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Biomedical subjects

T M Roy

Publications and source records attributed to T M Roy.

At least 127 records · Page 7Linked to original sources
PubMed1990

Fetal death due to nonlethal maternal carbon monoxide poisoning.

Fetal death due to acute carbon monoxide poisoning is rarely reported in the medical literature. Of the eight cases found in literature review, only one documented the fetal carboxyhemoglobin concentration. This paper reports a fetal death due to accidental nonlethal maternal carbon monoxide intoxication in which both maternal and fetal carboxyhemoglobin concentrations were obtained. The corrected carboxyhemoglobin concentration was 61% at the time of death in utero, while the maternal carboxyhemoglobin was measured at 7% after one hour of supplemental oxygen. The authors review the mechanisms of fetal death and emphasize the different carbon monoxide kinetics in the fetal circulation.

Adult↗
PubMed1990

AIDS: intensive care utilization and outcome.

A significant portion of health resource dollars are spent providing intensive care. We examined the immediate outcome of the utilization of medical intensive care for the patient with complications of the acquired immunodeficiency syndrome (AIDS) at the teaching hospital of the University of Louisville. Our experience indicates that utilization of critical care services for the AIDS patient may favorably alter immediate morbidity and mortality.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Exacerbation of chronic obstructive pulmonary disease due to hyperinfection with Strongyloides stercoralis.

Pulmonary infection due to the filariform larvae of Strongloides stercoralis may occur in immunocompromised patients residing in endemic areas of the United States. Such infection usually presents as dyspnea with a cough that sometimes results in bloody sputum. Although the chest roentgenogram often reveals a patchy bilateral alveolar infiltrate, acute respiratory distress is unusual. We report a patient who experienced severe exacerbation of his underlying obstructive lung disease that was associated with chest infiltrates and recovery of S stercoralis from his sputum. Although initial improvement was accomplished with Thiobendazole treatment, a re-exacerbation occurred when antiparasitic therapy was completed. The persistence of his infection is correlated to factors that are commonly employed in the treatment of COPD but may be overlooked as predisposing causes of hyperinfection with S stercoralis.

Animals↗
PubMed1990

Intensive care for respiratory failure in Guillain-Barré syndrome.

Although relatively uncommon, Guillain-Barré syndrome remains the most frequent cause of sudden weakness in persons under the age of 40 years. While most patients enjoy spontaneous resolution of their neurologic deficits, death still occurs in some individuals who suffer secondary complications from profound respiratory muscle weakness. This review of patients with ascending paralysis who required intubation and mechanical ventilation underscores that the major factors which contribute to death and morbidity can be anticipated and largely avoided using a vigilant multidisciplinary approach.

Adult↗
PubMed1989

Autonomic influence on cardiovascular performance in diabetic subjects.

PURPOSE: Cardiomyopathy, coronary artery atherosclerosis, or autonomic neuropathy may affect the cardiovascular performance of the diabetic patient. To evaluate the role of parasympathetic nervous system activity on cardiovascular performance, 25 diabetic subjects who lacked symptoms, signs, or objective measurements of ischemia or cardiomyopathy were studied. PATIENTS AND METHODS: Diabetic subjects were classified according to their RR variation, an index of cardiac parasympathetic nervous system activity. Fourteen diabetic subjects had a normal RR variation of greater than 30 (D-NOR), and 11 diabetic patients had an abnormal RR variation of less than 20 (D-ABN). Fifteen age- and weight-matched, healthy, nondiabetic subjects (NOR) constituted the control group. All subjects had oxygen consumption, multigated acquisition determination of cardiac output, and work product measured before and during supine bicycle maximum exercise testing. RESULTS: There was no difference in the resting cardiac output among the groups. Resting work product, however, was greatest in the D-ABN group when compared with performance in the other two groups (D-ABN: 11,500 +/- 800; D-NOR: 9,000 +/- 600; NOR: 8,700 +/- 400; p less than 0.0025). This was due to an increase in both heart rate (p less than 0.025) and systolic blood pressure (p less than 0.015). In the diabetic subjects, there was an inverse relationship between the RR variation and resting work product (r = 0.47, n = 25, p less than 0.005). In response to exercise, the percent increase in cardiac output at matched percent maximum oxygen uptake was greatest in the NOR, D-NOR, and D-ABN groups, respectively (analysis of variance, p less than 0.01). In the diabetic subjects, there was a significant relationship between the RR variation and the maximum percent change in cardiac output (r = 0.41, n = 25, p less than 0.02). Compared with the NOR group, the maximum increase in work product was impaired in diabetic subjects (p less than 0.002) and not different between the D-NOR and D-ABN groups. CONCLUSIONS: The increase in resting work product and the poor cardiac output responses to exercise in the D-ABN group are due to a decrease in cardiac parasympathetic nervous system activity and can be suggested by an abnormal RR variation. This index of parasympathetic nervous system activity can help the physician identify that subset of diabetic patients that may need special consideration when exercise training is prescribed.

Adult↗
PubMed1989

Empyema associated with pulmonary sporotrichosis.

Sporothrix schenckii produces an insidious debilitating illness in humans. The lungs are seldom involved and pleural involvement is distinctly unusual, with only four patients described in the literature. We have described a patient with both parenchymal lung disease and pleural effusion. The characteristics of the pleural fluid were unlike those previously reported, and suggest that the coexistence of a parenchymal Sporothrix infiltrate may alter the nature of the pleural fluid to mimic an empyema rather than a self-limited hypersensitivity reaction.

Empyema↗
PubMed1989

Tularemic pneumonia mimicking Legionnaires' disease with false-positive direct fluorescent antibody stains for Legionella.

Pleuropulmonary tularemia may mimic atypical pneumonia caused by other common etiologic agents, including Legionella. The correct identification of the pathogen responsible for the atypical pneumonia is usually made serologically or with the use of special stains and cultures. We have reported a case of pleuropulmonary tularemia whose diagnosis was confounded by false-positive direct fluorescent antibody stains for Legionella.

Adult↗
PubMed1989

Resting gas exchange in nonsmoking bituminous-coal miners with simple pneumoconiosis.

Gas exchange at rest under normoxic conditions was studied in 2,297 nonsmoking bituminous-coal miners with and without simple coal workers' pneumoconiosis (CWP). Measurements of arterial oxygen tension (Pao2) and arterial carbon dioxide tension (Paco2) from blood gas samples obtained at rest in the seated position were used to calculate the alveolar-arterial oxygen tension difference, (A-a)Do2, using the classic alveolar-air equation. We then recalculated the (A-a)Do2 using the age-predicted Pao2 for each miner. The difference between the actual and the predicted (A-a)Do2 was measured and the mean difference for each category of simple CWP was analyzed. We found no evidence that the resting gas exchange differs significantly from the age-predicted (A-a)Do2 in the nonsmoking bituminous-coal minor with simple CWP. Likewise, there is no significant change in (A-a)Do2 with change in the category of simple CWP.

Age Factors↗
PubMed1989

Pulmonary complications after tricyclic antidepressant overdose.

We studied 82 consecutive patients admitted to the ICU with predominant tricyclic antidepressant overdose (mean plasma tricyclic level, 1,025 ng/ml) to determine the nature and incidence of respiratory complications. The majority of patients (80.4 percent) had a decreased arterial to alveolar oxygen tension ratio (PaO2/PAO2) on initial emergency room arterial blood gas analysis (mean, 0.56). Mechanical ventilation was required in 76.8 percent of the patients for a mean duration of 46.2 h. Chest radiograph abnormalities developed during the first 48 h in 32/82 patients (39 percent). The group with radiographic abnormalities had higher mean drug levels than the group without (p less than 0.05). Of 82 patients, nine (11 percent) developed radiographic evidence of bilateral alveolar infiltrates suggestive of acute lung injury. This group had significantly higher mean drug levels than the groups with other types of radiographic abnormalities (p less than 0.001). Charcoal was recovered from the airway of 18/72 patients who received activated charcoal slurry by nasogastric tube in the emergency room after endotracheal intubation. The group who aspirated did not show statistically significant difference in the incidence of chest radiograph abnormalities, gas exchange, or survival compared with the group that did not aspirate.

Adult↗
PubMed1989

Cigarette smoking and federal black lung benefits in bituminous coal miners.

The records of 1000 consecutive coal miners applying for benefits under the Federal Coal Mine Health and Safety Act were examined to determine the contribution of age, dust accumulation, and cigarette smoking to the profile of the miner who satisfies the current pulmonary criteria for disability. Using the presence of pneumoconiosis on chest radiograph as the indication of significant coal dust accumulation, the miners were separated into Group A--those without pneumoconiosis (n = 316) and Group B--those with pneumoconiosis (n = 684). The federal spirometric criteria for disability identified 55/316 miners in Group A (14.5%) and 99/684 miners in Group B (17.4%) potentially eligible for an award (P = .27). The mean ages of miners in both groups did not differ significantly, nor was there difference in the mean ages of groups that did or did not meet the federal criteria. In both groups, those miners potentially eligible for a financial award smoked more cigarettes than did their counterparts (Group A, 31.0 v 18.5 pack-years, P less than .001; Group B, 31.3 v 23.6 pack-years, P less than .001). There was no difference in the smoking histories of the miners from either group who met the federal criteria. Our data indicate that, in the case of bituminous coal miners, the present federal legislation intended to identify and remunerate those who suffer lung impairment from chronic occupational exposure to coal dust is biased in favor of those who sustain additional damage to their ventilatory capacity by smoking cigarettes.

Coal↗
PubMed1989

Double jeopardy: the diagnosis and treatment of pulmonary thromboembolism in pregnancy.

Current information about deep vein thrombosis and pulmonary embolism indicates that both conditions are greatly underdiagnosed. Since some of the newer methods for accurate diagnosis constitute a potential hazard to the fetus, underdiagnosis is most assuredly true for pregnant patients as well. The diagnostic approach to the pregnant female suspected of having pulmonary thromboembolism is discussed and the current treatment recommendations are reviewed.

Adult↗
PubMed1989

Nontraumatic chylothorax: a review of diagnosis and treatment.

The incidence of nontraumatic chylothorax is sufficiently low that most primary care physicians are unclear about the criteria for this diagnosis and the proper treatment options. A ten-year review of patients with pleural effusion treated by the university medical service identified 12 individuals with chylothorax. These patients and a current review of the English language medical literature provide us an opportunity to review the clinical presentation of chylothorax. The differential diagnosis and treatment options are reviewed.

Adult↗
PubMed1989

Respiratory failure associated with the post-polio syndrome.

The recent medical literature documents the occurrence of progressive muscle weakness 30 to 40 years after apparent recovery from poliomyelitis. We present a patient whose respiratory failure was attributed to the late effects of poliomyelitis on the respiratory muscles via spinal cord impairment. We examine the characteristics and proposed causes of the "postpolio syndrome."

Adult↗
PubMed1989

Perceptions and utilization of hyperbaric oxygen therapy for carbon monoxide poisoning in an academic setting.

The routine use of hyperbaric oxygen as therapy for carbon monoxide intoxication is being critically reexamined nationally. There are no controlled prospective clinical studies that show this modality to clearly be superior to the more traditional use of high concentrations of supplemental oxygen. Proponents of hyperbaric therapy often claim that such studies would now be unethical, would violate the accepted standard of care for this medical emergency, and would place the treating physician in an indefensible medical-legal position. In an attempt to determine the status of hyperbaric oxygen in our community as treatment for significant carbon monoxide exposure, we surveyed physicians practicing at the university regional trauma center to determine their perception of the indications for hyperbaric oxygen therapy for carbon monoxide poisoning. We then audited the medical records of all patients treated during a four-year period with the diagnosis of carbon monoxide poisoning or smoke inhalation to determine the actual utilization of this therapeutic modality. The results of our study indicate that hyperbaric referral is not the standard treatment for significant carbon monoxide intoxication in this academic setting.

Academic Medical Centers↗
PubMed1989

Synchronous mycotic aneurysms secondary to tuberculosis.

Mycotic aneurysm secondary to Mycobacterium tuberculosis is extremely unusual. We describe a 28-year-old female patient with tuberculosis who developed synchronous mycotic aneurysms of the abdominal aorta and the innominate artery. The pathogenesis, diagnosis, and treatment of tuberculous mycotic aneurysm is reviewed.

Adult↗
PubMed1989

Gastric stapling: a significant risk factor in the treatment of tricyclic antidepressant overdose.

Attention is called to prior gastric stapling as a risk factor for emesis and aspiration in those patients who are treated with single or repeated oral activated charcoal for tricyclic antidepressant overdose. When administered activated charcoal as part of the standard protocol for drug poisoning, these individuals have the potential for developing severe and repeated emesis with subsequent aspiration of this compound into the respiratory tract with development of the Acute Lung Injury syndrome.

Adult↗
PubMed1989

Symptomatic hypercalcemia pulmonary tuberculosis.

We describe a case of active pulmonary tuberculosis whose care was complicated by the onset of severe hypercalcemia that manifested after the institution of standard antituberculous therapy. We review the knowledge regarding the association of hypercalcemia with active pulmonary tuberculosis and present the proposed mechanisms for the pathogenesis of the disorder.

Aged↗