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Biomedical subjects

C Feldman

Publications and source records attributed to C Feldman.

At least 109 records · Page 6Linked to original sources
PubMed1989

Initial hormonal and metabolic profile in critically ill patients with community-acquired lobar pneumonia.

A prospective study of 18 critically ill patients with community-acquired lobar pneumonia was undertaken at Hillbrow Hospital, Johannesburg, in order to document the initial plasma hormonal and substrate profile as part of the stress response to the infection. The results of these studies, carried out before therapy, were compared with the results in a group of healthy fasting adults. Highly significant (P less than or equal to 0.005) increases in the mean plasma levels of adrenaline, noradrenaline, human growth hormone, cortisol, glucose and free fatty acids were noted in the study group, with a lesser increase in the prolactin concentration (P less than or equal to 0.01). The levels of dopamine, glucagon, insulin and adrenocorticotrophin did not show any significant change. No significant differences were found in the hormonal profile when comparing survivors with non-survivors. The neuro-endocrine hormonal and metabolic responses in pneumonia appear to be similar to those seen in other stress situations and failure of the initial stress response does not appear to contribute to the mortality of critically ill patients with community-acquired lobar pneumonia.

Adult↗
PubMed1989

The diagnostic yield of prebronchoscopy sputa and bronchial washings in patients with biopsy-proven pulmonary tuberculosis.

We report on a series of 35 patients with pulmonary tuberculosis diagnosed by flexible fibre-optic bronchoscopy and transbronchial lung biopsy after 3 sputum specimens had been microscopy-negative. This study re-evaluates this invasive procedure. Additional prebronchoscopy specimens of expectorated sputum yielded the diagnosis in 7 of 16 cases (43.8%) on microscopy. Sputum culture results were positive in 12 of 33 (36.4%). Pleural fluid culture was diagnostic in 1 case, and in another miliary tuberculosis was demonstrated on bone marrow trephine biopsy. The availability of these results could therefore have obviated the need for bronchoscopy in 14 of the 35 patients (40%). Bronchial washings were positive for acid-fast bacilli on microscopic examination in 13 of 34 cases (38.2%) and culture-positive in only 18 of 34 (52.9%), and should therefore not be the sole procedure utilised when bronchoscopy is performed. Transbronchial lung biopsy remains a valuable procedure to confirm pulmonary tuberculosis in patients whose sputum is culture-negative for mycobacteria.

Adolescent↗
PubMed1989

Endobronchial appearance of tracheobronchial amyloidosis. A case report and suggested classification.

Tracheobronchial amyloidosis with the co-existence of submucosal plaques and tumour-like masses is reported. The subdivision of tracheobronchial amyloidosis into submucosal plaques and tumour-like masses is questioned since there appears to be no difference in their clinical presentation and pathological appearance. It is suggested that lower respiratory tract amyloidosis should be classified into tracheobronchial, nodular parenchymal and diffuse alveolar septal amyloidosis.

Amyloidosis↗
PubMed1989

Community-acquired pneumonia of diverse aetiology: prognostic features in patients admitted to an intensive care unit and a "severity of illness" core.

In a retrospective study of 73 patients with community-acquired lobar pneumonia of diverse aetiology admitted to an intensive care unit, an attempt was made to identify those factors among the demographic and clinical features and results of initial laboratory investigations that were predictive of the ultimate outcome. A lower mean white cell count (p = 0.03), platelet count (p = 0.02), total serum protein (p = 0.005) and albumin (p = 0.02) and a higher mean serum creatinine (p = 0.03) and phosphate level (p = 0.02) appeared to be predictive of a poor prognosis. The most significant variable predictive of mortality, was the presence of bacteraemia (p = 0.0005). Severity of illness scoring systems by omitting microbiological data appear to underestimate predicted patient mortality. The mortality rate of critically ill patients with community-acquired lobar pneumonia remains high, despite advances in antimicrobial chemotherapy and intensive care unit facilities, particularly in the presence of certain negative prognostic factors of which the presence of bacteraemia is the most important.

Adult↗
PubMed1989

Effect of Streptococcus pneumoniae on human respiratory epithelium in vitro.

A total of 11 of 15 Streptococcus pneumoniae culture filtrates and all five bacterial autolysates produced by cell death in the stationary phase caused slowed ciliary beating and disruption of the surface integrity of human respiratory epithelium in organ culture. This effect was inhibited by cholesterol and was heat labile and reduced by standing at room temperature but was stable at -40 degrees C. The activity was detected at the late stationary phase of culture and was associated with the presence of hemolytic activity. Gel filtration of a concentrated culture filtrate and autolysate both yielded a single fraction of approximately 50 kilodaltons which slowed ciliary beating and were the only fractions with hemolytic activity. Rabbit antiserum to pneumolysin, a sulfhydryl-activated hemolytic cytotoxin released by S. pneumoniae during autolysis, neutralized the effect of the culture filtrate on respiratory epithelium. Both native and recombinant pneumolysin caused ciliary slowing and epithelial disruption. Electron microscopy showed a toxic effect of pneumolysin on epithelial cells: cytoplasmic blebs, mitochondrial swelling, cellular extrusion, and cell death, but no change in ciliary ultrastructure. Recombinant pneumolysin (10 micrograms/ml) caused ciliary slowing in the absence of changes in cell ultrastructure. Release of pneumolysin in the respiratory tract during infection may perturb host defenses, allowing bacterial proliferation and spread.

Autolysis↗
PubMed1989

A reevaluation of sputum microscopy and culture in the diagnosis of pulmonary tuberculosis.

This prospective study was undertaken to determine the interpretation of "scanty-positive" acid-fast bacilli on microscopy and to reevaluate simultaneous microscopy and culture of sputum for the accurate diagnosis of pulmonary tuberculosis (PTB). A total of 2,560 specimens were processed from 727 patients. There were 435 positive specimens (17.0 percent), originating from 139 patients, 10 by microscopy only, 176 by culture only, and 249 on both microscopy and culture. Review of the hospital records showed that 107 patients had PTB, 1 had Mycobacterium kansasii colonization, and 31 were thought not to have PTB. Sensitivity and specificity were 53.1 and 99.8 percent for microscopy, 81.5 and 98.4 percent for culture, and 77.6 and 100 percent for microscopy and culture, respectively. Seventy-five microscopy specimens (46 patients) were reported as scanty-positive, of which five (four patients) were deemed false positives, yielding a positive predictive value of 93.3 percent. In those patients with positive sputum microscopy, acid-fast bacilli were detected in one of the first four specimens. Seven isolates (three patients) were mycobacteria other than tubercle (0.27 percent of specimens and 1.6 percent of mycobacteria cultured). Despite the ready availability of laboratory evidence of disease, only 73 percent of cases were diagnosed by ward staff and 36 percent notified by the primary physician. Eleven patients (10.3 percent) died, six of whom had not received diagnoses of PTB before death. Sputum microscopy and culture remains reliable despite Bayesian predictions when applied to a population with a decreasing incidence of tuberculosis.

Bacteriological Techniques↗
PubMed1988

Enzyme-linked immunosorbent assay for the detection of antibodies against Mycobacterium tuberculosis in bronchial washings and serum.

This prospective study evaluates an enzyme-linked immunosorbent assay (ELISA) for the detection of IgG antibodies against Mycobacterium tuberculosis when applied to serum and bronchial washings (BW) of patients requiring bronchoscopy for definitive diagnosis. The ELISA employed an adsorbed fraction of mycobacterial sonicates as antigen. Of the 57 patients tested, 12 had tuberculosis (TB), 13 had malignant disease, 14 acute pneumonia or chronic destructive pneumonia, 13 had no demonstrable disease, and five had miscellaneous diseases. The mean optical density (OD) at 492 nm for a 1 in 40 dilution of serum of patients with TB was 0.338 +/- 0.218 and for control subjects was 0.162 +/- 0.098 (p = 0.0323). Values for neat BW were 0.317 +/- 0.122 for TB patients and 0.191 +/- 0.140 for control subjects (p = 0.0084). Using stepwise discriminant analysis, the ELISA on serum gave a sensitivity of 70.0 percent and specificity of 86.4 percent and 83.3 percent correct classification. When applied to BW, there was a 72.7 percent sensitivity, a 82.2 percent specificity, and patients were correctly classified in 80.4 percent of cases. It is concluded that the assay is a useful and reliable adjunct to conventional tests for tuberculosis.

Adult↗
PubMed1988

Differentiation of sarcoidosis from tuberculosis using an enzyme-linked immunosorbent assay for the detection of antibodies against Mycobacterium tuberculosis.

This study evaluates the ability of an enzyme-linked immunosorbent assay (ELISA) using adsorbed mycobacterial sonicates as antigen to differentiate between patients with tuberculosis (TB) and patients with sarcoidosis. The study group consisted of 11 patients with active sarcoidosis, seven patients with sputum-positive tuberculosis, and seven normal control subjects. Serum specimens were subjected to ELISA. Serum anti-TB IgG optical density measured at 492 nm (mean +/- SD); pulmonary TB, 0.291 +/- 0.040; normal control subjects, 0.092 +/- 0.011; and sarcoidosis, 0.064 +/- 0.033 (TB vs sarcoid, p less than 10(-6)). This ELISA is a valuable test for the differentiation between sarcoidosis and TB.

Adult↗
PubMed1988

Pneumococcal bacteraemia in adults in a low socio-economic urban population.

Between January 1984 and December 1985, 183 adult patients, subsequently shown to have pneumococcal bacteraemia, were admitted. Of these infections, nine were caused by penicillin-resistant strains, and three of these were resistant to other antibiotics. The organisms from 150 patients were serotyped/grouped. The primary site of infection was lung in 90 per cent of patients. Among the patients with pneumonia, those with serovar 3 strains accounted for most intensive care unit admissions, most cases requiring inotropic drugs, and mechanical ventilation and had the highest complication rate and mortality. Findings which predicted the need for intensive care included higher age, elevated concentrations of serum urea, creatinine, and phosphate and lower levels of total serum protein, albumin and calcium. Twenty-four patients died of whom 23 had pneumonia. The case fatality rate among all of the patients admitted to the intensive care unit was 60 per cent and among those not admitted to the unit, 9.2 per cent. Of the patients who died, 41.7 per cent did so within the first five days of admission. The prophylactic use of polyvalent pneumococcal vaccine in industrial workers from low socio-economic groups should be carefully considered.

Adult↗
PubMed1987

Lack of association of cleft uvula with otitis media in Apache Indian children.

Cleft uvula occurs in approximately 20% of Athabaskan Indians. The association of cleft uvula with otitis media was examined in a cohort of 175 Apache Indian children followed up prospectively from birth. No association was found between the occurrence of cleft uvula and the rate, frequency, or timing of otitis media attacks.

Arizona↗
PubMed1987

Acute respiratory failure in active tuberculosis.

We describe 15 patients whose acute respiratory failure associated with pulmonary tuberculosis necessitated their ICU admission during a 42-month period. There was a 1.5% incidence of respiratory failure in hospitalized tuberculosis patients. Eleven of the 15 patients required ventilatory assistance for a mean 17.3 days. Five patients died in ICU (early mortality = 33%), and two others died within 3 months of discharge (total mortality = 47%). We began specific anti-tuberculous chemotherapy in these patients within 3 +/- 4 (SD) days after hospital admission. Pulmonary histology was available in five cases. Despite the clinical and radiologic features compatible with the adult respiratory distress syndrome in these patients, histology showed confluent tuberculous bronchopneumonia with no evidence of the syndrome.

Acute Disease↗
PubMed1987

Transbronchial biopsy during mechanical ventilation.

The diagnostic yield and risks of transbronchial biopsy (TBB) during mechanical ventilation were assessed in 13 patients with progressive pulmonary infiltrates. TBB was of considerable diagnostic value in ten patients and useful in excluding potentially treatable infections in the remaining three patients. Complications included two pneumothoraces, pulmonary hemorrhage in one case, and supraventricular tachycardia in another. No fatalities were attributable to TBB. TBB proved to be a relatively safe procedure, with a high diagnostic yield in these critically ill patients.

Acute Disease↗
PubMed1987

'Low-dose' corticosteroid prophylaxis against fat embolism.

The effect of 'low-dose' corticosteroids (9 mg/kg methylprednisolone), given after skeletal trauma, on the incidence of the fat embolism syndrome and isolated arterial hypoxemia was studied in 42 controls and 40 steroid-treated subjects. Fat embolism occurred in ten controls (23.8%) and one steroid-treated subject (2.5%) (p = 0.01). A further 44 subjects developed isolated hypoxemia. This was severe (PaO2 less than 50 mm Hg) in seven of 32 controls (21.9%) and one of 39 steroid-treated subjects (2.6%) (p = 0.01). The overall incidence of hypoxemia was 67.1%, affecting 33 controls (78.6%) and 22 steroid-treated patients (55%) (p less than 0.05). The degree of hypoxemia was severe (PaO2 less than 50 mm Hg) in 12 controls (28.6%) and two (5%) of the steroid-treated subjects (p = 0.005). No control subject died or required mechanical ventilation. One steroid-treated subject without fat embolism died of a fulminant infection. Although methylprednisolone in a relatively low dose provides protection against fat embolism and pulmonary dysfunction after skeletal trauma, the safety of this therapy requires further evaluation.

Adult↗
PubMed1986

Pulmonary mucormycosis presenting with Horner's syndrome. Report of a medical cure.

A patient with pulmonary mucormycosis caused by Rhizopus oryzae was treated with a total dose of intravenous amphotericin B 2060 mg which resulted in medical cure. This is the first reported medical cure in the RSA of pulmonary mucormycosis. Mucormycosis with brachial plexus involvement and Horner's syndrome has not been previously reported.

Amphotericin B↗