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Biomedical subjects

E M Cordasco

Publications and source records attributed to E M Cordasco.

At least 19 recordsLinked to original sources
PubMed2001

Permanent respiratory impairment and upper airway symptoms despite clinical improvement in patients with reactive airways dysfunction syndrome.

We previously reported clinical findings for 19 patients who developed symptomatic airways hyperactivity following an acute exposure to an inhaled irritant and who were given the diagnosis of reactive airways dysfunction syndrome (RADS). We now report on nine of these patients who have been followed for a mean of 9 years, allowing assessment of function, symptoms, and comorbidity beyond the early phase of acute airway injury and inflammation. None of the patients have resolved their airway hyper-responsiveness and symptoms completely, although only in one subject, who had a premorbid history of asthma, has the condition progressed. A common feature has been sinusitis and other upper-airway symptoms. We conclude that in this group of patients, RADS presented in a consistent pattern regardless of the cause of airway injury, resolved only partially, even in subjects without a premorbid history of respiratory disease, and was associated with significant secondary morbidity, especially affecting the upper airway. This pattern was evident regardless of smoking status or age at time of exposure. We conclude that for these subjects, RADS was a distinct entity with a consistent natural history that conferred permanent impairment, but did generally improve somewhat over time.

Adult↗
PubMed1995

Noncardiac pulmonary edema, newer environmental aspects. An update.

Accidental spread of potentially toxic gases, fumes, and particulate chemicals has been reported recently in various cities throughout the country and appears to be on the increase throughout the world in the past few years. Moreover, cerebral trauma, septic shock (ARDS), and environmental pulmonary edema from drug intoxication have been commonly encountered. Newer modalities of treatment include selective [corrected] fiber optic bronchoscopy, constant positive airway pressure mask, administration of surfactant, pentoxifylline, and use of newer experimental agents such as nitrous oxide, antitumor necrosis factor (ATNF), and extracorporeal carbon dioxide with low-frequency positive pressure (ECCO2R-LFPPV). The future holds promise for probable reductions in both morbidity and mortality rates of this ubiquitous occupational and environmental health problem, which is of global importance.

Accidents, Occupational↗
PubMed1993

Concentric tracheal and subglottic stenosis. Management using the Nd-YAG laser for mucosal sparing followed by gentle dilatation.

Treatment of tracheal stenosis varies with the type and extent of the disease. Tracheostomy with stents, end-to-end anastomosis, or extensive reconstructive procedures often is required, especially when tracheomalacia is present. High recurrence rate is associated with relatively less invasive endotracheal treatments, such as bougie dilatation or total laser ablation. Mucosal sparing technique using Nd:YAG laser photodissection (LPD) and gentle dilatation (GD) can provide durable successful results in selected patients with benign concentric tracheal stenosis (CTS). In our study of 18 patients with CTS, 12 were successfully treated with Nd:YAG LPD and GD. Of these patients, eight required a single treatment while four required two or more treatments. No patients required new tracheostomy to carry out the procedure. Follow-up periods ranging from 2 to 85 months (mean: 32.6 +/- 1.5 months) for 12 successfully treated patients have revealed no recurrence of their stenosis. Lengthy scars (> 1 cm) and tracheomalacia were the clinical features common to those patients who failed the treatment. We advocate the use of Nd:YAG LPD in conjunction with "gentle" rigid bronchoscopic dilatation as the initial treatment of CTS.

Adult↗
PubMed1991

Hypersensitivity pneumonitis versus invasive pulmonary aspergillosis: two cases with unusual pathologic findings and review of the literature.

Two brothers simultaneously exposed to moldy hay, who developed differing forms of Aspergillus-related lung disease, are presented. Patient 1 developed a true case of hypersensitivity lung disease, whereas his brother developed invasive aspergillosis with bronchoalveolar lavage eosinophilia and unusual pathologic features including tissue eosinophilia. The possible overlap between hypersensitivity pneumonitis and invasive aspergillosis in the immunocompetent host is discussed.

Adult↗
PubMed1990

Multiplane gallium tomography in assessment of occupational chest diseases.

Gallium-67 scintigraphy is helpful in the evaluation of inflammatory, respiratory diseases. Single-photon emission computed tomography (SPECT) provides three-dimensional tomographic reconstruction of radioisotope distribution in the body. The addition of SPECT to gallium-67 scanning in 27 patients demonstrated an improvement in the sensitivity for detecting the presence and extent of interstitial occupational lung disease. This technique may provide earlier detection of parenchymal lung changes than can the chest x-ray and planar scanning in some patients with asbestosis. Findings in six patients with asbestosis are reported.

Adult↗
PubMed1990

Lymphangiomyomatosis--newer concepts in pathogenesis and management--case reports.

Lymphangiomyomatosis was first reported more than forty years ago. Although its incidence is rare, its occurrence is being increasingly recognized and has been the subject of a growing number of cases reports in recent years. This study adds 2 more cases to the file. Both cases involved young women with the characteristic symptoms of dyspnea, cough, abdominal discomfort and swelling, chest pain, and hemoptysis, with abundant formation of refractory chylous, serous ascites. Although the progression of the disease differed in each case, pulmonary function was affected in a similar way by the presence of obstructive and restrictive defects and a decrease in diffusing capacity. Underlying abnormalities were dilated lymphatics, thickened lymphatic walls, and muscular proliferation of leiomyomatous origin, leading to bronchial restriction. The authors point to the subtlety required in arriving at a differentiated diagnosis of lymphangiomyomatosis lymphangioleiomyomatosis and the difference between the two conditions. They also make particular recommendations in respect to the importance of preliminary hormone receptor tests and to the wisdom to be exercised in ligating a main lymphatic duct in the chest to control the formation of ascites. Pneumothorax, a frequent manifestation of lymphangiomyomatosis, is found to be the result of chronic air trapping due to a combination of narrowing of conducting airways and disruption of normal lung parenchyma.

Adult↗
PubMed1990

Quantitation of abnormal 67Ga uptake in pulmonary interstitial vascular disease--a new test to detect diffuse lung disease.

Gallium 67 has been used as a modality to diagnose and follow the clinical course of diseases such as tumors, infections, inflammatory disorders, and interstitial lung disease. It has been appreciated, however, that mild to moderate changes in scan activity, when these disorders are followed over time, are less than optimal. SPECT (single-photon emission computed tomography) scanning is a new technique designed to obviate this problem. SPECT scanning utilizes computer acquisition to provide three-dimensional scanning and the additional benefit of colorization to aid in discerning differences of uptake. SPECT scanning was performed on 22 patients with interstitial lung disease of various etiologies. Additionally, 7 patients had follow-up SPECT scanning to determine their response to treatment. Two patients are presented as examples.

Female↗
PubMed1990

The effects of steroid therapy on pulmonary hypertension secondary to fibrosing mediastinitis.

Mediastinal fibrosis, a rare cause of pulmonary hypertension, may produce cough, dyspnea, and hemoptysis. Steroid therapy has been suggested for individuals with progressive symptoms, but data demonstrating the efficacy of such therapy are lacking. We present a case of pulmonary hypertension secondary to fibrosing mediastinitis. Hemodynamic and scintigraphic studies performed before and after a trial of corticosteroid therapy were unable to demonstrate any therapeutic benefit from the corticosteroids. In order to achieve better use of steroids for the treatment of this disease, we suggest that similar determinations be made on other patients with mediastinal fibrosis who receive such treatment.

Adult↗
PubMed1986

Hyperventilation syndrome and asthma.

Hyperventilation syndrome is a common and often disabling condition. Traditional treatment consists of reassurance and anxiolytic drugs. Hyperventilation is known to precipitate an asthmatic reaction. A retrospective review of patients with hyperventilation syndrome was performed to ascertain the frequency of asthma as well as the response to bronchodilator medication. Forty-seven patients were seen. Thirty-eight were tested, and asthma was proved in 36. Two additional patients had positive clinical responses with bronchodilators. Thus, asthma was identified in 38 of 47 consecutive patients seen for hyperventilation syndrome (80 percent), and asthma was proved in 36 of 38 of patients tested (95 percent). Hyperventilation syndrome was eliminated in 29 of 35 patients (90 percent) treated with a combination of explanation and bronchodilator treatment.

Adult↗
PubMed1986

Pulmonary edema of environmental origin--newer concepts.

Pulmonary edema of non-cardiac origin is usually an urgent clinical problem, which has recently increased in frequency throughout the world in the past few years. This is partly due to sociological factors and to pre-eminent advances in industrial technology. Recent severe massive toxic gas explosions have had national and worldwide implications. Therefore, urgent and appropriate therapy is of utmost importance in most of these patients. The use of high flow oxygen with Constant Positive Pressure Breathing are the main inhalational therapeutic approaches. Newer modalities of treatment include: (1) earlier Fiberoptic bronchoscopy in those individuals afflicted with aspiration problems and (2) certain specific chemical blocking agents for the management of phosgene intoxication and hydrogen sulfide toxicity. Preventive environmental measures are also important.

Adult↗
PubMed1986

Transdermal scopolamine in the treatment of asthma: a preliminary report.

The use of atropine has emerged over the past few years as a treatment for asthma. Scopolamine is pharmacologically similar to atropine and, as such, was used in a study of nine patients as a bronchodilator. These nine patients had diverse types of lung diseases. Two patients were intolerant to the medication and were not able to participate in the study. The other seven patients had variable responses with significant improvement in baseline pulmonary function testing occurring in four patients. Five of the seven patients had symptomatic relief and are now employing transdermal scopolamine on a once-every-3-days basis for the treatment of their bronchoconstriction. Baseline testing was performed to indicate response to parasympatholytic medications. Transdermal scopolamine appears to be a safe and effective means of achieving bronchodilation in some patients with asthma.

Administration, Cutaneous↗
PubMed1986

Home care ventilation: the Cleveland Clinic experience from 1977 to 1985.

A need for long-term ventilation in the home has created a demand for home care services that has been a source of growth for an industry. Evaluation of the patient and family who will guarantee successful home care requires careful psychological and psychiatric evaluation. Beyond this evaluation, long-term success is possible if appropriate financial resources are available. The implementation of successful home care is best done by a team consisting of primary physician, primary ICU nurse, social worker, psychiatrist, and home care respiratory therapist. An appropriate classification of patients based on goals of care, as well as the study of the incidence and prevalence of associated disorders, will be helpful in the future allocation of resources.

Data Collection↗
PubMed1986

An angiographic dilemma: bronchopulmonary sequestration versus pseudosequestration: case reports.

Bronchopulmonary sequestration is a congenital anomaly in which part of the pulmonary tissue is detached from the normal lung and is supplied by anomalous systemic arteries. The sequestered, aberrant lung tissue does not have normal connections with the tracheobronchial tree or pulmonary arteries. In some patients with angiographic characteristics of this disorder, no sequestration is found at the time of surgery. We present three cases in which systemic arterialization of a portion of lung occurred without actual sequestration. Such cases of pseudosequestration can present a diagnostic challenge preoperatively and should be considered whenever angiographic findings compatible with bronchopulmonary sequestration are found.

Adolescent↗
PubMed1984

Pulmonary lymphangiomyomatosis.

Lymphangiomyomatosis is an interesting disease with distinctive clinical and histopathologic findings. We report herein two additional cases of lymphangiomyomatosis, including one with clinical improvement after therapy with progesterone. This case is of particular significance in view of the patient's negative sex steroid receptor analysis. These findings open new avenues for future considerations in the therapy of this unusual but interesting disease.

Adult↗