Stent thrombosis: consider also low response to antiplatelets.
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Aspirin↗
Biomedical subjects
David H Roberts
Publications and source records attributed to David H Roberts.
MRSA endocarditis--postcardiac surgery.
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Aged, 80 and over↗
Loss of anteroposterior intralobar attenuation gradient of the lung: Correlation with pulmonary function.
RATIONALE AND OBJECTIVES: Since the initial description of an intralobar attenuation gradient by Webb et al, it has been suggested that departure from the intralobar attenuation gradient could indicate early lung diseases. However, its significance has not been determined in detail. We aimed to quantify the anteroposterior intralobar attenuation gradient on volumetric end-inspiratory and end-expiratory high-resolution computed tomography (CT) in patients with emphysema and to correlate the gradient values with pulmonary function. MATERIALS AND METHODS: The study population consisted of 21 consecutive patients with emphysema evaluated with volumetric expiratory high-resolution CT and 6 patients with normal high-resolution CT findings. The anteroposterior intralobar attenuation gradient values were quantified on end-inspiratory and end-expiratory sagittal reformations using a lung analysis software program and were correlated with pulmonary function tests results. RESULTS: The intralobar attenuation gradient values in patients with forced expiratory volume in 1 second (FEV1) < or =70% were significantly smaller compared with those in patients with FEV1 >70% in bilateral lower lobes at end-expiration (P = .0061, P = .047, respectively, unpaired t-test). The FEV1 values in patients with attenuation gradient values < or =0.02 were significantly lower than in those with attenuation gradient values >0.02 (right lower lobe: P = .024; left lower lobe: P = .0034; chi-squared test). The intralobar attenuation gradient values in bilateral lower lobes at end-expiration were significantly correlated with FEV1 and FEV1/forced vital capacity (right: P = .031, P = .039, respectively; left: P = .036, P = .030, respectively, Pearson correlation). CONCLUSIONS: The quantitative measurement of the anteroposterior intralobar attenuation gradient values of the lung showed that these gradients at end-expiration in both lower lobes correlate with obstructive physiology.
Adult↗
Medical and psychologic outcome of living lobar lung transplant donors.
BACKGROUND: Living donor lobar lung transplantation is a viable therapy for carefully selected patients with end-stage pulmonary disease. Its success is largely dependent upon donor outcome, including both physical and emotional factors. To date, there has been little focus on psychosocial outcomes of lobar lung donors. METHODS: Retrospective evaluation of 15 of 20 living lobar lung transplant donors was performed. Donors underwent evaluation of pulmonary function after recovery from donor lobectomy. Participants completed two self-report questionnaires, the SF-36 Health Survey (SF-36) and the Beck Depression Inventory (BDI), as well as an open-ended psychiatric interview. RESULTS: After lobar donation, mean forced expiratory volume in 1 second (FEV(1)) decreased by 21 +/- 2%, forced vital capacity (FVC) decreased by 16 +/- 3%, total lung capacity (TLC) decreased by 15 +/- 3%, and single-breath diffusing capacity (DLCO) decreased by 14 +/- 4%. All subjects scored higher than the national average on both the physical and mental health components of the SF-36. The BDI scores showed no evidence of clinical depression. However, the subjective interviews elicited two common complaints: (1) a decline in exercise performance, not accounted for by resting lung function measurements; and (2) a dissatisfaction with the degree of acknowledgment of their donation. CONCLUSIONS: Living lobar lung transplant donors enjoy generally satisfactory physical and emotional health. Donors report positive feelings about donation, but wish to be recognized and valued by the transplant team and by the recipient. Despite preservation of lung function within the normal range, some donors also experience a subjective decline in exercise tolerance. Long-term medical and psychologic follow-up appears warranted to monitor symptoms of exercise impairment and to enhance the donor experience.
Forced Expiratory Volume↗
Bronchomalacia in sarcoidosis: evaluation on volumetric expiratory high-resolution CT of the lung.
RATIONALE AND OBJECTIVES: The aim of this study is to investigate the frequency of bronchomalacia associated with sarcoidosis and compare the extent of air trapping in patients with sarcoidosis with and without bronchomalacia. MATERIALS AND METHODS: Eighteen consecutive patients (6 men, 12 women; age, 29-64 years; mean age, 47 years) with pathologically proven sarcoidosis who underwent clinical volumetric expiratory high-resolution computed tomography were studied. On contiguous end-expiratory images, the presence and severity of bronchomalacia and extent of air trapping were evaluated. The extent of air trapping was compared between patients with sarcoidosis with and without bronchomalacia. RESULTS: Bronchomalacia was noted in 11 of 18 patients (61%) with sarcoidosis (grade 1 [mild], n = 6; grade 2 [moderate], n = 4; and grade 3 [severe], n = 1). Air trapping was observed in 17 of 18 patients (94%; grade 1 [1%-25%], n = 8; grade 2 [26%-50%], n = 9). The extent of air trapping in patients with bronchomalacia was significantly greater than that in patients without bronchomalacia (P = .027, chi-squared test). CONCLUSION: Bronchomalacia frequently was associated with sarcoidosis, and the extent of air trapping was significantly greater in patients with sarcoidosis with bronchomalacia compared with those without bronchomalacia.
Adult↗
Combined catheter ventricular septal defect closure and multivessel coronary stenting to treat postmyocardial infarction ventricular septal defect and triple-vessel coronary artery disease: a case report.
Ventricular septal defect following acute myocardial infarction is a rare but life-threatening complication. Early surgical closure improves survival but carries a considerable risk. Percutaneous transcatheter closure is an alternative but experience to date is limited. We report a case of successful transcatheter closure of postmyocardial infarction ventricular septal defect (VSD) in a 55-year-old male with the Amplatzer muscular VSD occluder device and complete percutaneous revascularization with successful multivessel coronary stenting for three-vessel disease as a staged procedure. The technique and its potential use as an alternative to surgical approach for treatment of acute myocardial infarction and its complication (VSD) are discussed.
Cardiac Catheterization↗
Donor-recipient gender mismatch in lung transplantation: impact on obliterative bronchiolitis and survival.
BACKGROUND: Because of the shortage of donor lungs, liberalization of donor selection criteria in terms of age, gas exchange, and smoking history has been proposed. METHODS: We evaluated a single-institution population of lung transplant recipients (n = 98) for donor-recipient gender matching. We measured overall survival, time to acute allograft rejection, and time to development of obliterative bronchiolitis (OB). RESULTS: We found significant improvement in overall survival for gender-mismatched donor and recipient pairs (p = 0.078) and a significantly shorter OB-free period for male donor and female recipient pairs (p = 0.017). CONCLUSION: These findings suggest that donor organ allocation based on gender may affect long-term survival and other outcomes after lung transplantation.
Acute Disease↗
Eosinophilic pneumonia as an initial manifestation of rheumatoid arthritis.
Rheumatoid arthritis is a systemic disease that may have pulmonary manifestations. We describe a case of eosinophilic pneumonia as the primary presentation of rheumatoid arthritis. While several cases of acute and chronic eosinophilic pneumonia have been reported in patients with preexisting rheumatoid arthritis, this is the first case reported in which the eosinophilic lung disease was the initial manifestation of systemic rheumatoid arthritis.
Adult↗
Pulmonary capillary hemangiomatosis with atypical endotheliomatosis: successful antiangiogenic therapy with doxycycline.
We report here our experience in achieving remission in a 20-year-old man with pulmonary capillary hemangiomatosis (PCH) with atypical endotheliomatosis following therapy with doxycycline. PCH is a rare disorder characterized by proliferating capillaries that invade the pulmonary interstitium and alveolar septae, and occlude the pulmonary vasculature. The patient's symptoms, lung function, and radiographic findings had worsened despite treatment with both prednisone and alpha-interferon. He was considered to be a candidate for transplantation. Given the elevated levels of basic fibroblast growth factor (bFGF) in urine and the capillary proliferation noted on biopsy specimens, we elected to treat the patient with doxycycline, a matrix metalloproteinase and angiogenesis inhibitor. Following several weeks of therapy, a gradual resolution of symptoms was noted, with normalization of pulmonary function test results and urine bFGF levels. After 18 months of therapy, the patient remains in complete remission.
Adult↗
Excessive collapsibility of bronchi in bronchiectasis: evaluation on volumetric expiratory high-resolution CT.
OBJECTIVE: To evaluate the frequency and severity of bronchomalacia, defined as excessive collapsibility of bronchi, in bronchiectasis; to compare the extent of air trapping in bronchiectasis patients with/without bronchomalacia; and to correlate the severity of bronchomalacia and the extent of air trapping versus pulmonary function. MATERIALS AND METHODS: Forty-six patients with bronchiectasis evaluated by volumetric expiratory high-resolution computed tomography (CT) and pulmonary function tests were studied. The presence and severity of bronchomalacia were evaluated on contiguous axial high-resolution CT images using a 4-point scale. The extent of air trapping was graded on coronal reformations using a 5-point scale. Differences in the extent of air trapping in patients with/without bronchomalacia and the correlation between the severity of bronchomalacia and the extent of air trapping were investigated. The severity of bronchomalacia and the extent of air trapping were correlated with pulmonary function. RESULTS: Of 46 patients with bronchiectasis, 32 patients (70%) had bronchomalacia. Air trapping was present in 43 patients (93%). The extent of air trapping in patients with bronchomalacia was significantly greater compared with the patients without bronchomalacia (P=0.0308). The correlation between the severity of bronchomalacia and extent of air trapping was not statistically significant (rs=0.029, P=0.8457). CONCLUSIONS: The extent of air trapping in bronchiectasis patients with bronchomalacia was significantly greater compared with bronchiectasis patients without bronchomalacia, suggesting that the bronchomalacia is one of the underlying mechanisms of air trapping in bronchiectasis.
Adult↗