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Biomedical subjects

G McGuinness

Publications and source records attributed to G McGuinness.

At least 19 recordsLinked to original sources
PubMed2002

Mechanisms of colchicine effect in the treatment of asbestosis and idiopathic pulmonary fibrosis.

The objective of this study was to evaluate the mechanisms of colchicine action in pulmonary fibrosis. The study included 10 patients with pulmonary fibrosis (idiopathic pulmonary fibrosis 5, asbestosis 4, and scleroderma 1) who had been admitted to Bellevue Hospital Center, a tertiary care public hospital in New York City. We administered colchicine 0.6 mg orally for 12 weeks to patients with pulmonary fibrosis. Symptoms, high resolution CT scans, pulmonary function tests, and bronchoalveolar lavage parameters were compared prior to and after treatment. Results showed declines in dyspnea index, selective improvement in several CT scans, but no statistically significant change in BAL cells, cytokines, fibronectin, or hydroxyproline. However, there was a decline in hydroxyproline in the BAL fluid in 8/10 patients. We concluded that colchicine has a mild antifibrotic effect which may be in inhibiting collagen formation since there was no effect on the inflammation that accompanies fibrosis.

Aged↗
PubMed2001

Respiratory symptoms at age 8 years in a cohort of very low birth weight children.

The childhood respiratory consequences of very low birth weight (birth weight < or =1,500 g) are incompletely understood, especially since the introduction of recent changes in neonatal care. To assess prevalence, trends, and risk factors for respiratory symptoms, the authors followed to age 8 years a cohort of 384 very low birth weight children from six regional neonatal intensive care units in Wisconsin and Iowa who were born between August 1, 1988, and June 30, 1991. A control group of 154 Wisconsin schoolchildren was also assembled. Respiratory symptoms in the past 12 months and history of asthma ("asthma ever") were reported by parents on a questionnaire used in the International Study of Asthma and Allergies in Childhood (ISAAC). Control group prevalence resembled ISAAC prevalence worldwide and in Canada, but respiratory symptoms were twice as common among very low birth weight children. With advent of the availability of pulmonary surfactants, the prevalence of wheezing at age 8 decreased from 50% to 16% (p = 0.002) among children with bronchopulmonary dysplasia, but it increased from 14% to 38% among those with milder neonatal respiratory disease. Bronchopulmonary dysplasia, family history of asthma, smoking in the household, and patent ductus arteriosus were predictive of wheezing in the previous 12 months. Antenatal steroid therapy had a borderline-significant protective association with wheezing (odds ratio = 0.56, 95% confidence interval: 0.29, 1.1). There were interaction effects between several of the predictors.

Asthma↗
PubMed2001

Early lung cancer action project: initial findings on repeat screenings.

BACKGROUND: The Early Lung Cancer Action Project (ELCAP) was designed to evaluate the usefulness of annual computed tomography (CT) screening for lung carcinoma. With the baseline results having been reported previously, the focus of the current study was on the early results of the repeat screenings. METHODS: A cohort of 1000 high-risk individuals was recruited for baseline and annual repeat CT screening. At last follow-up, a total of 1184 annual repeat screenings had been performed. A positive result from the screening test was defined as newly detected, one to six noncalcified pulmonary nodules with interim growth. The diagnostic workup of the individuals was guided by recommendations supplied by the ELCAP investigators to the collaborating clinicians. RESULTS: Of the 1184 repeat CT screenings, the test result was positive in 30 (2.5%). In 2 of these 30 cases, the individual died (of an unrelated cause) before diagnostic workup and the nodule(s) resolved in another 12 individuals. In the remaining 16 individuals, the absence of further growth was documented by repeat CT in 8 individuals and further growth was documented in the remaining 8 individuals. All eight individuals with further nodular growth underwent biopsy and malignancy was diagnosed in seven. Six of these seven malignancies were nonsmall cell carcinomas (five of which were Stage IA and one of which was Stage IIIA) and the one small cell carcinoma was found to be of limited stage. The median size dimension of these malignancies was 8 mm. In another two subjects, symptoms prompted the interim diagnosis of lung carcinoma. Neither of these malignancies was nodule-associated but rather were endobronchial; one was a Stage IIB nonsmall cell carcinoma and the other was a small cell carcinoma of limited stage. CONCLUSIONS: False-positive screening test results are uncommon and usually manageable without biopsy; compared with no screening, such screenings permit diagnosis at substantially earlier and thus more curable stages. Annual repetition of CT screening is sufficient to minimize symptom-prompted interim diagnoses of nodule-associated malignancies.

Aged↗
PubMed2001

Early lung cancer action project: a summary of the findings on baseline screening.

PURPOSE: The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography (low-dose CT) in persons at high-risk for lung cancer. METHODS: Since starting in 1993, the ELCAP has enrolled 1,000 asymptomatic persons, 60 years of age or older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs per day for 5 years) of cigarette smoking, no prior cancer, and medically fit to undergo thoracic surgery. After a structured interview and informed consent, baseline chest radiographs and low-dose CT were obtained on each subject. The diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN) was guided by ELCAP recommendations which included short-term high-resolution CT follow-up for the smallest nodules. Baseline RESULTS: On low-dose CT at baseline compared to chest radiography, NCN were detected three times as commonly (23% versus 7%), malignancies four times as commonly (2.7% versus 0.7%), and stage I malignancies six times as commonly (2.3% versus 0.4%). Of the 27 CT-detected cancers, 96% (26/27) were resectable; 85% (23/27) were stage I, and 83% (19 of the 23 stage I) were not seen on chest radiography. Following the ELCAP recommendations, biopsies were performed on 28 of the 233 subjects with NCN; 27 had a malignant and one a benign NCN. Another three individuals underwent biopsy outside of the ELCAP recommendations; all had benign NCNS: No one had thoracotomy for a benign nodule. CONCLUSION: Baseline CT screening for lung cancer provides for detecting the disease at earlier and presumably more commonly curable stages in a cost-effective manner.

Clinical Trials as Topic↗
PubMed2000

The normal CT appearances of the second carina and bronchial stump after left upper lobectomy.

We retrospectively evaluated the computed tomography (CT) appearance of the bronchial stump and second carina (left upper lobe spur) after left upper lobectomy. There were 69 CT examinations in 38 patients; all were free of recurrent or metastatic disease. The spur was graded as a) sharp (wedge-shaped tip configuration with <90 degrees angulation), b) lobulated (bulbous tip with <90 degrees angulation), or c) widened (>90 degrees angulation regardless of tip configuration). The bronchial stump was evaluated for the presence or absence of soft tissue in proximity to the surgical staples. The spur had a sharp appearance in 33 of 38 patients (87%) and was lobulated in 5 of 38 (13%). No patient had soft tissue at the bronchial stump. Serial examinations showed no change in the appearance of either structure. The spur remains sharp after left upper lobectomy in most patients; lobulation occurs in 13%. No changes occur over time. Interval change, widening of the spur, or soft tissue at the bronchial stump may suggest abnormality. Knowledge of normal and potentially abnormal appearances is essential to proper CT interpretation, particularly in the setting of postoperative surveillance for recurrent or metastatic disease.

Aged↗
PubMed1999

Early Lung Cancer Action Project: overall design and findings from baseline screening.

BACKGROUND: The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. We report the baseline experience. METHODS: ELCAP has enrolled 1000 symptom-free volunteers, aged 60 years or older, with at least 10 pack-years of cigarette smoking and no previous cancer, who were medically fit to undergo thoracic surgery. After a structured interview and informed consent, chest radiographs and low-dose CT were done for each participant. The diagnostic investigation of screen-detected non-calcified pulmonary nodules was guided by ELCAP recommendations, which included short-term high-resolution CT follow-up for the smallest non-calcified nodules. FINDINGS: Non-calcified nodules were detected in 233 (23% [95% CI 21-26]) participants by low-dose CT at baseline, compared with 68 (7% [5-9]) by chest radiography. Malignant disease was detected in 27 (2.7% [1.8-3.8]) by CT and seven (0.7% [0.3-1.3]) by chest radiography, and stage I malignant disease in 23 (2.3% [1.5-3.3]) and four (0.4% [0.1-0.9]), respectively. Of the 27 CT-detected cancers, 26 were resectable. Biopsies were done on 28 of the 233 participants with non-calcified nodules; 27 had malignant non-calcified nodules and one had a benign nodule. Another three individuals underwent biopsy against the ELCAP recommendations; all had benign non-calcified nodules. No participant had thoracotomy for a benign nodule. INTERPRETATION: Low-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage. Although false-positive CT results are common, they can be managed with little use of invasive diagnostic procedures.

Aged↗
PubMed1999

Viral and Pneumocystis carinii infections of the lung in the immunocompromised host.

Viruses and Pneumocystis carinii are significant causes of pneumonia in immunocompromised patients, particularly patients with impaired cell-mediated immunity. They are often simultaneously considered in the differential diagnosis of diffuse pneumonitis in these patients and, because radiographic appearances and the periods of vulnerability to these infections may overlap, may be difficult to differentiate. This article will correlate radiographic findings to evolving histopathologic changes in select specific infections, as they affect three different immune impaired populations: (a) acquired immunodeficiency syndrome, (b) immunosuppression secondary to therapy for underlying malignancy or with solid organ transplantation, and (c) immune impairment in the bone marrow transplant patient. Appreciation of the specific clinical setting in which to consider these infections will be emphasized.

AIDS-Related Opportunistic Infections↗
PubMed1999

Multinodular disease: anatomic localization at thin-section CT--multireader evaluation of a simple algorithm.

PURPOSE: To evaluate the interobserver variability and accuracy of an algorithm for anatomic localization of small nodules evident on thin-section computed tomographic (CT) images of the lungs. MATERIALS AND METHODS: Four experienced chest radiologists independently evaluated thin-section CT images in 58 patients by using an algorithm and a standard score sheet. Nodules were placed into four possible anatomic locations or categories: perilymphatic, random, associated with small airways disease, or centrilobular. Algorithm accuracy was assessed by comparing the localization by the observers to that expected for each specific disease in the study group on the basis of reports in the literature. Interobserver variability was assessed by placing cases into one of three groups: (a) complete concordance, (b) triple concordance, and (c) discordant. RESULTS: All observers agreed in 79% (46 of 58) of the cases with regard to nodule localization; three of the four concurred in an additional 17% (10 of 58). The observers were correct in 218 (94%) of 232 localizations in the 58 cases. There were no apparent differences in the number of either discordant or incorrect localizations between the observers. The most noteworthy source of error and of disagreement between observers was the confusion of perilymphatic and small airways disease-associated nodules in a small number of cases. CONCLUSION: The proposed algorithm is reproducible and accurate in the majority of cases and facilitates nodule localization at thin-section CT.

Adult↗
PubMed1998

Primary multifocal tuberculous osteomyelitis with involvement of the ribs.

Two cases of primary multifocal tuberculous osteomyelitis with involvement of the rib cage are presented. The lungs were normal and the appearance of the skeletal lesions did not suggest tuberculosis. These lesions were predominantly lytic, with minimal soft tissue involvement. Tuberculosis should be high in the differential diagnosis of multiple destructive bone lesions, especially in patients from regions where tuberculosis is endemic.

Adult↗
PubMed1998

Evaluation of criteria for chronic lung disease in surviving very low birth weight infants. Newborn Lung Project.

Criteria in common use for the diagnosis of chronic lung disease of prematurity or bronchopulmonary dysplasia in the neonatal period have not been sufficiently compared and validated against indicators of later respiratory complications. In this study of all 680 infants < or = 1500 gm birth weight admitted to six perinatal centers August 1, 1988, to July 31, 1990, 524 were alive and had no major congenital anomalies at 5 years old. Of 419 who had given permission to release their names and addresses, 272 were located and participated in a follow-up study. The following diagnostic criteria for bronchopulmonary dysplasia and chronic lung disease of prematurity were used during the initial hospitalization: (1) use of supplemental oxygen on day 30 of life, (2) a comprehensive bronchopulmonary dysplasia severity score applied at 25 to 35 days of life developed by a clinician panel to adjust for practice variation in ventilatory support and blood gases, (3) use of supplemental oxygen on day 30 of life with radiographic evidence consistent with bronchopulmonary dysplasia between days 25 and 35 of life, (4) radiographic evidence consistent with bronchopulmonary dysplasia alone, and (5) use of supplemental oxygen at 36 weeks' postconceptional age. These criteria were assessed against use of bronchodilators or steroids during the first 2 years of life, diagnosis of asthma, and hospitalizations for respiratory causes up to age 5. Although all criteria were significantly associated with all the outcomes, radiographic evidence was most predictive. These results indicate that, during a period when 21% of neonates were exposed to antenatal steroids, 24% received surfactant and 9% received postnatal corticosteroids, radiographic evidence was more predictive of long-term respiratory outcome than other commonly used criteria.

Bronchopulmonary Dysplasia↗
PubMed1998

Association of tocolytic therapy with antenatal steroid administration and infant outcomes. Newborn Lung Project.

The use of tocolytic agents to halt premature labor is controversial. We examine a database on very low-birth-weight infants born following the onset of premature labor (n = 540) for association between tocolytic and antenatal steroid therapy, and to assess neonatal and childhood outcomes following combined therapy. Data are from a multicenter regionally based study of all infants below 1501 g at seven neonatal intensive care units (NICUs) in Wisconsin and Iowa, born August 1, 1988 through June 30, 1991. Infant outcomes analyzed are death in the first 30 days, respiratory distress syndrome (RDS), and intraventricular hemorrhage (IVH). Fewer deliveries occurred within 12 hours of labor onset with tocolytics (61 vs. 75% without). A strong association between tocolytic therapy and antenatal steroid administration was found [adjusted odds ratio OR = 5.7, 95% confidence interval CI: (3.3, 10.0)]. Tocolytics were associated with lower mortality in the first 30 days [OR = 0.29, CI: (0.15, 0.56)]. Joint administration of tocolytics and antenatal steroids versus neither was associated with lower incidence of the combined outcome of respiratory distress syndrome (RDS) or death [OR = .30, CI: (0.15, 0.60)] and grade III-IV IVH or death [OR = 0.35, CI: (0.14, 0.98)]. Tocolytic therapy alone was not associated with IVH grade III-IV [OR = 1.0, CI: (0.57, 1.9)] among survivors.

Cerebral Hemorrhage↗
PubMed1998

Epstein-Barr-virus-associated lymphoproliferative disease of the lung: CT and histologic findings.

PURPOSE: To assess the computed tomographic (CT) and histologic findings of intrathoracic lymphoproliferative disease (LPD) associated with the Epstein-Barr virus (EBV). MATERIALS AND METHODS: The authors retrospectively reviewed the CT scans of the chest and the pathologic specimens obtained in 24 patients with histologically proved intrathoracic LPD and with positive serologic findings or immunohistochemical staining for EBV. Five patients had acquired immunodeficiency syndrome (AIDS); one had common variable immune deficiency; and 18 were receiving immunosuppressive therapy for heart, lung, or heart-lung (n =15) or bone marrow (n = 2) transplantation and vasculitis (n = 1). RESULTS: Final diagnoses included malignant lymphoma (n = 15), polyclonal LPD (n = 8), and hyperplasia of bronchus-associated lymphoid tissue (n = 1). CT findings included multiple nodules (n = 21), lymphadenopathy (n = 9), areas of groundglass opacification (n = 8), septal thickening (n = 7), consolidation (n = 5), pleural effusion (n = 4), and solitary endobronchial lesion (n = 2). The nodules were 2-4 cm in diameter, involved mainly the middle and lower lung zones, and frequently had a predominantly peribronchovascular (n = 15) or subpleural (n = 14) distribution. CONCLUSION: EBV-associated LPD may range from benign lymphoid hyperplasia to high-grade lymphoma. The most common CT manifestation consists of multiple nodules, frequently in a predominantly peribronchovascular or subpleural distribution.

AIDS-Related Opportunistic Infections↗
PubMed1998

Pulmonary nodule detection: low-dose versus conventional CT.

PURPOSE: To quantitate the effectiveness of low-dose computed tomography (CT) in the identification of pulmonary nodules while controlling for anatomic nodule characteristics and to establish what factors lead to reduced diagnostic sensitivity at low-dose CT. MATERIALS AND METHODS: Each of six participating radiologist independently rated 200 image panels by using a four-point confidence scale. Conventional images were obtained at 200 mAs; low-dose images were obtained at 20 mAs. To fully control their characteristics, nodules were simulated with a given diameter, shape, and section thickness while preserving the resolution, noise level, and reconstruction artifacts of the original images. Panels were matched so that nodules on low-dose and conventional images had equivalent sizes, locations, and relationships to blood vessels. RESULTS: Among 864 positive panels, 259 (60%) of 432 low-dose panels and 272 (63%) of 432 conventional panels were correctly interpreted (P = .259). Lowering the x-ray dose significantly reduced the detectability of peripheral nodules (P = .019) and nodules separated from blood vessels (P = .044). Surprisingly, 3-mm nodules were detected with approximately equal sensitivity (P = .181) at conventional and low-dose CT. The specificity of low-dose images was 88% (148 of 168 panels) versus 91% (153 of 168 panels) for conventional images (P = .372). CONCLUSION: Low-dose CT is acceptable for pulmonary nodule identification, making it suitable for primary screening. These results confirm the strong effect of size, location, and angiocentricity on the sensitivity of nodule detection with conventional CT.

Computer Simulation↗
PubMed1997

Volumetric (helical/spiral) CT (VCT) of the airways.

Volumetric computed tomography (VCT) represents an important improvement over conventional CT for assessing most airway abnormalities. Elimination of misregistration due to variations in respiration coupled with decreased motion artifact and the ability to obtain routine overlapping sections allow a more confident estimation of the presence and extent of disease. Recently, attention has focused on newer reconstruction techniques including: multiplanar reconstructions (MPRs), including curved multiplanar reformations; multiplanar volume reconstructions (MPVRs) using ray projection techniques, such as maximum and minimum projection imaging; external rendering, or 3D-shaded surface displays; and, most recently, internal rendering or so-called "virtual bronchoscopy". Given the often redundant nature of many of these methodologies determining indications for their use remains to be established, especially by comparison to axial imaging. The purpose of this article is to review these various reconstruction techniques and, based on current knowledge, place them in an appropriate clinical context.

Humans↗
PubMed1997

Pulmonary aspergilloma and AIDS. A comparison of HIV-infected and HIV-negative individuals.

OBJECTIVE AND METHODS: While pulmonary aspergilloma has been well described in immunocompetent hosts, to date and to our knowledge, there has not been a description of pulmonary aspergilloma in the HIV-infected individual. A retrospective review of cases seen by the Bellevue Hospital Chest Service from January 1992 through June 1995 identified 25 patients with aspergilloma. To investigate the impact of HIV status on pulmonary aspergilloma, we compared clinical presentation, progression of disease, treatment, and outcome in the HIV-infected patient vs the HIV-negative patient with aspergilloma. RESULTS: Of the 25 patients identified, 10 were HIV-infected and 15 were HIV-negative. Predisposing diseases included tuberculosis (18/25, 72%), sarcoidosis (4/25, 16%), and Pneumocystis carinii pneumonia (3/25, 12%). All 25 patients had evidence of aspergilloma on chest CT. In addition, 17 of 25 patients had evidence of Aspergillus species in fungal culture, pathologic specimens, or immunoprecipitins. Hemoptysis was present in 15 of 25 (60%) (11/15 [73%] of the HIV-negative group vs 4/10 [40%] of the HIV-infected group). Severe hemoptysis (> 150 mL/d) occurred in 5 of 15 (33%) of the HIV-negative group vs 1 of 10 (10%) of the HIV-infected group. Disease progression occurred more frequently among the HIV-infected group (4/8, 50% vs 1/13, 8% in HIV-negative individuals). All patients with disease progression had lymphocyte subset CD4+ < 100 cells per microliter. Four of eight (50%) of the HIV-infected group vs 1 of 13 (8%) of the HIV-negative group died. SUMMARY AND CONCLUSIONS: We conclude the following: (1) although tuberculosis and sarcoidosis are the most prevalent predisposing diseases, P carinii pneumonia in the HIV-infected individual is a risk factor for pulmonary aspergilloma; (2) HIV-infected individuals with CD4+ < 100 cells per microliter are more likely to have disease progression despite treatment; and (3) HIV-negative patients are more likely to have hemoptysis requiring intervention.

AIDS-Related Opportunistic Infections↗
PubMed1997

AIDS-related airway disease.

To our knowledge, the importance of airway disease in HIV-positive patients has been infrequently noted. This deficit likely reflects a combination of factors including lack of familiarity with recent changes in clinical and epidemiologic patterns of pulmonary manifestations of HIV infection and documented limitations of chest radiography for identifying and differentiating airway disease from other causes of pulmonary disease in HIV-positive patients. Familiarity with the imaging findings for these various entities should facilitate prompt diagnosis and treatment. The accuracy of CT in detecting airway disease [55-59] is well established and should be of value in excluding more common diseases that may be initially confused with airway abnormalities [60, 61]. Small airways disease, in particular, which may be occult or mimic an interstitial infiltrate on chest radiography, can be recognized with CT as likely representing infectious bronchitis or bronchiolitis. Patients with findings suggesting bacterial infections may benefit from empiric antibiotic therapy. CT also may be valuable for differentiating between various noninfectious pulmonary diseases, allowing a presumptive diagnosis of parenchymal Kaposi's sarcoma in the appropriate clinical context. In distinction, by detecting localized endobronchial or parenchymal abnormalities in patients with mycobacterial or fungal infections or lymphoma, CT may be valuable for deciding between various invasive methods of obtaining either histologic or bacteriologic diagnoses.

AIDS-Related Opportunistic Infections↗
PubMed1997

Changing trends in the pulmonary manifestations of AIDS.

This article reviews the changing trends observed in AIDS patients over the course of the epidemic. The spectrum of diseases of the chest associated with HIV infection is vast and varied. To generate a useful differential diagnosis based on imaging findings, the radiologist must appreciate shifts in disease prevalence and epidemiology and appreciate changing radiographic manifestations of many of these diseases. Imaging findings, both with chest radiography and CT scan, are summarized and the importance of integration of clinical information in interpreting these images and generating a reasonable differential diagnosis is emphasized.

AIDS-Related Opportunistic Infections↗