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Biomedical subjects

S M Garay

Publications and source records attributed to S M Garay.

36 records · Page 2Linked to original sources
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↗
PubMed1987

Pulmonary manifestations of Kaposi's sarcoma.

Pulmonary Kaposi's sarcoma is an unusual pre-mortem diagnosis in AIDS patients. During a four-year period, 318 patients with AIDS-associated Kaposi's sarcoma presented to New York University Medical Center; 19 patients were found to have pulmonary involvement. All 19 patients were homosexual men; 18 of these patients presented with cutaneous and/or visceral Kaposi's sarcoma. Seventy-nine percent of patients had previous or concurrent pulmonary opportunistic infections. Clinical presentation of pulmonary Kaposi's sarcoma was indistinguishable from opportunistic pneumonia with respect to symptoms, physical examination results, and laboratory findings. Chest roentgenograms revealed a typical nodular pattern in only five patients. In contrast to AIDS-associated opportunistic pneumonia, the yield from fiberoptic bronchoscopy (24 percent) and open lung biopsy (56 percent) was low. Pathologically, Kaposi's sarcoma of the lung is less cellular than the cutaneous lesion. It is focal and scattered throughout the pulmonary interstitium, which may explain the difficulty in pre-mortem diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1987

The role of open lung biopsy in patients with the acquired immunodeficiency syndrome.

To assess the role of open lung biopsy in patients with the acquired immunodeficiency syndrome (AIDS), we retrospectively reviewed the cases of 42 patients with AIDS who underwent this procedure for the diagnosis of pulmonary infiltrates. Four patients had no preceding bronchoscopy because the severity of the respiratory failure or abnormalities of coagulation precluded the safe performance of this procedure. Twenty-nine cases had a preceding nondiagnostic bronchoscopic procedure, and nine others underwent open lung biopsy because of progressive deterioration despite treatment for diseases diagnosed bronchoscopically. We found that open lung biopsy was likely to be useful diagnostically when bronchoscopy could not be safely performed or when a preceding bronchoscopic procedure was not diagnostic. Open lung biopsies done on patients whose condition continued to deteriorate despite treatment for disorders established bronchoscopically were not likely to yield information therapeutically useful. In only one of nine such cases was a new treatable diagnosis obtained (Legionella). The others showed either severe pulmonary fibrosis or persistence of the initial disease process diagnosed at the time of bronchoscopy.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Comparison of CT and fiberoptic bronchoscopy in the evaluation of bronchial disease.

CT was compared to fiberoptic bronchoscopy in a large series of patients to study the value of CT for visualizing bronchial disease. CT scans were available for review in 64 cases in which focal airway disease was identified with fiberoptic bronchoscopy and in 38 patients in whom the airways appeared normal at bronchoscopy. CT was positive in 59 of 64 cases in which lesions were detected endoscopically. If the results are analyzed according to the extent of involvement of individual bronchi, CT successfully identified 88 (90%) of 98 lesions. CT correctly excluded disease in 35 (92%) of 38 cases that were subsequently verified to be normal by fiberoptic bronchoscopy. In no case was the diagnosis of malignancy missed by CT. While extremely accurate in detecting focal lesions, CT was inaccurate in predicting whether a given abnormality was endobronchial, submucosal, or extrinsic (peribronchial). In three cases CT failed to detect submucosal extension into the left mainstream bronchus, which has important implications concerning the value of CT in staging bronchial malignancy. It is concluded that CT is helpful when bronchoscopy is contraindicated or refused. CT may also be used in selected cases when there is low clinical suspicion of endobronchial disease and as a complementary procedure to fiberoptic bronchoscopy for outlining the exact location of major mediastinal and hilar vessels, lymph nodes, and tumor in relation to adjacent airways.

Bronchial Diseases↗
PubMed1987

Piroxicam in juvenile rheumatoid arthritis.

There is little consistency in drug treatment of children with juvenile rheumatoid arthritis, in part because there are few controlled studies of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in this disease. To determine the safety and efficacy of piroxicam in children with juvenile rheumatoid arthritis, 26 patients ranging in age from three to 25 years were randomly assigned to treatment with piroxicam or naproxen. The number of painful and swollen joints decreased significantly (p less than 0.05) in the piroxicam group. The overall assessment of the investigators was that 67% of the patients in the piroxicam group showed clinical improvement, in contrast to 38% of the naproxen-treated patients. Side effects in the piroxicam group were mild and transient, and no patient was removed from the study because of side effects. The recurrence of a cutaneous rash necessitated the removal of one naproxen-treated patient from the study. Although the results should be interpreted with caution because of the small sample size, piroxicam appears to be more effective and better tolerated than naproxen in this study.

Adolescent↗
PubMed1987

Gallium-67 scans of the chest in patients with acquired immunodeficiency syndrome.

Eighty-six [67Ga]citrate chest scans were performed in 71 adult patients with the acquired immunodeficiency syndrome. Forty-five of these patients also had Kaposi's sarcoma. Only 29 of 57 abnormal scans were correlated with abnormal chest radiographs. Chest radiographs were negative for 27 scans and unavailable for one. Several scan patterns were seen. Diffusely increased lung uptake was seen most commonly with Pneumocystis carinii pneumonia, but also other infections and noninfectious inflammatory conditions. Focal uptake corresponding to regional lymph node groups occurred most often with Mycobacterium avium-intracellulare but aslo with lymphoma. Localized intrapulmonary uptake was seen in bacterial pneumonias. Perihilar activity occurred in two cases. When chest radiographs were abnormal and 67Ga scans negative, the most common diagnosis was pulmonary Kaposi's sarcoma.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Hypercapnia in the obstructive sleep apnea syndrome. A reevaluation of the "Pickwickian syndrome".

The mechanisms of hypercapnia in eight patients with the "Pickwickian" syndrome and obstructive sleep apnea (OSAS) were evaluated pretherapy and posttherapy (tracheostomy in seven patients and chronic nocturnal use of nasal CPAP in one). Four patients (correctors) became eucapnic within two weeks of therapy. Four others (noncorrectors) remained hypercapnic. Neither residual apneas, changes in pulmonary function, change in anatomic dead space, nor changes in ventilatory chemoresponsiveness differentiated the two groups, nor did the last three factors account for return to eucapnia in the correctors. The results indicated two separate mechanisms exist for chronic hypercapnia in OSAS: a critical balance between the ventilation during the time spent awake and hypoventilation due to apneas, a mechanism removed by treatment for obstructive apnea; and sustained hypoventilation independent of the apnea phenomenon and therefore not correctible. The subset of patients with the second mechanism appears to represent the true "Pickwickian" syndrome and can be identified before therapy by measuring a low level of ventilation in the sustained awake state.

Aged↗
PubMed1986

The Hermansky-Pudlak syndrome: radiographic features.

We present the radiologic features of four patients proven to have Hermansky-Pudlak syndrome. All four patients had evidence of pulmonary involvement characterized by a progressive, diffuse, bilateral interstitial fibrosis. Extensive bullous changes were seen in one patient. Two patients with evidence of diffuse colitis exhibited an asymmetrical pattern of focal, superficial, and deep ulcerations similar to that of Crohn's disease. The association of these radiographic abnormalities with albinism, ocular abnormalities, bleeding diathesis, and Puerto Rican ancestry establishes the diagnosis.

Adult↗
PubMed1985

Hermansky-Pudlak syndrome: a clinicopathologic study.

The Hermansky-Pudlak syndrome is a rare disease characterized by multisystemic involvement. Seven families with the disorder were identified in the Puerto Rican population of one municipal hospital, suggesting that the incidence in the Puerto Rican community is sufficient to warrant both dissemination of information about the disease and further investigation. The present study was an attempt to achieve both of these goals.

Adolescent↗
PubMed1981

Sustained reversal of chronic hypercapnia in patients with alveolar hypoventilation syndromes. Long-term maintenance with noninvasive nocturnal mechanical ventilation.

Described in this study are eight patients with alveolar hypoventilation syndromes who presented with carbon dioxide narcosis and coma. After reversal of severe hypercapnia, all patients were discharged and maintained at home for an average period of 10 years utilizing "noninvasive" nocturnal mechanical ventilation. The use of "noninvasive" mechanical ventilation at home attempted to void the hazards of tracheostomy and the difficulties inherent in continuous daytime use of oxygen. This form of treatment has allowed these patients to continue their previously productive lives. This study represents the first published long-term follow-up regarding this mode of treatment in patients with alveolar hypoventilation.

Adult↗
PubMed1981

Regulation of ventilation in the obstructive sleep apnea syndrome.

The recent recognition of the sleep apnea syndrome has forced a re-evaluation of the mechanism of hypercapnia and disordered respiratory control in obese patients. Thirteen obese patients with sleep apnea were studied in an attempt to relate the pattern of sleep abnormality and awake ventilatory control to the presence of chronic hypercapnia. Patients with hypercapnia and/or hypoxemia had reduced ventilatory responses to hypercapnic and hypoxic stimulation, respectively. The presence of hypercapnia, however, did not separate the patients with respect to type, duration, or frequency of apneas. The degree of awake chemical drives could not be related to the severity of the sleep apnea phenomenon. However, patients with intact ventilatory control demonstrated augmented ventilation after apneas, which may explain their eucapnic state.

Adult↗
PubMed1979

Hermansky-Pudlak syndrome. Pulmonary manifestations of a ceroid storage disorder.

The Hermansky-Pudlak syndrome is a form of oculocutaneous albinism, characterized by a qualitative platelet defect and deposition of ceroid-like material throughout the reticuloendothelial system. During a 16 month period five patients with Hermansky-Pudlak syndrome presented with symptoms, chest films and pulmonary function studies consistent with restrictive pulmonary disease. In two patients, lung biopsies revealed diffuse interstitial fibrosis. However, light and electron microscopy demonstrated ceroid-like material within alveolar macrophages. In addition, two patients presented with inflammatory bowel disease with deposition of ceroid-like material in the colon. This disorder appears to be more common than is currently recognized and should be considered in the differential diagnosis of diffuse interstitial pulmonary disease and inflammatory bowel disease. A relationship between the deposition of ceroid-like material and pulmonary fibrosis is discussed in light of recent research concerning inflammatory processes. In view of the serious pulmonary, gastrointestinal and hematologic consequences of this syndrome, there is a need for genetic counseling of these patients.

Adult↗
PubMedDate not supplied

Juvenile onset Reiter's syndrome. A retrospective study of 26 patients.

Clinical, laboratory and radiological findings were evaluated in 26 children with Reiter's syndrome, all of whom met the 1982 diagnostic criteria of A. Calin. Twenty-two of the patients (85%) were male and 4 were female (15%); the mean age at onset was 10.5 years (range 4-15.5 yrs). Mean follow-up time was 28.6 months. Diarrhea prior to onset was observed in 18 cases (69%), but there was no report of venereal disease. The full classic triad was initially observed in only 9 patients (35%), urethritis alone in 6 (23%) and conjunctivitis alone in 4 (15%). Arthritis was present in all patients, with the lower limb joints involved in 25 cases (96%); the pattern was pauciarticular in 18 (69%), polyarticular in 7 (27%) and monoarticular in one (4%). There was complete remission in 15 out of the 26 patients (58%), while a sustained and fluctuating course was seen in 7 (27%) and 3 (11.5%) patients, respectively; a single patient showed a remitting course. Balanitis was present in 11 out of the 22 male (50%) cases. Twelve out of 18 patients tested (67%) proved to be HLA B27 positive and there was radiological evidence of sacroiliitis in 5 out of 24 patients (21%). Reiter's syndrome should be included in the differential diagnosis of the arthritic child. As a rule, the course of joint involvement is remittent and sequelae affecting functional capacity are indeed exceptional.

Adolescent↗
PubMedDate not supplied

Nasal CPAP in obstructive sleep apnea: mechanisms of action.

Sixteen patients with the obstructive sleep apnea syndrome (OSAS) were studied for 1-2 h while receiving continuous positive airway pressure (CPAP) delivered via a nasal mask. Obstructive apneas were obliterated in all. Eight patients had studies of genioglossal muscle activity (GG EMG) and one patient had computed tomograms (CT) of the upper airway while on nasal CPAP. The GG EMG studies showed two patterns: suppression and augmentation of GG EMG while on CPAP. The CT scan showed the airway to be narrowed while the patient was awake off CPAP. It returned to a normal caliber when CPAP was applied, despite sleep. These results are interpreted to suggest three potential mechanisms of action for nasal CPAP in OSAS: 1) reduced upper airway resistance due to prevention of sleep-induced collapse of the airway; 2) reduced upper airway resistance due to dilatation of the airway by nasal CPAP beyond its dimension in the awake state; and 3) possible stimulation of mechanoreceptors leading to an increase in airway tone while CPAP is applied.

Airway Resistance↗