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Biomedical subjects

S M Garay

Publications and source records attributed to S M Garay.

At least 19 recordsLinked to original sources
PubMed2000

Inhaled mometasone furoate reduces oral prednisone requirements while improving respiratory function and health-related quality of life in patients with severe persistent asthma.

BACKGROUND: Inhaled corticosteroid therapy in severe persistent asthma has been shown to reduce or eliminate oral corticosteroid (OCS) use while retaining effective asthma control. OBJECTIVE: We sought to evaluate the ability of mometasone furoate (MF) delivered by means of dry powder inhaler to reduce daily oral prednisone requirements in OCS-dependent patients with severe persistent asthma. METHODS: We performed a 12-week, double-blind, placebocontrolled trial (21 centers, 132 patients) comparing 2 doses of MF (400 and 800 microg administered twice daily) with placebo, followed by a 9-month open-label phase in which 128 patients received treatment with MF. RESULTS: At the endpoint of the double-blind trial, MF 400 and 800 mg twice daily reduced daily OCS requirements by 46.0% and 23.9%, respectively, whereas placebo increased OCS requirements by 164.4% (P <.01). Oral steroids were eliminated in 40%, 37%, and 0% of patients in the MF 400 and 800 mg twice daily and placebo groups, respectively. Pulmonary function and quality of life significantly increased for MF-treated patients. Further reductions in OCS requirements were achieved with long-term MF treatment in the open-label phase. CONCLUSION: MF inhaled orally as a dry powder is an effective alternative to systemic corticosteroids in patients with severe persistent asthma.

Administration, Inhalation↗
PubMed1996

Review: pneumothorax in patients with AIDS-related Pneumocystis carinii pneumonia.

A retrospective review was performed to describe the clinical characteristics, course, and outcome of pneumothorax for all patients admitted to Bellevue Hospital, New York, with AIDS who had Pneumocystis carinii pneumonia (PCP) diagnosed between January 1985, through July 1991. Of 1360 patients with AIDS and PCP, 67 patients (4.9%) were identified with pneumothorax; a group of 50 is the subject of this review. Of these 50 patients, 22 patients (44%) developed spontaneous pneumothorax, 15 patients (30%) developed pneumothorax during mechanical ventilation, and 13 patients (26%) had pneumothorax after an invasive procedure. Of the 22 patients with spontaneous pneumothorax, 8 had cystic parenchymal abnormalities on the chest radiograph and 6 had a history of PCP. The majority of patients were treated with tube thoracostomy and/or surgical intervention. All 15 patients who developed pneumothorax during mechanical ventilation died. Results of pathologic studies revealed varying degrees of interstitial inflammation and fibrosis interspersed with areas of hemorrhage and necrosis, and presence of P carinii cysts. Autopsy specimens obtained in two cases demonstrated multiple parenchymal cavities and evidence of an alveolar eosinophilic exudate with P carinii organisms. Spontaneous pneumothorax in patients with AIDS usually occurs in association with PCP and is associated with significant morbidity. Patients at risk include those with cystic lesions on chest radiograph and those patients with a history of PCP. Patients with AIDS and PCP who develop pneumothorax during mechanical ventilation have a poor outcome.

AIDS-Related Opportunistic Infections↗
PubMed1995

Unusual lymphoproliferative disorders in nine adults with HIV or AIDS: CT and pathologic findings.

PURPOSE: To identify characteristic computed tomographic (CT) findings in unusual pulmonary lymphoproliferative disorders seen in adults with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: The authors retrospectively reviewed the CT scans and pathologic specimens from nine patients with pulmonary lymphoproliferative disorders. CT scans were evaluated for nodules, reticulation, areas of ground-glass attenuation, consolidation, and bronchial disease. Changes seen in pathologic specimens were classified as consistent with classic lymphocytic interstitial pneumonitis (LIP), mucosa-associated lymphoid tissue lymphoma (MALTOMA), or atypical lymphoproliferative disorder (ALD). Immunopathologic results were reviewed when available. RESULTS: Eight patients had AIDS. Five patients had classic LIP. One patient had MALTOMA, and three patients had ALD. Altogether, 2-4-mm-diameter nodules were the predominant CT finding in eight patients; these were peribronchovascular in four patients. The presence of interstitial nodules correlated with the pathologic finding of nodular disease in seven patients. CONCLUSION: Familiarity with these AIDS-related disorders and their CT appearance should assist in the differential diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Cytomegalovirus pneumonitis: spectrum of parenchymal CT findings with pathologic correlation in 21 AIDS patients.

PURPOSE: To identify characteristic features of cytomegalovirus (CMV) pneumonitis at computed tomography (CT), particularly markers that may help differentiate CMV from Pneumocystis carinii pneumonia. MATERIALS AND METHODS: Bronchoalveolar lavage (BAL) and biopsy results in 21 patients with acquired immunodeficiency syndrome, cytopathologic evidence of CMV infection without other infections, and available CT scans were retrospectively evaluated. CT findings were correlated with radiographic and pathologic findings when available. RESULTS: BAL findings were positive for CMV in only six cases, 13 patients had extrathoracic CMV infection, and 10 had Kaposi sarcoma. CT findings included ground-glass attenuation, dense consolidation, bronchial wall thickening or bronchiectasis, and interstitial reticulation without air-space disease (12 patients had discrete pulmonary nodules or masses). Biopsy revealed air-space disease as the dominant process in eight cases. Histopathologic findings correlated well with CT appearances. CONCLUSION: CMV pneumonitis should be suspected in patients with either extrathoracic CMV or documented Kaposi sarcoma, especially when radiographic or CT evidence of pulmonary nodules or masses exists.

AIDS-Related Opportunistic Infections↗
PubMed1994

Hemoptysis: prospective high-resolution CT/bronchoscopic correlation.

The precise roles of fiberoptic bronchoscopy (FOB) and computed tomography (CT) of the chest in the evaluation of patients presenting with hemoptysis have not been clearly defined. On the assumption that both procedures would likely provide unique and complementary information, a prospective study with blinded interpreters using a modified high-resolution CT technique (HRCT) and FOB was designed to evaluate 57 consecutive patients admitted to Bellevue Hospital with hemoptysis. Etiologies included bronchiectasis (25 percent), tuberculosis (16 percent), lung cancer (12 percent), aspergilloma (12 percent), and bronchitis (5 percent): in an additional 5 percent of cases, hemoptysis proved to be due miscellaneous causes, while in 19 percent hemoptysis proved to be cryptogenic. Patients with lung cancer all were at least 50 years old, smoked an average of 78 pack-years, and had less severe hemoptysis but of longer duration. All had conditions diagnosed both by HRCT and FOB. High-resolution CT proved of particular value in diagnosing bronchiectasis and aspergillomas, while FOB was diagnostic of bronchitis and mucosal lesions such as Kaposi's sarcoma. Fiberoptic bronchoscopy localized bleeding in only 51 percent of cases. The high sensitivity of CT in identifying both the intraluminal and extraluminal extent of central lung cancers in conjunction with its value in diagnosing bronchiectasis suggest that CT should be obtained prior to bronchoscopy in all patients presenting with hemoptysis.

Adult↗
PubMed1994

Pleural tuberculosis and HIV infection.

Human immunodeficiency virus infection changes the clinical presentation of tuberculosis infection with atypical radiographs and more common extra-pulmonary involvement. We retrospectively studied pleural tuberculosis in HIV-positive patients over a 5-year period. We identified 70 patients with pleural tuberculosis by positive Mycobacterium tuberculosis cultures of pleural fluid and/or pleural tissue, including 43 HIV-positive and 27 HIV-negative patients. The HIV-positive patients were significantly younger (mean age, 38 +/- 1 years in HIV-positive vs 52 +/- 3 years in HIV-negative patients, p < 0.05). There were more intravenous drug abusers in the HIV-positive group (74 vs 30 percent, p < 0.01). The HIV-positive group had significantly fewer positive tuberculin skin tests (41 percent vs 76 percent, p < 0.03). Both groups had similar pleural fluid cellularity and pleural biopsy histologic conditions, but the HIV-positive patients demonstrated significantly more acid-fast bacteria identifiable in pleural tissue (69 percent vs 21 percent, p < 0.01), and a higher incidence of positive M tuberculosis cultures of sputum (53 percent vs 23 percent, p = 0.02). Pleural tuberculosis in HIV-positive patients presented more often as a manifestation of a greater burden of microorganisms and impaired host response.

AIDS-Related Opportunistic Infections↗
PubMed1993

Accessory cardiac bronchus: CT features and clinical significance.

PURPOSE: The accessory cardiac bronchus is a rare congenital anomaly of the tracheobronchial tree that arises from the medial wall of the bronchus intermedius. This report documents the computed tomographic (CT) appearance of this anomaly. MATERIALS AND METHODS: Six patients with this anomaly were identified. All six underwent CT; three underwent correlative bronchoscopy, and one had both bronchoscopic and surgical confirmation. RESULTS: In all six cases, a distinct airway could be identified originating from the medial wall of the bronchus intermedius. Associated lung parenchymal tissue was identified in four cases, while in three cases a discrete soft-tissue mass was seen, presumably representing vascularized bronchial or vestigial parenchymal tissue. In two cases, the lumen of the airway was filled with debris. CONCLUSION: Recognition of this anomaly is important, as associated clinical complications, including recurrent episodes of both infection and hemoptysis, may be anticipated in a small percentage of patients.

Adult↗
PubMed1991

Imaging of the intensive care unit patient.

Despite advances in "high tech," it is anticipated that plain chest film radiography will continue to play a significant role in the management of patients in the ICU. Digital radiography will most likely displace conventional approaches. As demonstrated throughout this article, CT has played an increasingly important role in the evaluation of the critically ill patient. The results are especially impressive, because most were obtained on earlier-generation CT machines, which are now totally outdated. Newer scanners have many technical improvements, including rapid scanning, which permits breathholding, and thin-section scanning, which has been discussed in great detail throughout this volume. Whether MR imaging will play an important role in ICU care remains to be determined.

Catheterization↗
PubMed1991

Radiographic evaluation of focal lung disease.

Optimal clinical management of patients with focal lung pathology necessitates thorough familiarity with basic concepts in imaging. Over the past decade, radiologic evaluation has undergone rapid change, reflecting considerable growth in imaging technology. As this article discusses and illustrates at length, improvements in computed tomography technology in particular have resulted in a significant alteration in our approach to both the diagnosis and treatment of patients with focal lung disease.

Humans↗
PubMed1990

Evaluation of the measurement methods for protrusio acetabuli in normal children.

The normal values of the radiological lines most frequently used as references in the diagnosis of adult protrusio acetabuli were prospectively determined in 150 children (300 hips) without femoral pathology and aged between 2 and 15 years, mean age 8 years. The teardrop shape was modified according to the child's age, the "crossed" type predominating (48.7%). The mean centre edge (CE) angle fluctuated, with a median value of 31.2 degrees +/- 6.2 degrees, increasing with age and with slightly greater values in females; a large spread of CE angle values was observed within age groups. Acetabular ilioischial line values ranged from +7 to -5 mm, with a mean of +1.8 +/- 2 mm. This last method was the most suitable because it was not modified by changes in incidence of X-rays in radiological studies. With this method protrusio is diagnosed in children when the acetabular line is projected medially, provided that the ilioischial line is 1 or 3 mm or more for boys and girls, respectively. We conclude that the most trustworthy method available to evaluate PA in children should be "line crossing".

Acetabulum↗
PubMed1989

Diagnostic implications of Ga-67 chest-scan patterns in human immunodeficiency virus-seropositive patients.

Consecutive gallium-67 scans (n = 237) of 180 human immunodeficiency virus-seropositive patients with suspected pulmonary infections were evaluated for intensity and pattern of gallium distribution. Scan findings were correlated with the history, chest radiographic findings, and clinicopathologic diagnoses. Pneumocystis carinii pneumonia (PCP) occurred significantly more often with heterogeneous diffuse uptake than with homogeneous diffuse uptake. Heterogeneous diffuse uptake had an 87% positive predictive value for PCP, which was higher than that of other patterns. Localized pulmonary uptake was most commonly due to bacterial pneumonia or PCP; ill-defined, perihilar uptake, to cytomegalovirus or PCP; and focal (lymph node) uptake, to tuberculosis or lymphoma. The positive predictive value of any pulmonary uptake for lung pathology was 93%, and the negative predictive value of a negative scan was 96%. These findings confirm the utility of gallium scanning in the detection of lung pathology related to acquired immunodeficiency syndrome, particularly PCP. Furthermore, identification of a diffuse pattern may permit the use of a less invasive test more specifically directed at the confirmation of a diagnosis of PCP.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Prognostic indicators in the initial presentation of Pneumocystis carinii pneumonia.

We prospectively evaluated 150 consecutive patients with Pneumocystis carinii pneumonia (PCP) as their sole initial manifestation of AIDS (group 1). Admission laboratory and radiographic criteria were analyzed for diagnostic and prognostic indicators and compared with those of patients presenting with non-PCP pulmonary manifestations of AIDS (group 2). Mean admission serum LDH level was 465 +/- 67 IU/L in PCP patients (group 1) and 211 +/- 28 IU/L in group 2 (p less than 0.01). Seventy-eight percent of PCP patients (117 of 150) survived. Comparing survivors with nonsurvivors, the mean admission LDH level was 394 +/- 45 vs 717 +/- 51 IU/L (p less than 0.01), and the mean P(A-a)O2 gradient was 42 +/- 6 vs 55 +/- 6 mm Hg (p less than 0.05). Serum LDH levels and P(A-a)O2 gradients have diagnostic and prognostic implications in patients with AIDS-related PCP.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Kaposi's sarcoma. CT-radiographic correlation.

The role of CT in the diagnosis of intrathoracic Kaposi's sarcoma (KS) was evaluated retrospectively in 24 patients, in the absence of coexistent opportunistic infections. In all cases the diagnosis of KS was initially established by histologic evaluation of extrathoracic disease: 15 patients had verified parenchymal KS and nine patients endobronchial KS. (Chest roentgenograms were analyzed separately for each group: in 14 patients serial films were available for review. The predominant radiographic findings was the presence of nonspecific, bilateral, perihilar infiltrates in 22 of 24 cases (92 percent). Corresponding CT scans documented the presence of abnormal hilar densities characteristically extending into the adjacent pulmonary parenchyma along distinctly perivascular and peribronchial pathways. Discrete, poorly marginated nodules were identified radiographically in ten cases (42 percent); these proved to be randomly distributed throughout the parenchyma on CT. Radiographic evidence of mediastinal adenopathy was distinctly unusual, seen in only two cases (8 percent). While CT typically demonstrated shotty adenopathy, significantly enlarged nodes (greater than 1 cm) were rarely identified. We concluded that CT is more specific than routine roentgenograms for identifying pulmonary KS. While not pathognomonic, peribronchial and perivascular disease is sufficiently characteristic to obviate more invasive diagnostic procedures, especially in patients with established KS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Septic pulmonary emboli: CT-radiographic correlation.

Radiographic and CT findings in 15 patients with clinically documented septic pulmonary emboli were compared retrospectively. In most cases, radiographic changes were nonspecific. In comparison, on CT a combination of specific signs could be identified in all patients. These included peripheral nodules with clearly identifiable feeding vessels associated with metastatic lung abscesses (10 [67%] of 15 cases), and subpleural, wedge-shaped densities with and without necrosis caused by septic infarcts (11 [73%] of 15 cases). Ancillary pleural, mediastinal, axillary, and pericardial abnormalities also were more easily identified with CT. We conclude that CT is complementary to other imaging techniques in the recognition of septic pulmonary emboli.

Adult↗
PubMed1988

Basilar segmental bronchi: thin-section CT evaluation.

Thin (1.5- and 5.0-mm) section contiguous computed tomographic (CT) scans obtained through the basilar segmental bronchi in 31 patients were reviewed in order to delineate normal anatomy and common variations of lower lobe airways. In each case, the frequency with which individual segmental and subsegmental bronchi were seen was established, as were variations in branching patterns. All basilar segmental bronchi were identified except in one case in which images of the left lung were obscured due to respiratory and cardiac motion. In the right lung, a division into subsegmental bronchi was identified in 84 of 150 (56%) visualized segmental bronchi. Six separate patterns of basilar segmental subdivision were found. In the left lung, subsegmental bronchi were identified arising from 51 of 145 (35%) visualized segmental bronchi. Five separate patterns of bronchial subdivision were found in the left lung. It is concluded that thin-section CT allows precise identification of all basilar segmental bronchi and, consequently, can play a significant role in the cross-sectional evaluation of lower lobe bronchial and parenchymal abnormalities.

Bronchi↗
PubMed1988

Solitary pulmonary nodules. CT-bronchoscopic correlation.

The possible contribution of computed tomography (CT) in the management of patients with solitary pulmonary nodules (SPNs) or masses was reviewed retrospectively in 65 patients undergoing fiberoptic bronchoscopy (FOB). Nodules were evaluated by size, location, surface contour, and the presence in cross-section of a bronchus leading to or contained within the nodule or mass, a "positive bronchus sign." Thirty-five lesions were associated with a positive bronchus sign; 21 of 35 (60 percent) were diagnosed endoscopically, (p = .027); of 30 cases with a negative bronchus sign, only ten (30 percent) had a diagnosis made by FOB (p = .034). It is concluded that CT may be of use in the routine evaluation of pulmonary nodules, prior to bronchoscopy, especially in cases for which histologic evaluation is essential, especially to determine the presence or absence of a CT bronchus sign.

Biopsy↗
PubMed1988

Pulmonary effects of AIDS: nosocomial transmission.

This review provides an overview of the risk of nosocomial infection in the "AIDS era." Airborne spread of Mycobacterium tuberculosis from affected patients has re-emerged as a hazard to hospital personnel. The risk of acquiring clinical illness due to Pneumocystis carinii or cytomegalovirus is, in contrast, a function of the immunocompetence of the health care worker. Methods of transmission as well as the epidemiology of human immunodeficiency virus-related infection in the health care worker will be discussed. The increase in the number of immunocompromised patients (AIDS and non-AIDS) requires careful attention to infection control methodology with respect to the cleansing of the fiberoptic bronchoscope, the intensive care unit's respiratory equipment (such as mechanical ventilators and nebulizers), and the pulmonary function laboratory.

Acquired Immunodeficiency Syndrome↗