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Biomedical subjects

A E O'Donnell

Publications and source records attributed to A E O'Donnell.

13 recordsLinked to original sources
PubMed2001

Pulmonary manifestations of HIV infection in the era of highly active antiretroviral therapy.

STUDY OBJECTIVES: To determine whether the spectrum of HIV-related pulmonary disease seen by a university medical center Pulmonary and Critical Care Medicine Service has changed since the introduction of highly active antiretroviral therapy (HAART). DESIGN: Retrospective chart review. SETTING: A tertiary care university hospital. PATIENTS: All HIV-infected patients referred to the Pulmonary and Critical Care Medicine Service from January 1, 1993, through December 31, 1995 (era 1) and from July 1, 1997, through June 30, 2000 (era 2). INTERVENTIONS: Inpatient and outpatient charts were reviewed for data regarding patient demographics, CD4 cell counts, viral load levels, duration of HIV seropositivity, history of opportunistic infections, and final diagnosis. RESULTS: Pneumocystis carinii pneumonia (PCP) was less common in the HAART era than in the pre-HAART era, whereas bacterial pneumonia and non-Hodgkin's lymphoma (NHL) were more common in the HAART era than in the pre-HAART era. HAART was protective against PCP (odds ratio [OR], 0.37; confidence interval [CI], 0.16 to 0.89) in a manner dependent on the CD4 cell count. Patients receiving HAART were at increased risk for the development of bacterial pneumonia (OR, 2.41; CI, 1.12 to 5.17) and NHL (OR, 15.11; CI, 3.14 to 28.32). A history of PCP indicated a risk factor for bacterial pneumonia (OR, 2.14; CI, 1.13 to 4.04). A history of cytomegalovirus infection indicated a risk factor for NHL (OR, 6.0; CI, 1.27 to 28.32). CONCLUSIONS: There have been significant changes in the spectrum of HIV-related pulmonary complications seen by our Pulmonary and Critical Care Medicine Service in the HAART era.

AIDS-Related Opportunistic Infections↗
PubMed1998

Treatment of idiopathic bronchiectasis with aerosolized recombinant human DNase I. rhDNase Study Group.

STUDY OBJECTIVE: To study the safety and efficacy of aerosolized recombinant human DNase I in the treatment of idiopathic bronchiectasis. DESIGN: Double-blind, randomized, placebo-controlled, multicenter study. POPULATIONS: Three hundred forty-nine adult outpatients in stable condition with idiopathic bronchiectasis from 23 centers in North America, Great Britain, and Ireland. INTERVENTIONS AND MEASUREMENTS: Study patients received aerosolized rhDNase or placebo twice daily for 24 weeks. Primary end points were incidence of pulmonary exacerbations and mean percent change in FEV1 from baseline over the treatment period. RESULTS: Pulmonary exacerbations were more frequent and FEV1 decline was greater in patients who received rhDNase compared with placebo during this 24-week trial. CONCLUSIONS: rhDNase was ineffective and potentially harmful in this group of adult outpatients in stable condition with idiopathic bronchiectasis. This contrasts with previously published results that demonstrated efficacy of rhDNase in patients with cystic fibrosis bronchiectasis.

Administration, Inhalation↗
PubMed1996

HIV in illicit drug users.

Illicit drug users comprise a substantial and growing proportion of the HIV-infected population. Although they develop pulmonary complications common to all HIV transmission groups, they also have unique respiratory illnesses due to the direct effect of the illicit drugs on the lung. Bacterial infections, tuberculosis, and noninfectious complications all have a major effect on morbidity and mortality in this portion of the HIV-infected population.

AIDS-Related Opportunistic Infections↗
PubMed1995

Pulmonary complications associated with illicit drug use. An update.

STUDY OBJECTIVE: In earlier years, nonopportunistic infectious pulmonary complications of illicit drug use were most common. We designed this study to update the pulmonary complications associated with illicit drug use in the 1990s. DESIGN: Concurrent and retrospective chart review. SETTING: Inner-city municipal hospital. PATIENTS: All illicit drug users with pulmonary complications seen by the pulmonary consult service were enrolled in the study. There were 105 hospital admissions of 97 patients in a 14-month study period. RESULTS: Sixty percent of the patients had HIV infection. The most common pulmonary complications were Pneumocystis carinii pneumonia (30%) followed by community-acquired pneumonia (12%) and tuberculosis (9%). CONCLUSIONS: The spectrum of pulmonary disease in illicit drug users has changed since 1988. Opportunistic HIV-related disease is much more common. Community-acquired pneumonia and tuberculosis remain relatively frequent complications. Septic pulmonary embolism is now rare.

AIDS-Related Opportunistic Infections↗
PubMed1993

Exercise-induced airflow obstruction in a healthy military population.

Clinical asthma is estimated to occur in 4 to 7 percent of the US population, but respiratory symptoms are much more common. The correlation between asthma, tests of bronchial hyperresponsiveness, and symptoms is imprecise and difficult to ascertain. The prevalence of exercise-induced airflow obstruction is not well known in healthy adults. We studied 100 consecutive US Air Force members to determine the prevalence of respiratory symptoms and the incidence of airflow obstruction after standardized free-run exercise. Subjects who developed airflow obstruction with exercise underwent methacholine challenge. We found that 31 percent of our population had respiratory complaints, but only 6 percent had significant airflow obstruction after exercise. Three of six subjects with abnormal results on exercise spirometry had bronchial hyperresponsiveness in response to methacholine. In summary, objective evidence of exercise-induced airflow obstruction was uncommon in our healthy subjects, although nonspecific respiratory complaints were frequent. In our study, methacholine challenge was positive in only half the subjects with abnormal spirometric data after exercise. We conclude that the diagnosis of exercise-induced asthma in healthy individuals is difficult because of the uncertain relationship between symptoms and objective testing and between modes of objective testing. Additionally, the role of free-run exercise testing needs further investigation in adults being screened for asthma.

Adult↗
PubMed1991

Interstitial pneumonitis associated with "crack" cocaine abuse.

A 33-year-old woman developed acute bilateral pulmonary infiltrates after the intense use of rock cocaine (crack). She subsequently had progressive deterioration of pulmonary function to the point of being ventilator-dependent. Open lung biopsy showed a chronic interstitial pneumonia with extensive accumulation of free silica within histiocytes associated with mild pulmonary fibrosis. This pattern of interstitial pneumonia has not been previously reported in crack users.

Adult↗
PubMed1990

Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea.

In an attempt to identify predictors of long-term compliance with nasal continuous positive airway pressure (CPAP), we reviewed the records of 125 patients with obstructive sleep apnea (OSA) referred to our center for nasal CPAP trials. Severity of sleep apnea, sleep staging, daytime hypersomnolence, effectiveness of nasal CPAP, previous palatal surgery, and adverse reactions were compared in compliant and noncompliant patients. Nineteen patients did not tolerate a nasal CPAP trial in the laboratory or refused home nasal CPAP therapy. Ten patients were unavailable for follow-up. Of the remaining 96 patients, 23 (24 percent) had discontinued therapy, while 73 (76 percent) were still using nasal CPAP at 14.5 +/- 10.7 months (mean +/- SD). There were no statistically significant differences between the compliant and noncompliant patients in baseline apnea plus hypopnea index (AHI), baseline sleep staging, AHI while receiving nasal CPAP, sleep staging while receiving nasal CPAP, or frequency of adverse reactions during therapy. Severe daytime sleepiness was present in 65 of the 73 compliant patients and in 12 of the 23 noncompliant patients (p less than 0.05). Ten of 43 in the compliant group had previous palatal surgery compared with ten of 23 noncompliant patients (p less than 0.05). Our data confirm earlier observations in smaller samples that compliant and noncompliant patients have equally severe sleep apnea and good initial responses to nasal CPAP. Long-term compliance with nasal CPAP may be associated with the severity of daytime hypersomnolence on presentation. Previous palatal surgery was more frequent in patients who did not tolerate long-term nasal CPAP therapy.

Female↗
PubMed1988

Bilateral pyopneumothorax secondary to intravenous drug abuse.

An intravenous drug abuser presented with bilateral pyopneumothoraces and bacteremia which is a previously unreported complication of jugular vein self-injection. The patient sustained direct pleural trauma and resultant infection by injecting herself with contaminated needles.

Adult↗
PubMed1988

Pulmonary complications of intravenous drug abuse. Experience at an inner-city hospital.

Fifty-one intravenous drug abusers were evaluated by a pulmonary consultative team over a 22-month period at a large inner city hospital. The most common pulmonary complication was septic pulmonary embolism, seen in 12 patients (23.5 percent). Community-acquired pneumonia was diagnosed in ten patients (19.6 percent). Mycobacterium tuberculosis occurred in five patients (9.8 percent). Although 25 of 40 patients (63 percent) tested for human immunodeficiency virus antibody were positive, acquired immunodeficiency syndrome (AIDS) was present in only five patients (9.8 percent). Bronchoscopy was used to evaluate pulmonary infiltrates in 15 of 51 cases (29 percent). Common bacterial infections and tuberculosis remain the most frequently encountered pulmonary problems in drug abusers, despite the onset of the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Endobronchial eosinophilic granuloma: a rare cause of total lung atelectasis.

A 12-yr-old male presented with left lung atelectasis secondary to a mainstem endobronchial mass. At thoracotomy, a left mainstem bronchial sleeve resection successfully extirpated what later proved to be an eosinophilic granuloma. This is the first case report, to our knowledge, of endobronchial eosinophilic granuloma.

Bronchi↗