Biomedical subjects

R S Lan

Publications and source records attributed to R S Lan.

At least 37 records · Page 2Linked to original sources

PubMed1992

Broncholithiasis: a neglected bronchial disease in this country. Illustration of three cases.

A broncholith is a calcified lymph node which partially or completely erodes into the bronchial lumen. Its manifestations are non-specific and may result in life-threatening complications. In Taiwan, pulmonary tuberculosis, one of the most common etiologies of broncholithiasis, is common. To our knowledge, no report on broncholithiasis can be found in literature in this country. We herein present three cases of broncholithiasis experienced in the past 11 years in Chang Gung Memorial Hospital. The presenting manifestations are obstructive pneumonia in two cases, and hemoptysis in the other one. In two of them, the broncholiths were located in the right side. Fiberoptic bronchoscopy was performed, and the stones were visible in all of them. Bronchoscopic removal of stone was successful in two cases, and the other coughed up stones spontaneously after bronchoscopies. In the absence of significant symptoms or complications, only observation is necessary. For the symptomatic borncholiths, we advocate that bronchoscopic removal is worth trying to eliminate the necessity of thoracotomy unless complications are present, which indicate surgical intervention such as massive hemoptysis, fistula formation between tracheobronchial trees and esophagus or vessels, recurrent pulmonary infection or suspicion of malignancy.

Adult↗

PubMed1991

Pneumonia preceding respiratory failure. A rare, easily misleading clinical manifestation in adult Arnold-Chiari malformation.

A 47-year-old woman was admitted for bilateral lower lobe pneumonia with respiratory distress. Two episodes of respiratory failure developed despite improvement of pneumonia after antibiotic chemotherapy. Loss of consciousness and quadriplegia accompanied the last episode of respiratory failure. Arnold-Chiari malformation type 1 was diagnosed and a suboccipital craniectomy was performed. The neuromuscular and respiratory disorders greatly improved after operation. We believe that ACM 1 should be considered when an adult develops unexpected respiratory failure after improvement of the primary pulmonary condition. This disease is potentially treatable by surgical management, and if it is misdiagnosed, will be fatal.

Arnold-Chiari Malformation↗

PubMed1991

Thoracic actinomycosis--review of 9 cases.

Nine cases of thoracic actinomycosis treated in the period from 1976 to 1990 were reviewed. Among them, 4 cases were children. The clinical symptoms and laboratory examinations were non-specific. Chest roentgenographic manifestations including nodular (3 cases), infiltrations (4 cases), and infiltrations with pleural changes (2 cases) were also non-specific. Chest wall masses were noted in four patients. There were no cases correctly diagnosed on admission. The diagnosis of thoracic actinomycosis was made from thoracotomy in 6 cases, from culture of chest wall mass incisional specimens in 2 cases and from bronchoscopic biopsy in 1. All the patients received antibiotics, however the varied duration of postoperative antibiotics did not change the outcome. No mortality or recurrence was noted in our 9 patients with a mean follow-up of 1.9 years (from 2 months to 6 years.) We conclude that surgical intervention is still the cardinal method for diagnosis and treatment. Establishment of the role of postoperative antibiotics will need further prospective study. The prognosis of thoracic actinomycosis is fairly good.

Actinomycosis↗

PubMed1991

Mycoplasma pneumoniae pneumonia: clinical analysis of 45 cases.

Mycoplasma pneumoniae (M. Pneumoniae) is a primarily pathogen of the respiratory tract. The clinical characteristics, laboratory findings, and roentgenographic patterns of 45 patients with serologically proven M. pneumoniae pneumonia admitted to Chang Gung Hospital from 1981 to 1989 have been reviewed. There were 23 males and 22 females. Forty-one (91%) were below 40 years old and 13 patients (29%) were below 5 years old. Fever, cough and chest rales were the most common symptoms and signs. A transient mild elevation of liver enzymes was seen in 33% of the patients, most of whom were below the age of ten (73%). A leukocyte count over 15,000/cu mm was not rare (16%). Roentgenographic features included unilateral infiltration (84%), lower lobe predominance (60%), and either confluent (56%) or patchy (33%) consolidation. Pleural effusion occurred in 24% of the patients. Complete resolution of chest roentgenography took from 8 to 42 days with a mean of 20 days. The response of fever to treatment with erythromycin took from 1 to 6 days with a mean of 3 days. There were no life threatening pulmonic or extrapulmonic complications.

Adolescent↗

PubMed1991

Multifocal atrial tachycardia as a prognostic indicator in patients with severe chronic obstructive pulmonary disease requiring mechanical ventilation.

The records of 121 patients admitted to the Medical Intensive Care Unit (MICU) of Chang Gung Memorial Hospital with severe chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation were reviewed retrospectively. Eighty-seven percent (20/23) of the patients with multifocal atrial tachycardia (MAT) expired during their ICU admission in contrast to 23.5% (23/98) of those without MAT. The only differences between these two groups were incidence of cor pulmonale, and right axis deviation, right bundle branch block, pulmonale P in electrocardiogram. MAT might be considered as a grave prognostic sign in patients with COPD severe enough to require mechanical ventilation.

Aged↗

PubMed1990

Treatment for collapsed lung in critically ill patients. Selective intrabronchial air insufflation using the fiberoptic bronchoscope.

A new, simpler method to re-expand collapsed lungs was introduced in 14 procedures in 12 critically ill patients. To close the bronchus, we wedge the fiberoptic bronchoscope into each segment or subsegment of the collapsed lung instead of using a balloon cuff. Room air was then insufflated into the atelectatic alveoli after repetitive sputum suctioning and bronchial washing with normal saline solution. Complete re-expansion was achieved in 12 of the 14 procedures and partial in two. The average alveolar-arterial oxygen pressure difference (P[A-a]O2) declined from 217.5 before the procedure to 200.3, 150.0 and 152.2, respectively at 30 minutes, 12 hours and 24 hours after. There were no complications.

Adolescent↗

PubMed1990

Respiratory failure of acute organophosphate and carbamate poisoning.

Respiratory failure (RF) developed in 43 (40.2 percent) of 107 patients with acute organophosphate or carbamate poisoning; 22 (51.2 percent) died. The 64 patients who did not develop RF survived. All cases of RF developed within 96 hours after poisoning: within 24 hours in 35 patients (acute onset) and between 24 and 96 hours in eight patients (subacute onset). Severity of poisoning was the primary determinating factor for RF. Cardiovascular collapse and pneumonia were also associated with RF. In 19 patients with cardiovascular collapse, 17 had acute onset of RF and two had subacute onset. In 28 patients with pneumonia, 17 developed acute onset of RF and eight developed subacute onset. No organophosphorus compound caused RF more frequently than another. The duration of ventilator support for subacute RF was significantly longer than for acute RF (287 +/- 186 vs 115 +/- 103 hours, p = 0.02). The use of pralidoxime did not reduce the incidence of RF. We found that severity of poisoning, cardiovascular collapse, and pneumonia were the predisposing factors to RF. The golden time for treatment of acute organophosphate or carbamate poisoning was the initial 96 hours. No RF occurred after this time. Aggressive treatment and prevention of the above three factors will reduce the incidence of RF, or in other words, reduce the mortality.

Acute Disease↗

PubMed1989

The role of fiberoptic bronchoscopy in patients with hemoptysis and a normal chest roentgenogram.

We reviewed the charts of 478 patients who had fiberoptic bronchoscopy (FOB) performed for evaluating hemoptysis with a normal chest roentgenogram. FOB provided a definite diagnosis of endobronchial lesion in only 10 patients (2.1%): bronchogenic carcinoma in 2 patients, bronchial adenoma in 1 patient, tracheal cancer in 1 patient, foreign body in 3 patients and endobronchial tuberculosis in 3 patients. FOB neither visualized tumor mass nor localized the bleeding site in 300 (95.8%) of 313 patients with mild hemoptysis. However, the bleeding site could be localized by FOB in 56% of the patients (n = 165) if the bleeding amount exceeded 60 ml/day. In conclusion, in patients with hemoptysis and normal chest roentgenograms, routine FOB may not rule out airway malignancy. In contrast, it is a good diagnostic tool for localizing the bleeding site if patients present with moderate amount of hemoptysis.

Adolescent↗

PubMed1989

The clinical manifestations of the tuberculous pleural effusion in adult patients.

The clinical data of 52 patients with tuberculous pleural effusion were analyzed. Their average age was 48 years old. Thirty two (62%) of them were sick for less than one week. Fever, chest pain and cough were the predominant pictures. Six of the 52 patients had coexisting disease. Intermediate strength protein purified derivative (PPD) test was found to be positive in 14 out of 31 (45%) patients. Their pleural effusions were usually unilateral, right-sided, and nearly half of them occupied more than half of the hemithorax. One third of these patients and concomitant pulmonary tuberculosis and pleural effusion. None of the patients had grossly bloody effusion. All of the effusions were exudative, and the glucose levels in the pleural fluid were invariably above 60 mg/dl. Presence of mesothelial cells in the pleural fluid was found in 28% of them, but none of the patients presented with significant eosinophils in the pleural fluid. Pleural fluid and sputum cultures for Mycobacterium tuberculosis usually reveal a negative study unless a concomitant pulmonary lesion was present. Combined antituberculosis and prednisolone treatment decreased the duration of constitutional symptoms and hastened the resolution of pleural effusion. In conclusion, tuberculous pleural effusion should be considered in elderly patients presenting with massive exudative pleural effusion even with a negative PPD study. Cultures of sputum and pleural fluid are less helpful in patients without parenchymal disease. Prednisolone is recommended in extremely ill patients.

Adolescent↗

PubMed1989

Fever characteristics in tuberculosis--clinical observation in 597 cases.

Fever characteristics were analyzed in 597 cases of tuberculosis diagnosed by positive culture for mycobacteria tuberculosis admitted to Chang Gung Memorial Hospital between March 1984 and February 1986. Among them, fever was noted in 356 cases (60.0%). Several factors were predisposing to the absence of fever: having a past history of tuberculosis (p less than or equal to 0.01), having a limited lung lesion (p less than 0.05), having an infection with isoniazide (INH) resistant strain (p less than 0.05). Fever typically developed in the late afternoon or evening in 66% of the cases, and this typical fever was significantly more common in patients less 60 years of age (p less than 0.05). The fever was low grade (less than 38.5 degrees C) in 59% of the cases. Among the 137 cases whose fever courses were completely monitored in the hospital, there were 30 cases (22%) whose fever subsided within 3 days after the start of antituberculous chemotherapy, 102 cases (74%) within 1 week and 128 cases (93%) within 2 weeks. Fever resolved within 4 weeks in all but one patient. There was no clinical factor predisposing to the delay of time for the fever to resolve including sex, age, immunocompromised condition, having a past history of tuberculosis, the infectious site(s) of tuberculosis, the extent of pulmonary involvement, the presence of cavitation in pulmonary involvement, and infection with resistant strains.

Adult↗

PubMed1989

Pleural mesothelioma--analysis of 12 cases in Chang-Gung Memorial Hospital.

Twelve cases of pathologically proved pleural mesothelioma collected from 1983 to 1987 were analyzed retrospectively. There were 9 males, and 3 females, aged 14-76 year-old (mean 54 year-old). Eight cases were malignant mesothelioma. Four cases were benign mesothelioma. The male to female ratio in malignant tumor was 1 to 7; in benign tumor it was 1 to 1. The mean age in malignant mesothelioma was 45 year-old, and in benign mesothelioma it was 58. Of the 8 cases with malignant mesothelioma, there were 2 cases (25%) of fibrous type, 1 case (12.5%) of epithelial type, and 5 cases (62.5%) of mixed type. Asbestos exposure history was not evident in our series. Definitive diagnosis was obtained in 10 cases by thoracotomy (83%). Two cases of malignant mesothelioma were verified by pleural biopsy. The diagnostic yield is 40% for pleural biopsy, and 100% for thoracotomy. Bronchoscopic examination, percutaneous biopsy, and pleural effusion analysis were useless in making a definitive diagnosis and distinguishing from metastatic adenocarcinoma in our opinions.

Adenocarcinoma↗

PubMed1989

Use of fiberoptic bronchoscopy to retrieve bronchial foreign bodies in adults.

The flexible fiberoptic bronchoscope was used to treat bronchial foreign bodies in 33 adults. The length of time that the foreign body was in the lung was less than 1 wk in six (acute group), more than 1 month in 21 (chronic group), and uncertain in two (uncertain group), and the foreign body was an endogenous broncholith in four patients (broncholith group). The foreign bodies were nonfragile, solid matter in most cases and they frequently had sharp projections on them. Granulations around the foreign body were common in the chronic group, but there was no correlation between the length of time the foreign body was in the lung and the amount of granulation or the number of the bronchoscopies needed for diagnosis or management. The granulations did not bleed easily on biopsy or during removal of the foreign body. In fact, they receded if several pieces were removed, making the foreign body much easier to recognize and to retrieve in the next bronchoscopy (about 1 wk later). After removal of the foreign body, the residual granulations regressed, and the bronchial lumen became more patent. The mortality, morbidity, and complication rates were very low, whereas the success rate was high. We conclude that flexible fiberoptic bronchoscopy is practical and safe in retrieving bronchial foreign bodies in adult patients.

Adult↗

PubMed1989

Airway lesions presenting with a normal chest X-ray.

From August 1980 to December 1987, 2,020 patients were proved by bronchoscopy to have endobronchial lesions at Chang Gung Memorial Hospital, Taipei. The chest roentgenograms, reviewed by 2 thoracic physicians and 1 radiologist, were reported to be normal in 31 of these patients. The incidence of airway lesions with a normal chest X-ray was 1.5% (31 out of 2,020 cases). These 31 patients included 18 males and 13 females, and their ages ranged from 7 months to 75 years with a mean of 40.3 years. The leading diseases in these cases were tracheal cancer (8 cases), tracheal and/or bronchial tuberculosis (6 cases), bronchogenic carcinoma (5 cases), tracheal schwannoma (2 cases), tracheal cyst (1 case) and bronchial adenoma (1 case). The trachea and main bronchi were the two most frequent sites of radiologically occult endobronchial lesions. Although the majority of the lesions occupied more than 50% of the diameter of the airway lumen, they were not well demonstrated in the routine chest radiological studies. Location, size and nature of the lesions were the major consideration that contributed to the normal-looking appearance of the chest X-ray. Alertness to the symptoms, physical signs and clinical history led to further investigation and the final diagnosis. The conclusion is that some airway lesions may present with a normal chest X-ray and delay the diagnosis. Careful history taking and observation of clinical symptoms and signs are important in the final diagnosis of these patients.

Adult↗

PubMed1989

Pleural effusion in pancreatitis with pancreatico-pleural fistula: report of a case.

Pancreatic pleural effusion due to an internal fistula is an uncommon and often unrecognized clinical syndrome which complicates chronic pancreatitis. It frequently presents with chest and respiratory symptoms of pleural effusion with little abdominal complaints, and history of previous pancreatic disease is often absent, making the diagnosis easily missed. A case of pancreatic pleural effusion due to an internal fistula is presented. To the best of our knowledge, this is the only case report in English journals on a pancreatico-pleural fistula resulting in pleural effusion that was not massive and the effusion amylase level was below 1,000 IU/L while being diagnosed. The potential of computed tomography in the diagnosis of this disease is illustrated.

Adult↗

PubMed1988