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Biomedical subjects

S Zwi

Publications and source records attributed to S Zwi.

At least 37 records · Page 2Linked to original sources
PubMed1987

Transbronchial biopsy during mechanical ventilation.

The diagnostic yield and risks of transbronchial biopsy (TBB) during mechanical ventilation were assessed in 13 patients with progressive pulmonary infiltrates. TBB was of considerable diagnostic value in ten patients and useful in excluding potentially treatable infections in the remaining three patients. Complications included two pneumothoraces, pulmonary hemorrhage in one case, and supraventricular tachycardia in another. No fatalities were attributable to TBB. TBB proved to be a relatively safe procedure, with a high diagnostic yield in these critically ill patients.

Acute Disease↗
PubMed1987

'Low-dose' corticosteroid prophylaxis against fat embolism.

The effect of 'low-dose' corticosteroids (9 mg/kg methylprednisolone), given after skeletal trauma, on the incidence of the fat embolism syndrome and isolated arterial hypoxemia was studied in 42 controls and 40 steroid-treated subjects. Fat embolism occurred in ten controls (23.8%) and one steroid-treated subject (2.5%) (p = 0.01). A further 44 subjects developed isolated hypoxemia. This was severe (PaO2 less than 50 mm Hg) in seven of 32 controls (21.9%) and one of 39 steroid-treated subjects (2.6%) (p = 0.01). The overall incidence of hypoxemia was 67.1%, affecting 33 controls (78.6%) and 22 steroid-treated patients (55%) (p less than 0.05). The degree of hypoxemia was severe (PaO2 less than 50 mm Hg) in 12 controls (28.6%) and two (5%) of the steroid-treated subjects (p = 0.005). No control subject died or required mechanical ventilation. One steroid-treated subject without fat embolism died of a fulminant infection. Although methylprednisolone in a relatively low dose provides protection against fat embolism and pulmonary dysfunction after skeletal trauma, the safety of this therapy requires further evaluation.

Adult↗
PubMed1986

Blastomycosis. A case report.

Blastomycosis was once thought to be restricted to North America; it has rarely been found in the RSA. The first case reported in the RSA was associated with a diffuse pulmonary infiltrate and cavitation; the patient responded to amphotericin B.

Amphotericin B↗
PubMed1985

Reflex heart rate control in asthma. Evidence of parasympathetic overactivity.

The bronchial hyperreactivity characteristic of asthma may be related to enhanced parasympathetic nervous activity. We postulated that an abnormality in the autonomic control of airway caliber might be reflected by a parallel change in the reflex control of heart rate. We examined the heart-rate variations induced by deep breathing (respiratory sinus arrhythmia), the Valsalva maneuver, and standing up from the recumbent position in asthmatic subjects and nonasthmatic control subjects. The asthmatic patients had evidence of enhanced parasympathetic neural drive to the sinoatrial node, as manifested by a significantly greater magnitude of respiratory sinus arrhythmia, than the controls (p less than 0.0005). We were unable to induce a similar change in normal subjects by resistance breathing. A statistical analysis suggested the presence of a relationship between the magnitude of respiratory sinus arrhythmia and the degree of bronchial hyperreactivity in a group of asthmatic patients. Our results support the hypothesis that enhanced parasympathetic activity is an important factor in the pathogenesis of bronchial asthma.

Adult↗
PubMed1985

Invasive pulmonary aspergillosis complicating influenza A pneumonia in a previously healthy patient.

A rare occurrence of invasive pulmonary aspergillosis complicates influenza pneumonia in a previously healthy adult. Five other similar cases are reported in the literature. Both transient depression of cell-mediated immunity and loss of ciliary function in the tracheobronchial tree occurs during acute influenzal illness and may predispose to fungal superinfection. Early diagnosis and treatment of opportunistic Aspergillus infection complicating influenza is mandatory in view of the high mortality associated with this complication.

Adult↗
PubMed1984

Experience at an adolescent and adult cystic fibrosis clinic. An analysis and overview.

Cystic fibrosis (CF) is the most common serious genetic condition in the White population groups. Thirty-three White patients (mean age 20 years, range 14-32 years) seen at an adult CF clinic at the Johannesburg Hospital between January 1980 and January 1983 are reviewed. All had elevated sweat chloride levels. There was a family history of CF in 45,5% of the cases. Most were of normal height but significantly underweight. Chronic obstructive pulmonary disease was present in 94% of the patients. Pulmonary infections played a major role in both symptomatic exacerbations and progressive lung disease. Most frequently, mucoid Pseudomonas aeruginosa and/or Staphylococcus aureus were cultured from the sputum. The management of infective exacerbations is discussed. Other respiratory complications included cor pulmonale, haemoptysis, recurrent pneumothorax and sinusitis. Chest radiographs and pulmonary function tests are also analysed. Gastro-intestinal complications included pancreatic exocrine insufficiency (94%), intestinal obstruction, cholelithiasis, and liver disease. Insulin-dependent diabetes occurred in 9%. Five pregnancies were recorded in 4 patients. By January 1983 there had been 7 deaths (mean age 19,4 years). Most of the patients are highly motivated, with few psychological problems, and appear to be well-functioning and integrated members of society.

Adolescent↗
PubMed1984

Comparison of the metabolic responses to alpha-adrenergic stimulation in asthmatics and non-asthmatics after clonidine.

The role of the alpha-adrenergic system in the pathogenesis of asthma is investigated. We administered 150 micrograms oral clonidine to a group of patients with relatively mild asthma and a group of non-asthmatic subjects, and compared their responses by measuring plasma levels of growth hormone (GH), immunoreactive insulin, potassium and glucose. There was no significant difference between the groups in respect of any of these variables, nor was there a significant difference in the blood pressure responses. However, 3 of the asthmatic subjects demonstrated marked hyper-responsiveness of the plasma GH levels after clonidine. It is possible that increased alpha-adrenergic responses may be more frequently demonstrable in a group of severe asthmatics or by means of an alpha-agonist which is more potent and less selective than clonidine. Alternatively, the 3 hyper-responsive individuals may represent a subgroup of asthmatics in whom alpha-adrenergic overactivity is an important pathogenetic mechanism.

Adult↗
PubMed1983

Otolaryngologic complications of acute porphyria.

The porphyrias are a group of diseases which may be complicated by acute neurological crises having serious morbidity and a high rate of mortality. We report a case of acute porphyria in which an acute neurological crisis, resulting in loss of laryngeal function, precipitated life-threatening aspiration pneumonia.

Acute Disease↗
PubMed1983

Survival following massive overdose of adrenergic blocking agents (acebutolol and labetalol).

Massive overdosage of adrenergic blocking drugs is associated with severe morbidity and a high mortality rate. We report the case of a 24-year-old medical intern who ingested 9.6 g acebutolol, 7.2 g labetalol and 0.625 g trimipramine in an attempted suicide. Blood samples drawn on admission were shown to contain markedly elevated plasma levels of acebutolol and its major metabolite and of labetalol. The patient was deeply comatose on admission. The heart rate was 60 min-1 (sinus rhythm) and the blood pressure was clinically unrecordable. Atropine, isoproterenol and dopamine initially had no effect on either heart rate or blood pressure. Only following the administration of inordinately large doses of isoproterenol and dopamine, together with glucagon was a clinical response obtained. The patient remained haemodynamically dependent on dopamine for 12 h and isoproterenol for 65 h. The total dose of isoproterenol administered was 260 mg, two thirds of this during the first 12 h. The patient left hospital well after 7 days but was readmitted after 26 days because of intestinal obstruction due to ischemic bowel necrosis.

Acebutolol↗
PubMed1982

Severe airway obstruction associated with rheumatoid arthritis and Sjögren's syndrome. A case report.

Numerous pulmonary complications associated with rheumatoid arthritis (RA) and Sjögren's syndrome (SS) have been described. Mild airway obstruction has recently been recognized in these disorders, severe obstruction occurring in only a few patients with RA. We report a patient with RA and SS who developed severe irreversible airway obstruction, an association not hitherto described. The airway disease failed to respond to bronchodilators, steroids or immunosuppressive agents.

Arthritis, Rheumatoid↗
PubMed1982

Experience with neuromuscular respiratory failure in an intensive care unit.

Between 1976 and 1980, 32 patients with respiratory failure primarily due to neuromuscular disease were admitted on 34 occasions to the Respiratory Intensive Care Unit of the Johannesburg Hospital. Ninety-four per cent of patients admitted survived and were discharged from hospital. Ninety per cent of the survivors are fully rehabilitated and another 6.7% continue to improve. Despite a frequently prolonged illness, these patients have an excellent prognosis. Early diagnosis and management of respiratory failure in an intensive care unit are essential if their survival is to be ensured.

Adolescent↗