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Biomedical subjects

H M Vandiviere

Publications and source records attributed to H M Vandiviere.

At least 19 recordsLinked to original sources
PubMed1993

Pulmonary hypertension and cor pulmonale.

This article is directed primarily to primary care physicians. The challenge is to suspect, diagnose, and treat pulmonary arterial hypertension when treatment is most effective and before the effects of cor pulmonale become fully manifested. A good history and physical examination should be followed by electrocardiographic and roentgenographic evaluations. Of additional value are arterial blood gas measurements, two-dimensional echocardiography, first-pass radionuclide angiography, and catheterization of the right ventricle. Chronic obstructive pulmonary disease (COPD) is one of the more common etiologies of pulmonary hypertension and cor pulmonale. COPD is most common in the elderly and cor pulmonale is fairly common among those with COPD; therefore, hypoxic pulmonary hypertension and the resultant cor pulmonale occur mostly in older patients. Because early signs are nonspecific, diagnosis and treatment are often delayed until the pulmonary disorder is severe. Thus it is imperative that the primary care physician be cognizant of this serious problem. Standard treatment of left ventricular failure (ie, "congestive heart failure") could have adverse effects in patients with cor pulmonale.

Adrenal Cortex Hormones↗
PubMed1991

Mycobacterium fortuitum pulmonary infection complicating achalasia.

Achalasia is a cause of chronic aspiration pneumonia that may be complicated by pulmonary infection with Mycobacterium fortuitum. In any patient with achalasia, the presence of a pulmonary infiltrate that does not respond to routine antibiotic therapy should suggest the possibility of M fortuitum pulmonary infection, and sputum should be cultured for these organisms.

Adult↗
PubMed1990

Pulmonary disease caused by nontuberculous mycobacteria.

Nontuberculous mycobacterial pulmonary infections have become more common in recent years. The diagnosis is often overlooked because the findings may be subtle or because the radiographic appearance may change slowly or not at all for long periods of time. As a rule, the radiographic findings of nontuberculous mycobacterial pulmonary infections are identical to those of tuberculosis in any given patient. Cavitary disease in nontuberculous mycobacterial infections is less common than in tuberculosis. The most common radiographic finding is one or more areas of clustered fibroproductive nodules that change slowly. Mycobacterium kansasii infection responds well to therapy, whereas M avium-intracellulare infection is difficult to treat. Awareness of the radiographic appearance of the nontuberculous mycobacterial pulmonary infections will facilitate their diagnosis so that appropriate therapy may be initiated before the disease is far advanced.

Diagnosis, Differential↗
PubMed1989

Air-filled, multilocular, bronchopulmonary foregut duplication cyst of the mediastinum. Unusual computed tomography appearance.

Mediastinal bronchopulmonary foregut duplication cysts are usually identified on computed tomography (CT) as well-defined masses of water density that may contain rim calcification. Occasionally they are heterogenous in attenuation or are of intermediate or high attenuation due to contained calcium. Communication with the tracheobronchial tree or esophagus is rare. We report a bronchogenic cyst that communicated with the trachea and was identified by CT as a multilocolor, completely air-filled cyst adjacent to the trachea and esophagus. This appearance of a bronchogenic cyst has received little attention in the literature.

Adult↗
PubMed1988

Intrathoracic lymphadenopathy in postprimary tuberculosis.

In the past, hilar or mediastinal lymphadenopathy was considered by many to be a feature of only the primary or first infection with Mycobacterium tuberculosis, and to exclude the diagnosis of reactivation or postprimary tuberculosis. In a series of 56 adult patients with documented postprimary disease due to M tuberculosis, we found hilar or mediastinal lymphadenopathy in three cases (5%). Although intrathoracic lymphadenopathy was more common in primary tuberculosis, we do not believe that intrathoracic lymphadenopathy is as specific for primary tuberculosis, particularly in the adult, as was once thought. For this reason, we believe that the roentgenographic demonstration of intrathoracic lymphadenopathy should not be used as a definitive research or clinical criterion for primary tuberculosis in an adult.

Adolescent↗
PubMed1987

Atypical mycobacteria causing pulmonary disease: rapid diagnosis using skin test profiles.

Purified protein derivatives (PPDs) prepared from M tuberculosis (PPD-S), M kansasii (PPD-Y), M scrofulaceum (PPD-G), M avium (PPD-A), M intracellulare (PPD-B), and M fortuitum (PPD-F) were used simultaneously as skin tests to elicit profiles of reactivity in patients with clinical pulmonary disease roentgenologically suggestive of mycobacteriosis. These profiles were useful in delineating the specific cause of mycobacterial disease weeks before bacteriologic confirmation by culture, and they provided a basis for early treatment. When bacteriologic confirmation was attained, the diagnosis suggested by skin testing was correct. Treatment regimens for non-M tuberculosis (atypical) mycobacterial disease varied: a two- to three-drug regimen in the treatment of M avium or M intracellulare disease was ineffective and inappropriate, whereas a five-drug regimen without surgical excision of residual disease produced good results. Combining surgical resection with the five-drug regimen before and after operation produced the best results, however, with all patients showing apparent cure.

Antitubercular Agents↗
PubMed1987

Roentgenographic features of pulmonary disease caused by atypical mycobacteria.

In a retrospective evaluation of chest roentgenograms and medical records of 40 patients with non-M tuberculosis (atypical) mycobacterial pulmonary disease, 34 had M avium-intracellulare, five had M kansasii, and one had M fortuitum. The roentgenologic spectrum of disease closely resembled that of M tuberculosis. One third of the patients had predisposing factors, and the disease predominated in middle-aged and elderly men. Two thirds of the patients had slow progression of the disease, with an average of 6.4 years before roentgenographic changes occurred. The diagnosis was frequently missed, and in most of the patients it was delayed from one to 16 years. Only after chronic, slow disease progression was atypical mycobacteriosis suspected clinically. The more widespread application of multiple simultaneous skin tests for atypical mycobacteria may improve the diagnosis and prognosis of this disease.

Female↗
PubMed1986

Update: the radiographic features of pulmonary tuberculosis.

Pulmonary tuberculosis produces a broad spectrum of radiographic abnormalities. During the primary phase of the disease these include pulmonary consolidation (50%), which often involves the middle or lower lobes or the anterior segment of an upper lobe; cavitation (29%) or pneumatocele formation (12%); segmental or lobar atelectasis (18%); pleural effusion (24%); hilar and mediastinal lymphadenopathy (35%); disseminated miliary disease (6%); and a normal chest radiograph (15%). During the postprimary phase of the disease, common abnormalities include exudative and/or fibroproductive parenchymal densities (100%), predominantly in the apical and posterior segments of the upper lobes (91%); cavitation (45%) with bronchogenic spread of disease (21%); marked fibrotic response in the lungs (29%); and pleural effusion, empyema, and fibrosis (18%, 4%, and 41%, respectively). Upper-lobe masslike lesions are seen occasionally (7%); spontaneous pneumothorax and intrathoracic lymphadenopathy are rare (5% each). Common causes of a missed diagnosis of tuberculosis are (1) failure to recognize hilar and mediastinal lymphadenopathy as a manifestation of primary disease in adults, (2) exclusion of tuberculosis because disease predominates in or is limited to the anterior segment of an upper lobe or the basilar segment of a lower lobe, (3) overlooking of minimal fibroproductive lesions or reporting them as inactive, (4) failure to recognize that an upper-lobe mass surrounded by satellite fibroproductive lesions might be tuberculous, and (5) failure to consider healed sequelae of primary disease or a positive purified protein derivative skin test as contributory to identifying the patient's pulmonary disease.

Adolescent↗
PubMed1984

Swyer-James syndrome--unilateral hyperlucent lung syndrome. A case report and review.

Swyer-James syndrome is a pulmonary condition acquired following bronchiolitis obliterans early in life. Clinically characterized by repeated bouts of pulmonary infections, Swyer-James syndrome is characterized radiographically by a unilateral small, hyperlucent lung that demonstrates diminished arterial supply to the involved lung, air-trapping, and bronchiectasis. Radioimaging procedures may reveal otherwise unsuspected bilateral involvement. A 14-year-old Caucasian female with classic findings of Swyer-James syndrome is presented. The differential diagnosis of conditions that may present with a unilateral hyperlucent lung is discussed. Therapy is aimed primarily at control of the intercurrent episodes of bacterial pneumonia.

Adolescent↗
PubMed1980

Profiles of skin test reactivity to antigens of various mycobacterial species in a human population and in experimental infections.

Sensitivity profiles to 6 mycobacterial skin test antigens prepared from Mycobacterium tuberculosis, M. kansasii, M. scrofulaceum, M. intracellulare, M. avium and M. fortuitum were obtained in 6 groups of guinea pigs, each infected with one of the 6 mycobacterial species. Each group of animals showed the greatest sensitivity towards the homologous antigen. A second infection with a different species was super-imposed two months after the skin tests; the sensitivity towards the second species usually became dominant. Sensitivity profiles with the 6 antigens in a large random sample of the population of a district of Haiti resembled closely the sensitivity profiles for all the guinea pigs infected with two mycobacterial species. This suggested that the Haitian population consisted of a mixture of persons infected with one or more mycobacteria. Haitians with the largest to an antigen, which was at least 6 mm in diameter and at least 2 mm larger than the reaction to any other antigen, were assumed to be infected with the corresponding mycobacterial species. Sensitivity profiles of these persons resembled closely the sensitivity profiles of guinea pigs infected with the same species. In the Haitian population prevalence of infection with other mycobacterial species was much more common than infection with M tuberculosis. In spite of this, after 15 years of age only the tuberculosis infection rates increased with age, suggesting that allergy produced by M. tuberculosis infection was stronger and subject to much less waning than allergy produced by other mycobacterial infections.

Adolescent↗