Biomedical subjects
Publications and source records attributed to G P LeMense.
We describe a case of pulmonary blastoma, a rare lung malignancy which affects a younger population. Despite its usually indolent presentation, it is an aggressive malignancy with a prognosis similar to that for bronchogenic carcinoma.
STUDY OBJECTIVE: We evaluated treatment and outcome of patients with thoracic empyema at a teaching institution. DESIGN AND SETTING: Retrospective chart review over a 44-month period at a university hospital. PATIENTS AND MEASUREMENTS: Charts of patients with a hospital discharge diagnosis of thoracic empyema were reviewed. Age, symptoms, alcohol use, empyema etiology, culture results, number of loculations, date and success of each procedure, length of hospital stay, and hospital discharge status were recorded for each patient. Success of procedure, recovery time, time between procedures, and total hospitalization time were compared between procedures and between subgroups. RESULTS: Charts from 43 patients were reviewed. Twenty-four of 43 (56%) cases were parapneumonic empyemas. Forty of 43 (93%) patients had symptoms attributable to their empyema, with fever being the most common (65%). Seventy-nine procedures were needed to treat the 43 patients (1.84 procedures per patient). Success rates ranged from 11% (3/27) for tube thoracostomy to 95% (21/22) for decortication (p = 0.0001). Delay between procedures averaged 6.2 +/- 1.1 (mean +/- SEM) days between the first and second procedure (n = 27), and 10.4 +/- 5.1 days between the second and third procedure (n = 8). Mean recovery after successful intervention ranged from 9 to 19.3 days depending on the procedure (p = NS). Comparisons between multiloculated and uniloculated empyemas, parapneumonic and nonparapneumonic empyemas, and culture proven and biochemically proven empyemas showed no significant difference in procedure success rates or length of hospital stay. CONCLUSION: Multiple therapeutic options exist for the treatment of thoracic empyema. Optimal therapy requires selection of the most appropriate first procedure for each patient with early postprocedure imaging to avoid inordinate delays between interventions.
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Two patients receiving low dose methotrexate, one with rheumatoid arthritis and the other with pityriasis rubra pilaris, developed disseminated histoplasmosis and Mycobacterium avium intracellulare pneumonia, respectively. Twenty-three cases of opportunistic infection in patients receiving low dose methotrexate have been reported previously, with Pneumocystis carinii pneumonia being the most common infection (10 of 23, 43%). Patients receiving low dose methotrexate are at risk for opportunistic infection despite normal leukocyte counts.
A 68-year-old man developed fever, cough, and dyspnea after intravesical bacillus Calmette-Guerin (BCG). Chest radiograph revealed diffuse reticulonodular infiltrates with caseating granulomas on transbronchial biopsy specimen. Cultures were negative and the patient's condition improved with corticosteroids. The mechanism for BCG-induced granulomatous inflammation is poorly understood. Optimal therapy includes corticosteroids.
Pulmonary nodules have been reported in up to 10 percent of heart transplant recipients. Most are infectious, with opportunistic pathogens most common. Atypical mycobacteria have not been reported as the etiology of pulmonary nodules in a heart transplant recipient. We report a case of Mycobacterium scrofulaceum infection presenting as three discrete pulmonary nodules.