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Biomedical subjects

R H Winterbauer

Publications and source records attributed to R H Winterbauer.

At least 37 records · Page 2Linked to original sources
PubMed1991

Slowly resolving, chronic, and recurrent pneumonia.

Slowly resolving, chronic, and recurrent pneumonias are clinical patterns that are often misunderstood and mistreated. This article reviews the natural history, clinical presentation, roentgenography, bacteriology, and relation to underlying illnesses of each of these atypical forms of community-acquired pneumonia. Standard definitions are presented and provide the physician with a means to classify the pneumonias. Appropriate diagnostic evaluation and therapy are also discussed.

Anti-Bacterial Agents↗
PubMed1991

Interstitial lung disease.

The interstitial lung diseases are comprised of a group of pulmonary disorders characterized clinically by diffuse infiltrates on the chest radiograph and histologically by distortion of the gas exchanging portion of the lung. The physiologic correlates are restriction of lung volumes and impaired oxygenation. The term "interstitial" when applied to these diseases is actually a misnomer because it implies that the inflammatory process is limited specifically to the area between the alveolar epithelial and capillary endothelial basement membranes. The diseases currently grouped as "interstitial" also frequently involve the alveolar epithelium, alveolar space, pulmonary microvasculature, and less commonly, the respiratory bronchioles, larger airways, and even the pleura. The enormous differential diagnosis of interstitial lung disease can be made manageable by understanding that pneumoconiosis, drug-induced disease, and hypersensitivity pneumonitis account for over 80% of the responsible entities and can usually be identified from the patient's history. The nine remaining diseases/disease categories include: sarcoidosis, idiopathic pulmonary fibrosis, bronchiolitis obliterans-organizing pneumonia, histiocytosis X, chronic eosinophilic pneumonia, collagen vascular disease-associated interstitial lung disease, granulomatous vasculitis (Wegener's granulomatosis, Churg-Strauss syndrome, lymphomatoid granulomatosis), Goodpasture's syndrome, and pulmonary alveolar proteinosis. The diagnosis of a specific interstitial lung disease can be made via various means including the patient's history, specific serologies, bronchoalveolar lavage, transbronchial biopsy, and biopsy of extrathoracic tissues or open lung biopsy. A directed diagnostic approach can be formulated based on an understanding of these techniques and a thorough knowledge of the clinical presentations and specific diagnostic criteria for each of the major diseases. This monograph will serve as a guide for the clinician to use in evaluating and treating patients with interstitial lung disease. We begin by reviewing the clinical presentation, diagnostic criteria, and management of specific interstitial lung diseases excluding pulmonary infection, neoplasm, and sarcoidosis. Pneumoconiosis and drug-induced syndromes are not discussed in detail, but the agents responsible and pertinent exposures are presented in tabular form in the discussion of the general diagnostic approach.

Biopsy↗
PubMed1987

New diagnostic approaches to the hospitalized patient with pneumonia.

The accurate diagnosis of pneumonia remains a formidable challenge in clinical medicine. The use of sputum, blood, and pleural fluid cultures provides a diagnosis in less than 50% of patients. A number of invasive techniques have recently been applied to the diagnosis of pneumonia. The methods are uniformly designed to separate upper respiratory saprophytic bacterial populations from the organisms responsible for the lower respiratory infection. Preeminent among these techniques is the use of fiberoptic bronchoscopy coupled with quantitative bacterial culture and immunofluorescence demonstration of antibody-coated bacteria. The methodology and results of this technique are described in detail in this paper. Recent clinical experience using transtracheal aspiration, percutaneous needle aspiration of the lung, and open lung biopsy are also reviewed.

Bacteriological Techniques↗
PubMed1985

Aspergillosis of the maxillary sinuses in otherwise healthy patients.

There is an increasing number of reports of fungal infections of the nose and paranasal sinuses, due in part to increasing recognition of this condition in both healthy and immunologically depressed patients. Three cases of aspergillosis of the maxillary sinus are presented, one of which demonstrates bone destruction in an otherwise healthy individual. In diagnosing aspergillosis sinusitis it is important to submit material for microscopic examination, as cultures are often negative for fungus. Treatment consists of surgery to establish good aeration and drainage with the addition of antifungal drugs in selected cases.

Aged↗
PubMed1985

Idiopathic fibrosing alveolitis: a review with emphasis on ultrastructural and immunohistochemical features.

Fibrosing alveolitis is a usually chronic pulmonary disease affecting middle-aged men and women and causing progressive dyspnea. This review discusses the nosologic, etiologic, immunopathogenic, histologic, immunohistochemical and ultrastructural features of this condition. A hypothesis is presented suggesting microvascular damage as the primary pathologic change in cases associated with collagen vascular diseases and viral pneumonia.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Bedside evaluation of respiratory distress.

Observations made at the time of the first trial of independent ventilation in 112 episodes of mechanical ventilatory support led to identification of a group of indicators, each of which, when present, was significantly associated (p less than 0.05) with a need for continued mechanical ventilation and/or with death. Six of these were potentially suitable for use in a format for clinical assessment of the risk of respiratory failure: pulse over 120 or under 70 beats per minute, respiratory rate of over 30, palpable scalene muscle recruitment in inspiration, palpable abdominal tensing in expiration, presence of irregular irregularity of respiratory rhythm with apneic pauses of varying duration, and coma or any condition preventing a patient from responding appropriately to commands aimed at producing ventilatory movements like those needed for vital capacity testing. When none of the six signs was present, there was a 90 percent chance of a favorable outcome. With one or two indicators positive, more than 50 percent of the subjects required further ventilatory support or died. There were no favorable outcomes when three or more of the signs were present together.

Adult↗
PubMed1984

Cephalosporin-induced interstitial pneumonitis.

This report describes a patient who developed dyspnea and bilateral pulmonary infiltrates following exposure to cephradine. The role of cephradine was substantiated by rechallenge.

Cephalosporins↗
PubMed1983

Endothelial cell damage and tubuloreticular structures in interstitial lung disease associated with collagen vascular disease and viral pneumonia.

Lung tissue showing the light microscopic changes of interstitial inflammation and fibrosis was studied electron-microscopically in 11 patients with collagen vascular disease and 26 patients with viral pneumonia. All patients exhibited progressive respiratory insufficiency and had abnormal pulmonary function test results. Endothelial cell cytoplasmic swelling and intracellular tubuloreticular structures were the dominant ultrastructural change in the lungs of both groups. Tubuloreticular structures were identified in peripheral blood lymphocytes in all patients with collagen vascular disease and in 2 with viral pneumonia. Tubuloreticular structures were not identified in the lung tissue from various control patients and in the lymphocytes from patients with idiopathic interstitial pulmonary fibrosis. We conclude that (1) the ultrastructural changes seen in viral pneumonia and collagen vascular-associated interstitial lung disease are essentially identical; (2) endothelial cell damage may be the primary pathologic change associated with both diseases; (3) tubuloreticular structures are seen in large numbers in lung tissue from patients with viral pneumonia and collagen vascular disease; (4) tubuloreticular structures are present in peripheral blood lymphocytes from all patients with collagen vascular disease.

Adult↗
PubMed1983

The use of quantitative cultures and antibody coating of bacteria to diagnose bacterial pneumonia by fiberoptic bronchoscopy.

This study uses quantitative cultures and immunofluorescent demonstration of antibody-coated bacteria to differentiate colonizing from infecting bacteria in lower respiratory secretions obtained by fiberoptic bronchoscopy. The fiberoptic bronchoscope was passed transnasally without the use of a nasotracheal tube, and a single-sheath cytology brush dipped in lower respiratory secretions served as inoculum for quantitative cultures. Secretions were also collected by aspiration through the bronchoscope side channel for fluorescent examination. None of 60 control patients had greater than 4,000 colony-forming units (CFU) per brush of a single bacterium on quantitative culture. In contrast, more than 4,000 CFU per brush were isolated from 29 of 33 episodes of clinically defined lower respiratory infection (p less than 0.001). Only 1 of 60 control patients had antibody-coated bacteria in their lower respiratory secretions, but antibody coating was demonstrated in association with 24 of 33 episodes of infection (p less than 0.001).

Adult↗
PubMed1981

Determination of mortality risk in obstructive pulmonary syndromes: physical examination compared with measurement of forced expired volume in one second.

A standardised physical examination based on four clinical signs was compared with the FEV1 with regard to ability to determine five-year mortality risk in subjects with varying degrees of obstructive airway disease. Both evaluation methods identified low, intermediate, and high risk groups within the population studied. Individuals with no positive physical signs, or with an FEV1 of 70% of predicted or more had mortality not significantly greater than that predicted on the basis of standard mortality tables. There was no difference between the FEV1 and the physical examination in ability to predict mortality.

Adult↗
PubMed1980

Use of pulmonary function tests in the management of sarcoidosis.

The literature on pulmonary function testing in sarcoidosis is critically reviewed. The results indicate that pulmonary function tests are not a reliable means for detecting the presence of parenchymal sarcoidosis, nor do they provide an accurate estimate of the extent of parenchymal disease. There are at present no known pulmonary function criteria that allow the clinician to predict the natural cause of pulmonary sarcoidosis or the response to therapy. The major value of pulmonary function testing is to assess changes in the disease course of the individual patient through sequential measurements. Currently there is no conclusive evidence that measurements of arterial blood gas tensions or pulmonary compliance add significantly to the sensitivity and specificity of the vital capacity and diffusing capacity in the management of sarcoidosis.

Adrenal Cortex Hormones↗
PubMed1978

Diffuse interstitial pneumonitis. Clinicopathologic correlations in 20 patients treated with prednisone/azathioprine.

Twenty patients with diffuse interstitial pulmonary disease diagnosed by open lung biopsy received combined prednisone/azathioprine therapy. Twelve patients demonstrated improvement with therapy. Each patient's clinical presentation, roentgenologic features and pathologic findings were correlated with their therapeutic response. Patients with an illness of one year's duration or less had a more favorable response to therapy than patients with a greater than two year duration of illness. Patients with associated extrathoracic abnormalities (anemia, glomerulitis, hepatopathy) exhibited a better therapeutic response that those with only pulmonary disease. The biopsy material from each patient was quantitatively graded on 20 morphologic variables. Statistical analysis using multiple linear regression revealed that a single variable, degree of interstitial fibrosis, was more that 90 per cent accurate in separating those responsive to therapy from those who failed to respond. Patients who respond to treatment had less interstitial fibrosis. Neither the amount of alveolar septal inflammation nor intra-alveolar cellular reaction was discriminatory in predicting response to therapy. A beneficial response to therapy was reflected in both improved lung volumes and gas exchange. Eight patients appeared to have a selective beneficial effect from azathioprine.

Adult↗