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Biomedical subjects

M B Nicotra

Publications and source records attributed to M B Nicotra.

16 recordsLinked to original sources
PubMed1995

Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort.

STUDY OBJECTIVE: Awareness of bronchiectasis on the part of clinicians has been low in recent years, although it was previously well recognized. We believe that bronchiectasis is underdiagnosed, and that current literature is skewed toward the esoteric etiologies of bronchiectasis. DESIGN: We reviewed the clinical, radiologic, microbiologic, and physiologic findings in 123 well-studied patients with proved bronchiectasis. SETTING: The University of Texas Health Center at Tyler Hospital and Clinics. MEASUREMENTS AND RESULTS: There were 38 men and 85 women with a mean (+/- SD) age of 57.2 +/- 16.7 years; 55% were lifetime nonsmokers. Diagnosis was confirmed with CTs of the chest in 56%, by bronchogram in 28%, and surgery with the remainder. Seventy percent of patients gave a history of an antecedent potentially causative event for the bronchiectasis, usually pneumonia. Symptoms of bronchiectasis included chronic cough with the production of purulent sputum, hemoptysis, recurrent fever, and pleurisy. The finding of crackles on chest examination was the rule (70%) with wheezing present in 34% of the group. Pulmonary function studies documented airway obstruction to be present in 54% of the lifetime nonsmokers. The chest radiographs were abnormal in 91.3%, showing fibrotic stranding and infiltrates. A variety of pathologic microbial flora, particularly Pseudomonas aeruginosa and other opportunistic organisms, were isolated from the sputum. Patients who had smoked had much the same picture as nonsmokers, although they had a greater degree of airway obstruction. CONCLUSIONS: A characteristic clinical picture of bronchiectasis emerges after review and evaluation of these data. Knowledge of this picture should allow ready recognition of the disease.

Adult↗
PubMed1994

Bronchiectasis.

Bronchiectasis, a condition characterized by abnormal and permanent dilatation of pulmonary airways, is an old disease, well recognized in the era before widespread immunization for childhood diseases and the development of antibiotics. After that time, interest in this disease waned. The recognition of bronchiectasis in association with congenital diseases awakened interest in the disease. Review of literature relating to the etiologies of bronchiectasis does not substantiate a congenital origin in most; it appears that the majority of cases of bronchiectasis result from prior infections of the lungs, either viral or bacterial, including mycobacterial. The initial insult triggers an inflammatory change in the bronchial wall that persists even after the episode ends. Over time, the bronchial wall is damaged, making it subject to permanent dilatation. Clinical findings of bronchiectasis include chronic cough with sputum production, often purulent, sometimes hemoptoic. Recurrent pleurisy and fever occur. Spirometry in most patients shows airway obstruction, even if the patient has never smoked. Chest radiographs are usually abnormal, with chronic increased markings caused by infiltrates or scarring, atelectasis, and pleural thickening. Microbiological studies may show a variety of organisms, some commensals, others pathogenic. Diagnosis is made based on the clinical picture with a compatible chest radiograph and confirmed with a high-resolution computed tomography (CT) scan. Therapy of bronchiectasis is directed at airway obstruction, including chest physiotherapy and bronchodilators, and at the infections. Few controlled studies to evaluate any therapy have been performed.

Bronchiectasis↗
PubMed1993

Con: antibiotic use in exacerbations of chronic bronchitis.

An acute exacerbation of chronic bronchitis represents one of the most common illnesses treated by physicians. In spite of this, the role of infection in general, and bacterial infection in particular, is difficult to establish. Clinical signs and symptoms in patients with bacterially associated disease are not separable from those in patients without bacterial infection. Studies evaluating the efficacy of antibiotics in this setting, though suggesting that antibiotics are useful, do not provide sufficient benefit to justify routine antibiotic use. Further, these studies have not defined a subpopulation for whom antibiotics are necessary. Routine antibiotic use may delay diagnosis of other serious disease and is unequivocally very expensive, primarily because of the use of the newer and higher-cost drugs. In some situations, such as severe infection or associated with surgery, routine antibiotic use may be justified, but the use of sputum culture to guide antibiotic choice is recommended. A well designed study to finally settle the issue of antibiotic need in acute exacerbations of chronic bronchitis is badly needed.

Anti-Bacterial Agents↗
PubMed1989

Demand oxygen delivery for patients with restrictive lung disease.

The demand oxygen delivery system has been reported to improve oxygen delivery 7:1 vs steady flow during rest and exercise in COPD patients. The present study evaluates the DODS during rest and exercise in eight patients with restrictive lung disease. It was concluded that the DODS provides substantial oxygen savings in RLD patients, particularly during exercise.

Exercise↗
PubMed1988

Chronic bronchitis: when and how to treat.

Chronic bronchitis, as defined by the magnitude and duration of sputum production, is a diagnosis that encompasses a variety of patients with physiological abnormalities ranging from mild to severe. The first element of therapy is the cessation of smoking, the single most frequent cause of chronic bronchitis. In assisting patients to stop cigarette abuse, nicotine-containing gum has been useful. Therapy directed at airway narrowing continues to be the most widely prescribed. The use of metered dose inhalers containing either beta-adrenergic stimulants or, more recently, ipratropium bromide, an atropine-like agent, continues to be the mainstream of therapy. Theophylline remains a widely prescribed bronchodilator. The use of corticosteroids remains controversial in the stable patient, but appears to be indicated clearly in the patient with an acute exacerbation. The usefulness of antibiotics in acute exacerbations is still uncertain; further studies are needed. Augmentation of survival by the use of chronic supplemental O2 is now certain; more efficient ways to administer O2 are now available. Finally, pulmonary rehabilitation provides a means of improving quality of life in severely disabled patients.

Adrenal Cortex Hormones↗
PubMed1985

Low-concentration oxygen therapy via a demand oxygen delivery system.

Recent heightened concern about the costs of medical care has stimulated research and development in devices and schemes for saving costs while retaining quality of care. Consistent with that concern is the fact that standard steady-flow oxygen delivery is so wasteful. Almost its entire benefit occurs at the very beginning of inspiration. We compared the efficacy of nasal oxygen delivery via a new demand oxygen delivery system (DODS) with the standard steady-flow (SF) method. The DODS incorporates a valve and sensor interposed between the oxygen reservoir and the patient, which meters oxygen to the patient only during early inspiration. Twelve COPD subjects with hypoxemia at rest received oxygen at flow settings of 1 to 4 L/min via SF and at various breath interval settings via the DODS method, calculated to match the above spectrum of the SF. We measured oxygen delivery using an ear oximeter. The results indicate that significantly less oxygen was required to provide equivalent saturations using the DODS compared with the SF method (p less than .001). The mean comparative savings in oxygen is better than seven to one favoring the DODS over the SF method. Further study is warranted, since the widespread use of such a device could result in substantial cost saving while increasing the range of portable oxygen delivery.

Aged↗
PubMed1982

Pseudomonas aeruginosa mucoid strain. Its significance in adult chest diseases.

Isolation of mucoid strains of Pseudomonas aeruginosa from bronchial secretions has occurred usually in the setting of cystic fibrosis. This association has been so strong that it is considered a sign of the presence of cystic fibrosis. We reviewed the records of 31 patients in whom this strain was isolated; in contract to previous experiences, we found that only 2 of our patients could be considered to have cystic fibrosis. The remainder all had a chronic pulmonary disease, and common to all was the presence of bronchiectasis. We conclude that isolation of mucoid strains of Pseudomonas aeruginosa from bronchial secretions of adults with a chronic pulmonary process indicates the presence of underlying bronchiectasis.

Adolescent↗
PubMed1982

Antibiotic therapy of acute exacerbations of chronic bronchitis. A controlled study using tetracycline.

We conducted a double-blind, randomized, placebo-controlled trial in 40 patients to evaluate the need for antibiotics in acute exacerbations of chronic bronchitis. All patients were sufficiently ill to require hospitalization although none needed ventilatory support; the presence of pneumonia was excluded. Treatment consisted of bronchodilators, corticosteroids, and either tetracycline, 500 mg, or placebo by mouth every 6 hours for 1 week. Arterial blood gases, spirometric tests, bacteriologic evaluation of sputum, and patient and physician evaluation of the severity of illness were assessed at the beginning and end of the study. All patients improved both symptomatically and by objective measures of lung function. At the end of the study period there were no differences between those patients receiving tetracycline and those receiving placebo. We conclude that antibiotic therapy is not needed in moderately ill patients with exacerbations of chronic bronchitis.

Acute Disease↗
PubMed1981

Trimellitic anhydride Toxicity. A cause of acute multisystem failure.

A person exposed to trimellitic anhydride (TMA) an epoxy resin widely used in industry, experienced respiratory failure, anemia, and gastrointestinal bleeding. A lung biopsy specimen demonstrated intra-alveolar hemorrhage and damage to alveolar lining cells. The patient and six co-workers were examined. Results indicated the presence of hemolytic antibodies directed against TMA-haptenized erythrocytes, IgG, IgA, and IgM antibodies directed against TMA-erythrocyte complexes, and antibodies against TMA-human serum albumin. Antibody levels in the patient were greater than in the co-workers. The elevated antibody levels demonstrate the antigenic potential of TMA. However, the cause of the pulmonary and hematologic damage remains uncertain and may represent either immunologic or direct toxic effects of TMA. In patients with multisystem failure of this nature, occupational hazards should be added to the differential diagnosis.

Adult↗
PubMed1981

Placidyl abuse: a dimorphic picture.

Eleven patients with documented intoxication with ethchlorvynol were evaluated for clinical and laboratory manifestations. All of the 7 patients who ingested the drug were severity neurologically depressed; 3 were hemodynamically unstable and 1 developed pulmonary edema documented to be noncardiogenic 40 h after admission. All of the remaining patients (including 1 who also ingested a small amount) presented with pulmonary edema in the absence of neurological changes, soon after injection of 2--3 capsules iv; hemodynamic measurements in one of these demonstrated a noncardiogenic etiology. The clinical manifestations in these 2 groups of patients seem to be clearly separable, depending on the dose and route of administration.

Adult↗
PubMed1981

Tricyclic antidepressant overdose: clinical and pharmacologic observations.

Forty-seven patients with confirmed TCA overdoses were thoroughly evaluated with regard to clinical and electrocardiographic findings. In 22 patients plasma levels of the primary TCA and the desmethyl metabolite were determined. We found that both neurologic and cardiovascular complications were common, but independent of each other. While plasma levels of the parent of TCA compound correlated best with the neurologic disturbances, cardiac abnormalities were more related to the desmethyl metabolite level. Although plasma levels correlate with the clinical findings, sufficient overlap between normal and abnormal levels and findings exist that we do not feel that routine measurement of plasma levels is clinically useful at this time.

Adult↗
PubMed1978

Pathogenesis of neurogenic pulmonary edema.

A patient presenting with apparent pulmonary edema in whom transient, large increases in systemic arterial, pulmonary arterial, and pulmonary capillary wedge pressures occurred and spontaneously resolved within a few minutes is presented. This appears to lend support to the pressure and volume overload theory of the pathogenesis of neurogenic pulmonary edema that previously has not been demonstrated in humans.

Cerebrovascular Disorders↗