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Biomedical subjects

D E Dines

Publications and source records attributed to D E Dines.

At least 19 recordsLinked to original sources
PubMed1987

Pulmonary alveolar phospholipoproteinosis: experience with 34 cases and a review.

A retrospective review of Mayo Clinic records through 1983 revealed 84 patients (24 male and 10 female; mean age, 41 years) with the diagnosis of pulmonary alveolar phospholipoproteinosis. The major clinical features were dyspnea, cough, fever, and chest pain. Chest roentgenograms usually showed bilateral symmetric alveolar infiltrates, but asymmetric, unilateral, and chronic patchy patterns were also noted. Diagnosis was established by thoracotomy-lung biopsy in 26 patients. Histologic analysis revealed uniform filling of the alveoli by periodic acid-Schiff-positive material and maintenance of normal alveolar architecture. Electron microscopy showed enlarged alveolar macrophages with lamellar osmiophilic inclusions, dense granules, and myeloid bodies. Of the 21 patients who underwent therapeutic bronchoalveolar lavage, 13 had no recurrence of the disease during a mean follow-up of 8.8 years. In patients who underwent pulmonary function testing both before and after lavage, significant restrictive dysfunctions present before the procedure were alleviated afterward. Three deaths occurred among the 34 patients. Pulmonary alveolar phospholipoproteinosis may result from defective clearance of phospholipids by the alveolar macrophages, excessive production of phospholipids by type II pneumocytes, or both. It is likely a nonspecific response to a variety of injuries to the alveolar macrophage or type II pneumocyte or both, including exposure to certain dusts and chemicals and occurrence of hematologic diseases or infections. The uncommon occurrence of this disorder suggests individual susceptibility.

Adolescent↗
PubMed1986

Chronic bronchitis. Managing the disease and related infections.

Chronic bronchitis is characterized by chronic, productive cough present on most days for at least three months of the year. Differential diagnosis must exclude an endobronchial obstructive lesion, asthma, nocturnal aspiration, bronchiectasis, cystic fibrosis, and immotile cilia syndrome. The most characteristic finding in patients with chronic bronchitis is hypertrophy of the mucous glands and goblet cells.

Alcoholism↗
PubMed1983

Pulmonary arteriovenous fistulas.

Previously reported from our institution has been a series of 63 patients with pulmonary arteriovenous fistula who were seen from Jan. 1, 1952, through Dec. 31, 1972. Subsequently, we have seen 38 additional patients during the 8 1/2-year period from Jan. 1, 1973, through June 1981. The series includes three patients with hereditary telangiectasia who had bilateral pulmonary arteriovenous fistulas removed at two separate thoracotomies. Our report also includes a brief description of five additional patients with acquired systemic artery-to-pulmonary artery fistula who underwent miniballoon occlusion of the fistula. We are including these five cases because we believe this therapeutic catheterization technique may be of particular value in patients with multiple or bilateral pulmonary arteriovenous malformations and may obviate extensive pulmonary resection and repeat thoracotomy. Pulmonary arteriovenous fistula is believed to occur most often in middle-aged women who have associated Rendu-Osler-Weber syndrome, but most of our patients did not have hereditary hemorrhagic telangiectasia. Twenty-three (36.5%) of the 63 patients in a previous Mayo Clinic series and 18 (47%) of the 38 in the present series had associated Rendu-Osler-Weber syndrome. A logical workup of a patient with pulmonary arteriovenous fistula includes, in sequential fashion based on priority, chest roentgenography and tomography, arterial blood gas measurements, contrast echocardiography with indocyanine green dye, angiography, and measurement of differential pulmonary venous oxygen content.

Adolescent↗
PubMed1983

Interstitial lung disease. Assessment by bronchoalveolar lavage.

Bronchoalveolar lavage is a new bronchoscopic technique that permits assessment of changes in the cellular traffic in the alveolar spaces. During a 16-month period, 120 patients underwent bronchoalveolar lavage at our institution. Control subjects (N = 11) had a predominance of alveolar macrophages (94 +/- 1%) with a few lymphocytes (4 +/- 1%), whereas 35 patients with idiopathic pulmonary fibrosis had a substantial increase in the number of polymorphonuclear leukocytes (17 +/- 2%), and 32 patients with sarcoidosis had an appreciable increase in the number of lymphocytes (27 +/- 2%). Further subtyping of these lymphocytes in 13 patients with sarcoidosis revealed the cells to be predominantly from the T-helper subclass (helper/suppressor ratio of 5.3/1.0; normal 1.8/1.0). In contrast, three other patients with a lymphocytic alveolitis (51 +/- 8% lymphocytes) had a pronounced predominance of T-suppressor lymphocytes (helper/suppressor ratio of 0.1/1.0) in the lavage fluid. Two of the three patients were thought to represent an unusual subset of patients with idiopathic pulmonary fibrosis, and the third patient had pulmonary involvement secondary to angioimmunoblastic lymphadenopathy. Thus, bronchoalveolar lavage may be a useful means by which to assess the influx of inflammatory or immune effector cells into the alveolar structures in patients with interstitial lung disease, and this procedure offers promise as a quantitative means by which to assess the disease activity and the response to therapeutic intervention in these patients.

Bronchi↗
PubMed1979

Radiographic findings in patients with esophageal involvement by mediastinal granuloma.

Of 97 patients with mediastinal granuloma, 13 had involvement of the esophagus by extension from adjacent lymph nodes or pleura. A knowledge of the anatomic relationships of these structures is important in understanding the distribution and radiologic features of these lesions. The most common manifestation was extrinsic compression, being present in 7 (54%) of the 13 patients. Three patients (31%) had either a fistula or a sinus tract. Esophageal stricture and diverticulum formation also occurred. Mediastinal granuloma should be considered in the differential diagnosis in patients with any of these findings.

Diverticulum, Esophageal↗
PubMed1979

Mediastinal granuloma and fibrosing mediastinitis.

Thirty-one patients with mediastinal granuloma and fibrosing mediastinitis were seen at the Mayo Clinic from 1975 through 1977. Review of this series reveals that surgery is necessary to establish a diagnosis if the lesions are noncalcified and indeterminate. Fibrosing mediastinitis most likely develops after rupture of the fibrocaseous material from mediastinal lymph nodes into the mediastinum. Thoracotomy, with evacuation of the granulomas, is recommended, especially when the lesions are large, in order to prevent subsequent fibrosing mediastinitis with involvement of the contiguous structures, such as the superior vena cava, azygos vein, trachea, esophagus, and left atrium. In most patients, obstruction of the superior vena cava develops slowly, and efficient collateral venous circulation occurs, allowing long-term survival and minimal disability.

Adolescent↗
PubMed1978

The significance of a cytologically negative pleural effusion in bronchogenic carcinoma.

Bronchogenic carcinoma complicated by ipsilateral cytologically positive effusion is considered unresectable. Bronchogenic carcinoma with cytologically negative effusion, even if bloody, has also been thought by many to be unresectable. Seventy-three patients with bronchogenic carcinoma and ipsilateral cytologically negative effusions were studied. Sixty-six underwent exploratory thoracotomy for staging or therapy; five had pleural biopsies and two had mediastinoscopies, all disclosing metastatic carcinoma. Four of the 73 patients (5.5 percent) had surgically resectable disease. They have remained free of disease for 3, 6, 7, and 14 years. Sixty-nine patients (94.5 percent) had unresectable carcinoma with metastases. Seventeen (94 percent) of 18 patients with bloody effusions had unresectable cancer. Carcinoma was resected in one patient with cytologically negative bloody effusion, and the patient remained free of disease during the 14-year follow-up period. Unresectability must be documented surgically in these patients to exclude those in whom curative resection can be performed.

Adenocarcinoma↗
PubMed1978

Pericardial reconstruction of the membranous trachea after resection of adenoid cystic carcinoma (cylindroma).

An intraluminal adenoid cystic carcinoma (cylindroma) in the patient reported herein involved just the membranous portion of the distal region of the trachea and extended caudally to include the carina and the membranous portions of both main-stem bronchi--a total linear involvement of 6 cm. The tumor occluded 90% of the airway in its greatest extension. Conservative resection of this extensive tumor was successfully performed by membranous tracheal reconstruction with a pedicled autogenous pericardial patch graft.

Bronchial Neoplasms↗
PubMed1978

Disseminated Strongyloides stercoralis in an immunosuppressed host.

It is important that clinicians be aware that Strongyloides stercoralis can disseminate, because the helminth can exist as an asymptomatic infestation for years in a person from an endemic area and then become manifest when immunosuppressive therapy is given. A case of fatal strongyloidiasis is presented to emphasize this potential for causing serious infection in the compromised host.

Adult↗
PubMed1978

Dumbbell neurogenic tumors of the mediastinum. Diagnosis and management.

Among 706 collected cases of mediastinal neurogenic tumors were 69 patients (9.8%) with extension through an intervertebral foramen, so that the composite neoplastic mass was dumbbell-shaped. Although only 10% of these dumbbell tumors were malignant, the majority of the patients presented with neurologic symptoms of spinal cord compression. In about 40% of reported cases, the intraspinal component, although present, was not clinically apparent. Such cases of asymptomatic intraspinal extension should be suspected when special roentgenologic views of the spine demonstrate erosion of the vertebral pedicle or enlargement of the intervertebral foramen adjacent to the posterior mediastinal mass. Workup of these patients should include myelographic studies to determine whether a dumbbell tumor is indeed present; if it is, surgery should be carried out by a team of thoracic surgeons and neurosurgeons in a one-stage combined resection of both the intraspinal and the mediastinal component of the tumor. With early diagnosis and surgical intervention, long-term survival is the rule. When the patient is in the pediatric age bracket, an orthopedic surgeon should be included on the team to help minimize subsequent skeletal growth deformity.

Adult↗
PubMed1978

Obstructive disease of the airways associated with stage I sarcoidosis.

Stage I sarcoidosis usually presents with roentgenographic evidence of hilar adenopathy and the patients are totally asymptomatic. However, five patients were studied at the Mayo Clinic who had stage I sarcoidosis associated with obstructive disease of the airways. Four of the five presented with dyspnea, wheezing, and cough, and they were found to have expiratory slowing on physical examination. One patient was asymptomatic and her physical examination was normal. On pulmonary function testing, she had a decrease in maximal midexpiratory flow, and at fiberoptic bronchoscopy, mucosal changes consistent with noncaseating granuloma of sarcoidosis were seen. All five patients had the classic roentgenographic appearance of sarcoidosis, with hilar and right paratracheal adenopathy. Endobronchial involvement is well known in sarcoidosis, but its significance in stage I disease has not been emphasized in the literature. An awareness of this possibility is important because it may be an indication for bronchoscopy and mucosal biopsy in the patient with stage I sarcoidosis, particularly when the patient presents with dyspnea, wheezing, and cough. Also, corticosteroid, therapy may be indicated in selected patients with stage I sarcoidosis.

Adult↗
PubMed1976

Usefulness of chromosome examination in the diagnosis of malignant pleural effusions.

To determine whether chromosome analysis could facilitate the diagnosis of malignant pleural effusions, we examined chromosomes in effusions from 104 unselected patients. An effusion was regarded as malignant if at least three of 30 metaphase cells were hyperdiploid or contained a marker chromosome. Results were compared with standard cytologic diagnoses. All 22 benign effusions were diagnosed correctly by cytologic examination, but one nosed correctly by cytologic examination, but one (acute rheumatoid lung disease) was misclassified as positive by chromosome criteria. Of the 82 malignant effusions, 53 (65 per cent) were diagnosed correctly by cytologic tests, as compared with 58 (71 per cent) by chromosome analysis (P greater than 0.2). Among patients with malignant neoplasms, 13 had leukemia or lymphoma; only four of these (31 per cent) were diagnosed by cytologic tests as compared with 11 (85 per cent) by chromosome analysis (P less than 0.01). The combination of standard cytologic and chromosome analyses correctly identified 83 per cent of the neoplasms, a result significantly better than that with either technic alone (P less than 0.01).

Aged↗
PubMed1976

Esophageal involvement with mediastinal granuloma.

A review of 95 patients seen at the Mayo Clinic with mediastinal granuloma indicated that ten (10.5%) had esophageal involvement. The primary complaint was dysphagia. Esophageal roentgenographic features included compression, stricture, diverticulum, sinus tract formation, and tracheoesophageal fistula. An esophagogram should be included in the workup of any patient with suspected mediastinal granuloma.

Adolescent↗
PubMed1976

Pleural effusion. A diagnostic dilemma.

The cause of pleural effusion in 108 of 133 patients was determined by laboratory tests and clinical examination; it was indeterminate in 25, even after complete diagnostic evaluation. In 164 diagnostic thoracenteses, 136 cytologic examinations were done; the results were positive for cancer in 20 (15%). Five of 19 patients (26%) with bronchogenic cancer, 13 of 25 (52%) with metastatic cancer of the lung, and two of 20 (10%) with lymphoma had positive results on cytologic examination. Of 143 routine bacterial cultures, only five were positive (3%). Of 103 mycobacterial and 76 fungal cultures, only one was positive in each instance. Despite the high incidence of indeterminate diagnoses, we recommend that only measurement of protein content and cytologic examination be ordered routinely. Our algorithm provides a logical, cost-effective approach to the diagnostic problem of pleural effusion.

Bacterial Infections↗
PubMed1976

Detecting intrapulmonary right-to-left shunt with contrast echocardiography. Observations in a patient with diffuse pulmonary arteriovenous fistulas.

Contrast echocardiography has been useful in detecting intracardiac right-to-left shunts. In a patient with hereditary hemorrhagic telangiectasia and diffuse pulmonary arteriovenous fistulas, we have demonstrated the feasibility of detecting intrapulmonary right-to left shunting using this technique. After venous injection of indocyanine green dye, the characteristic contrast flow pattern consisted of a markedly delayed appearance of echoes in the left ventricle.

Adult↗