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Biomedical subjects

T M Roy

Publications and source records attributed to T M Roy.

At least 73 records · Page 4Linked to original sources

Cardiac tamponade as the initial presentation of bronchioloalveolar cell carcinoma.

Bronchioloalveolar cell carcinoma (BCC) is a relatively uncommon form of bronchogenic cancer with an insidious onset and a variety of radiographic appearances. Although the World Health Organization currently classifies it as a subtype of adenocarcinoma, many investigators view BCC as a distinct tumor with characteristic clinical features. There are still uncertainties regarding its origin, as well as the significance of associated clinical findings such as cardiac tamponade.

Adenocarcinoma, Bronchiolo-Alveolar↗

"Ovarian asthma"-- act or fancy?

Hormonal interactions have been suspected of worsening airways dysfunction in a subgroup of female asthmatics. Despite reports of fatal and near-fatal asthma attacks associated with menstruation, there is little consensus about the impact of this biologic function on the clinical expression of asthma. The authors present a young asthmatic female whose episodic and potentially fatal worsening of asthma typically occurred within the days prior to her menses in the absence of other trigger factors.

Adult↗

Treatment of pneumothorax in the patient with AIDS.

With the diagnosis of the adult immunodeficiency syndrome (AIDS), a patient's risk of sustaining a nontraumatic pneumothorax increases to 450 times that of the general population. The approach to pneumothorax that occurs in the patient with AIDS differs from the strategy that is used for spontaneous pneumothorax in immunocompetent young adults. The modifications in treatment are predicated on understanding the etiology of spontaneous lung collapse in the patient with AIDS.

AIDS-Related Opportunistic Infections↗

Pulmonary abscess due to Corynebacterium striatum.

Non-diphtheria corynebacteria are normal commensals of the skin and mucous membranes of humans. Increasingly, however, these saprophytic organisms are being recognized as pathogens. Patients infected with these bacteria typically have an underlying immunosuppressive process and/or an indwelling venous catheter. Pleuropulmonary infection with Corynebacterium striatum is rare. We present a patient with diabetes mellitus who developed an intrapulmonary abscess due to C. striatum.

Aged↗

Nutritional status and mortality in respiratory failure caused by tuberculosis.

A retrospective analysis of the records of all patients admitted to the intensive care unit with respiratory failure and nonmiliary tuberculosis was conducted to determine variables that might be predictive of survival. Nutritional status, as reflected by the patient's serum albumin and hemoglobin, were the best predictors of survival and were more helpful than the widely accepted APACHE II scoring system. This observation suggests that early and aggressive attention to improving the patient's nutritional status may be as important as effective antitubercular therapy and mechanical ventilation in salvaging these individuals.

Adult↗

Phrenic nerve injury following scalenectomy in a patient with thoracic outlet obstruction.

We present a case in which a patient with normal pulmonary reserve experienced orthopnea and hypoxia secondary to unilateral diaphragmatic paralysis following right scalenectomy. This operation was performed in an attempt to relieve neurovascular compromise at the thoracic outlet. To our knowledge, this association has not been previously described in the literature.

Dyspnea↗

Gastrointestinal hemorrhage and small cell carcinoma.

Despite widespread dissemination of primary lung carcinoma by lymphangitic and hematogenous routes, acute gastrointestinal signs and symptoms are rarely presenting symptoms for bronchogenic carcinoma. We present a patient with small cell carcinoma of the lung who came to medical attention because of a lower gastrointestinal hemorrhage. In the absence of radiographically apparent pulmonary disease, the correct diagnosis was suggested by the biopsy specimens of the colon.

Aged↗

Abnormal pulmonary function and juvenile onset diabetes mellitus.

The metabolic and microcirculatory abnormalities associated with insulin-dependent diabetes mellitus involve most organ systems, including the lung. The adverse effects of diabetes mellitus on the function of the respiratory system are minor compared to the morbidity sustained by the cardiovascular, renal, neural, and ophthalmic systems. Nevertheless, physicians should be aware that some indices of pulmonary function may be abnormal in diabetic patients, independent of the more commonly recognized respiratory risk factors.

Adult↗

Hepatocellular carcinoma presenting as a mediastinal mass.

We present a patient with hepatocellular carcinoma with systemic hematogenous metastases, but without parenchymal pulmonary involvement. Thoracic imaging revealed prominent mediastinal involvement. This pattern of hepatocellular tumor spread is unique.

Adult↗

Juvenile laryngeal papillomatosis: a new complication.

Extension of juvenile papillomas to the lung parenchyma is unusual. When it occurs, the patient's prognosis worsens because these lesions destroy lung tissue as they grow. Respiratory complications eventually occur in the presence of multiple nodular and cystic lesions due to the attendant parenchymal destruction. We have observed that pneumothorax can occur after the development of cystic pneumatoceles, presumably from the ball valve effect of a nodular lesion (Fig 3).

Adult↗

Cardiac arrhythmias during performance of the flow-volume loop.

The purpose of our study was to determine the frequency of cardiac ectopy during the performance of flow-volume loops. The performance of an adequate flow-volume loop entails significant shifts in intrathoracic pressure and oxyhemoglobin saturation that could heighten myocardial arrhythmogenicity and lead to increased cardiac ectopy. Forty-two male patients referred for performance of flow-volume loops were studied with an ambulatory cardiac monitor and an arterial oxyhemoglobin saturation monitor during the performance of three flow-volume loops before and after administration of an aerosolized, selective beta 2-agonist. For comparison, the 60 min prior to and after completion of the loop testing was monitored with the continuous cardiac monitor. The frequency of cardiac ectopy was determined in four patient populations delineated by the presence or absence of cardiac, pulmonary, or cardiopulmonary disease. Each group was further divided based on the occurrence of arterial oxyhemoglobin desaturation during the performance of the flow-volume loop. We found that, despite the presence or absence of underlying cardiopulmonary disease or the occurrence of oxyhemoglobin desaturation during flow-volume loop performance, the number of cardiac ectopies diminished significantly during loop performance when compared with the 60-min study period prior to testing. This is in contrast to what had been reported previously. We conclude that the flow-volume loop is safe to perform in the general population, including those individuals with an increased risk of arrhythmias such as those with cardiac or pulmonary disease.

Aged↗

Primary spontaneous pneumothorax. Therapeutic considerations.

Primary pneumothorax represents the single most frequent cause of admission of young adults to a hospital's thoracic service. However, the best management of these patients with rupture of subpleural blebs in the apical region remains controversial. In a retrospective analysis of 108 consecutive patients with spontaneous primary pneumothorax treated at a university hospital over a 5-year period, we were able to examine the risks and benefits of various treatment approaches. Interestingly, although male patients outnumbered female patients approximately 2:1, female patients were statistically more likely to undergo operative intervention.

Adolescent↗