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Biomedical subjects

E C Rosenow

Publications and source records attributed to E C Rosenow.

At least 19 recordsLinked to original sources
PubMed1997

Physical examination during space flight.

OBJECTIVE: To develop techniques for conducting a physical examination in microgravity and to describe and document the physiologic changes noted with use of a modified basic physical examination. DESIGN: On the basis of data gathered from physical examinations on KC-135 flights, three physical variables were assessed serially in astronauts during two shuttle missions (of 8- and 10-day duration, respectively). Preflight, in-flight, and postflight examinations were conducted by trained physician-astronauts or flight surgeons, who used this modified examination. MATERIAL AND METHODS: Five male and two female crewmembers participated in the "hands-on" physical examination of all physiologic systems except the genitourinary system. Level of edema, intensity of bowel sounds, and peripheral reflexes were assessed and graded. RESULTS: This investigation identified unique elements of a physical examination performed during space flight that will assist in the development of standard methods for conducting examinations of astronauts in weightlessness. In addition, demonstrable changes induced by microgravity were noted in most physiologic systems examined. CONCLUSION: The data support the hypothesis that the microgravity examination differs from that conducted on earth or in a 1g environment. In addition, alterations in the physiologic response can be detected with use of hands-on technique. These data are invaluable in the development of optimal medical care for humans in space.

Auscultation↗
PubMed1996

Persistent cough: causes and cures.

Refractory cough in a patient with a normal chest X-ray usually falls into one of five categories: drug-induced (especially by ACE inhibitors), secondary to postnasal discharge, gastroesophageal reflux, or hyperactive airway disease, and idiopathic but responsive to nebulized lidocaine. The history may point to the most likely cause, and empiric therapy may confirm the diagnosis.

Algorithms↗
PubMed1996

Drug-induced interstitial lung disease.

Drugs can have multiple different adverse effects on the lungs, airways, pleura, mediastinum, and the interstitium. Their appearance can mimic other interstitial lung diseases and, for the most part, drug-induced interstitial lung disease is a condition of exclusion rather than a specific entity that can be diagnosed with imaging studies or histology. It is important to be aware of all the potential adverse effects of drugs on the lung in order to recognize the condition and to discontinue the drug as soon as possible, as death will result in many of the situations discussed here if appropriate measures are not taken.

Anti-Arrhythmia Agents↗
PubMed1996

Pulmonary artery sarcoma. Clinical features.

STUDY OBJECTIVES: To define characteristic clinical and radiographic presentations of patients found to have primary sarcoma of the pulmonary artery and differentiate this entity from acute and chronic pulmonary thromboembolism. To review pathologic characteristics of pulmonary artery sarcoma. DESIGN: A retrospective review of medical records at a large medical center and a review of the literature. SETTING: Tertiary care medical center. PATIENTS: Patients found to have pulmonary artery sarcoma based on surgical or autopsy findings. INTERVENTIONS: Review of medical records. MEASUREMENTS AND RESULTS: Presenting symptoms of patients with pulmonary artery sarcoma are similar to those of patients with other pulmonary vascular disease, including progressive dyspnea, cough, hemoptysis, and chest pain. Symptoms not commonly associated with pulmonary vascular disease consist of progressive weight loss, anemia, and fever, which are symptoms commonly associated with malignancy. The diagnosis is often not suspected prior to surgery, which is often undertaken with an alternative diagnosis such as bronchogenic carcinoma or chronic pulmonary thromboembolism. Prolonged survival is rare; most patients survive only a few months. Survival longer than 3.5 years was not observed. Recent experience with MRI of the thorax and transesophageal echocardiography suggests that these diagnostic entities may be rewarding in separating the abnormalities seen on chest radiographs and angiography from thrombus in the pulmonary artery, mediastinal adenopathy, or primary bronchogenic carcinoma. CONCLUSIONS: Although a rare entity, the key is to suspect the presence of pulmonary artery sarcoma in evaluation of patients with atypical presentations of pulmonary vascular disease especially if associated with symptoms such as weight loss, fever, or anemia.

Adult↗
PubMed1995

Venous and pulmonary thromboembolism: an algorithmic approach to diagnosis and management.

The frequently encountered disorder of venous thromboembolism (VTE) can cause serious morbidity and even death. Nevertheless, in more than 70% of patients who die of pulmonary embolism (PE), the diagnosis is not considered before death. Thus, clinicians should have a high index of suspicion for VTE, especially in high-risk patients. Some risk factors for VTE are a recent surgical procedure and general anesthesia, immobilization, congestive heart failure, previous PE, pregnancy, and oral contraceptive use. Before therapy can be initiated, a definitive diagnosis of VTE must be established. An algorithm for assessing patients with possible VTE is presented; decisions about proceeding with various studies are based primarily on the clinician's degree of suspicion for the presence of PE and the findings on a ventilation-perfusion scan. Elevation of the patient's legs before, during, and after a surgical procedure is a simple measure that may substantially decrease the occurrence of PE.

Algorithms↗
PubMed1995

Drug-induced pulmonary disease.

In any febrile patient with an unexplained chest radiographic abnormality who is on medication, the possibility that the observed abnormality is drug-induced must be kept in mind. This is a significant problem in the immunocompromised host receiving chemotherapeutic agents because these agents are almost always associated with a fever, although the fever may not be daily and is usually not associated with sweats or shaking chills. The infiltrate initially can be quite focal and then unilateral, exhibiting diffuse lung disease before becoming bilateral. Thus, in its early stages, it mimics an infectious process. Unfortunately there is no diagnostic test to rule in drug-induced lung disease because it really is a condition of exclusion. Lung biopsy may be required to exclude other causes. It is also important to remember that drugs may be a factor in the immunocompetent patient who is taking medication and has a fever. It is important for the clinician to be aware of which drugs can do this.

Amiodarone↗
PubMed1994

Drug-induced pulmonary disease.

Drug-induced disease of any system or organ can be associated with high morbidity and mortality, and it is tremendously costly to the health care of our country. More than 100 medications are known to affect the lungs adversely, including the airways in the form of cough and asthma, the interstitium with interstitial pneumonitis and noncardiac pulmonary edema, and the pleura with pleural effusions. Patients commonly do not even know what medications they are taking, do not bring them to the physician's office for identification, and usually do not relate over-the-counter medications with any problems they have. They assume that all nonprescription drugs are safe. Patients also believe that if they are taking prescription medications at their discretion, meaning on an as-needed basis, then these medications are also not important. This situation stresses just how imperative it is for the physician to take an accurate drug history in all patients seen with unexplained medical situations. Cardiovascular drugs that most commonly produce a pulmonary abnormality are amiodarone, the angiotensin-converting enzyme inhibitors, and beta-blockers. Pulmonary complications will develop in 6% of patients taking amiodarone and 15% taking angiotensin-converting enzyme inhibitors, with the former associated with interstitial pneumonitis that can be fatal and the latter associated with an irritating cough that is not associated with any pathologic or physiologic sequelae of consequence. The beta-blockers can aggravate obstructive lung disease in any patient taking them. Of the antiinflammatory agents, acetylsalicyclic acid can produce several different airway and parenchymal complications, including aggrevation of asthma in up to 5% of patients with asthma, a noncardiac pulmonary edema when levels exceed 40 mg/dl, and a pseudosepsis syndrome. More than 200 products contain aspirin. Low-dose methotrexate is proving to be a problem because granulomatous interstitial pneumonitis develops in 5% of those patients receiving it. This condition occurs most often in patients receiving the drug for rheumatoid arthritis, but it has been reported in a few patients receiving it for refractory asthma. Chemotherapeutic drug-induced lung disease is almost always associated with fever, thus mimicking opportunistic infection, which is the most common cause of pulmonary complications in the immunocompromised host. However, in 10% to 15% of patients, the pulmonary infiltrate is due to an adverse effect from a chemotherapeutic agent. This complication is frequently fatal even when recognized early.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

Chylothorax in Gorham's syndrome. A common complication of a rare disease.

One hundred forty-six cases of Gorham's syndrome are documented in the literature. Twenty-five (17 percent) patients have been reported to have chylothorax as a complication. To our knowledge, this high incidence of chylothorax has not been reported previously. We describe two such patients treated by thoracic duct ligation and compared our results with others to support early surgical intervention via a low right-sided thoracotomy in these cases.

Adolescent↗
PubMed1993

Idiopathic pulmonary hilar fibrosis: an unusual cause of pulmonary hypertension.

A 37-year-old man with progressive exertional dyspnea had pulmonary hypertension associated with pulmonary arterial and venous obstruction. An autopsy revealed that the cause of death was idiopathic pulmonary hilar fibrosis, a variant of mediastinal fibrosis. Pulmonary hilar fibrosis can mimic thromboembolic pulmonary hypertension, pulmonary veno-occlusive disease, and pulmonary venous hypertension.

Adult↗
PubMed1993

Pulmonary lymphoproliferative disorders.

Pulmonary lymphoproliferative disorders are a diverse group of conditions that primarily or secondarily involve the lungs. Modern diagnostic modalities, including immunologic and molecular genetics techniques, have contributed substantially to the continuously evolving understanding of these complex lesions. In this review, we classified pulmonary lymphoproliferative disorders into benign, intermediate or indeterminate, and malignant categories and described the clinical, radiographic, and pathologic features for the entire spectrum. Our emphasis is on the clinical findings and the role of tissue biopsy as well as ancillary techniques in diagnosis. Various treatments and expected responses are also discussed.

Humans↗