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Biomedical subjects

C J Tellis

Publications and source records attributed to C J Tellis.

At least 19 recordsLinked to original sources
PubMed1991

Urinary desmosine excretion as a marker of lung injury in the adult respiratory distress syndrome.

Desmosine, the intermolecular and intramolecular cross link between the chains of elastin polypeptide, may be useful as a marker of a lung injury in adult respiratory distress syndrome (ARDS). A radioimmunoassay for rabbit antibody developed against desmosine, conjugated to bovine serum albumin, can detect as little as 100 pg of desmosine in plasma or urine. Desmosine is not metabolically absorbed, reused, or catabolized by the body, but rather eliminated unchanged in the urine as low molecular weight peptides. The lung is relatively rich in elastin, and we reasoned that a timed collection could be used as an index of elastin degradation in vivo. A 2-h collection of urine for desmosine assay was obtained at the time of Swan-Ganz catheter insertion in 41 consecutive patients. On the basis of clinical and initial Swan-Ganz catheter data, the patients were assigned to one of three groups: an ARDS group (n = 12); a cardiogenic pulmonary edema (CPE) group (n = 12); and a critically ill, nonpulmonary edema group (NPE, n = 17). The mean urine desmosine concentration (mg/L) for the ARDS group (0.728 +/- 0.22 SE) differed from the CPE group (0.149 +/- 0.07; p less than 0.001). The total excretion (microgram/2 h) was 64.95 +/- 24.7 in the ARDS group and 24.71 +/- 11.7 in the CPE group (p less than 0.05). Urine desmosine concentration/serum creatinine index for the ARDS group (0.78 +/- 0.28) was greater than in the CPE group (0.07 +/- 0.04; p = 0.019). Desmosine excretion was increased in the NPE group compared with CPE and ARDS groups, possibly reflecting heterogeneity in this group. In the differentiation of ARDS from CPE, we conclude that substantial increases in urinary desmosine excretion favor a diagnosis of ARDS.

Adult↗
PubMed1988

Mycobacteria other than tuberculosis. Pulmonary involvement in patients with acquired immunodeficiency syndrome.

A normal host can be colonized by mycobacteria other than tuberculosis (MOTT), resulting in bronchoscopic isolates of no clinical significance. In the acquired immunodeficiency syndrome (AIDS), Mycobacterium avium-intracellulare, Mycobacterium kansasii, and Mycobacterium xenopi have caused widely disseminated infection. To determine the usefulness of fiberoptic bronchoscopy (FB) in evaluating MOTT infection in AIDS, we reviewed MOTT cultures from 36 FBs, correlated these to clinical course, and identified MOTT isolates from cultures of all other sources in these patients. Of ten bronchoscopic MOTT isolates, seven were not related to lung disease or to dissemination within one month of FB. Of the four Mycobacterium fortuitum and seven M avium-intracellulare that did disseminate within one month, only two were reflected in bronchoscopic cultures. In patients with AIDS, bronchopulmonary MOTT colonization does occur. We recommend that standard criteria for pulmonary mycobacterial disease be applied. Negative bronchopulmonary cultures do not seem to exclude dissemination.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Posterior mediastinal mass with intraspinous extension.

The differential diagnosis of masses in the posterior mediastinum includes neurogenic neoplasms, cysts, esophageal tumors, infectious processes including abscesses, and disorders of the thoracic spine. Nonoperative procedures, including transcutaneous and transbronchial biopsies and thoracoscopy, may not lead to a definitive diagnosis. We present two cases in which a neurogenic tumor, with and without significant spinal canal involvement, was diagnosed at thoracotomy after several nondiagnostic procedures. The appearance of the mass on chest roentgenogram can be used to narrow the preoperative differential diagnosis between ganglion-series and nerve-sheath tumors. The utility of computerized tomography of the chest, in addition to the chest roentgenogram, in assessing the bony involvement of the thoracic tumor is illustrated. The role of magnetic resonance imaging is yet to be fully defined in this entity. These lesions may be approached by separate thoracic and neurosurgical approaches, or by a combined, single-staged procedure. These cases and a review of the literature support the use of the single-staged approach.

Diagnosis, Differential↗
PubMed1986

Overnight nasal CPAP improves hypersomnolence in sleep apnea.

Eleven adult men with sleep apnea underwent nocturnal polysomnography on two successive nights. The first study, done without NCPAP, served as the control. The second (treatment) was done with the application of 7.5 to 15 cm H2O nasal continuous positive airway pressure (NCPAP). A subjective sleepiness index (SSI) was noted upon awakening from each night of polygraphic recording. During the control night, the mean frequency of apnea episodes/sleep hr was 35.95 +/- 4.5 SE, and the mean duration was 28.68 +/- 2.7 sec. Mean frequency of disorder of breathing (DOB) episodes/sleep hr was 19.25 +/- 6.2 and mean duration of DOB episodes was 23.1 +/- 2.8 sec. During the treatment night, all obstructive apnea episodes were abolished. During the control night, the mean decrease in arterial oxygen saturation during obstructive apnea episodes was 11.2 +/- 1.9 percent and the mean lowest saturation was 67.6 +/- 4.0 percent. NCPAP eliminated arterial oxygen desaturation. While 44.5 +/- 5.7 percent of total sleep time was spent in either apnea or disordered breathing during the control night, NCPAP decreased this to 0.73 +/- 0.3 percent. In addition to the improvement in respiration during sleep, SSI decreased from a mean of 3.73 +/- 0.49 after the control night to 1.64 +/- 0.24 after treatment, reflecting an improvement in daytime hypersomnolence. We conclude that nasal CPAP is effective in eliminating obstructive apnea episodes, and results in a marked decrease in daytime hypersomnolence after one treatment night.

Adult↗
PubMed1985

Pulmonary involvement in mixed connective tissue disease.

To determine the frequency of pulmonary function abnormalities in mixed connective tissue disease (MCTD), we studied 16 consecutive patients. Spirometry, total lung capacity (TLC), diffusing capacity (Dco), static lung compliance (Cst), and tests of respiratory muscle function (peak inspiratory pressure [PIP] and the maximum change in transdiaphragmatic pressure [delta PDI] during a diaphragmatic Müeller maneuver) were obtained. Airway resistance (RAW) and frequency dependence of compliance were also measured. Static lung compliance was less than 0.2 L/cm H2O in four of nine patients. The PIP was less than 75 cm H2O in only one patient and delta PDI was greater than 45 cm H2O in all ten patients evaluated. Frequency dependence of compliance was abnormal in seven of ten patients, whereas RAW was increased in only three of eight patients. The TLC and DCO were less than 80 percent of the predicted values in ten of 16 and 14 of 16 patients respectively. There was no correlation between the level of extractable nuclear antigen and pulmonary function abnormalities. The study did not identify significant abnormalities in respiratory muscle function.

Adult↗
PubMed1985

Clinical presentations of chronic obstructive pulmonary disease.

The diagnosis of chronic obstructive pulmonary disease covers a wide range of lung problems that have as their base the partial blockage of the smooth movement of air from the lungs during expiration. Asthma, simple bronchitis, chronic obstructive bronchitis, and emphysema are the diseases usually considered as chronic obstructive disease. Many of their multiple presentations are quite common in clinical medicine but are sometimes difficult to recognize. Once the inciting event is identified, it is often reversible.

Adult↗
PubMed1984

Control of breathing in obstructive sleep apnea.

We studied the responses of ventilation and occlusion pressure (P100) to hypercapnia, with and without the application of an inspiratory flow-resistive load (12 cm H2O/L/sec), in eight control subjects and in eight subjects with obstructive sleep apnea who did not retain carbon dioxide while awake. The hypercapnic response was assessed by a modification of the Read rebreathing technique. For a given endtidal carbon dioxide, ventilation in control subjects was the same with or without load, and P100 was increased with loading. In contrast, the subjects with sleep apnea decreased their ventilation during loading and did not increase their P100 in response to loading. Relationships between ventilation and P100 were similar in the two groups both with and without load. We conclude that patients with occlusive sleep apnea do not exhibit the normal increase in neural drive to compensate for inspiratory flow-resistive loading.

Adult↗
PubMed1984

Obstructive sleep apnea in hypothyroidism.

To determine the incidence and frequency of sleep apnea in persons with hypothyroidism, 11 consecutive patients with newly diagnosed disease were studied before and during thyroid hormone replacement therapy. Nine patients had episodes of apnea, with the number of episodes per hour of sleep ranging from 17 to 176 (mean, 71.8). Six of the nine patients were obese and had 99.5 episodes per hour compared with 16.3 episodes per hour in the 3 nonobese patients (p less than 0.02). After 3 to 12 months of thyroxine replacement therapy, mean apnea frequency decreased from 71.8 +/- 18.0 (SE) to 12.7 +/- 6.1 episodes per hour, without reduction in body weight. There were fewer changes in sleep stage per hour during treatment (22.1 +/- 4.9) than pretreatment (57.6 +/- 14.5). Carbon dioxide response tests done under non-loaded and flow-resistive loaded conditions before and during thyroxine replacement therapy showed increases in the loaded respiratory effort and ventilation during thyroxine treatment. Sleep apnea episodes are common in persons with untreated hypothyroidism, even with normal lung function. Thyroxine replacement therapy decreases apnea frequency, even without change in body weight.

Adult↗
PubMed1982

Pulmonary metastasis of carcinoma of the cervix: a retrospective study.

The medical records of 243 patients admitted over a five-year period with a diagnosis of carcinoma of the cervix were reviewed to determine (1) the frequency of pulmonary metastasis, (2) the relationship between the stage of the primary lesion and the incidence of pulmonary metastasis, and (3) the relationship between the disease-free interval and the incidence of pulmonary metastasis. We found that pulmonary metastasis had developed in 22 of 243 patients. Pulmonary metastasis occurred in 4.24% of all patients with Stage I carcinoma of the cervix; in 13% of all patients with Stage II; 7.4% of all patients with Stage III; and 57% of all patients with Stage IV disease. The average disease-free interval was 39 months in Stage I disease; 37.3 months in Stage II disease; 18 months in Stage III disease; and less than one month in Stage IV disease. The most common roentgenographic pattern was that of multiple pulmonary nodules (13 of 22 patients). Twenty-five percent (five of 20) of patients with pulmonary metastasis had no evidence of other metastasis.

Carcinoma, Squamous Cell↗
PubMed1979

Systemic sarcoidosis presenting with a testicular nodule.

A patient presenting with the clinical and radiographic picture of pulmonary sarcoidosis was found to have a testicular nodule. Orchiectomy was done, and the pathologic specimen revealed only granulomatous inflammation. The involvement of the testis in sarcoidosis is reviewed, and recommendations are made regarding surgical diagnosis and medical treatment.

Adult↗
PubMed1978

Hemoptysis.

Patients presenting with hemoptysis frequently have a serious underlying disease. Even when the amount of blood is minimal, thorough investigation is indicated. Since many different types of diseases give rise to bleeding from the respiratory tract, a careful and thorough diagnostic evaluation is indicated. Treatment depends upon the cause of the bleeding. Massive hemoptysis is frightening and requires more rapid assessment. When bleeding is considered to be massive, surgical intervention rather than conservative management yields the best chance of survival.

Adolescent↗
PubMed1977

Pulmonary disease caused by Mycobacterium xenopi:two case reports.

Two cases of pulmonary disease caused by Mycobacterium xenopi are presented. One represents the first case report of Mycobacterium xenopi isolated from surgically resected lung tissue in the United States. The epidemiologic, bacteriologic, and clinical aspects of the disease are presented.

Adult↗