Biomedical subjects

Raymond G Slavin

Publications and source records attributed to Raymond G Slavin.

26 records · Page 2Linked to original sources

PubMedDate not supplied

Sinusitis: viral, bacterial, or fungal and what is the role of Staph?

Recently, it has been recognized that inflammation is the major cause of chronic rhinosinusitis (CRS) rather than bacterial infection. Fungi have emerged as a possible pathogenic agent that drives CRS. One clear-cut group of fungal sinusitis can be divided into invasive and noninvasive. The condition that the allergist is most likely to see is allergic fungal sinusitis. Generally, it appears in atopic, immunocompetent, adolescents and young adults and is marked by the presence of nasal polyps and allergic mucin, which includes eosinophils, Charcot-Leyden crystals, and fungal hyphae. Computer tomographic imaging shows sinus opacification with hyperdense areas. Treatment has been successful with definitive nasosinus surgery and long-term oral prednisone. There is some evidence that fungi also may account for a large percentage of the remaining CRS patients. In this instance, the immune response to common airborne fungi appears to be IgG mediated rather than IgE mediated. Promising therapeutic results have been seen with intranasal antifungal agents but larger multicenter double-blinded placebo-controlled studies are needed. Another unanswered question includes the possible role of staphylococcus-derived enterotoxins in the pathogenesis of CRS.

Animals↗

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Primary paranasal Aspergillus granuloma: case report and review of the literature.

BACKGROUND: Primary paranasal aspergillus granuloma (PPAG) is a slowly progressive chronic infection of the sinus extending beyond the confines of the sinus. It has been reported only in patients from the Sudan and India. Microscopically, it differs from chronic invasive fungal sinusitis in that there are pseudotubercles containing giant cells, histiocytes, lymphocytes, plasma cells, newly formed capillaries, eosinophils, and Aspergillus fungal elements. CONCLUSION: We describe the first case of PPAG in the United States in an immunocompetent nonatopic woman who had never left Missouri.

Adult↗

PubMedDate not supplied

Resistant rhinosinusitis: what to do when usual measures fail.

There are some patients with rhinosinusitis in whom the condition never clears or it recurs after a short period of time. The clinician must consider underlying conditions that must be brought under control to arrive at a satisfactory outcome. These conditions include allergy, immune deficiency, cystic fibrosis, gastroesophageal reflux, and structural abnormalities. Other disease states are important to consider because they may mimic bacterial rhinosinusitis but require other therapeutic approaches. These include chronic hyperplastic eosinophilic rhinosinusitis, fungal sinusitis, and aspirin sensitivity.

Humans↗

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Mucoid impaction: a localized form of allergic bronchopulmonary aspergillosis.

Mucoid impaction is defined as the obstruction of proximal bronchi by mucous plugs and exudates. There are striking similarities between patients with mucoid impaction and those with allergic bronchopulmonary aspergillosis (ABPA), often referred to as "mucoid microimpaction." We evaluated three patients with mucoid impaction for diagnostic criteria of ABPA and human leukocyte antigen type. We found that certain human leukocyte antigen types were common among mucoid impaction patients and those with ABPA. It is possible that patients with mucoid impaction could represent a localized form of ABPA.

Aged↗

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The elderly asthmatic patient.

The fastest growing population in the United States is the elderly person. Clinicians can expect to see more patients that are elderly in their practice with asthma because the incidence is about the same as the general population. Asthma in the elderly patient is underdiagnosed because of false perceptions by both patient and physician. The high incidence of comorbid conditions in the elderly patient makes the diagnosis and management more difficult. The elderly asthmatic patient appears to be undertreated with fewer being given inhaled corticosteroids. Asthma in the elderly patient adversely affects quality of life and results in a higher hospitalization rate and mortality. Allergy is common enough in the elderly asthmatic patient to warrant appropriate diagnostic techniques and intervention including environmental control, pharmacotherapy, and immunotherapy.

Age Factors↗

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An overview of allergic bronchopulmonary aspergillosis with some new insights.

Allergic bronchopulmonary aspergillosis (ABPA) occurs as a complication of bronchial asthma or cystic fibrosis (CF). The diagnostic criteria speak to an exaggerated type I hypersensitivity response to the ubiquitous organism Aspergillus fumigatus. Immunologic parameters indicative of Aspergillus sensitization in CF may be lost spontaneously. Therefore, it is important that the diagnosis of ABPA in CF include clinical parameters. CF transmembrane regulator gene mutations may occur in asthmatic ABPA patients indicating a subset of ABPA patients that warrant further study to exclude the diagnosis of CF. The extensive tissue damage seen in ABPA may, in part, be caused by proteases released from aspergillus. Host characteristics may predispose to the development of ABPA. It appears that human leukocyte antigen DR2 and particularly DRB1*1503 and *1501 alleles represent significant ABPA susceptibility genes with the possibility that human leukocyte antigen DQ2 allele confers protection in the non-ABPA population. These findings may offer an additional clinical aid in early diagnosis and provide insight into T-cell reactivity in ABPA that may lead to the development of specific immunotherapy.

Allergens↗

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The allergist and the workplace: occupational asthma and rhinitis.

Occupational respiratory disease is a significant problem and appears to be on the rise. The allergist should make every effort to become familiar with the workplace environment and appreciate the many causes of occupational rhinitis and asthma. In addition to prescribing appropriate medications, the clinician should be the patients total health advocate in terms of encouraging changes in the working environment to benefit the patient. Inattention to this may result, particularly in the case of occupational asthma, in progressive respiratory deterioration.

Asthma↗

PubMedDate not supplied

Allergic rhinitis: managing the adult spectrum.

With the general population increasing in age, clinicians will be seeing more elderly patients. Many present with bothersome rhinitis. A number of physiological and anatomic changes associated with age predispose the elderly population to develop rhinitis. A number of categories of rhinitis occur in elderly people and it is important to make the correct diagnosis. Appropriate therapy is available but the clinician must be wary of side effects, particularly to antihistamines and decongestants that may be more severe in elderly patients.

Adult↗