE: This study was designed to evaluate the usefulness of the skin test and amplified ELISA technique for quantifying specific IgE in the diagnosis of soybean asthma. PATIENTS AND RESULTS: Ninety epidemic asthmatic patients and 95 nonepidemic asthmatic patients were studied 2 years after the last epidemic. Results of prick tests and ELISAs for specific IgE with hull and dust extracts showed a significant difference between the two groups of patients (p < 0.001). Sensitivity and specificity of glycerinated prick test with hull extract in epidemic asthmatic patients were 57.7% and 95.3%, respectively, and ELISA values were 56.6% and 93.7%, respectively. Similar results were obtained with dust extracts. CONCLUSION: Glycerinated skin prick tests and ELISAs with soybean hull and dust extracts have proved effective in the diagnosis of soybean asthma, even 2 years after the epidemics. Taking into account the sensitivity (90.5%) and specificity (93.7%) of ELISA test results for epidemic asthmatic patients found when the epidemic occurred, data from this study suggest that both tests may be very useful for the diagnosis of soybean dust-induced asthma.

Asthma↗
PubMed1995

An epidemic of occupational allergy to latex involving health care workers.

IgE-mediated sensitivity to natural rubber latex is being recognized more frequently among health care workers. Between January 1990 and June 1993, we evaluated 342 consecutive Mayo Medical Center employees who reported symptoms suggestive of latex allergy. All were interviewed and underwent puncture skin testing with extracts of rubber gloves. In some cases, latex-specific IgE antibodies were measured by immunoassay. One hundred four of the 342 employees evaluated (30%) were latex-allergic. Risk factors for sensitization included frequent use of disposable gloves, presence of prior atopic disease, and prior or current hand dermatitis. The peak onset of symptoms occurred in late 1989 and early 1990 and did not correlate with a peak in glove usage at our medical center, which continued to rise. Most sensitized employees (78%) reported contact urticaria from rubber gloves, and over two thirds also experienced allergic rhinitis, conjunctivitis, or asthma when working in areas where large numbers of gloves were being used. Sixteen episodes of rubber-induced anaphylaxis were documented in 12 employees; six episodes occurred after latex skin testing and were easily reversed with appropriate therapy. Our findings substantiate a local epidemic of latex allergy among medical center employees. Epidemiologic studies are needed to assess the effects of various interventions to reduce occupational exposure to latex allergens. Although prick skin testing with concentrated latex glove extracts presents some risk of systemic reaction, pending availability of commercial diagnostic extracts, such testing is generally safe when performed by skilled laboratory personnel. Skin testing is warranted to investigate health care workers suspected of being latex-sensitive.

Anaphylaxis↗
PubMed1995

Atkinson tube placement.

Endoscopic intubation of a malignant esophageal stricture with an endoprosthesis allows quick and adequate palliation for a patient with a very limited life span. The technique of Atkinson tube insertion is described and illustrated. Complications are discussed briefly.

Esophageal Neoplasms↗
PubMed1994

Long-term survival of a cohort of community residents with asthma.

BACKGROUND: Reports of an increase in asthma-related mortality have been based on studies of death certificates from the general U.S. population on which asthma was listed as an underlying cause of death. We addressed the issue in a different way by analyzing long-term survival in a defined, population-based cohort of patients with asthma. METHODS: We identified all residents of Rochester, Minnesota, in whom asthma was diagnosed from January 1, 1964, through December 31, 1983, by reviewing the medical records of all patients with asthma and associated diagnoses, using explicit predefined criteria. The patients' vital status at last follow-up was ascertained. Medical records, death certificates, and autopsy reports were reviewed to classify deaths as due either to asthma or to other conditions. RESULTS: We identified 2499 patients with definite or probable asthma. The mean duration of follow-up was 14 years (range, 0 to 29). There were 140 deaths during 32,605 person-years of follow-up. Overall survival was not significantly different from the survival that was expected for residents of Rochester. Survival was less than expected in patients who were 35 years of age or older when their asthma was diagnosed and who also had another lung disease (predominantly chronic obstructive pulmonary disease). Four percent of all deaths in the study cohort were due to asthma, and all were among adults. Survival was not related to the year of onset of asthma. CONCLUSIONS: Survival among patients with asthma but no other lung disease was not significantly different from expected survival. However, patients 35 or older who had asthma associated with chronic obstructive pulmonary disease did have worse than expected survival. Asthma was classified as the cause of death in only 4 percent of the patients, and there was no evidence of an increased risk of death among patients with a more recent diagnosis of asthma. These results provide assurance that community-based patients with asthma usually have a good prognosis.

Adolescent↗
PubMed1994

Quantification of occupational latex aeroallergens in a medical center.

To determine the quantity, variability, and mean aerodynamic diameter of latex aeroallergens in a large medical center, we collected air samples from work sites by using area and personal breathing zone air samplers, and we measured latex allergens by an inhibition assay with IgE antibodies from latex-sensitive individuals. Latex aeroallergen concentrations in 11 areas where powdered latex gloves were frequently used ranged from 13 to 208 ng/m3, and in areas where powdered latex gloves were never or seldom used, concentrations ranged from 0.3 to 1.8 ng/m3. Installation and use of a laminar flow glove changing station in one work area did not reduce latex aeroallergen levels. Large quantities of allergen were recovered from used laboratory coats and anesthesia scrub suits and from laboratory surfaces. Latex allergen concentrations in personal breathing zone samplers worn by health care workers in areas where powdered gloves were frequently used ranged from 8 to 974 ng/m3. Exposure likely occurs when gloves are changed and as a result of resuspension from reservoirs of powder in the room and clothing. Latex allergens were found in all particle sizes but were predominant in particles greater than 7 microns in mass median aerodynamic diameter. Results of electrophoretic immunoblotting showed that the aeroallergens are primarily the higher molecular mass components of the latex glove proteins. Measures to control exposure can be monitored by both area and personal air sampling with this immunochemical approach. Use of gloves with low allergen content or powder-free gloves appears to be more effective than use of a laminar flow glove changing station in reducing aeroallergen levels.

Academic Medical Centers↗
PubMed1994

Endobronchial HIV associated lymphoma.

A 27 year old HIV infected man presented with two days of haemoptysis. Flexible bronchoscopy revealed a large carinal mass partially obstructing the left and right main stem bronchi. Rigid bronchoscopy was required to make the diagnosis of large cell immunoblastic lymphoma.

Adult↗
PubMed1994

Thoracic endometriosis. Recurrence following hysterectomy with bilateral salpingo-oophorectomy and successful treatment with talc pleurodesis.

This is a report of an unusual patient who had four of the five manifestations of thoracic endometriosis, including right pneumothorax, left hemothorax, chest pain, and hemoptysis. This patient shows that recurrence of symptoms can occur while a patient is receiving hormonal replacement therapy even after hysterectomy and bilateral salpingo-oophorectomy; estrogen replacement should probably be delayed for several months to allow complete regression of the ectopic endometrial tissue. Alternatively, chemical pleurodesis can be effective in treating recurrent pneumothorax or hemothorax while the patient is receiving hormonal replacement. Bilateral pleural involvement and hemoptysis suggest microembolization of endometrial tissue as the pathogenic mechanism for thoracic endometriosis.

Adult↗
PubMed1994

Endoscopic palliation of esophageal carcinoma.

Endoscopic palliation of unresectable esophageal carcinoma includes techniques of dilation, esophageal intubation, laser ablation, and intraluminal brachytherapy. Indications, advantages, disadvantages, results, and complications of these methods are discussed. Less common techniques include electrocoagulation, chemical necrolysis, and photodynamic therapy. Prospective randomized trials comparing techniques are reviewed. The thoracic surgeon must be acquainted with several endoscopic means of palliation in order to meet the needs of the individual patient.

Brachytherapy↗
PubMed1994

Benign tumors of the esophagus.

Benign esophageal tumors and cysts are rare. Leiomyomas and various cysts account for about 80% of all lesions. Thoracic surgeons must be aware of the clinical, radiologic, and endoscopic features of benign lesions since treatment is usually simple and effective.

Child↗
PubMed1994

Prevalence of p53 mutations in patients with squamous cell carcinoma of the esophagus.

Squamous cell carcinoma of the esophagus has an uneven geographic distribution with a strong prevalence in the South Carolina Lowcountry. Although many environmental influences and some genetic factors have been implicated in its development, the molecular events required for tumorigenesis have not been defined. Point mutations in the p53 tumor suppressor gene are the most commonly noted genetic defect in human tumors. Our study shows that p53 point mutations occur more frequently in patients with esophageal cancer from this region than in patients from other areas of the world where the disease is prevalent.

Carcinoma, Squamous Cell↗
PubMed1994

Neoadjuvant therapy of esophageal carcinoma.

To quote Steiger, the "multimodality treatment of esophageal cancer brings creativity and imagination to a field of medicine plagued with failure." However, acceptance of neoadjuvant chemotherapy or chemoradiotherapy as routine must await the results of large phase III studies. Even with a positive response, many questions will remain. The ability to stage patients more accurately might allow us to apply neoadjuvant therapy with more discrimination. The role of radiation therapy--the fractionation schedule, total dose, and sequencing--will require evaluation. Creativity and innovation must be applied to the quest of predicting who will respond to neoadjuvant treatment. Better drug combinations and methods to reduce toxicity must be sought. The neoadjuvant therapy of esophageal cancer is a field requiring continued rigorous scientific investigation, honesty, and hope.

Adenocarcinoma↗
PubMed1994

The importance of eosinophils in the immunology of asthma and allergic disease.

Immunologic concepts of asthma and related allergic diseases are undergoing revolutionary changes. Research into immunologic mechanisms has typically focused on the acute anaphylactic component, that is, on the role of mast cells and immunoglobulin E. Briefly, when a multivalent allergen cross-links IgE molecules bound to high-affinity Fc epsilon receptors on the mast cell surface, the cells release chemical mediators that constrict the bronchi, dilate blood vessels, cause edema, and recruit eosinophils. Recent investigation, utilizing bronchoscopic lavage and biopsy and cell biology, is emphasizing chronic eosinophilic airway inflammation and is clarifying the mechanisms of a complex multicellular chain of reactions that involve not only mast cells and basophils, but lymphocytes, eosinophils, endothelial cells, and epithelial cells, and may also involve platelets, macrophages, and neutrophils. The airways contain activated TH2-like lymphocytes that release cytokines which recruit and activate eosinophils. These cytokines also generate adhesion molecules on endothelial cell surfaces that promote diapedesis of the eosinophils out of the circulation into the submucosa, mucosa, and lumen of the airway. In the tissues, the eosinophils degranulate, releasing toxic proteins that damage the respiratory epithelium and account for many of the histopathologic abnormalities of asthma.

Asthma↗
PubMed1993

Preventing asthma epidemics due to soybeans by dust-control measures.

BACKGROUND: The inhalation of soybean dust released during the unloading of soybeans into a silo caused outbreaks of asthma in Barcelona, Spain. This study was designed to determine morbidity due to asthma and serum IgE reactivity before and after the installation of filters in the silo. METHODS: We measured soybean-allergen concentrations in 136 samples of air collected for 9 months before and 24 months after the installation of filters. We compared the number of days on which there was an unexpected increase in emergency room visits for asthma, the number of days on which the number of emergency room visits for asthma in one four-hour period was so high that it was unlikely to be due to chance, and the mean daily number of emergency room and intensive care unit admissions for asthma for a total of 60 months before and after filter installation. Serum IgE antibodies against soybean allergens were measured in 38 patients before and after filter installation. RESULTS: The concentration of airborne soybean allergens on days when soybeans were unloaded decreased from 324 to 25 U per cubic meter after the installation of filters (P < 0.001). The number of days on which there was an unusually large number of visits to the hospital for asthma and the number of days on which asthma was epidemic both decreased significantly (both P < 0.001), from 29 to 6 and from 18 to 0, respectively. The mean daily number of emergency room and intensive care unit admissions for asthma on days when soybeans were unloaded decreased from 8.3 to 5.4 and from 0.26 to 0.01, respectively (both P < 0.001). The mean serum IgE antibody concentrations in the 38 patients studied decreased from 2 Pharmacia reference units per milliliter to 1 (P < 0.001). CONCLUSIONS: Installing filters on silos to prevent airborne dissemination of allergenic soybean dust eliminates outbreaks of asthma caused by inhalation of the dust, thus supporting the idea that the avoidance of allergens helps prevent asthma.

Adolescent↗
PubMed1993

Accuracy of the death certificate in a population-based study of asthmatic patients.

OBJECTIVE: To quantify the reliability of death certificate data concerning asthma. DESIGN: The complete medical records of decedents were reviewed by a physician certified in allergy and pulmonology who determined the cause of death without having access to the original death certificate. Disagreements between the death certificate and the reviewer were adjudicated by an expert panel. SETTING: The community of Rochester, Minn. PATIENTS: The mortality cohort included 339 deaths from a larger cohort of 5241 Rochester residents who received medical treatment for asthma between 1964 and 1983. MAIN OUTCOME MEASURES: Kappa coefficients were used to measure agreement beyond that expected by chance between the reviewer and the death certificate. The sensitivity and specificity of the death certificate diagnosis of asthma were calculated against the standard of the reviewer/panel diagnosis. RESULTS: Death certificates reported asthma as an immediate or underlying cause of death in 22 instances (6%), whereas the reviewer/panel identified asthma in 53 cases (16%). In four cases, the death certificate listed asthma and the panel identified another cause of death. The death certificate had a sensitivity of 42% and a specificity of 99% compared with the reviewer/panel. Agreement between death certificates and the reviewer was not influenced by whether an autopsy was performed. CONCLUSIONS: Death certificate diagnosis of asthma as an underlying cause of death had a low sensitivity but a high specificity. Increases in mortality due to asthma are not likely caused by false-positive diagnoses of asthma as an underlying cause of death. Asthma mortality rates, determined from death certificate data, may indeed underestimate actual asthma-related mortality.

Adolescent↗
PubMed1993

Assessment of right ventricular contractile performance after pulmonary resection.

Right ventricular (RV) performance deteriorates after pulmonary resection. The mechanism remains unclear and could be related to changes in loading conditions or contractility. To assess the role of alteration in RV contractility, we developed a simple and reliable means to measure RV contractile performance in adult patients. Using thermodilution methods and rapid volume infusion in the preoperative setting, the relationship between RV stroke work (RVSWI) and end-diastolic volume (RVEDVI), termed the preload recruitable stroke work relation, was plotted using linear regression. Experimental studies have demonstrated that the preload recruitable stroke work relation is a linear and load-insensitive index of RV contractile performance. Our study confirms this finding in adult patients: RVSWI = 0.33 (RVEDVI) - 20.4 (n = 108; r = 0.94; p < 0.01). Examination of RV pump function and hemodynamic parameters in the early postresection period (up to 24 hours postoperatively) revealed significant changes in loading conditions, but isochronal RVEDVI and RVSWI values were within the confidence limits of the preload recruitable stroke work relation. Thus, depressed RV contractility does not appear to play a predominant role in this early postoperative period. Further study in a larger patient population will be required to verify this observation and to assess RV performance beyond 24 hours after resection.

Female↗