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Biomedical subjects

D M Kovnat

Publications and source records attributed to D M Kovnat.

12 recordsLinked to original sources
PubMed1978

A prospective cooperative study of complications following flexible fiberoptic bronchoscopy.

The frequency of complications following flexible fiber-optic bronchoscopic procedures was studied prospectively in 908 patients from 13 cooperating hospitals. Major complications (respiratory arrest, pneumonia, pneumothorax, and obstruction of airways) occurred in 1.7 per cent (15) of the procedures. There was one death, yielding a mortality of 0.1%. Minor complications, including vasovagal reactions, fever, cardiac arrhythmias, bleeding, obstruction of airways, nausea and vomiting, pneumothorax, psychotic reaction, and aphonia, occurred in 6.5% of the procedures. Pneumothorax occurred after 5% (four) of 85 transbronchial biopsies. Although serious complications occur more frequently than previously reported from retrospective studies, complications after fiberoptic bronchoscopic procedures are still quite infrequent. The relative risks and benefits must always be carefully weighed in patients being considered for a fiberoptic bronchoscopic procedure.

Adult↗
PubMed1977

Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult.

In order to define the roentgenographic manifestations of pulmonary tuberculosis in the adult, we reviewed a 12 month experience with newly diagnosed patients with active pulmonary tuberculosis in two Boston hospitals. Of 88 patients, 30 (34 per cent) presented with roentgenographic manifestations other than those associated with "usual" postprimary disease. At least 12 patients (13.5 per cent) had primary tuberculosis, including two subjects over 60 years of age. Six patients (6.8 per cent) had disease confined to the lower lung fields, eight patients (9 per cent) had tuberculomas and four (4.5 per cent) had miliary tuberculosis. Twenty per cent of the patients were totally asymptomatic. With the shift of tuberculosis care to community hospitals, knowledge of the varied roentgenographic manifestations is of increasing importance for the practicing internist.

Adult↗
PubMed1977

Bronchial brushing in bronchogenic carcinoma. Factors influencing cellular yield and diagnostic accuracy.

In a prospective study, varying the bronchial brushing technique through the flexible fiberoptic bronchoscope was examined for the effects of cellular yield and diagnostic accuracy. The yield of cells obtained from the 1.7-mm brush was increased by more than twofold when the brush and bronchoscope were withdrawn as a unit through the pharynx and nose, (nonwithdrawn brushing), rather than withdrawing the brush alone through the aspiration channel of the bronchoscope (withdrawn brushing). The greater number of total cells in the nonwithdrawn brushing specimen was largely due to squamous cells, and the yield of tumor cells by the two methods was similar. The yield of cells from the same brush withdrawn through a new suction adapter available on the bronchoscope (Olympus BF-B2) was significantly decreased, as compared with the withdrawn brushing. There was a further decrease using a shielded 1-mm brush. In 23 of 30 cases of proven carcinoma, the diagnosis was made by the single withdrawn brushing, and in 26 of the 30 by the single nonwithdrawn brushing, a difference which was not statistically significant. We conclude that diagnostic accuracy is not significantly enhanced by withdrawing the brush and bronchoscope as a unit through the pharynx and nose; use of a small shielded brush offers no advantage over a larger unshielded brush; modifications of flexible bronchoscopes, such as the adapter to improve efficacy of suction, should be evaluated for effects on harvests of cells from bronchial brushes before being put into general use.

Biopsy↗
PubMed1975

Fever and pneumonia after flexible fiberoptic bronchoscopy.

The frequencies of fever, parenchymal infiltration, and bacteremia were studied prospectively after 100 flexible fiberoptic bronchoscopies performed transnasally under topical anesthesia. Fever occurred after 16 per cent, and parenchymal infiltration, after 6 per cent of the procedures. Most complications were mild and transient; however, one patient developed rapidly progressive pneumonia and died. No organisms were isolated from cultures of blood drawn at the time of the procedure or during complications. The organisms most commonly isolated from the sputum of the patients who developed pneumonia were the aerobic and anaerobic bacteria normally found in the mouth. Isolation of a significant pathogen before the procedure did not predispose to development of a complication. Advanced age (greater than 60 years) and the endoscopic findings of abnormalities were significant predisposing factors. Bronchial brushing, but not bronchial biopsy or bronchial washing, was associated with significantly higher complication rates in patients with bronchial carcinomas than in those without a neoplasm. The mechanism of the fever and parenchymal infiltration is thought to be related to obstructive atelectasis and infection produced by organisms present in the airways at the time of the procedures.

Adult↗
PubMed1975

Bronchial brushing through the flexible fiberoptic bronchoscope in the diagnosis of peripheral pulmonary lesions.

Bronchial brushing was performed concomitantly with transnasal flexible fiberoptic bronchoscopy in 44 patients with localized peripheral pulmonary lesions and absence of visible bronchial abnormality down to subsegmental level. Fluoroscopic confirmation of brush placement was obtained. A diagnosis of malignancy was made by bronchial brushing in 12 of 23 patients (52 percent) proved to have neoplasm, although diagnostic accuracy rose to six of seven patients (86 percent) in the final quarter of the study. There was no relationship between diagnostic accuracy and tumor location. Diagnostic accuracy was highest for squamous cell carcinoma, intermediate for adenocarcinoma, and lowest for undifferentiated carcinoma. A diagnosis of tuberculosis was made in two of 21 patients found not to have malignancy, and bronchial brushing was the only procedure to yield diagnostic material in these two patients. There were no false-positive cytologic examinations and no complications. Fluoroscopic control of placement of the bronchial brush passed through the fiberoptic bronchoscope allows a single, highyield, diagnostic procedure to be performed with minimal risk to the patient. In selected cases, thoracotomy may be avoided by this procedure.

Adenocarcinoma↗
PubMed1975

Prolonged rate of decay of arterial PO2 following oxygen breathing in chronic airways obstruction.

Nine patients with moderate to severe chronic obstructive lung disease were grouped according to results of pulmonary function testing. After a short period of 100 percent oxygen breathing, it took on the average 20 minutes (range--18 to 24 minutes) for their partial pressure of arterial oxygen to return to baseline levels. These data suggest that, after discontinuing supplemental oxygen in patients with chronic airways obstruction, more than 25 minutes should elapse if a blood gas measurement is to reflect with certainty conditions during room air breathing.

Aged↗
PubMedDate not supplied

Subcostal loculated pleural effusion in congestive heart failure: an unusual case of vanishing tumor.

Localized collection of fluid in an interlobar fissure as a consequence of congestive heart failure is a well-known entity. It has been termed vanishing tumor because of its appearance as a mass lesion in the lung and its propensity to resolve with diuretic therapy. We report a case of loculated pleural effusion in the subcostal pleural space without interlobar fluid collection. This was initially thought to represent an occult metastatic malignancy; however, the cause of the density became obvious when it disappeared with therapy of heart failure and recurred concurrent with cardiac decompensation. Loculated pleural effusion must be included in the differential diagnosis of roentgenographic densities in the chest when seen in subcostal as well as in interlobar locations.

Aged↗
PubMedDate not supplied

Adult respiratory distress syndrome following mammary augmentation.

Sudden death after subcutaneous injection of silicone has been described. However, there are no cases in the literature of clinically diagnosed noncardiogenic pulmonary edema. In the patient reported here, progressive hypoxemia and diffuse pulmonary infiltrates occurred following intramammary injection of a material presumed to be silicone. The presence of birefringent particles in the alveolar macrophages implies entrance of this material into the vascular compartment, its embolization to the lung and migration across the damaged alveolar-capillary membrane. Large volume subcutaneous injections of silicone should be added to the differential diagnosis of the etiology of the adult respiratory distress syndrome.

Adult↗