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M A Judson

Publications and source records attributed to M A Judson.

54 records · Page 3Linked to original sources
PubMed1996

The pleural space and organ transplantation.

Pleural disease both before and after organ transplantation has important implications. Pleural effusions are common in candidates for heart, liver, and kidney transplantation. A thoracentesis is not mandatory in these patients, but it should be performed if clinical or radiologic features suggest that the effusion is not the result of organ failure. Posttransplant pleural infections and pleural PTLD relate to the level and duration of immunosuppression and are probably not organ-specific. Organ-specific pleural complications include pleural effusion from hepatic venoocclusive disease, spontaneous pneumothorax associated with obstructive airway disease from chronic GVHD after bone marrow transplantation, and early pleural effusion from urinothorax and late effusion from perirenal lymphocele years after kidney transplantation. The treatment of pleural disease in potential lung transplant candidates should minimize the extent of pleurodesis. Pleural effusions are expected sequelae after lung transplantation, and they may be harbingers of acute rejection. Interpleural communication, an expected finding after heart-lung transplantation or double-lung transplantation with a "clamshell" incision, has therapeutic implications.

Graft Rejection↗
PubMed1996

Pleural effusions following lung transplantation. Time course, characteristics, and clinical implications.

The time course and characteristics of ipsilateral pleural effusion in nine consecutive single lung transplant recipients are described and compared with those of six patients who underwent other cardiothoracic operations. Ipsilateral pleural fluid occurs in all lung transplant recipients, beginning immediately following transplantation and continuing for up to 9 days. Pleural fluid immediately after lung transplantation is bloody, exudative, and neutrophil predominant, which is similar to the characteristics of pleural fluid following other cardiothoracic surgery. Pleural fluid cellularity, lactate dehydrogenase, and total protein content decrease rapidly over the first week in lung transplant recipients. The percentage of neutrophils decreases from 90 to 50% by day 7. Pleural fluid output in lung transplant recipients declines steadily during the first week and is minimal by day 9. Pleural fluid output declines more rapidly in patients who have undergone cardiothoracic surgery than in the lung transplant recipients. An early rise in pleural fluid output may reflect the development of posttransplant pulmonary edema. We conclude that it is unnecessary to analyze pleural fluid after lung transplantation if the pleural fluid output is decreasing and the clinical course is appropriate.

Adult↗
PubMed1994

Clinical judgment.

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Clinical Competence↗
PubMed1994

Refractory hypotension associated with hypocalcemia and renal disease.

A 35-year-old hypertensive man presented with chronic renal insufficiency, congestive heart failure, and refractory hypotension. He had metabolic acidosis and profound hypocalcemia. Left ventricular function and blood pressure worsened after intravenous infusion of saline and bicarbonate, but improved dramatically after intravenous calcium administration. This case illustrates that hypocalcemia is a cause of refractory hypotension and heart failure.

Adult↗
PubMed1994

Endobronchial HIV associated lymphoma.

A 27 year old HIV infected man presented with two days of haemoptysis. Flexible bronchoscopy revealed a large carinal mass partially obstructing the left and right main stem bronchi. Rigid bronchoscopy was required to make the diagnosis of large cell immunoblastic lymphoma.

Adult↗
PubMed1994

Endobronchial lesions in HIV-infected individuals.

Endobronchial manifestations of HIV infection are rare. The endobronchial appearance and clinical presentation of these lesions may suggest the correct diagnosis. Establishing an appropriate differential diagnosis at the time of visualization of the endobronchial lesion is important because some lesions require specific biopsy techniques or special stains. The bronchoscopist must consider the risks vs benefits of biopsy when confronted with an endobronchial lesion. With the notable exception of pseudomembranous necrotizing tracheobronchial aspergillosis, there are no specific endobronchial lesions associated with HIV infection which increase the risk of complications when they are biopsied. Although EKS is a vascular lesion and an early case report suggested that endobronchial biopsy might result in excessive bleeding, this complication was not observed in two subsequent series. Fortunately, a presumptive diagnosis of EKS can usually be made without biopsy by the characteristic appearance of the lesions. EKS is the most common endobronchial lesion associated with HIV infection; however, its incidence will probably decline as the incidence of KS declines. Many of the other endobronchial lesions described herein have been reported recently. We suspect these and other lesions will be found more frequently, as the epidemic of HIV continues to evolve.

AIDS-Related Opportunistic Infections↗
PubMed1994

Mycobacterium scrofulaceum infection presenting as lung nodules in a heart transplant recipient.

Pulmonary nodules have been reported in up to 10 percent of heart transplant recipients. Most are infectious, with opportunistic pathogens most common. Atypical mycobacteria have not been reported as the etiology of pulmonary nodules in a heart transplant recipient. We report a case of Mycobacterium scrofulaceum infection presenting as three discrete pulmonary nodules.

Heart Transplantation↗
PubMed1993

Clinical aspects of lung transplantation.

Lung transplantation, which was a universally unsuccessful procedure at the start of the last decade, has now become a viable therapeutic option. Improvements in operative technique, patient selection, and immunosuppression have contributed to the dramatic improvement in outcome. Few aspects of lung transplantation are standardized, and the procedure is being continually refined. Actuarial 1 year survival rates are approaching 70%, and it appears that these rates will continue to improve. Scarity of donor lungs is rapidly becoming a serious impediment to the performance of lung transplantation in the United States.

Animals↗
PubMed1990

Chylothorax in a patient with AIDS and Kaposi's sarcoma.

We have described the case of a patient with AIDS in whom a chylothorax developed, probably as a result of lymphatic obstruction from KS. This case emphasizes that the loss of proteins, fats, and lymphocytes into chylous pleural effusions can be particularly devastating in AIDS patients, who have profound nutritional problems and a marked depletion in the level of helper T-lymphocytes.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Pneumocystis carinii pneumonia manifested as a hilar mass and cavitary lesion: an atypical presentation in a patient receiving aerosolized pentamidine prophylaxis.

A case of Pneumocystis carinii pneumonia (PCP) in a patient with AIDS was manifested radiographically as a hilar mass and cavitary lesion. The patient had been receiving aerosolized pentamidine as prophylaxis against PCP. Nonuniform deposition of aerosolized pentamidine was probably responsible for this atypical radiographic appearance of PCP.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Diagnosis of pulmonary Kaposi's sarcoma with fiberoptic bronchoscopy and endobronchial biopsy. A report of five cases.

Fiberoptic bronchoscopy is a major tool in the diagnostic evaluation of pulmonary disease in patients with the Acquired Immune Deficiency Syndrome. Multiple opportunistic infections and Kaposi's sarcoma affect the lung in this disorder. In contrast to opportunistic infections, Kaposi's sarcoma is rarely reported to be diagnosed by means of bronchoscopy. This report describes five of seven patients in whom endobronchial lesions consistent with submucosal involvement by the tumor were seen, and Kaposi's sarcoma was diagnosed without complication. Kaposi's sarcoma must be considered in the differential diagnosis of pulmonary disease in patients with a proven extrapulmonary tumor focus, and fiberoptic bronchoscopy is the initial diagnostic procedure of choice. Endobronchial Kaposi's sarcoma may be a marker for parenchymal involvement by the tumor. Diagnosis of endobronchial Kaposi's sarcoma can be an important factor in decisions regarding therapy.

Adult↗