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Biomedical subjects

R H Israel

Publications and source records attributed to R H Israel.

At least 37 records · Page 2Linked to original sources
PubMed1985

Differentiation of tuberculous from nontuberculous cavitary lung disease.

Tuberculous and nontuberculous cavitary lung disease is often initially misdiagnosed, delaying therapy. To identify findings which might help avoid such delays, we performed a retrospective review of all patients admitted to two community hospitals over a 6-year period for infectious cavitary disease of the upper lobe or apical segment of the lower lobe. 10 patients with tuberculosis and 16 with nontuberculous infections were identified. Delays in initiating therapy were common to both. Most signs and symptoms were nonspecific. The mean duration of symptoms was greater in tuberculosis (72 days) compared to nontuberculous infections (18 days). Putrid sputum was found only in nontuberculous infections (11/16). Roentgenographic features of fibronodular infiltration and atelectasis occurred only in tuberculosis. Air fluid levels were seen only in nontuberculous disease (10/16). Leukocytosis with immature neutrophils was found only in patients with nontuberculous cavities. We conclude that the previously described clinical, laboratory, and roentgenographic features may be useful in correctly diagnosing infectious cavitary lung disease.

Blood Gas Analysis↗
PubMed1985

Sensitivity, specificity, and predictive values of bronchoscopy in neoplasm metastatic to lung.

Bronchoscopic examination to diagnose lung metastases has not been as rewarding as in primary lung cancer. Despite a lower expected yield, we believe the procedure has value in certain patients, ie, those with clinical findings of endobronchial disease. To determine better the value of bronchoscopy in this population, we retrospectively reviewed records of patients at five community teaching hospitals over a 66-month period. These patients all underwent fiberoptic bronchoscopy. They had a history of prior nonpulmonary malignancy and an abnormal chest roentgenogram suspicious for recurrent malignant disease, or they presented with abnormal chest roentgenographic findings and further evaluation showed the lung disease to be metastatic. Bronchoscopy for metastatic lung disease was most likely diagnostic in patients with primary colorectal cancer (79 percent) and breast cancer (57 percent), and least likely in patients with genitourinary tract cancer (33 percent). Hemoptysis, signs of local airway obstruction, or a roentgenogram showing either atelectasis or diffuse lung disease especially favored a positive biopsy. Bronchoscopy is a valuable diagnostic procedure in selected patients with metastatic lung disease.

Adolescent↗
PubMed1984

Haemophilus parainfluenzae lung abscess.

To our knowledge, Haemophilus parainfluenzae lung abscess has not been described previously. Such a case is presented in the setting of diabetes mellitus. The implications of diagnosis and management are discussed.

Adult↗
PubMed1984

The protective effect of methylprednisolone on carbachol-induced bronchospasm.

We studied the effect of acute treatment with methylprednisolone in 12 asthmatics not dependent on steroids. Carbachol challenge was performed according to a standardized method. Baseline measurements of forced expiratory volume in one second (FEV1), specific airway conductance (SGaw), the provocative dose of carbachol for a 20% decrease in FEV1 (PD20), and that for a 35% decrease in SGaw (PD35) were established. Thereafter, patients returned for retesting at 2, 4, and 6 wk. Prior to each visit, the patients received 1 of 3 treatments: placebo, low-dose (32 mg) methylprednisolone, or high-dose (128 mg) methylprednisolone given orally and distributed in a randomized double-blind fashion. Blood levels confirmed compliance in all subjects. All subjects remained stable throughout the study, with intrasubject FEV1 values agreeing within 5% at the start of each session. The pairwise differences for low-dose methylprednisolone versus placebo were significantly different for both PD20 (p = 0.0004) and PD35 (p = 0.0068). The pairwise differences for high-dose methylprednisolone versus placebo were also significantly different for PD20 (p = 0.04) and PD35 (p = 0.0034). Blocked comparisons of the 2 different methylprednisolone doses were not significantly different. We conclude that methylprednisolone has a protective effect on carbachol-induced bronchospasm, and that this effect is not dose-related at the two doses studied.

Adult↗
PubMed1984

Sensitivity, specificity, and predictive values of closed pleural biopsy.

To determine the clinical value of a nonspecific pleural biopsy specimen and fluid in malignant neoplasm and tuberculosis, we retrospectively reviewed records of all patients with pleural effusions undergoing the procedure at three community hospitals over six years. Two hundred eleven patients underwent biopsies. Adequate tissue was obtained in 207. The results were compared with the ultimate clinical and pathologic outcome by follow-up for 12 to 72 months. The initial procedure was diagnostic of malignant neoplasm in 54 patients and granulomatous disease in ten. A nonspecific or normal result was found in 143 (68%). Malignant neoplasms or tuberculosis was eventually established in 30 and excluded in 101 of the 143 patients. In 12 patients, no diagnosis was made. The procedure's sensitivities were 65% (malignant neoplasm) and 90% (tuberculosis). One false-positive result occurred in a patient with nontuberculous granulomatous pleuritis. The specificity and positive predictive value were 99% and 98%, respectively. The negative predictive value was 77%. Closed pleural biopsy with simultaneous fluid analysis is a valuable diagnostic procedure in community hospital patients, but a nonspecific result does not exclude malignant disease.

Adolescent↗
PubMed1983

Pleural-pulmonary aspects of Listeria monocytogenes infection.

The most common forms of Listeria monocytogenes infection in adults are meningitis-encephalitis and sepsis. Infection of the pulmonary parenchyma and pleura have rarely been reported. A case of listeria meningitis presenting with pleural space infection in an immunosuppressed patient is presented and a review of 5 additional patients with listeria infection of the respiratory tract is included. All 6 patients described in this report had L. monocytogenes infections presenting with respiratory tract symptomatology, although 4 patients subsequently had positive blood or cerebrospinal fluid cultures. It is emphasized that a culture report of 'diphtheroids' from a thoracentesis specimen should not be automatically dismissed as contamination, particularly in an immune compromised patient.

Humans↗
PubMed1983

Survival of patient with pleural involvement by breast carcinoma.

To determine factors which affect survival in patients with pleural involvement by breast carcinoma, we reviewed records of all patients at two community teaching hospitals presenting with malignant pleural effusion over a 6-year period. Forty-five patients had had mastectomy for breast cancer, no history of other malignancy, and cytologic confirmation of subsequent pleural metastases. All had received conventional combination systemic chemo- or hormonal therapy. Ten patients (group 1) in whom effusion was the initial and only site of recurrent disease had a median survival of 48 months. The median survival was 12 months in 35 patients (group 2) who developed effusion in association with other metastatic disease. Half of the patients in group 1 had no axillary node involvement at mastectomy. Twenty-eight patients (80%) in group 2 had had more advanced disease at initial diagnosis. This, and behavior of the effusion as regional rather than systemic disease, suggested by the high incidence of effusion on the ipsilateral side of the mastectomy, probably accounts for the better outlook in patients with effusion alone.

Adult↗
PubMed1982

Chronic cough: bronchoscopy or pulmonary function testing?

To determine how frequently bronchoscopic examination and pulmonary function testing are useful in establishing a diagnosis in patients with chronic cough as an isolated clinical symptom, we reviewed the records of all patients referred to pulmonary specialists at 3 community hospitals for evaluation of cough over a 6-yr period. There were 109 patients with the isolated symptom of chronic cough and a normal or stable chest roentgenogram. Bronchoscopy was performed in 51. All patients but 1 were followed until the cough disappeared or for a minimum of 1 yr. Carcinoma was established as the cause for cough in 1 patient. Spirometry and/or bronchial inhalation challenge was performed in 87 patients. Previously undiagnosed asthma was discovered in 39 patients by these means. Pulmonary function testing has diagnostic value in this population, but bronchoscopy is of limited value in determining the cause of isolated chronic cough.

Adolescent↗
PubMed1981

Insidious onset of acute alveolar hypoventilation following intermittent positive-pressure breathing (IPPB).

2 patients developing acute alveolar hypoventilation following IPPB therapy are presented. The hypoventilation occurred insidiously following therapy. It is hypothesized that respiratory center depression from excessive oxygen administration caused the hypoventilation. When the IPPB machines were driven by compressed air instead of oxygen, this complication was revealed in 1 of the patients.

Acute Disease↗
PubMed1981

A graphic approach for prediction of arterial oxygen tension at different concentrations of inspired oxygen.

A rapid, simple method for predicting the arterial oxygen tension (PaO2) at any fractional concentration of inspired oxygen (FIO2) is presented. The method is based on a nomogram interrelating PaO2, arterial carbon dioxide tension (PaCO2) and FIO2, allowing rapid determination of the arterial to alveolar oxygen tension ratio a/A PO2. The applicability of the nomogram and its reliability for predicting the PaO2 at any FIO2 were studied prospectively in nine consecutive patients requiring mechanical ventilation (16 trials). On each occasion, a desired PaO2 was chosen and from the nomogram an FIO2 expected to yield this PaO2 was administered. The PaO2 was then measured. Actual PaO2 differed from desired PaO2 by a mean of 2.6 mm Hg (range 0 to 10 mm Hg, standard deviation (SD) 4.8). Retrospectively, we analyzed the nomogram's ability to predict the PaO2 +/- 9.6 mm Hg (2 SD) at varying FIO2. The overall sensitivity of this method was 85 percent (126 predictions out of 149 trials). We conclude that appropriate levels of supplemental oxygen can be rapidly and reliably chosen using the nomogram in selected patients.

Adult↗
PubMed1980

Adult respiratory distress syndrome associated with acute nitrofurantoin toxicity. Successful treatment with continuous positive airway pressure.

A case of adult respiratory distress syndrome associated with nitrofurantoin use is described. The patient was successfully managed with continuous positive airway pressure (CPAP) through a tightly fitting face mask; clinical deterioration followed discontinuation of the CPAP, with improvement occurring when it was restarted. Acute nitrofurantoin pleuropulmonary reactions are reviewed, and CPAP by face mask is discussed.

Female↗