PubMed Health⌕ Search

Biomedical subjects

A M Fein

Publications and source records attributed to A M Fein.

At least 73 records · Page 4Linked to original sources
PubMed1987

Procoagulant activity in bronchoalveolar lavage in the adult respiratory distress syndrome. Contribution of tissue factor associated with factor VII.

Alveolar fibrin deposition commonly occurs in the lungs of patients with the adult respiratory distress syndrome (ARDS). Bronchoalveolar lavage (BAL) from patients with ARDS, control patients with interstitial lung disease (ILD), congestive heart failure, or exposure to hyperoxia, and normal healthy subjects was studied to determine whether local alterations in procoagulant activity favor alveolar fibrin deposition in the lungs in ARDS. Procoagulant activity capable of shortening the recalcification time of plasma deficient in either factor VII or factor VIII was observed in unconcentrated BAL of all patients, but was significantly greater in BAL from patients with ARDS when compared with that of control subjects (p less than 0.001). Unconcentrated BAL from patients with ARDS shortened the recalcification time of plasma deficient in factor X, but no functional thrombin was detectable. BAL procoagulant from patients with ARDS was inhibited by concanavalin A, an inhibitor of tissue factor. The hydrolysis of purified human factor X by BAL from the ARDS and other patient groups was determined by measuring the amidolytic activity of generated factor Xa on its N-benzoyl-L-isoleucyl-L-glutamyl-glycyl-L-arginine-p-nitroanilide substrate. The procoagulant activity of BAL was associated with the development of amidolytic activity, indicating activation of factor X. BAL from patients with ARDS contained more factor X activating activity than did BAL from control groups (p less than 0.001). This activity was calcium dependent and was maximal at 1 mM ionized calcium. The BAL factor X activating activity was most active at neutral pH and was sedimented by ultracentrifugation at 100,000 x g.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

"When the pneumonia doesn't get better".

Nonresolving pneumonia is a common and frequently misunderstood problem faced by the practicing pulmonologist. While radiographic resolution of most infections is relatively long and lags behind clinical signs of recovery, data suggest that a variety of host defense problems are a consequence of systemic illness and are often involved. When such factors are not implicated, other specific etiologies should be sought, including unusual organisms like mycobacteria, higher order bacteria, and fungi. Noninfectious causes for delayed resolution include neoplastic disease, immunologic disease, thromboemboli, and inhalation injuries. This article discusses the natural history of common pneumonias to establish the usual clinical limits of resolution and outlines a diagnostic strategy to use when these limits are exceeded.

Airway Obstruction↗
PubMed1987

Reversal of sleep apnea in uremia by dialysis.

Obstructive sleep apnea (OSA) is a common syndrome occurring in 1% to 4% of the population. While obesity is the most common predisposition to OSA, metabolic disorders have been associated with this syndrome. We describe a patient who presented with severe OSA while in an advanced untreated uremic state, which resolved following intensive dialysis. We speculate that the sleep disturbances, which are common in uremia, may be accounted for in some patients by OSA and may resolve with specific therapy for advanced renal failure.

Aged↗
PubMed1986

The interaction of infection and the adult respiratory distress syndrome.

Infection, particularly that involving the respiratory tract, is commonly seen in the patient with ARDS. It can be either an etiologic factor leading to the syndrome or a complicating factor leading to a high likelihood of mortality. Pneumonia develops in up to 70% of individuals with ARDS, and when present, converts the syndrome to its most severe and mortal form. In addition, when systemic injury coexists with any type of infection, ARDS will develop with an increased frequency. Nosocomial pneumonia results when upper and lower respiratory tract defenses fail and these sites are overwhelmed by bacteria. Colonization of the oropharynx and tracheobronchial tree, both of which are common in critically ill patients, precedes the development of pneumonia. In the patient with ARDS, all levels of host antibacterial defenses may be impaired, thus accounting for the high incidence of both colonization and pneumonia. These impairments result from the acute lung injury itself, coexisting systemic illnesses, therapeutic interventions, and acquired malnutrition. Once pneumonia develops in the course of acute lung injury, diagnosis is exceedingly difficult and potentially inaccurate. With proper application of the protected specimen brush, inserted bronchoscopically, diagnostic accuracy may improve. Therapy must be undertaken early and with agents directed at likely pathogens, particularly P. aeruginosa and other gram-negative bacilli. In the future, preventive efforts against pneumonia may be effective for the ARDS patient. Strategies that may be effective include hyperalimentation, judicious use of all pharmacotherapy, active and passive antibacterial vaccines, airway microenvironment manipulation, and the use of aerosolized antibiotics.

Cross Infection↗
PubMed1986

Pneumonia in the elderly.

Pneumonia from bacterial and viral agents is the fourth leading cause of death in persons over age 65, accounting for 169.7 deaths per 100,000 persons per year. This high incidence of infection is the result of aging itself as well as age-related coexisting illnesses and their therapies. These factors combine to affect upper and lower respiratory tract host defenses adversely against invading pathogens. Gram-negative colonization of the oropharynx, followed by the spread of bacteria to the tracheobronchial tree, commonly precedes the development of pneumonia. Bacterial adherence is one important and modifiable pathogenetic factor that leads to colonization at both of these sites. Diagnosis of pneumonia in the elderly is often thwarted by difficulties in recognizing infection, as signs and symptoms differ from those observed in younger patients. Therapy is confounded by the frequent inability to obtain adequate culture material to establish a likely pathogen and by altered drug metabolism. In this instance epidemiologic data may be helpful in guiding therapy. Streptococcus pneumoniae is the most common pathogen in community patients, followed by Legionella pneumophila and enteric gram-negative bacilli. Hospitalized and institutionalized individuals are commonly infected with Klebsiella pneumoniae and other enteric gram-negative bacilli, and Legionella pneumophila and Streptococcus pneumoniae are also found. Because recognition of pneumonia may be difficult and therapy is fraught with problems, mortality is high in the elderly. Accordingly, serious attention must be paid to prevention. Prophylaxis includes the use of pneumococcal and influenza vaccines as well as careful attention to the patient's host defense status. Disease states leading to impairment of the immune system should be sought, and efforts should be made to improve host factors that assist the individual in removing invading pathogens.

Aged↗
PubMed1985

Tension ball valve mucus plug in asthma.

This report describes a patient with status asthmaticus and respiratory failure in whom profound hypoxemia developed during mechanical ventilation. During the hypoxemic episode, breath sounds were absent over the left lung, and chest radiography revealed a hyperlucent left hemithorax with tension shift of the mediastinum to the right. The presence of lung markings in the left lung on radiography eliminated the possibility of tension pneumothorax and led to the diagnosis of tension mediastinal shift secondary to a ball valve obstruction by a central mucus plug. Bronchoscopic lung lavage removed the mucus plug, thereby correcting the hypoxemia. Recognition of this previously undescribed acute complication of mechanical ventilation in status asthmaticus is essential so that confusion with tension pneumothorax is avoided and appropriate therapy instituted.

Adult↗
PubMed1985

Usefulness of tumor markers in serum and bronchoalveolar lavage of patients undergoing fiberoptic bronchoscopy.

To evaluate the diagnostic usefulness of simultaneous determinations of 4 tumor markers (carcinoembryonic antigen, calcitonin, creatinine kinase-BB, and DNA), we studied 31 patients with lung cancer, 22 with benign lung disease, and 15 normal volunteers as control subjects. The measurements were made by radioimmunoassay in bronchoalveolar lavage (BAL) and in serum obtained on the same day. The results showed that in serum, only CEA levels were significantly higher in malignancy; in lavage fluids, all 4 markers were abnormally high in cancer patients when compared with control subjects (p less than 0.05); there was no correlation between the levels in lavage and those in the bloodstream. When the mean levels in lavage of the normal control subjects were designated as the limits for a positive test, significant association was found between malignancy and abnormally elevated marker concentration (p less than 0.01). The particular combination of CEA-BAL greater than 35 ng/mg, CEA-serum greater than 4 ng/ml, and calcitonin-BAL greater than 120 pg/mg taken together with the results of bronchoscopy (histologic and cytologic) showed the highest discriminating power between malignant and benign lung disease. The sensitivity of the bronchoscopy procedure increased from 50 to 89%, with at least 2 positive markers, and had a specificity of 71%. When both bronchoscopy and all 3 markers were negative, the results showed a negative predictive value of 100%. We conclude that tumor marker levels in lavage are a useful aid in the diagnosis of malignancy in patients undergoing bronchoscopy.

Adult↗
PubMed1984

Hypercapnia complicating massive pulmonary embolism.

An elevated PaCO2 is distinctly unusual in pulmonary embolic disease. We report 2 patients with massive pulmonary emboli complicated by hypercapnia in the absence of underlying chronic obstructive lung disease. Profound alterations in ventilation/perfusion matching and reduced cardiac output are probable mechanisms of this gas-exchange problem.

Adolescent↗
PubMed1984

Proteinase inhibitory function in inflammatory lung disease. I. Acute bacterial pneumonia.

This study examines the bronchial alveolar lavage (BAL) samples from a group of patients with acute bacterial pneumonia (n = 13) and makes a comparison with a control group (n = 5). The proteinase inhibitory capacity was examined and found to be composed primarily of alpha 1-proteinase inhibitor (PI, alpha 1-antitrypsin) and, to a lesser extent, bronchial mucosal inhibitor. Although the average PI concentration was elevated approximately 5-fold in the pneumonia group, its inhibitory function against elastase was decreased 15-fold when compared with that in the control group. The pneumonia group showed an increased concentration of immunologically identified elastin-derived peptides. Some of the BAL fluid from patients with pneumonia showed elastolytic activity against amorphous insoluble lung elastin. The majority of the elastase appears to be of neutrophil origin. Bronchial mucosal inhibitor is shown to be a component of both normal and pneumonia BAL fluids by both immunologic quantitation and by its resistance to perchloric acid inactivation. Compared with those from control subjects, BAL samples from patients with acute bacterial pneumonia showed a decreased proteinase inhibitor function and both increased elastolytic activity and elastin-derived peptide concentration.

Acute Disease↗
PubMed1984

Is pulmonary artery catheterization necessary for the diagnosis of pulmonary edema?

The ability to differentiate cardiac from permeability edema on the basis of clinical and radiographic criteria was studied in 70 ICU patients in whom subsequent pulmonary artery catheterization (PAC) was performed. Our study demonstrated that the clinical assessment of permeability pulmonary edema was correct in 17 of 20 patients (85%). In contrast, of the 50 patients initially suspected of having cardiac edema, only 31 (62%) were predicted correctly (p less than 0.05). Complications relating to catheterization occurred in 25% of patients, with 3 deaths. We conclude that the diagnosis of cardiogenic pulmonary edema, based on clinical criteria alone, is often inaccurate in the intensive care setting. The failure of patients to respond to initial therapy should mandate pulmonary artery catheterization, despite the attendant risks. Furthermore, even though the clinical diagnosis is correct in 85% of patients with permeability pulmonary edema, PAC data may be necessary for optimal management.

Aged↗
PubMed1984

Cardiopulmonary effects of acute thallium poisoning.

Gastrointestinal distress and alopecia are the most commonly reported symptoms of acute thallium intoxication; however, cardiac and pulmonary disease may dominate the acute stages of the disease. We report four cases which illustrate the importance of cardiac and respiratory disease in this syndrome.

Acute Disease↗
PubMed1983

The risk factors, incidence, and prognosis of ARDS following septicemia.

Adult respiratory distress syndrome (ARDS) is frequently associated with septicemia. However, the incidence, risk factors, and prognosis are poorly defined. Therefore, during a nine-month period, 116 consecutive patients with septicemia were analyzed. ARDS occurred in 21 of 116 (18 percent) of septicemic patients. Shock preceded all cases of ARDS but occurred in only 15 percent of patients without ARDS (p less than 0.001). Thrombocytopenia was more frequent (62 percent vs 16 percent, p less than 0.001). Age, sex, compromised host status, type of septicemia, temperature, and white blood cell count were not significantly different between the two groups. It is concluded that ARDS frequently complicates all forms of septicemia. It is usually preceded by shock and thrombocytopenia and significantly worsens the prognosis.

Aged↗