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E W Russi

Publications and source records attributed to E W Russi.

At least 19 recordsLinked to original sources
PubMed1992

[Diagnosis and course of patients with HIV infections and exclusion of Pneumocystis carinii pneumonia].

30 patients infected with HIV (20 men, 10 women; mean age 34 [26-54] years), suspected of having Pneumocystis carinii (Pc) pneumonia, had undergone bronchoalveolar lavage which proved negative for Pc. They were then kept under observation for 5 months. No transbronchial biopsy was performed. 27 patients were in stage IV of the HIV infection, and 14 had been on pentamidine prophylaxis. The most frequent diagnosis with the bronchial lavage was bacterial infection (19 patients), next most frequent was mycobacterial infection (6, atypical in 5). A neoplasia (Kaposi sarcoma; non-Hodgkin lymphoma) was found in two, with pulmonary involvement. The diagnosis remained unclear in only three patients who were treated as for Pc pneumonia. The remaining 27 patients did not receive any treatment against Pc. Nonetheless, there were no cases of Pc pneumonia in the 5 months of observation so that bronchoalveolar lavage has a negative predictive value of 90% (27 of 30), high enough to make additional bronchial biopsy unnecessary.

Adult↗
PubMed1992

[Significance of bronchial alveolar lavage in the diagnosis of eosinophilic pneumonia].

We describe 3 cases of eosinophilic pneumonia of unknown etiology with atypical clinical findings diagnosed by bronchoalveolar lavage (BAL). In 2 patients with subacute symptoms and restrictive ventilatory dysfunction there was no eosinophilia in peripheral blood, and chest X-ray showed a bilateral acinar and mixed interstitial-acinar pattern respectively. Transbronchial lung biopsies revealed only nonspecific changes. The third patient had acute respiratory failure and the eosinophils in peripheral blood were 1500/microliters. Chest X-ray demonstrated only minimal interstitial changes. In all instances the eosinophilic pneumonia was diagnosed by a marked BAL-eosinophilia of 25 to 45%. No specific etiology could be detected for the eosinophilic lung disease. The response to treatment with corticosteroids was prompt.

Aged↗
PubMed1992

[Pneumocystis carinii pneumonia in HIV-negative immunosuppressed patients].

During a period of 10 years 129 immunosuppressed HIV-negative patients were evaluated for pulmonary complications. A definite diagnosis could be established in 72 cases (56%): Pneumocystis carinii pneumonia (PCP) (25), pulmonary involvement of underlying disease (10), drug toxicity (8), mycobacterioses (6), bacterial pneumonias (5), aspergillosis (5), others (13). The underlying conditions in patients with PCP were: lymphatic neoplasias (11), immunosuppression after solid organ (9) and after bone marrow transplantation (3), cytotoxic therapy for lupus erythematodes (1) and carcinoma (1). In 8 of 9 transplant patients anti-rejection therapy preceded the episode of PCP. Six patients (24%) died from respiratory failure 1 to 25 days after diagnosis of PCP, despite mechanical ventilation in four. Two patients recovered completely after mechanical ventilation for 14 and 30 days respectively. The frequency of PCP has markedly increased during the last few years: 1981-1987: 2 cases (6%), 1988: 4 (14%), 1989: 8 (42%) and 1990: 11 (26%). This can hardly be explained by improved diagnostic sensitivity or an increased number of immunosuppressed patients. Apart from the use of more potent immunosuppressive agents, the increased prevalence of Pneumocystis carinii may play an important role.

Adolescent↗
PubMed1992

Prospective evaluation of a prognostic score for Pneumocystis carinii pneumonia in HIV-infected patients.

Serum lactate dehydrogenase levels, alveolar-arterial oxygen gradient, and percentage of neutrophils in bronchoalveolar lavage correlate most strongly with early mortality in Pneumocystis carinii pneumonia (PCP) in HIV-infected patients. However, the individual outcome can not be predicted by these parameters due to a considerable overlap between survivors and nonsurvivors. We prospectively investigated a PCP severity score, which has been developed earlier based on a retrospective analysis. Seven of 94 consecutively examined HIV-infected patients died within 14 days after diagnosis of PCP. A PCP severity score greater than 7 had a positive predictive value for early fatal outcome of 66.7 percent (6/9) and a negative predictive value of 98.8 percent (84/85). The overall diagnostic accuracy was 95.7 percent (90/94). The positive predictive value for early fatal outcome of a P(A-a)O2 > 35 mm Hg was 24 percent (6/25); the negative predictive value was 98.6 percent (68/69). However, the overall diagnostic accuracy was only 78.7 percent (74/94). The PCP severity score is a valuable tool for clinical decision making, for the early identification of patients with a prognostic unfavorable course, and for the comparison of patient populations in future studies of HIV-associated PCP.

AIDS-Related Opportunistic Infections↗
PubMed1991

[Long-term course following respiratory decompensation in chronic obstructive pulmonary disease (COPD)].

The probability of respiratory decompensation in chronic obstructive pulmonary disease correlates with the severity of the ventilatory impairment. Forced expiratory volume in one second (FEV1) is an easily measurable parameter to quantify bronchial obstruction and predicts long-term outcome. Patients who need to be ventilated because of respiratory decompensation belong to a prognostically unfavourable group. This overview discusses the indications for artificial ventilation as well as measures which evidently or possibly may improve the quality and duration of life in these patients.

Airway Obstruction↗
PubMed1991

[The therapy of chronic respiratory insufficiency].

The treatment of chronic respiratory failure aims to influence the underlying disease and to alleviate the pathophysiologic consequences. Respiratory stimulants, long-term oxygen-therapy as well as mechanical stabilization of the upper airways and ventilation at home are discussed.

Almitrine↗
PubMed1991

[The clinical significance of bronchoalveolar lavage].

Bronchoalveolar lavage (BAL) has evolved from a powerful investigative tool to an important clinical method. It has been found to be diagnostic in several infectious and noninfectious diseases involving the lower respiratory tract, and it provides valuable information for the differential diagnosis, management and prognosis of interstitial lung disorders. Nevertheless there is a pressing need for standardization of the technical aspects of BAL.

Alveolitis, Extrinsic Allergic↗
PubMed1991

[Old and new aspects in the diagnosis of pulmonary embolism].

Pulmonary embolism remains a common complication of deep venous thrombosis. The diagnosis is often difficult, since symptoms and clinical signs are sensitive but unspecific. ECG, chest X-ray and blood chemistry serve to rule out other diseases. A normal lung perfusion scan excludes clinically relevant recent pulmonary emboli; multiple segmental perfusion defects support this diagnosis. Other scintigraphic findings have to be interpreted cautiously. Pulmonary angiography remains the diagnostic gold standard.

Angiography↗
PubMed1991

Primary pulmonary hypertension in HIV infection.

A prospective evaluation of 74 human immunodeficiency virus (HIV)-infected patients with cardiopulmonary complaints revealed six patients (8.1 percent) with pulmonary hypertension with elevated right ventricular systolic over right atrial pressure of 58 +/- 8 mm Hg (range, 49 to 66 mm Hg), as documented by Doppler echocardiography. A thromboembolic cause was excluded by normal lung perfusion scans. Electrocardiographic and roentgenographic features of pulmonary hypertension were present in five patients. Two patients died three and nine months after diagnosis of pulmonary hypertension. Autopsy revealed plexogenic pulmonary arteriopathy in both. The observation of six patients with primary pulmonary hypertension (PPH) in a cohort of 1,200 HIV-infected subjects corresponding to an incidence of 0.5 percent is striking and suggests a possible association of PPH with HIV infection.

Adult↗
PubMed1990

[Current aspects in the diagnosis of pulmonary infections in intensive care patients].

The diagnosis of pneumonia in the ICU patient is difficult and controversial. Clinical aspects and examination of tracheobronchial secretions are often unhelpful and even misleading. Blood and pleural fluid cultures are not sensitive, while transtracheal or transthoracic aspirations are contraindicated in the ventilated patient. However, quantitative cultures of protected specimen brush samples and bronchoalveolar lavage fluid improve sensitivity and specificity of diagnosis in pulmonary infections in the ICU patient. An easy and rapid aid in differentiating infection from colonization is quantitative analysis of gram-stained specimens of bronchoalveolar lavage fluid.

Acute Disease↗
PubMed1990

[Pneumocystis carinii pneumonia in HIV infection: better prognosis because of early diagnosis].

The clinical presentation of 60 consecutive Pneumocystis carinii pneumonias in 58 HIV-infected patients (48 men, 10 women, mean age 34 [22-53] years) was prospectively evaluated from April to August 1989 and compared with 60 consecutive P. carinii pneumonias in 59 HIV-infected patients (55 men, 4 women, mean age 37.5 [22-60] years) between 1981-88. Mortality rates within 14 days after diagnosis of P. carinii pneumonia were 50% (8 of 16 patients) until 1985, 20.5% (9 of 44) between 1986 and August 1988, and 1.7% (one of 60) in 1989. The degree of severity of the pneumonias at time of diagnosis was markedly lower in 1989, as shown by following parameters (averages of 1989, compared with averages of 1981-88): lactate dehydrogenase 540 (250-1419) U/l versus 680 (235-1920) U/l (not significant); alveolo-arterial difference of partial oxygen tension (pA-aO2) 22.9 (0.5-73.5) mmHg versus 39.7 (19-70) mmHg (P less than 0.001); score of radiological findings 1.4 (0-3) versus 2.7 (0-4) (P less than 0.001). In 1989, mainly clinical symptoms (dry cough: 57 of 60 cases, dyspnea: 44 of 60 cases, fever: 43 of 60 cases) initiated the diagnostic procedure: chest radiographs, lactate dehydrogenase and pA-aO2 were normal in 13, 25 and 33 episodes, respectively. The lower mortality rate of P. carinii pneumonia could not primarily be explained by therapeutical progress since the treatment of choice did not change fundamentally since 1981. Above all, early diagnosis fundamentally determined the probability of survival.

Adult↗
PubMed1990

[Experiences with long-term transtracheal oxygen therapy].

A transtracheal catheter (TTC) (Scoop) was implanted in 24 patients (19 men, 5 women) with a mean age of 64 +/- 9 (47 to 78) years. The pO2 was 6.78 +/- 1.65 kPa. Two patients suffered from pulmonary restriction, 22 from severe COPD with a FEV1 of 880 +/- 165 ml. Purulent tracheitis developed in six patients. The pre-Scoop catheter had to be removed in three. In four patients, bronchoscopic aspiration of mucus plugs adhering to the tip of the TTC was necessary. In one patient, the TTC was removed after an uneventful course due to patient's discomfort; another patient no longer qualified for LOT. 19 patients were using the TTC without major problems. Of those, five have died due to severe lung disease. By using TTC, oxygen consumption is halved for the same degree of oxygenation. 12 are using a demand valve device (Oxymatic), which allows a further conservation of oxygen. Patients prefer LOT by a TCC for cosmetic reasons and lack of nasal discomfort.

Aged↗
PubMed1990

[Sleep disturbances from the internist's viewpoint].

Sleep disorders are common and can be caused by somatic diseases. Chronic pain as well as heart and lung conditions are able to interfere with the normal sleep pattern. Obstructive sleep apnea is caused by a deranged central control of breathing occurring during sleep and leads to a sleep-fragmentation and consequently to daytime hypersomnolence. A problem oriented meticulous history can give valuable insights and distinct diagnostic considerations form the basis for an eventually successful therapeutic approach. Polysomnography is done in particularly puzzling cases and for evaluation of invasive therapeutic measures.

Asthma↗
PubMed1990

Prognostic score for Pneumocystis carinii pneumonia.

Sixty episodes of Pneumocystis carinii pneumonia in 59 patients were evaluated for risk factors predicting fatal outcome within 14 days after bronchoscopy. We found significantly higher values for serum lactate dehydrogenase (p less than 0.001), alveolar-arterial oxygen difference (p less than 0.001) and percentage of bronchoalveolar lavage neutrophils (p less than 0.001) in patients dying within 14 days, but there was considerable overlap of these variables between the two groups. Using a score system combining the three parameters allowed however an excellent discrimination between the two groups.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Nosocomial infections of the respiratory tract].

Nosocomial pneumonia is a well recognized complication in hospitalized patients, particularly in those who are intubated and who receive mechanical ventilation. Pathogenesis, diagnostic approach, treatment as well as prevention are discussed.

Bacterial Infections↗
PubMed1989

[Alveolar hemorrhage].

Alveolar hemorrhage (AH) is the result of diffuse bleeding into the acinar portion of the lung. Cardinal symptoms of AH include hemoptysis, dyspnea, alveolar filling opacities on chest roentgenogram, anemia and hypoxemia. However, AH is often misdiagnosed as pneumonia or pulmonary edema at the time of initial presentation. Isolated AH may occur but is more often seen in diffuse connective tissue diseases or in rapidly progressive glomerulonephritis. - At the Medical Clinic of the University Hospital of Zurich we have diagnosed AH in 18 patients (13 males, 5 females) over the last ten years (1978-1988). In 2 patients AH occurred as an isolated symptom: once due to occupational inhalation of fumes containing trimellitic anhydride, and once as so-called idiopathic pulmonary hemosiderosis. In 16 patients AH was associated with kidney disease, including the following disorders: vasculitis and collagen vascular disorders (9), rapidly progressive glomerulonephritis (4) and Goodpasture's syndrome (3). In 5 patients the presenting symptom was AH. 9 patients presented initially with renal symptoms and in 2 patients renal and pulmonary features occurred simultaneously. 7 patients died of the underlying disease or its complications. Both patients with isolated AH have survived. In the remaining 9 patients 1 required dialysis temporarily and 4 permanently. All patients except the one with AH due to inhalation of trimellitic anhydride were treated with immunosuppressive agents. - Since the pulmonary features are similar in each of the AH syndromes, diagnosis of the underlying disorder is heavily dependent upon pathologic evaluation of diseased extrapulmonary organs. Moreover, immunologic studies are essential. Failure to diagnose or treat AH syndromes in the early stages may have lethal consequences.

Adult↗