Biomedical subjects

Gerald J Berry

Publications and source records attributed to Gerald J Berry.

44 records · Page 3Linked to original sources

PubMed2002

PG490-88, a derivative of triptolide, attenuates obliterative airway disease in a mouse heterotopic tracheal allograft model.

The current treatment of obliterative bronchiolitis in lung transplant recipients is sub-optimal. Triptolide is a novel immunosuppressant that has a mechanism of action distinct from currently available immunosuppressants, including induction of T-cell apoptosis, blockade of fibroblast proliferation/maturation and inhibition of transforming growth factor-beta (TGF-beta) mRNA production. We hypothesized that triptolide may be helpful in blocking obliterative airway disease in lung transplant recipients. We investigated the effect of PG490-88, a water-soluble derivative of triptolide, in a mouse heterotopic tracheal allograft model of obliterative airway disease. We show that PG490-88 attenuates airway obliteration in this model and inhibits accumulation of inflammatory cells, and therefore may have preventive or therapeutic benefits for patients with obliterative airway disease (OAD) following lung transplantation.

Animals↗

PubMed2002

The role of right ventricular endomyocardial biopsy for idiopathic giant cell myocarditis.

BACKGROUND: Idiopathic giant cell myocarditis (GCM) is an uncommon cause of cardiac failure distinguished clinically from lymphocytic myocarditis by rapidly progressive heart failure, arrhythmias, and heart block. Unlike fulminant lymphocytic myocarditis, patients with fulminant cardiac failure caused by GCM may respond to certain immunosuppressive agents; however, right ventricular endomyocardial biopsy (EMB) is infrequently used to establish the diagnosis partly because the sensitivity of EMB for GCM is unknown. The purpose of this study was to estimate the sensitivity of right ventricular EMB for GCM in a referral population. METHODS AND RESULTS: Twenty subjects (of 63 total) in the Multicenter Giant Cell Myocarditis Registry underwent both right ventricular EMB and heart pathology (HRTP) evaluation from apical wedge, explantation, or autopsy. The false-negative rate of right ventricular EMB was defined as the ratio of negative EMB to positive HRTP results. Ten of the 20 subjects were women. The mean age was 38 years (range, 16-53 years). Twelve (60%) subjects had a positive EMB and positive HRTP confirming GCM. Three (15%) had a negative EMB and positive HRTP for GCM. Five had a positive EMB and negative HRTP evaluation for GCM. The resulting sensitivity of EMB for GCM was 80% (12/15) with a positive predictive value of 71%. Assuming the 5 subjects with a positive EMB and negative HRTP are true positives, the sensitivity improves to 85% (17/20). Predictors of negative HRTP after positive EMB were time from symptom onset to HRTP (P.006) and time from EMB to HRTP (P.03). CONCLUSIONS: The sensitivity of right ventricular EMB is high in patients with GCM who have early disease presentation and a fulminant clinical course. Although these results may not apply to individuals with less aggressive disease, EMB may be used selectively to distinguish fulminant heart failure caused by GCM from other causes in which the prognosis may differ.

Acute Disease↗

PubMed2002

Imaging for suspected appendicitis: negative appendectomy and perforation rates.

PURPOSE: To determine which patients suspected of having acute appendicitis benefit from preoperative imaging. MATERIALS AND METHODS: The medical records of 462 consecutive patients who underwent appendectomy for clinically suspected acute appendicitis and underwent preoperative evaluation at our institution were retrospectively reviewed. Patients were divided into four groups: women (n = 166), girls (n = 46), men (n = 178), and boys (n = 72). Preoperative computed tomography (CT) or ultrasonography (US), requested by the referring clinician, was performed in 313 of the 462 patients. Unnecessary, or negative, appendectomy and perforation rates were calculated for each group for preoperative evaluation with CT, with US, and with neither CT nor US. In addition, the sensitivity and positive predictive value of CT and US were calculated for diagnosing appendicitis. RESULTS: In women, the negative appendectomy rate was significantly lower for those who underwent preoperative CT (7% [six of 85 patients], P =.005) or US (8% [four of 49 patients], P =.019), as compared with 28% [nine of 32 patients] for those who underwent no preoperative imaging (P >.35 for all groups). The negative appendectomy rates for girls, men, and boys were not significantly affected by preoperative imaging. The sensitivity of CT and US for diagnosing acute appendicitis exceeded 93% and 77%, respectively, in all groups. The positive predictive values for both CT and US were greater than 92% in all groups. CONCLUSION: Women suspected of having appendicitis benefit the most from preoperative CT or US, with a statistically significantly lower negative appendectomy rate than women who undergo no preoperative imaging. Therefore, we propose that preoperative imaging be considered part of the routine evaluation of women suspected of having acute appendicitis.

Acute Disease↗

PubMed2002

Lymphoid interstitial pneumonia: a narrative review.

Lymphoid interstitial pneumonia (LIP) is regarded as both a disease and a nonneoplastic, inflammatory pulmonary reaction to various external stimuli or systemic diseases. It is an uncommon condition with incidence and prevalence rates that are largely unknown. Liebow and Carrington originally classified LIP as an idiopathic interstitial pneumonia in 1969. Although LIP had since been removed from that category, the most recent consensus classification sponsored by the American Thoracic Society and the European Respiratory Society recognizes that some cases remain idiopathic in origin, and its clinical, radiographic, and pathologic features warrant the return of LIP to its original classification among the idiopathic interstitial pneumonias. LIP also belongs within a spectrum of pulmonary lymphoproliferative disorders that range in severity from benign, small, airway-centered cellular aggregates to malignant lymphomas. It is characterized by diffuse hyperplasia of bronchus-associated lymphoid tissue. The dominant microscopic feature of LIP is a diffuse, polyclonal lymphoid cell infiltrate surrounding airways and expanding the lung interstitium. Classically, LIP occurs in association with autoimmune diseases, most often Sjögren syndrome. This has led to consideration of an autoimmune etiology for LIP, but its pathogenesis remains poorly understood. Persons who are seropositive for HIV, and children in particular, are at increased risk of acquiring LIP. Some studies suggest causal roles for both HIV and Epstein-Barr virus. The incidence of LIP is approximately twofold greater in women than men. The average age at diagnosis is between 52 years and 56 years. Symptoms of progressive cough and dyspnea predominate. There is great variability in the clinical course of LIP, from resolution without treatment to progressive respiratory failure and death. Although LIP is often regarded as a steroid-responsive condition, and oral corticosteroids continue to be the mainstay of therapy, response is unpredictable. Approximately 33 to 50% of patients die within 5 years of diagnosis, and approximately 5% of cases of LIP transform to lymphoma.

Adult↗

PubMedDate not supplied

Primary cardiac angiosarcoma: case report and review of the literature.

We report of a young man who was referred for evaluation of the right atrial mass. He had presented outside the hospital with shortness of breath. A transthoracic echocardiogram (TTE) done there showed a bright echodensity in the right atrium with moderate pericardial effusion. He was treated for presumed viral pericarditis. Pericardiocentesis showed a bloody effusion. Four weeks after this initial presentation, a repeat TTE was done to evaluate for recurrent pericardial effusion due to shortness of breath. The right atrial mass had increased in size and no effusion was noted. He was referred to us for further evaluation. The tumor was successfully resected during surgery, and the pathological examination revealed primary cardiac angiosarcoma. The case highlights the misdiagnosis in initial clinical presentation, current diagnostic modalities, and treatment options for cardiac angiosarcoma.

Adult↗

PubMedDate not supplied

Pulmonary cryptococcosis: CT and pathologic findings.

PURPOSE: The purpose of this work was to describe the CT and pathologic findings of pulmonary cryptococcosis. METHOD: CT scans of 11 patients (7 immunocompromised, 4 immunocompetent) with proven pulmonary cryptococcosis were analyzed for number, morphologic characteristics, and distribution of parenchymal abnormalities as well for presence of lymphadenopathy and pleural effusion. Pathology of lung specimens obtained by open biopsy or resection (n = 5) and transbronchial biopsy (n = 1) was reviewed by one dedicated pulmonary pathologist. RESULTS: Pulmonary nodules, either solitary or multiple, were the most common CT finding, present in 10 of 11 patients (91%); associated findings included masses (n = 4), CT halo sign (n = 3), and consolidation (n = 2). On histologic examination, focal areas of ground-glass attenuation surrounding or adjacent to nodules were found to represent airspace collections of macrophages and proteinaceous fluid. CONCLUSION: Pulmonary cryptococcosis should be considered in the differential diagnosis of solitary or multiple pulmonary nodules (with or without associated CT halo sign), particularly in immunocompromised patients.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Recurrent lymphoma of the lung: computed tomography appearance.

OBJECTIVE: To describe the computed tomography findings of recurrent lymphoma involving the lung. METHODS: Computed tomography scans of 15 patients with biopsy-proven recurrent lymphoma involving the lung were reviewed. Group mean age of enrolled patients was 38 years (range: 14-68 years). Pathologic specimens were obtained by thoracoscopic or open wedge biopsy (n = 8), transbronchial biopsy (n = 5), and fine needle aspiration (n = 2). RESULTS: Nodules, the most common manifestation, were present in all patients; nodules were greater than 10 in number in 12 (80%) of 15 cases and predominantly 6-10 mm in size in 8 cases (53%). Nodular distribution was bilateral and multilobar except in 2 patients, in whom a solitary pulmonary nodule was found. Lymphadenopathy was the second most common finding; it was seen in 13 (87%) of 15 cases and involved an average of 5 nodal stations. CONCLUSION: Recurrent lymphoma in the lung most commonly manifests as multiple pulmonary nodules that are typically bilateral and multilobar in distribution.

Adolescent↗

PubMedDate not supplied

Paraplegia after routine cardiac surgery: a rare complication.

Two cases of spinal cord infarction with clinical paraplegia are discussed in patients undergoing elective and uncomplicated cardiac procedures with cardiopulmonary bypass. In both cases, the primary etiology was likely peripheral embolization. Other possible etiologies are reviewed, previously reported cases are discussed, and possible solutions to avoid this devastating problem are addressed.

Aged↗