Biomedical subjects
Publications and source records attributed to T M Roy.
Rifampin therapy is an infrequently reported cause of pseudomembranous colitis. A low index of suspicion may account for this lack of recognition. Awareness of this potentially hazardous complication of rifampin therapy is encouraged, especially since increasing numbers of patients infected with the human immunodeficiency virus, who may have diarrhea from other etiologies, require rifampin therapy.
Thrombotic veno-occlusion of the upper extremity is infrequent in the absence of external trauma or in the presence of an indwelling catheter. Inadvertent injury to the underlying venous circulation can occur when the upper extremity is subjected to an unaccustomed repetitive action. The resultant intimal damage may become a nidus for thrombus development.
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Despite the impairments of cellular and humoral immunity that accompany the acquired immunodeficiency syndrome, there has not been increased evidence of thoracic actinomycosis. We report on a patient with the human immunodeficiency virus (HIV) infection who had pulmonary actinomycosis. We review the current ideas regarding this unusual pulmonary pathogen and offer possible explanations for its rare appearance in the HIV population.
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The potential difficulties offered by the presence of a solitary pulmonary nodule in a patient with rheumatoid arthritis are illustrated by a male non-smoker with clinical, serologic and radiographic rheumatoid arthritis, active and fibrosing alveolitis and a new lung nodule. This nodule proved to be squamous cell carcinoma without the typical risk factors. The findings of a solitary pulmonary density or nodule in a patient with rheumatoid arthritis provides no assurance that the lesion is benign. Both necrobiotic nodules and lung cancer may present as solitary pulmonary nodules in patients with this autoimmune disease.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
We present a patient with left chest and neck pain due to fibrous dysplasia of the first rib. This condition was not considered as part of the differential diagnosis of chest discomfort, since it is typically painless. We believe this is the first patient described with fibrous dysplasia of the rib with left chest pain that mimicked angina pectoris.
In a study of 83 patients with active pulmonary tuberculosis who were treated in East Tennessee, only three developed hypercalcemia. The incidence of hypercalcemia in East Tennessee is markedly lower than that quoted in earlier studies performed in the United States. The explanation for the infrequent occurrence of elevated serum calcium in our population is probably multifactorial, but does not appear to be related to the selection of antituberculous agents.
An acid-induced cholinergic esophagobronchial reflex has been described whereby acid refluxing into the esophagus causes bronchospasm. Reports of exertional gastroesophageal acid reflux prompted us to study the possibility that exercise-induced asthma (EIA) could be related to gastroesophageal reflux (GER). Following an overnight fast, 10 athletes with a history of EIA (nine men, one woman; mean age 31) were studied. Continuous monitoring of intraesophageal pH and motility, ECG, and arterial oxygen saturation was done. After baseline monitoring at rest for 15 min, subjects underwent treadmill exercise for 10 min followed by continuous monitoring for 30 min after exercise. Spirometry was done at baseline prior to exercise, then repeated every 5 min after exercise for 30 min. Two subjects were retested at a later date following a standard test meal. All 10 subjects demonstrated a decrease in FEV1 in response to exercise, but only half met criteria for EIA. Although 60% (6/10) showed some evidence GER, only three subjects demonstrated a pathologic degree of GER. In the two subjects retested postprandially, change in FEV1 was no different in one and improved in the other despite worsening of GER in both. There was no significant correlations between GER and EIA (P = 0.2). EIA correlated inversely with amplitude of esophageal contractions (P = 0.029) and was directly related to the percentage of multipeaked contractions and the duration of peristaltic contractions (P = 0.08). EIA is not associated with exertional GER.
Seventeen patients with biopsy-confirmed hepatic cirrhosis and tense ascites performed reproducible pulmonary functions and had arterial blood gas analysis before and after having a therapeutic large volume paracentesis. Each patient showed significant improvement in the static lung volumes as determined by helium dilution techniques. Dynamic airflow also improved as expressed by the FVC and the FEV1. The FEV1/FVC ratio remained unchanged. Each patient showed a significant improvement in oxygenation 120 minutes after LVP. Alveolar ventilation as expressed by PaCO2 did not change. The pathophysiology that explains the improvement in oxygenation remains speculative. Large volume paracentesis appears to have a salutary effect on oxygenation, as well as on pulmonary function.
Solitary extramedullary plasmacytomas are uncommon neoplasms. They occur most frequently in the upper aerodigestive tract and account for 4% of the nonepithelial tumors in this site. The evolution of a plasmacytoma is unsteady and symptoms at presentation have included dystonia, dysphagia, oral pain, cough, and dyspnea on exertion. Plasmacytoma of the upper aerodigestive tract has not been previously reported as a cause of obstructive sleep apnea.
In conclusion, extrapulmonary TB remains a significant fraction of the total TB cases in Tennessee. During the last few years, the percentage of extrapulmonary TB in Tennessee has been on the increase. Understanding these changes in the epidemiology of extrapulmonary TB will help the clinician in making a prompt diagnosis, leading to appropriate therapy. Understanding the changing trends at the national level may aid state health departments in reorganizing disease control programs, thus, facilitating the eradication of TB and other communicable diseases in Tennessee.
The diagnosis of progressive massive fibrosis (PMF) is traditionally associated with exposure to coal dust. Since the legislation of better control of mine dust, the incidence of PMF has declined significantly. Clinicians who are not regularly involved in the medical care of coal workers may have limited knowledge of this incapacitating problem. Physicians are reminded that PMF is a complex process that can occur after exposure to mixed respirable particles other than coal dust.
Potential phrenic nerve injury that results in diaphragmatic dysfunction and respiratory insufficiency has important implications for the anesthesiologist who must insure adequate ventilation and gas exchange. A variety of traumatic injuries as well as some surgical manipulations have been identified with an increased frequency of diaphragmatic paralysis. We have observed the occurrence of this sequelae after scalenotomy for thoracic outlet obstruction, a previously unreported association.
Each year approximately 2 million people are seriously injured in traffic accidents. Injuries to the chest play a major role in the mortality and morbidity of these patients. One-third to one-half of motor vehicle crash victims suffer blunt thoracic trauma. The spectrum of injuries is broad but posttraumatic pulmonary masses are rarely noted. The proper use of radiographic imaging procedures allows documentation of pulmonary hematoma and exclusion of more ominous lesions.