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Biomedical subjects

G Mangiapan

Publications and source records attributed to G Mangiapan.

At least 19 recordsLinked to original sources
PubMed2006

Utility of high-resolution chest CT scan in the emergency management of haemoptysis in the intensive care unit: severity, localization and aetiology.

The purpose of this study is to assess the utility of the chest high-resolution computed tomography (HRCT) scan for estimating the severity of haemoptysis, localize the bleeding site and to determine a cause of the bleeding. We reviewed 80 consecutive patients who were admitted to a respiratory intensive care unit (RICU) for haemoptysis and who underwent unenhanced HRCT scanning and fibre-optic bronchoscopy (FOB) within 48 h. The number and type of lobar involvement on the CT scan were correlated to prognostic factors, the amount of bleeding and the bleeding aetiology. We compared HRCT scan observations on localization and bleeding aetiology with FOB results. The number of involved lobes was correlated with the daily (p<0.001) and cumulative (p<0.001) volume of haemoptysis and found to be significantly greater in the group of patients who were mechanically ventilated and/or died (2.7 vs 1.8, p<0.03). FOB and HRCT localized the bleeding site or side, respectively, in 71 (89%) and 64 (80%) patients (p>0.05). Of the nine patients without FOB localization, HRCT localized the bleeding site in six patients (67%). The initial HRCT scan correctly identified 48 aetiologies (60%), whereas FOB identified only 2 proximal bronchogenic carcinomas. The extent of lobar involvement seen by HRCT is a prognostic factor correlated with the daily and cumulative volume of haemoptysis. FOB and HRCT are complementary techniques for bleeding site localization. HRCT-scan is also the best exam to determine the cause of haemoptysis, even while it is occurring.

Adult↗
PubMed2003

Significance of Aspergillus fumigatus isolation from respiratory specimens of nongranulocytopenic patients.

The aim of this study was to determine the significance of isolation of Aspergillus fumigatus from cultures of respiratory specimens in nongranulocytopenic patients. The medical records of patients with respiratory specimens positive for Aspergillus fumigatus who were admitted to an adult pneumology ward were reviewed during a 2-year period. A total of 80 respiratory specimens from 76 patients yielded Aspergillus fumigatus. Forty-eight patients were colonized with Aspergillus fumigatus, whereas the 28 (37%) remaining patients had pulmonary aspergillosis, manifest as aspergilloma ( n=19 patients), chronic necrotizing pulmonary aspergillosis ( n=7 patients), and bronchial aspergillosis ( n=2 patients). The presence of typical hyphae in direct examination of bronchoscopic specimens was more likely to be found in infected than in colonized patients ( P=0.04). No immunological test was positive in colonized patients, whereas anti- Aspergillus antibodies were detected in 55% of infected patients ( P<0.001). Pulmonary tuberculosis was the most common underlying lung disease in patients with aspergilloma, but it was not found in any patient with chronic necrotizing pulmonary aspergillosis ( P=0.006). Anti- Aspergillus antibodies were more likely to be detected in patients with aspergilloma (78%) than in patients with chronic necrotizing pulmonary aspergillosis (14%) ( P=0.007). The analysis of predisposing factors, in conjunction with immunological tests and examination of bronchoscopic specimens, is helpful in distinguishing between colonization and infection with Aspergillus fumigatus, as well as for differentiating between aspergilloma and chronic necrotizing pulmonary aspergillosis.

Adult↗
PubMed2001

[Primary pleural lymphoma: a rare complication of tuberculosis pleural sequelae].

We report two cases of malignant lymphoma of B phenotype occurring after therapeutic pneumothorax for tuberculosis. In both cases, outcome was fatal without time for specific treatment. Mainly reported in Japan, this pathology seems to be less frequent in western countries. As for B phenotype lymphoma associated with immunodeficiency, association with Epstein Barr virus is reported. Definite diagnosis is difficult and requires surgical biopsy. Prognosis remains poor with a survival ranging from 3 to 6 month.

Aged↗
PubMed2000

Pulmonary arteriovenous malformations.

OBJECTIVE: Helical CT scan (HCT), a noninvasive method, can detect pulmonary arteriovenous malformations (PAVMs). Its sensitivity is superior to that of global digitalized angiography, but patients receive a significant dose of radiation during diagnostic HCT. We compared HCT to contrast-enhanced pulmonary magnetic resonance angiography (CEMRA), a new noninvasive radiation-free method, in the diagnosis of PAVMs. PATIENTS AND METHODS: Five consecutive patients with PAVMs underwent HCT, CEMRA, and pulmonary artery digital subtraction angiography (PADSA). CEMRA was performed during the pulmonary arterial phase of an IV bolus of gadolinium. PADSA was performed during the embolization procedure. All images were examined for PAVMs. The site and size of aneurysms were specified, as well as the diameter of the vascular pedicles. RESULTS: Thirty PAVMs were detected by CEMRA and 38 by HCT. All 20 PAVMs at least 5 mm in diameter and 10 of the 18 PAVMs < 5 mm in diameter identified on HCT were also identified by CEMRA. Whatever the site, all PAVMs with a feeding artery diameter of at least 3 mm (ie, PAVMs with clinical consequences) were detected by CEMRA. No false-positive results were obtained with CEMRA. CEMRA therefore had a sensitivity of 78% and a specificity of 100%. CONCLUSIONS: CEMRA, a nonionizing and noninvasive procedure, has high sensitivity and specificity for the diagnosis of clinically relevant PAVMs.

Adult↗
PubMed2000

[A mediastinal opacity in a patient with cirrhosis].

Radiological mediastinal shadows have numerous causes. Paraesophageal varices might be revealed by such radiological findings. We described herein the case of a patient with radiological mediastinal opacity occurring after sclerotherapy that was finally related to esophageal varices.

Esophageal and Gastric Varices↗
PubMed2000

[Evaluation of occupational exposures in lung cancer].

Occupational lung cancers are underestimated by the number of cases compensated in the French National Insurance System. Rules of compensation of occupational diseases were recently modified in France. Therefore a study was conducted on incident cases of lung cancer in a general hospital in the Paris area. The aim was to evaluate the exposure to carcinogens using data of a detailed specific occupational questionnaire, and to determine the number of cases who could receive compensation. Two hundred and seven subjects (171 males, 36 females, mean age = 64.5 years) were eligible in 1996, and 122 had an occupational questionnaire. Definite exposure to one or more occupational carcinogens in at least one job was identified in 50 subjects, the most frequent agent was asbestos (42 subjects). Claim for compensation was done in 32 subjects, mainly for asbestos (30 subjects). This study emphasizes the frequency of occupational exposure to carcinogens, and the usefulness of systematic occupational questionnaire in subjects having lung cancer. Social and financial consequences are important for these subjects. Further studies are needed, with recruitement of control subjects to allow calculation of the attributable risk to occupational factors in lung cancer.

Aged↗
PubMed1999

[Acute respiratory distress in a patient with sickle-cell anemia].

The acute chest syndrome is a frequent complications of sickle-cell disease characterized by chest pain, fever, and new infiltrate on chest x-ray image. Pathophysiologic factors appear to be multifactorial and better known. We report the case of a 28-year-old woman with homozygous sickle cell anemia who developed acute chest syndrome probably secondary to fat embolism.

Acute Disease↗
PubMed1998

[Computed tomographic diagnosis of a fortuitously discovered opacity].

We report a case of pleuroparietal lipoma discovered fortuitously. Despite the small size, the diagnosis was obtained with computed tomography using a rigorous protocol demonstrating a negative density corresponding to fat tissue. A series of slices sufficiently thin to avoid a partial volume effect was required to obtain reliable measurements. In case of doubt, magnetic resonance imaging would be indicated.

Aged↗
PubMed1997

Diagnosis of smear-negative pulmonary tuberculosis using sequence capture polymerase chain reaction.

Techniques based on the polymerase chain reaction (PCR) can be used to rapidly identify DNA from Mycobacterium tuberculosis in clinical samples from patients with tuberculosis, but prior studies evaluating this approach in the diagnosis of paucibacillary forms of pulmonary tuberculosis have reported poor sensitivity and/or specificity. We have developed a procedure in which mycobacterial DNA in crude samples is specifically captured prior to amplification, thereby concentrating the target sequences and removing irrelevant DNA and other inhibitors of the amplification reaction (sequence capture PCR). To evaluate the usefulness of this approach in the diagnosis of paucibacillary forms of pulmonary tuberculosis, sequence capture PCR was performed prospectively on samples of bronchoalveolar lavage fluid from consecutive patients suspected of having pulmonary tuberculosis but for whom three consecutive samples of respiratory secretions were smear negative. Of the 27 patients evaluated, active tuberculosis was diagnosed in nine; sequence capture PCR was positive for all of these patients, including the three for whom all specimens submitted for culture were negative. No positive results were obtained for lavage fluid from the 18 patients for whom the diagnosis of active tuberculosis was subsequently excluded or 25 additional patients undergoing bronchoalveolar lavage for evaluation of other pulmonary problems, even though many of these patients had a history of prior tuberculosis or radiographic evidence of prior tuberculous infection. Paucibacillary forms of pulmonary tuberculosis can be rapidly identified with high sensitivity and specificity using sequence capture PCR performed on samples obtained by bronchoalveolar lavage.

Adult↗
PubMed1996

[Nosocomial pneumonia].

Second cause of nosocomial infections and certainly the most serious, pneumonia concerns nearly 1% of all hospitalized patients. The need for intensive care, especially mechanical ventilation, is the leading risk factor for acquiring nosocomial pneumonia. Clinical and radiological data are contributive but insufficient for diagnosis and correct selection of antibiotics. Many germs are potentially accountable for these diseases, especially Pseudomonas and Staphylococcus. The endobronchial protected brush has been considered as the gold standard for diagnosis by the fifth consensus report of SRDLF (Société de Réanimation de Langue Française). Other methods are currently proposed which are less traumatic, cheaper, easier to use and give quicker results, but their sensitivity and specificity are debated. The bacteriological results of these searches are precious guides to choose curative antibiotics. The prevention of nosocomial pneumonia has become an accepted priority for public health.

Anti-Bacterial Agents↗
PubMed1996

[Pulmonary emphysema: surgical indications].

Surgery for pulmonary emphysema, with the exception of lung transplantation, is limited at present to resection of the emphysematous areas. The resection of a unique bulla within an otherwise healthy parenchyma can be indicated in case of complications but rarely in asymptomatic patients. When the bullae are large (i.e. volume greater than one-third of the hemithorax) in a patient suffering from diffuse emphysema, bullectomy is the ideal indication. Mortality varies from 0 to 10%, essentially due to infection or acute respiratory failure. In most patients, the subjective improvement in terms of dyspnea and the objective improvement as measured by spirometry remains significative up to 5 years after surgery. Inversely, surgical resection is classically considered to be contraindicated in patients with small poorly-limited bullae. Recent data would however question this idea since subjective and objective improvement after reduction of the lung volume is still present 1 year after surgery in most patients, even those with severe obstruction. The mechanism is probably related to increased elastic recoil. Even if only temporary improvement can be achieved for a few years, the persisting course of emphysema would suggest that volume reduction should always be entertained as an alternative before lung transplantation.

Humans↗
PubMed1996

Sequence capture-PCR improves detection of mycobacterial DNA in clinical specimens.

The rapid identification of mycobacterial DNA in clinical samples by PCR can be useful in the diagnosis of tuberculous infections, but several large studies have found that the sensitivity of this approach is not better than that of culture. In order to improve the sensitivity of detection of mycobacterial DNA in clinical specimens from patients with paucibacillary forms of tuberculosis, we have developed a procedure permitting the specific capture of mycobacterial DNA in crude samples prior to amplification, thereby concentrating the target sequences and removing irrelevant DNA and other potential inhibitors of the amplification reaction (sequence capture-PCR). By using this approach to capture and amplify two different sequences specific for organisms of the Mycobacterium tuberculosis complex (IS6110 and the direct repeat region), it was possible to detect as little as one genome of mycobacterial DNA in samples containing up to 750 micrograms of total DNA, representing a 10- to 100-fold increase in sensitivity compared with that obtained by purifying total DNA prior to amplification. Detection of the IS6110 sequence in pleural fluid samples from patients with tuberculous pleurisy by sequence capture-PCR gave positive results in 13 of 17 cases, including 3 of 3 culture-positive samples and 10 of 14 culture-negative samples. In contrast, when total DNA was purified from these samples by adsorption to a silica matrix prior to amplification, only the three culture-positive samples were positive by PCR. The sensitivity of detection of the direct repeat sequence in these samples by sequence capture-PCR was similar to that of IS6110 and, in addition, permitted immediate typing of the strains from some patients. We conclude that sequence capture-PCR improves the sensitivity of detection of mycobacterial DNA in paucibacillary samples. This approach should be useful in detecting rare target sequences from organisms implicated in other pathologic processes.

Adult↗
PubMed1996

[Drug-induced pneumopathies accompanied by acute respiratory insufficiency].

Drug induced pneumonias accompanying acute respiratory failure are defined by a delay in presentation of less two months and severe hypoxaemia (PaO2 < 60 mmHg in ambient air). They are poorly indexed, often poorly understood by the clinician and pose difficult problems both of diagnosis and treatment. This general review touches successively on hypoxaemic drug induced pneumonia observed in oncology and haematology then those observed outside this very specific context. In each of the two groups five questions are posed: 1) Which patients? 2) Which clinical patterns? 3) What initial diagnostic discussion? 4) Which successful elements support the drug induced hypothesis? 5) What outcome? The replies obtained were compared to case reports from the literature (188 references) or from recent general reviews concerned more specifically with the hypoxaemic forms.

Acute Disease↗
PubMed1995

[Pulmonary artery hypertension due to tumor micro-embolism].

We report the case of a 37 years old woman with a past history of a chondrosarcoma who was admitted to hospital for acute pulmonary hypertension which proved rapidly fatal; autopsy confirmed that the etiology was tumour microemboli rising from a single cardiac metastases from her chondrosarcoma. The originality of this case report lies in the origin of the microemboli and the way in which they presented as a recurrence of the cancer.

Adult↗