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Biomedical subjects

C B Payne

Publications and source records attributed to C B Payne.

At least 19 recordsLinked to original sources

Pulmonary hyalinizing granuloma: an unusual association with multiple sclerosis.

Pulmonary hyalinizing granuloma (PHG) is a rare entity included in the differential diagnosis of pulmonary nodules of unknown origin. The pathologic entity may represent a peculiar form of pulmonary immune reaction. We report the case of a 40-year-old white woman who had nodular lesions in both lung bases after a 10-year history of multiple sclerosis. An open lung biopsy was required to make the diagnosis. The association of pulmonary hyalinizing granuloma with multiple sclerosis could be coincidental, but since there is a possibility of immune reaction in the pathogenesis of both diseases, the association may be significant.

Adult

Regional and systemic CD4 and CD8 subsets in bronchogenic carcinoma.

We studied lung and blood lymphocytes from 12 asymptomatic patients with peripheral bronchogenic carcinoma. Bronchoalveolar lavage was performed in the lung segment with tumor and a contralateral uninvolved lung segment and analyzed separately. After partial removal of macrophages by plastic adherence, cells were labeled with markers for CD4 and CD8 and analyzed by flow cytometric analysis. We found no significant difference in the percentages of mononuclear cells in either immune subset when comparing the lung containing tumor with the uninvolved lung. We did find, however, a depressed CD4/CD8 ratio in the peripheral blood. We conclude that a lung carcinoma does not change the local immunologic milieu of the lung parenchyma containing the carcinoma. It is not clear if the immunologic findings in the lungs and blood are due to the bronchogenic carcinoma, smoking, or the underlying chronic obstructive pulmonary disease.

Aged

Mediastinal radiographic abnormality caused by anomalous venous drainage: how often is it seen in Afro-Americans?

An abnormal superior mediastinal density seen on a chest x-ray led to computerized tomography scan detection of an enlarged azygous vein produced by anomalous embryologic development of the inferior vena cava. This potentially clinically important abnormality is uncommon and statistics indicating its frequency are best available from the Japanese. In addition to alerting clinicians to this abnormality, a plea is made for review of autopsy series in Afro-Americans by pathologists in order to determine potential risks in a variety of surgical procedures.

Aged

Neoplastic obstruction of the trachea complicating pseudobulbar palsy.

We have reported a case of pseudobulbar palsy with airflow obstruction initially attributed to chronic aspiration and chronic airflow obstruction caused by cigarette smoking. The finding of stridor led to a detailed evaluation of the obstruction. Flow-volume loops, fiberoptic bronchoscopy, CT scan of the upper thorax, and fine-needle biopsy of a lesion of the trachea were required to make the diagnosis of non-small-cell carcinoma involving the trachea.

Airway Obstruction

Effects of transoral and transnasal fiberoptic bronchoscopy on oxygenation and cardiac rhythm.

The association of hypoxemia and cardiac arrhythmias with fiberoptic bronchoscopy (FOB) is known. The effects of various methods of inserting the bronchoscope on blood oxygen tensions, the true prevalence of arrhythmias, and the clinical significance of PaO2 and rhythm changes are poorly defined. Arterial blood gas values, oxygen saturation and cardiac arrhythmias detected by 24-hour Holter monitoring were compared in 20 male patients undergoing either transoral or transnasal FOB. No significant difference in oxygen saturation was found; however, PaO2 values fluctuated widely and unpredictably and were significantly higher in the eight patients in the transnasal FOB group. No life-threatening arrhythmias were induced during bronchoscopy; however, because of minor arrhythmias such as sinus tachycardia, the overall frequency of arrhythmias rose from 60% to 65%. The incidence of arrhythmias in this study was similar to that reported during pulmonary function testing.

Adult

Nonpulmonary causes of dyspnea.

Dyspnea as a symptom is often related to pulmonary disorders. However, nonpulmonary disorders could be significantly responsible for causing dyspnea. Basic pathophysiology and clinical approach to nonpulmonary disorders causing dyspnea are discussed in this article.

Anemia

Two-step tuberculin testing in a veterans domiciliary population.

Seven hundred ninety-six veterans were scheduled for tuberculin testing during a hospital/domiciliary employee health program in southern Ohio. The Mantoux test, using 5 TU of commercial purified protein derivative (PPD) was used. Nonsignificant reactors were retested at one week to detect and quantitate the "booster phenomenon," following Centers for Disease Control (CDC) recommendations. Cost data were recorded. The initial frequency of 39.3% reactions greater than 10 mm in 740 tested subjects increased to 46.7% on two-step testing. Fifty-five of 414 subjects exhibited the booster effect, a rate intermediate between that reported in Alabama and no boosting reported in Rochester, New York. Costs of two-step testing exceeded, by a small margin, estimated costs of isoniazid preventive therapy for apparent converters detected by two-step testing.

Adult

Papillomas of the tracheobronchial tree with malignant degeneration.

Papillomas are rare tumors of the respiratory tract, which are usually considered benign. We studied a male patient with adult onset of squamous papillomatosis involving both the trachea and the bronchi, with malignant degeneration. When we obtained specimens bronchoscopically, only the bronchial lesions showed carcinomatous changes. Thoracotomy demonstrated carcinoma in the tracheal lesion as well. We conclude that transbronchoscopic biopsy may be inadequate in the evaluation of papillomatosis.

Bronchi

On respirable organic antigens, mattresses and some idiopathic lung diseases.

In surveying the environment of workers in a mattress factory thermophilic actinomycetes as well as phycomycetes and aspergillus species were isolated readily from work room dust, finished bat, sissal and the interior of baled linters. Those persons working with cotton products were shown to have a heavy, daily exposure to organisms known to be implicated in the pathogenesis of hypersensitivity pneumonitis. The authors suggest that further study of the inhaled antigens to which cotton workers are exposed is indicated before discarding immunologic mechanisms to explain the development of byssinosis and other pulmonary disorders to which such workers are subject.

Alveolitis, Extrinsic Allergic

Phthalic anhydride asthma.

A patient with occupational asthma caused by phthalic anhydride is described. Inhalation challenges under laboratory control produced immediate and delayed asthmatic responses. Repeat exposure to phthalic anhydride after treatment with cromolyn sodium showed inhibition of the late but not early bronchoconstrictive, asthmatic response.

Adult

Pulmonary injury following exposure to chlorine gas. Possible beneficial effects of steroid treatment.

Two sisters were exposed to chlorine gas in toxic quantities in the same room of their home during an industrial accident. One was hospitalized and treated with corticosteroids and oxygen therapy, while the other received evaluation in the emergency room, and brief oxygen therapy and was released without corticosteroid therapy. Pulmonary physiologic studies have been performed on both patients at intervals following the exposure. The treated patient was stable, with normal results on studies of pulmonary function at the end of two years, while the sibling not treated with corticosteroids had demonstrable abnormalities of gas exchange which persisted during 55 months of observation. This "natural experiment" gives evidence of prolonged detrimental effects of sublethal exposure to chlorine gas on human pulmonary function in some patients. The effect of the differences in treatment between the two siblings cannot be definitely assessed in this single situation.

Accidents, Occupational