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Biomedical subjects

R H Poe

Publications and source records attributed to R H Poe.

53 records · Page 3Linked to original sources

Sensitivity and specificity of needle biopsy in lung malignancy.

Ninety-five patients with pulmonary parenchymal lesions suggestive of malignancy underwent 103 combined puncture-aspiration biopsies using an 18-gauge Rotex biopsy needle. The over-all sensitivity of the procedure was 90%, and the specificity was 95%, as determined by pathologic and clinical outcome. Needle biopsy was diagnostic in 69 of 77 patients (90%) with malignancy. In 3 patients with a false-negative biopsy result, a second needle biopsy was diagnostic, increasing the yield to 94%. One false-negative biopsy result occurred in a patient with actinomycosis. In the 17 patients in whom no malignancy was found on percutaneous biopsy, subsequent surgical biopsy, culture of aspirate, or stability or disappearance of the lesion within a year or more confirmed the initial diagnosis of nonmalignant disease. Pneumothorax was the only significant complication, requiring tube drainage after 6 biopsies (5.8%). Our study confirms that needle puncture-aspiration is an extremely reliable technique in diagnosing lung malignancy and is adaptable to use in a community teaching hospital.

Adenocarcinoma↗

Adult respiratory distress syndrome related to ampicillin sensitivity.

A patient with the adult respiratory distress syndrome was found to have an alveolar allergic reaction demonstrated by transbronchial lung biopsy. The clinical course and subsequent skin test reactivity suggested ampicillin as the cause. This is an unusual presentation of ampicillin allergy, and drug sensitivity is suggested as another cause of the adult respiratory distress syndrome.

Adolescent↗

Probability of a positive transbronchial lung biopsy result in sarcoidosis.

Forty-one consecutive patients with suspected sarcoidosis underwent pulmonary function testing and transbronchial lung biopsy at three community teaching hospitals. Transbronchial biopsy disclosed noncaseating granulomas in 22 of 23 patients (96%) in whom parenchymal disease was roentgenographically apparent and in eight of 18 patients (44%) in whom it was not. The stage of the disease as determined by the chest roentgenogram was the most reliable determinant for a positive biopsy result. Not the presence of cough, dyspnea, or constitutional symptoms or pulmonary function as measured by forced vital capacity and carbon monoxide diffusing capacity served to predict a positive transbronchial biopsy finding any more accurately than did the roentgenographic staging of the disease itself. This study suggests that while transbronchial lung biopsy may be an acceptable initial diagnostic procedure in suspected sarcoid patients without parenchymal lung disease, clinical symptoms and pulmonary function abnormalities are not helpful in predicting the liklihood of a positive biopsy result.

Biopsy↗

Pulmonary edema in cervical spinal cord injury.

A 15-year-old patient with acute cervical spine injury (C5) and pulmonary edema is presented. There was no craniocerebral injury. Causes other than the injury are excluded. Acute cervical spine injury appears to be another cause of noncardiogenic pulmonary edema.

Acute Disease↗

Lung abscess due to Pseudomonas cepacia.

A diabetic patient with pneumonia of unspecified origin developed a lung abscess after therapy with ultrasonic nebulization. The etiologic organism was identified as Pseudomonas cepacia. Investigation determined the source of the organism to be the reservoir of the ultrasonic nebulizer, to which the patient was directly exposed through removal of the bottom of the disposable medication cup. When this organism is isolated a nosocomial source of infection should be suspected.

Aged↗

The rapid development of an aspergilloma secondary to allergic bronchopulmonary aspergillosis.

A patient with allergic bronchopulmonary aspergillosis who developed a cavitary lung lesion suggestive of neoplasm is presented. At thoracotomy an aspergilloma was found. Although coexistence of these two forms of aspergillosis has been reported, the brief history of preceding asthma and the rapid development of the aspergilloma in the absence of typical roentgenographic features are unusual. Aspergilloma should be considered when a patient with allergic bronchopulmonary aspergillosis develops a cavitary pulmonary lesion.

Aged↗

Small airway testing and smoking in predicting risk in surgical patients.

A prospective study was performed on 185 surgical patients without overt respiratory disease to determine whether three sensitive tests for early airway obstruction or cigarette smoking at the time of hospitalization were useful in identifying the patient at risk for a postoperative pulmonary complication. Subjects were evaluated by questionnaire. Pulmonary function testing consisted of the single breath nitrogen test (SBN2) to determine the closing volume (CV) and slope of the alveolar plateau, and a maximum expiratory flow volume curve (MEFV) to determine expiratory flow at low lung volumes. Fifty-five patients had upper abdominal surgery and 130 a major surgical procedure under general or spinal anesthesia upon another part of the body. Ninety-six (52%) of the 185 patients were smokers. Seventy-nine patients (43%) had one or more abnormal function parameters. The CV was abnormal in 59, alveolar plateau in 18, and MEFV in 12. Fifty-four percent of smokers and 30 percent of nonsmokers had abnormal small airway tests. Sixteen of 185 patients (8.6%) developed a postoperative respiratory complication determined by review of the hospital record. Eleven were in the 96 smokers, but 13 were in the 79 patients with abnormal small airway tests. The incidence was highest (38%) in smokers with an abnormal alveolar plateau who underwent upper abdominal surgery. Identification of the patient at risk was better served by tests of small airway abnormality than by smoking history alone.

Adult↗