Upper airway obstruction following angiotensin-converting enzyme inhibitor therapy.
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Adult↗
Biomedical subjects
C L Fields
Publications and source records attributed to C L Fields.
Dissecting aortic aneurysm mimicking massive pulmonary embolism.
The finding of a massive unilateral segmental defect with normal ventilation upon lung scanning does not always secure the diagnosis of acute pulmonary embolus. We present a patient whose ventilation-perfusion lung scan suggested a significant embolic phenomenon, but who was subsequently found to have compression of her right pulmonary artery by a dissecting aortic aneurysm. Conditions that present with a unilateral perfusion defect merit further evaluation with pulmonary arteriography.
Adult↗
The value and limitation of pleural fluid pH measurement.
Analysis of an aliquot of fluid from a pleural effusion will often provide the clinician with the information needed to establish a presumptive or definitive diagnosis of the patient's illness. A properly performed pleural fluid pH can maximize the diagnostic yield and provide guidelines for further clinical interventions.
Carcinoma, Squamous Cell↗
Bronchogenic carcinoma in young adults.
Lung cancer occurs most frequently in the sixth decade of life. It has been suggested that the incidence of bronchogenic neoplasm is increasing in the population under the age of 40. While this observation may simply reflect the general increase in lung cancer in both sexes, there is a distinct difference in the pathology and behavior of lung tumors that occur in the young.
Adult↗
Variable vocal cord dysfunction: an asthma variant.
Vocal cord dysfunction is a little recognized cause of dyspnea and wheezing. Its lack of recognition has often led to the institution of inappropriate therapeutic methods, including intubation and tracheostomy. Awareness of this possible cause of respiratory distress should allow early institution of appropriate psychotherapy, rather than unnecessary medical intervention.
Adult↗
Upper lobe cystic lesions and cough in a young woman.
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Adult↗
Thrombosed pulmonary artery aneurysm. A rare cause of a high-probability lung scan.
The high-probability ventilation-perfusion lung scan is accepted as supportive of pulmonary embolism and often negates further diagnostic evaluation; however, there are processes that mimic the clinical presentation and radiographic findings of pulmonary emboli, including a unilateral segmental or greater perfusion defect. We present the findings in a patient whose presentation and ventilation-perfusion scans over a three-month course were suggestive of pulmonary embolism, yet pulmonary angiography revealed a thrombosed pulmonary artery aneurysm. The interpretation of a unilateral segmental perfusion defect as high probability does not secure the diagnosis of pulmonary embolism and should not preclude further evaluation for alternative etiologies.
Adult↗
Bronchoscopy for pulmonary hygiene in the intensive care unit.
The safety and ease of fiberoptic bronchoscopy recommends its use in the intensive care unit. In critically ill patients, the procedure may be a valuable diagnostic or therapeutic tool. In most instances, the diagnostic indications are well defined. The therapeutic indications for bronchoscopy, however, are more controversial. They center around using the bronchoscope for removal of secretions, mucus plugs and reversing atelectasis in mechanically ventilated patients. This report examines the small but definite risk of therapeutic bronchoscopy in mechanically ventilated patients.
Adult↗
Blastomycosis: a reminder of Kentucky's other fungus.
Although not as common as Histoplasmosis, the disease caused by Blastomyces dermatitidis is also endemic in the Commonwealth of Kentucky. Greater clinical awareness of this systemic mycosis and the newer effective forms of treatment may lessen the significant morbidity and mortality of this potentially serious infection. To illustrate the varied manifestations of this illness, we contrast the presentation of an urban female with blastomycosis and atypical chest radiographic changes to the more classic features of blastomycosis described in the literature.
Adult↗
Pulmonary emphysema in a nonsmoker with normal alpha-1-antitrypsin.
Premature and rapidly progressing emphysema of the lung is unique in the absence of cigarette smoking or an inherited homozygous alpha-1-antitrypsin deficiency. We describe a young man with radiographic evidence of early onset bullous emphysema without the usual risk factors and provide a review of the alternative explanations proposed for this form of lung damage.
Adult↗
DaCosta's syndrome: chronic symptomatic hyperventilation.
In 1871, DaCosta published his observation of somatic symptoms preceded by significant hyperventilation. More than a century later, the hyperventilation syndrome remains a poorly defined but common clinical condition. Although familiar to most practitioners of medicine when it presents as an acute phenomenon, the diagnosis may go unrecognized in its chronic form. The ability of a chronic hyperventilatory state to mimic a life-threatening cardiopulmonary disease is not always appreciated.
Adult↗
Recognition of upper airway obstruction misdiagnosed as asthma.
Distinguishing new onset asthma from an insidious upper airway obstruction can prove difficult and is more frequently being addressed in the medical literature. We examine our experience in a teaching hospital and analyze the problems relating to establishing the correct diagnosis.
Adult↗
Impact of arterial blood gas analysis in disability evaluation of the bituminous coal miner with simple pneumoconiosis.
The Department of Labor has set guidelines for the use of resting arterial blood gas analysis in determination of total and permanent disability for coal workers' pneumoconiosis. To determine the prevalence with which bituminous coal miners fall below the arterial tensions of both oxygen and carbon dioxide published in the Federal Register, we studied 1012 miners who had both reproducible spirometry and arterial blood gas analysis as part of their disability evaluation. Eighty-seven percent of impaired miners could be identified by the spirometric criteria. Thirteen percent of impaired bituminous coal miners had acceptable pulmonary function but were eligible for black lung benefits by the blood gas guidelines. This population would have been missed if blood gas analysis were excluded from the evaluation process. On the other hand, approximately 25% of the blood gas analyses that were performed could be eliminated if a policy was adopted to do this test only on miners with spirometry that exceed the federal guidelines.
Carbon Dioxide↗
Tuberculosis in the intensive care unit: a chemotherapeutic controversy.
A survey of 150 practicing pulmonary physicians was conducted to determine chemotherapy preferences for the treatment of the patient suffering respiratory insufficiency secondary to active nonmiliary tuberculosis. An equal sample was selected from both the private sector and academic medicine in order to determine if antituberculous agent selection differed between these two groups. The majority of the 109 physicians who responded to the questionnaire (64.2%) indicated that they would use isoniazid, rifampin, and a third agent. There was no statistical difference in the choice of ethambutol, pyrazinamide, or streptomycin as the third drug. There was no difference between university and community based physicians in the use of three drug combinations or in the selection of the specific third agent. This study suggests that, although the majority of pulmonologists responding would treat the patient with respiratory insufficiency from tuberculosis with an aggressive three drug approach, there is no consensus as to which agent should be the third drug.
Antitubercular Agents↗
Yellow nail syndrome: a perspective.
The Yellow Nail syndrome is an unusual lymphangitic disorder classically characterized by the presence of nail discoloration, lymphedema and pleural effusion. Since the recognition of the significance of these associated physical findings, four cases have been diagnosed at our institution in the last six years. This suggests that the syndrome may not be as rare as previously reported in medical literature. More often it may remain unrecognized in the absence of the classic triad of physical findings. To heighten awareness of this disorder, we describe our most recent patient diagnosed with YNS and provide a review of the current medical literature.
Female↗
Wegener's granulomatosis complicated by pregnancy. A case report.
A 23-year-old woman who presented in the 17th week of her third intrauterine pregnancy was diagnosed as having active Wegener's granulomatosis. Therapy, consisting of corticosteroids, cyclophosphamide and hemodialysis, was instituted and maintained until delivery. Although Wegener's granulomatosis complicated by pregnancy has been reported previously, this is the first reported patient to be treated successfully with the above agents during the second and third trimesters without apparent harm to her or her infant.
Adult↗
Pneumothorax: an unusual presentation of primary bronchogenic neoplasm.
We report the occurrence of spontaneous pneumothorax as the initial pulmonary event in a patient subsequently found to have a primary adenocarcinoma of the ipsilateral lung. A review of the literature regarding this rare presenting feature of bronchogenic neoplasm is provided.
Adenocarcinoma↗
Thallium-201 scintigraphy in the diagnosis and management of myocardial sarcoidosis.
We have described three patients with clinical evidence of myocardial sarcoidosis to illustrate the utility of thallium-201 scintigraphy in demonstrating the myocardial lesions. Both the symptomatic and asymptomatic individuals studied showed the characteristic "reverse redistribution" phenomenon. No abnormalities were seen during the exercise phase of the thallium study, but myocardial defects were detected in each patient when repeat studies were obtained at rest six hours later. Steroid therapy resolved the defects in each case. We propose thallium-201 scintigraphy of the heart as a safe and useful tool for documenting myocardial involvement in sarcoidosis and following the effects of therapy.
Adrenal Cortex Hormones↗