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Biomedical subjects

S A Sahn

Publications and source records attributed to S A Sahn.

At least 55 records · Page 3Linked to original sources
PubMed1995

Pleural diagnostic techniques.

An etiologic diagnosis of a pleural effusion is made presumptively in approximately 50% of patients and definitively in an additional 25%. The cause of the effusion in the remaining patients usually is ascertained by observation with or without repeat pleural fluid analysis, specialized testing of the pleural fluid, or invasive procedures. However, a small number of patients defy a precise etiologic diagnosis even after invasive procedure. Investigators have sought various biochemical and immunologic markers in pleural fluid that would increase diagnostic certainty. Thoracoscopy, a less invasive procedure than open thoracotomy, is excellent for the diagnosis of malignancy but is of minimal benefit in the diagnosis of benign pleural disease.

Humans↗
PubMed1994

Chemical pleurodesis for malignant pleural effusions.

PURPOSE: To provide information about available agents for chemical pleurodesis. DATA SOURCES: A MEDLINE search (1966 to October 1992) was conducted using the terms malignant pleural effusion and pleurodesis. STUDY SELECTION: All articles containing references to patients with recurrent, symptomatic, malignant pleural effusions treated with chemical pleurodesis were selected and reviewed for pleurodesis regimen, number of patients treated, success rate (complete response), and adverse effects. The agents studied included doxycycline, minocycline, tetracycline, bleomycin, cisplatin, doxorubicin, etoposide, fluorouracil, interferon-beta, mitomycin-c, Corynebacterium parvum, methylprednisolone, and talc. DATA EXTRACTION: Independent extraction by three observers. RESULTS: Studies including a total of 1168 patients with malignant pleural effusions were reviewed for efficacy of the pleurodesis agent and studies including 1140 patients were reviewed for toxicity. Chemical pleurodesis produced a complete response in 752 (64%) of 1168 patients. The success rate of the pleurodesis agents varied from 0% with etoposide to 93% with talc. Corynebacterium parvum, the tetracyclines, and bleomycin had success rates of 76%, 67%, and 54%, respectively. The most commonly reported adverse effects were pain (265 of 1140, 23%) and fever (220 of 1140, 19%). CONCLUSIONS: Doxycycline and minocycline, with success rates of 72% and 86%, respectively, appear to be effective tetracycline-replacement agents in the few patients studied. Talc appears to be the most effective and least expensive agent; however, insufflation has the disadvantages of the expense of thoracoscopy and the usual need for general anesthesia. Bleomycin appears to be less effective than talc and the tetracyclines and is substantially more expensive.

Adjuvants, Immunologic↗
PubMed1994

Endobronchial HIV associated lymphoma.

A 27 year old HIV infected man presented with two days of haemoptysis. Flexible bronchoscopy revealed a large carinal mass partially obstructing the left and right main stem bronchi. Rigid bronchoscopy was required to make the diagnosis of large cell immunoblastic lymphoma.

Adult↗
PubMed1994

Opportunistic infection during treatment with low dose methotrexate.

Two patients receiving low dose methotrexate, one with rheumatoid arthritis and the other with pityriasis rubra pilaris, developed disseminated histoplasmosis and Mycobacterium avium intracellulare pneumonia, respectively. Twenty-three cases of opportunistic infection in patients receiving low dose methotrexate have been reported previously, with Pneumocystis carinii pneumonia being the most common infection (10 of 23, 43%). Patients receiving low dose methotrexate are at risk for opportunistic infection despite normal leukocyte counts.

Aged↗
PubMed1994

Endobronchial lesions in HIV-infected individuals.

Endobronchial manifestations of HIV infection are rare. The endobronchial appearance and clinical presentation of these lesions may suggest the correct diagnosis. Establishing an appropriate differential diagnosis at the time of visualization of the endobronchial lesion is important because some lesions require specific biopsy techniques or special stains. The bronchoscopist must consider the risks vs benefits of biopsy when confronted with an endobronchial lesion. With the notable exception of pseudomembranous necrotizing tracheobronchial aspergillosis, there are no specific endobronchial lesions associated with HIV infection which increase the risk of complications when they are biopsied. Although EKS is a vascular lesion and an early case report suggested that endobronchial biopsy might result in excessive bleeding, this complication was not observed in two subsequent series. Fortunately, a presumptive diagnosis of EKS can usually be made without biopsy by the characteristic appearance of the lesions. EKS is the most common endobronchial lesion associated with HIV infection; however, its incidence will probably decline as the incidence of KS declines. Many of the other endobronchial lesions described herein have been reported recently. We suspect these and other lesions will be found more frequently, as the epidemic of HIV continues to evolve.

AIDS-Related Opportunistic Infections↗
PubMed1994

Acute hypoxemic respiratory failure following intrapleural thrombolytic therapy for hemothorax.

Intrapleural instillation of thrombolytic agents has been useful in the treatment of hemothorax when thoracostomy tube drainage is unsuccessful. We present a patient who developed acute hypoxemic respiratory failure following the intrapleural instillation of both streptokinase and urokinase 24 h apart. Hypoxemia most likely resulted from a direct effect of the products of fibrinolysis on the pulmonary circulation.

Acute Disease↗
PubMed1994

Pleurodesis using talc slurry.

OBJECTIVE: To determine the efficacy and safety of talc slurry for pleurodesis. DESIGN: Retrospective. PARTICIPANTS: All patients who received talc slurry via tube thoracostomy at Memorial Sloan-Kettering Cancer Center from March 1991 to April 1992. RESULTS: Fifty-eight patients received talc slurry in 75 procedures; five patients had 2 unilateral procedures and 12 had bilateral procedures. Fifty-two patients had malignant pleural effusions with the most common cell types being breast (23 of 52, 44 percent), lung (4 of 52, 8 percent), ovarian (4 of 52, 8 percent), and endometrial (3 of 52, 6 percent). Four patients had benign conditions. The mean duration of follow-up was 171 days (range, 2 to 450 days). Success, defined as the absence of pleural fluid reaccumulation, was evaluable in 47 of 73 (64 percent) procedures. Pleurodesis was successful in 38 of 47 (81 percent). Adverse effects associated with pleurodesis included fever (46 of 73, 63 percent), empyema (4 of 73, 5 percent), atrial arrhythmia (3 of 73, 4 percent), hypotension (3 of 73, 4 percent), and hypoxemic respiratory failure (3 of 73, 4 percent). There were no deaths attributable to the procedure. CONCLUSIONS: Talc slurry instilled through a chest tube is an effective bedside method of pleurodesis. Fever occurs frequently. Respiratory failure is a rare but potentially serious complication that deserves further investigation.

Adult↗
PubMed1994

Thoracic endometriosis. Recurrence following hysterectomy with bilateral salpingo-oophorectomy and successful treatment with talc pleurodesis.

This is a report of an unusual patient who had four of the five manifestations of thoracic endometriosis, including right pneumothorax, left hemothorax, chest pain, and hemoptysis. This patient shows that recurrence of symptoms can occur while a patient is receiving hormonal replacement therapy even after hysterectomy and bilateral salpingo-oophorectomy; estrogen replacement should probably be delayed for several months to allow complete regression of the ectopic endometrial tissue. Alternatively, chemical pleurodesis can be effective in treating recurrent pneumothorax or hemothorax while the patient is receiving hormonal replacement. Bilateral pleural involvement and hemoptysis suggest microembolization of endometrial tissue as the pathogenic mechanism for thoracic endometriosis.

Adult↗
PubMed1994

Noninvasive evaluation of the patient with a pleural effusion.

Pleural fluid formation is an indicator of a pathologic process that may be of primary pulmonary origin but also may be a reflection of disease in virtually any other organ system or a systemic disease. A thoracentesis should be performed on any patient in whom the cause of the effusion has not been established yet. The possible exception to this is an effusion thought to be secondary to uncomplicated congestive heart failure. The presumptive or definitive diagnosis can be established in 75% of patients by following patient history, physical examination, and pleural fluid analysis.

Diagnosis, Differential↗
PubMed1993

Pleural effusions in hospitalized patients with AIDS.

OBJECTIVE: To determine the incidence, cause, and characteristics of pleural effusions in hospitalized patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Retrospective. PARTICIPANTS: A total of 222 patients with AIDS hospitalized between January 1986 and January 1992 at the Medical University of South Carolina hospitals. RESULTS: Pleural effusions occurred in 59 patients for an overall incidence of 27%. The mean age of the patients was 35 +/- 2 years (SE) and the male to female ratio was 5:1. The cause was infectious in 39 (66%) patients, noninfectious in 18 (31%), and unknown in 2 (3%). Pleural effusions were caused by bacterial pneumonia in 18 (31%) patients, Pneumocystis carinii pneumonia in 9 (15%), Mycobacterium tuberculosis in 5 (8%), septic embolism in 2 (3%), Nocardia asteroides in 2 (3%), cryptococcus neoformans in 2 (3%), and Mycobacterium arium intracellulare in 1 (2%). Among noninfectious causes (n = 18), hypoalbuminemia was the cause in 11 patients (19%), cardiac failure in 3 (5%), and atelectasis, Kaposi sarcoma, uremic pleurisy, and adult respiratory distress syndrome in 1 (2%) each. Patients with AIDS who had pleural effusions had significantly lower serum albumin levels and had lower CD4 counts than did those without pleural effusions (P < 0.001). CONCLUSIONS: Pleural effusions are common in hospitalized patients with AIDS. Bacterial pneumonia is the most common cause for pleural effusion in AIDS. Large effusions are associated with Kaposi sarcoma and tuberculosis. Hypoalbuminemia is a common cause of noninfectious pleural effusions.

AIDS-Related Opportunistic Infections↗
PubMed1993

Pleural macrophages differentially alter mesothelial cell growth and collagen production.

Intrapleural tetracycline (TCN) results in pleural macrophage influx and pleural fibrosis; intrapleural carrageenan (CAR) induces macrophage influx without fibrosis. Because macrophage products can modulate mesothelial cell activity, we investigated the role of TCN- and CAR-induced pleural macrophages on mesothelial cell growth can collagen production. Rabbit pleural macrophages, isolated by plastic adherence 72 h after 20 mg/kg TCN or 10 mg CAR instilled intrapleurally, were cultured for 20 h. Macrophage-conditioned media (MCM) from TCN-or CAR-induce pleural macrophages (TCN MCM, CAR MCM, respectively), were added to non-confluent or confluent rat visceral pleural mesothelial cells and compared to the effects of TCN and CAR. Nonconfluent mesothelial cells were harvested 72 h later for hemacytometry cell counts. A 20-h pulse of [3H] proline (1 mu Ci, 30 Ci/mM) preceded 72-h-cell harvesting of confluent cells. Collagen content was determined in the cell fraction and cell media separately after bacterial collagenase exposure. Mesothelial cells exposed to TCN MCM were found to have decreased numbers when compared to all groups (P < 0.05) except CAR. Cell media collagen content was increased in all macrophage-conditioned-media and chemical-exposed groups compared with control, with TCN MCM having a larger increase than TCN alone (P < 0.05). We conclude that stimulated pleural macrophages release a factor(s) that alters mesothelial cell growth and collagen production and that TCN- and CAR-stimulated pleural macrophages are functionally different. These in vitro mesothelial cell alterations may be important in the genesis of TCN pleurodesis.

Animals↗
PubMed1993

Intrapleural streptokinase in experimental empyema.

Intrapleural streptokinase has been used in multiloculated empyemas to enhance pleural space drainage, presumably by causing fibrinolysis of the interlocular septae. We evaluated the efficacy and safety of daily administration of 10,000 U intrapleural streptokinase or equal volumes of saline to enhance resolution of experimental empyema in the rabbit pleural space. Seventy-two hours after intrapleural turpentine, 10(8) colony-forming units each of Escherichia coli, Peptostreptococcus anaerobius, and Bacteroides fragilis were injected into the sterile pleural effusion of all animals. Immediately after bacterial inoculation, and daily for 3 days, animals received 10,000 U streptokinase or saline intrapleurally. Animals that achieved a pleural fluid pH < 7.30 and either glucose < 50 mg/dl or LDH > 500 IU/L were included for data analysis. At Day 4 after bacterial inoculation, the streptokinase-treated empyemic rabbits had more pleural fluid (18.8 +/- 5.1 ml) (mean +/- SEM) than did saline-treated control animals (4.8 +/- 1.7 ml) (p = 0.015), fewer interpleural adhesions (8.2 +/- 2.7) than did saline-treated control animals (25.1 +/- 3.6) (p = 0.002), and comparable amounts of visceral and parietal pleural plaque than did saline-treated control animals (p = NS). No evidence of systemic fibrinolysis was observed at 1 h after intrapleural streptokinase administration. We conclude that intrapleural streptokinase decreases interpleural adhesion numbers but fails to reduce the amount of pleural plaque observed in experimental empyema in rabbits. The increases in pleural fluid volume observed after streptokinase administration may be due to mechanisms other than fibrinolytic activity.

Animals↗
PubMed1993

The clinician's perspective on parapneumonic effusions and empyema.

Respondents at an interactive symposium on pleural space infections (n = 339) at the 1991 American College of Chest Physicians Annual Scientific Assembly recorded their personal management preferences for hypothetical patients with empyema. The group's preference was to treat pleural sepsis from an anaerobic multiloculated empyema by pleural decortication (49 percent); however, open thoracotomy with directed chest tube placement (22 percent), chest tube placement with intrapleural streptokinase (14 percent), placement of a single chest tube into the largest pleural loculus (8 percent), and placement of multiple small-bore catheters with computed tomographic guidance (7 percent) all had proponents. In the case of a multiloculated empyema not completely drained by a first chest tube in a nontoxic patient, the preference was drainage by a second chest tube, either a small-bore (42 percent) or a large-bore (36 percent) tube. The heterogeneity of responses suggests that prospective trials comparing treatment modalities are needed.

Attitude of Health Personnel↗
PubMed1993

Critical illness in pregnancy. An analysis of 20 patients admitted to a medical intensive care unit.

There is a paucity of literature with regard to the need for intensive care treatment of critically ill obstetric patients. In this review, the findings from 20 obstetric patients admitted to a medical ICU (MICU) over a 40-month period were analyzed. Demographics, preexistent medical problems, diagnoses, days in the hospital and the MICU, need for mechanical ventilation, maternal and fetal mortality, and invasive procedures were reviewed. (For comparison, a limited analysis of nonobstetric admissions to the MICU over the same time period were included.) Fifty percent (10) of the patients had preexisting medical problems. Maternal mortality was 20 percent (4 patients), with a fetal mortality of 35 percent (7). In all of the maternal deaths, adult respiratory distress syndrome was present. Although mortality and the need for mechanical ventilation did not differ between the obstetric and nonobstetric patients, pulmonary artery and arterial catheters were placed at a higher rate in the obstetric patients. Critically ill obstetric patients, although younger than general MICU patients, appear to have as great a risk of dying of their critical illness and have a high infant mortality.

Adolescent↗