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Biomedical subjects

D Bouros

Publications and source records attributed to D Bouros.

At least 73 records · Page 4Linked to original sources
PubMed1996

Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema.

Intrapleural urokinase has not been evaluated systemically in terms of efficacy, safety, and cost of treatment in a large series of patients with complicated (parapneumonic) pleural effusions (CPE) and pleural empyemas (PE). Furthermore, the optimal dose and duration of treatment is not known. Twenty consecutive patients with multiloculated parapneumonic effusions (13 with CPE and 7 with PE), in whom a single chest tube failed to drain the fluid, were studied prospectively. The age of the patients ranged 15-92 yrs (median 51 yrs). Urokinase was administered intrapleurally, in a low single daily dose of 50,000 U in 100 mL normal saline via the chest tube. Previous intrapleural instillation of 100 mL normal saline failed to promote drainage in all patients. Urokinase enhanced drainage in all patients. Clinical and radiological improvement was noted in all but one patient. The mean (SD) volume of fluid significantly increased in the first 24 h post-urokinase (p<0.001). The number of urokinase instillations ranged 3-7 (median 5). Radiological evaluation showed excellent improvement in 13 of the 20 (65%) patients. Urokinase was well-tolerated in all patients. The clinical course of patients was uneventful at a mean follow-up of 15 months (range 6-30 months) later. Mean total cost of treatment was $530 +/- 34.6. Our results show that intrapleural instillation of small doses of urokinase is a cost-effective and safe mode of treatment of complicated pleural effusions and pleural empyema and could be the fibrinolytic of choice.

Adolescent↗
PubMed1995

Orthodeoxia and platypnoea after acute organophosphorus poisoning reversed by CPAP: a newly described cause and review of the literature.

The case of a 60-year-old male patient, who survived severe organophosphorus poisoning, and subsequently developed platypnoea and orthodeoxia is described. The patient was mechanically ventilated for a long period of time in the intensive care unit. During the weaning trial, he developed platypnoea and orthodeoxia (PaO2 85 mmHg in recumbency, and 40 mmHg in upright position). Interestingly, the patient's orthodeoxia was alleviated on continuous positive airway pressure (CPAP) treatment. This is a newly described cause of the platypnoea-orthodeoxia syndrome. The possible pathophysiological mechanisms are discussed and a review of the reported abnormal states associated with this condition is presented.

Acute Disease↗
PubMed1995

Tuberculin sensitivity trends in Hellenic army recruits during the period 1981-91.

SETTING: The tuberculin skin test is widely used to define the tuberculous infection in the community. Serial representative tuberculin surveys demonstrate the trend of the risk of tuberculous infection. OBJECTIVE: The study of tuberculous infection in Hellenic army recruits for the purposes of BCG vaccination, which with chemoprophylaxis and early case-finding are the major strategies used for preventing tuberculosis (TB). DESIGN: We investigated tuberculin skin sensitivity on 544210 Hellenic Armed Forces recruits during 1981-91. The age of the subjects ranged between 18-28 years (mean 21 +/- 1.5 years). We used the Mantoux technique with tuberculin PPD-RT 23 with Tween 80, dose 2 IU (1/5000) of the Hellenic Pasteur Institute. Tuberculin skin reactions were examined by two experienced readers after 48 hours. Indurations < 5 mm were considered as negative reactions, > or = 10 mm as positive, and 5-9 mm as doubtful reactions. RESULTS: The results of the present study were compared to other studies undertaken in recruits during the period 1934-80. We found a decrease of positive reactions from 14.2% in 1981 to 6.8% in 1991. The mean annual reduction was 0.74%. The decline has continued since 1947, as previous studies during the period 1934-80 have shown. CONCLUSION: We conclude that the tuberculin reactivity in recruits of the Hellenic army, although still high in relation to other European countries and North America, is declining steadily. We predict that the number of positive reactions will fall to about 1% by the year 2000, assuming that the same trend continues.

Adolescent↗
PubMed1995

Q fever in the Greek Island of Crete: epidemiologic, clinical, and therapeutic data from 98 cases.

A retrospective study was undertaken in Crete, Greece, to investigate the epidemiologic, clinical, and therapeutic aspects of Q fever. Over a period of 5 years (1989-1993), 1,298 patients were examined and 98 cases were identified. Individuals who were aged 20-29 years and 30-39 years appeared to have an increased risk of infection. Contact with animals was found to be a major risk factor for acquisition of Q fever. The predominant clinical manifestations of the infection were fever (91.7% of patients) and respiratory disease (88.5%), whereas hepatitis was the dominant feature in only a minority (7.1%) of patients. Chest radiographs frequently revealed pulmonary interstitial changes (36.4% of patients) and alveolar changes (34.4%). Abnormal echocardiographic findings were also observed. There was no difference in the duration of fever whether the patient received therapy with tetracycline or erythromycin, a finding that may be explained by the delay in initiating tetracycline therapy.

Adult↗
PubMed1995

Probability and characteristics of human immunodeficiency virus infection in male Greek military personnel with tuberculosis.

The probability of an AIDS patient being infected with tuberculosis (TB) has been studied in different populations and found to be increased by as much as 500 times, but the reverse, i.e. the probability of a patient with TB being infected with HIV, has not been studied. The aim of this study was to investigate the hypothesis of greater HIV seropositivity and altered immune status, as indicated by CD4+ T-lymphocyte counts, in TB patients. We prospectively studied 162 males, aged 18-30 years, hospitalized for active, proven TB. Serum for HIV antibodies was tested twice by ELISA and confirmed by the Western blot technique. The control group consisted of 145,000 blood donor volunteers serving in the army, aged 18-30 years. The number of CD4+ T lymphocytes was also measured in the patients and the control group. We found that the rate of HIV seropositivity in TB patients was 2.4% (4 of 162), while it was 0.214% in the control group (p < 0.0001). Using the Bayes' theorem we found that the probability of a TB patient being infected with HIV was 9.1%, approximately 150 times higher than the expected rate in the matched control group (p < 0.0001). The number of CD4+ T lymphocytes was significantly lower in pulmonary and extrapulmonary TB patients than in the control group, taking into account the HIV status (p < 0.001). Our results suggest that there is a 150 times greater probability of a TB patient being infected with HIV. CD4+ T lymphocytes are significantly lower in all groups of TB patients.

AIDS-Related Opportunistic Infections↗
PubMed1995

Diffuse interstitial lung disease as an early manifestation of ankylosing spondylitis.

A rare case of ankylosing spondylitis with interstitial pulmonary disease of the upper lung field, at an early stage in the disease, is described. The patient, a 35-year-old asymptomatic woman, was admitted to the hospital due to an abnormal chest radiograph that was found during preoperative evaluation for a toxic adenoma of the thyroid gland. Her mother and sister were also found to suffer from ankylosing spondylitis but without lung involvement. History, physical and laboratory examination as well as open lung biopsy excluded other causes of an interstitial pulmonary disease. The diagnosis of ankylosing spondylitis was based on clinical, radiographic, positive human leukocyte antigen (HLA-B27) and histologic findings.

Adult↗
PubMed1995

Incidence of tuberculosis in Greek armed forces from 1965-1993.

Studies investigating the epidemiology of tuberculosis in Greece are lacking. Tuberculosis (TB) continues to be a public health problem and its dimensions are not clearly defined. The aim of this study was to estimate the incidence of pulmonary and pleural TB in each of the three branches of military personnel serving in the Greek armed forces, during the period 1965-1993. All military personnel with confirmed pulmonary or pleural TB during the period 1965-1993 were studied retrospectively. The age of the patients ranged from 18-45 years. A significant number of TB patients were detected by the regular chest radiography screening using mass miniature radiography during enrollment. The diagnosis of TB was made both by clinical and paraclinical examinations, such as history, symptoms, physical examination, tuberculin skin reactivity, chest X-ray and/or computed tomography of the thorax, bronchoscopy, microbiological examination of specimens (sputum, washings, bronchoalveolar lavage) as well as histological and bacteriological examination of the biopsies. We found that during the period studied, 4,628 patients were hospitalised for TB, 3,588 for pulmonary TB, and 1,040 for TB pleuritis (3,781 in the army, 445 in the navy and 402 in the air force). In 1965, the incidence (per 100,000) of TB (pulmonary and pleural) in the army was 60, in the navy 50, and in the air force 30. This incidence increased gradually from 1965 to 1980, followed by a decrease, since BCG vaccination became obligatory in 1980; values in 1993 were 18 in the army, 25 in the navy, and 15 in the air force. These figures are significantly higher than those reported for the civilian population, probably due to underreporting in the latter. Our results suggest that the incidence of TB in the Greek armed forces, although still high, is declining steadily. Strengthening of the anti-TB campaign is indicated.

Adolescent↗
PubMed1995

Respiratory muscle strength during continuous ambulatory peritoneal dialysis (CAPD).

The purpose of this study was to investigate the effect of chronic renal failure (CRF) and continuous ambulatory peritoneal dialysis (CAPD) on respiratory muscle function. Global respiratory muscle strength was assessed by measuring mouth pressures during maximum static inspiration (PIMAX) near residual volume (RV) and expiration (PEMAX) near total lung capacity (TLC), in 26 patients. Maximum pressures, spirometry and lung volumes were measured before dialysis, 4 h after the administration of 2 l of dialysate into the peritoneal cavity, and just after the next drainage. In addition, biochemical indices (urea, creatinine, sodium, potassium, calcium and phosphorus) and haematological indices (haemoglobin (Hb) and haematocrit (Hct)) were measured once before the treatment. The results showed that mean PIMAX and PEMAX were normal, with a very wide range between patients, before CAPD. However, seven patients (27%) showed a PIMAX of < 75% predicted (pred) and eight (31%) a PEMAX < 75% pred. Maximal pressures decreased significantly during CAPD and increased again after the drainage of fluid. Similarly, lung volumes were within the normal range before and decreased significantly during CAPD. The forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio did not change. We conclude that respiratory muscle strength was preserved in the majority of the patients with chronic renal failure treated with CAPD. During CAPD, lung volumes and respiratory muscle function were decreased, demonstrating an effect of the abdominal cavity on the mechanics of the respiratory system. However, the decrease in the maximum pressures was less than 20%, indicating that CAPD is a safe procedure in patients without pre-existing pulmonary disease or uraemic pulmonary complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1995

BOOP presenting with haemoptysis and multiple cavitary nodules.

A 47 year old woman developed idiopathic bronchiolitis obliterans organizing pneumonia (BOOP) presenting with haemoptysis and diffuse multiple cavitary nodules. The disease was histologically confirmed by open lung biopsy after other entities had been excluded. The patient responded to a course of corticosteroids. This BOOP should be added to the list of diseases with multiple cavitary nodules.

Biopsy↗
PubMed1995

The varied manifestation of pulmonary artery agenesis in adulthood.

OBJECTIVE: Unilateral pulmonary artery agenesis (UPAA), a rare congenital anomaly that is frequently associated with other cardiovascular abnormalities, is usually diagnosed in childhood. Most patients who have no associated cardiac anomalies have only minor or absent symptoms and survive into adulthood. The conditions of such patients are frequently misdiagnosed in adulthood. In this report, we describe six patients with UPAA in whom the diagnosis was first established in adulthood. The varied clinical presentation of these patients is reviewed and the relative effectiveness of a variety of diagnostic tests is compared. SUBJECTS AND METHODS: During the period January 1987 through December 1990, six male patients, aged 17 to 20 years, were found to have UPAA at the time of their medical screening for enrollment into the armed forces. The diagnosis was based on history, clinical and imaging examinations, including chest radiography, ventilation-perfusion lung scan, digital subtraction angiography (DSA), computed tomography (CT), and magnetic resonance imaging (MRI). RESULTS: In four of the patients, the UPAA was on the left side and in two it was on the right. A right aortic arch was present in three patients and other cardiovascular anomalies were found in three. Pulmonary function studies showed a mild restrictive pattern in four. In contrast to previous reports, the ventilation scan showed a diminished "wash in" and "equilibrium" phase without a delayed "wash out" phase on the affected side in all patients. Selective bronchography through the fiberoptic bronchoscope revealed ipsilateral mixed-type bronchiectasis in two of four patients studied, a finding of clinical significance that has not been described previously. In all cases, the diagnosis was made by DSA. CT of the thorax (n = 6) and MRI (n = 4) were diagnostic in all cases in which they were performed, but added no significant information. CONCLUSION: UPAA is frequently misdiagnosed in adulthood and is often not considered in the differential diagnosis of the unilateral hyperlucent lung. Clinicians and radiologists should be aware of the possibility of undiagnosed cases in adults, with many atypical characteristics.

Adolescent↗
PubMed1994

Role of streptokinase in the treatment of acute loculated parapneumonic pleural effusions and empyema.

BACKGROUND: Intrapleural administration of streptokinase has been shown in a few small series to be effective treatment for complicated parapneumonic effusions and pleural empyemas, but techniques of instillation of streptokinase differ. The role of streptokinase in promoting drainage was investigated prospectively in a larger series of patients with complicated parapneumonic effusions and pleural empyemas. METHODS: Twenty consecutive patients with parapneumonic effusions, 15 with complicated parapneumonic effusions and five with pleural empyemas, drawn from 160 patients presenting with pleural effusions were studied. The age of the patients ranged from 15 to 92 years. Initial thoracocentesis showed mean (SD) values of pH 7.1 (0.15), glucose 45.9 (17.5) mg/dl, white blood cell count 12,000 (6627)/mm3. Streptokinase was administered intrapleurally in a single daily dose of 250,000 units in 100 ml normal saline via the chest tube once the drainage was < 100 ml/24 hours. Patients were treated for 3-10 (mean 6) days. RESULTS: Following administration of streptokinase a clinical and radiological improvement was noted in all but one patient who died on the fourth day of hospitalisation due to widespread adenocarcinoma. Another patient with clinical but minimal radiological improvement underwent thoracotomy, but a clear pleural space with only fibrotic changes was found. The mean (SD) volume of fluid drained 24 hours before streptokinase was 42.5 (39) ml, which increased in the first 24 hours after streptokinase to 334 (130) ml. Radiological evaluation showed an excellent improvement in 14 of the 20 patients, a moderate improvement in three, and minimal improvement in the remaining three patients. One patient developed a high fever as an adverse reaction to streptokinase. All 19 patients who completed the treatment were well at follow up 6-30 months (mean 15 months) later. CONCLUSIONS: Intrapleural instillation of streptokinase is an effective and safe mode of treatment for complicated parapneumonic effusions and pleural empyemas and alleviates the need for thoracotomy.

Adolescent↗
PubMed1994

Bronchoalveolar lavage findings in a young adult with idiopathic pulmonary haemosiderosis and coeliac disease.

Idiopathic pulmonary haemosiderosis is a rare disease of unknown autoimmune aetiology, mainly affecting children and adolescents. A variety of coexisting autoimmune diseases have been described, including coeliac disease. We describe the case of a man, aged 19 yrs, presenting with a one year history of recurrent haemoptysis. Gluten and gliadin antibodies were positive, and the jejunal biopsy revealed villous atrophy consistent with the diagnosis of coeliac disease. Bronchoalveolar lavage fluid analysis showed a mean haemosiderin score (Golde index) of 240, and a local suppressor/cytotoxic profile on immunocytology. Both clinical and immunological improvement was obtained after a month of gluten-free diet. These immunological findings provide new insight into the pathogenesis of this disease.

Adult↗
PubMed1993

Respiratory muscles in endocrinopathies.

The aim of this review was to demonstrate that RM function is altered in various endocrinopathies and that RM weakness is a common finding. RM function has been well-studied in diseases such as thyroid dysfunction, and steroid induced RM myopathies. Less well documented reports on RM function were found in parathyroid dysfunctions, disorders of mineralocorticoids and pituitary disturbances. Controversial reports were found in diabetes mellitus. No report was found connecting RM function with androgens, pheochromocytoma or adrenaline deficiency in humans. These diseases could potentially cause RM impairment leading to severe respiratory failure (pump failure) putting life in great danger. Therefore, it is obvious that further studies are needed to investigate the performance of RMs in endocrinopathies. Such studies are extremely urgent in Cushing's and Addison's disease, acromegaly, disorders of the adrenal medulla, and in diabetes insipidus.

Endocrine System Diseases↗
PubMed1993

Effect of aminophylline on respiratory muscle strength after upper abdominal surgery: a double blind study.

BACKGROUND: The effect of aminophylline on maximum respiratory muscle strength in patients undergoing upper abdominal surgery was investigated. METHODS: An open pilot study was performed in which aminophylline was administered continuously for 48 hours after surgery (protocol I). In a second group of subjects aminophylline was given for 24 hours after cholecystectomy in a double blind placebo controlled trial (protocol II). Twelve patients participated in the pilot study (group A) and 25 in protocol II of which 14 received aminophylline (group B) and 11 placebo (control, group C). Respiratory muscle strength was assessed by measuring mouth pressures during maximum static inspiratory and expiratory efforts. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), vital capacity (VC), inspiratory maximum pressures (PImax), expiratory maximum pressures (PEmax) were measured 24 hours preoperatively, PImax and serum theophylline 24 hours postoperatively, and FEV1, FVC, VC, PImax, PEmax, and serum theophylline 48 hours after surgery. RESULTS: FEV1, FVC, and VC decreased in all groups of patients at +48 hours. PImax fell at +24 hours and +48 hours but this decrease was significantly smaller in the two groups who received aminophylline than in the control group. PEmax showed a decrease at +48 hours but this reduction was similar in all three groups studied, independent of the treatment given. These data suggest that either aminophylline had a protective effect only on the inspiratory muscles or, most probably, that the effect of aminophylline was central, reducing the phrenic nerve inhibition induced by cholecystectomy and thus improving diaphragmatic function. CONCLUSIONS: Upper abdominal surgery decreases inspiratory and expiratory muscle strength and aminophylline has a protective effect only on inspiratory muscle function. This may have important clinical applications in minimising pulmonary complications after cholecystectomy.

Abdomen↗
PubMed1992

The role of inexperience in measuring tuberculin skin reaction (Mantoux test) by the pen or palpation technique.

We have shown previously that experienced readers can use the palpation or pen method for reading the Mantoux tuberculin skin test with accuracy. In order to investigate if the inexperienced reader can use both methods with the same degree of accuracy, we performed Mantoux tests in 539 healthy subjects, aged 20-57 years (mean 33 years), using the PPD-RT 23 in dose 2 I.U. (1/5000). In random order and a double-blind fashion, an experienced and an inexperienced reader measured the induration after 48 h by the palpation method initially and then by the pen method, without knowing the identity of the subject. Results of the study did not show any significant difference in any range of measurements by the two readers, using either the pen or palpation method (P greater than 0.1). A highly statistically significant linear relationship was found between the measurements by the pen method used by experienced and inexperienced readers (r = 0.823, P less than 0.0001) and between the palpation measurements by the two readers (r = 0.939, P less than 0.0001). We conclude that the effects of an inexperienced examiner in the measurement of of tuberculin skin induration are minimal. Inexperienced readers can use the pen method as accurately as the traditional palpation method.

Adult↗
PubMed1992

Massive bilateral pleural effusion as the only first presentation of systemic lupus erythematosus.

A rare case of systemic lupus erythematosus (SLE), with massive bilateral pleural effusions as the first manifestation, is described. The patient was a previously healthy 20-year-old soldier. Initial investigations were unrevealing, but after 3 months the patient developed the full-blown syndrome. He responded well to corticosteroids and cyclophosphamide with resolution of the pleural effusions and improvement of the clinical picture. SLE should always be considered in cases of massive pleural effusions, even in the absence of other overt stigmata of the disease.

Adult↗
PubMed1992

Mediastinal fibrosis and radiofrequency radiation exposure: is there an association?

A 45-year-old officer, working for a period of 18 years at a military radar base, presented with progressive exertional dyspnea, dry cough, and hemoptysis. Subsequent evaluation demonstrated a left pulmonary artery occlusion as well as a left upper lobe bronchus stenosis, due to a dense fibrotic mediastinal mass. Histologically, this proved to be idiopathic mediastinal fibrosis (IMF). The development of IMF in a man exposed for a long period to radio-frequency radiation (RFR) is unique in the literature in English. The possible association of radiation exposure with IMF is discussed.

Angiography, Digital Subtraction↗