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Biomedical subjects

J D Epstein

Publications and source records attributed to J D Epstein.

11 recordsLinked to original sources
PubMed1992

Physiologic studies of tracheobronchial stents in airway obstruction.

When airway obstruction is due to extraluminal compression and/or dynamic collapse, metal and silicone rubber prosthetic stents may stabilize the affected airway. Through a rigid bronchoscope, we inserted three metal stents in two patients and 18 silicone stents in 15 adult patients with symptomatic tracheobronchial compression and dynamic airway collapse. The underlying cause was malignancy in three patients; benign tracheobronchial malacia in three patients, two of whom refused surgical resection; and tracheobronchial stenosis that developed at the anastomotic site following lung transplantation in 11 patients. Clinical status and lung function studies were analyzed before and after stent insertion. Following stent insertion, airway diameter at least doubled and near normal patency of the affected tracheobronchial tree was achieved in every patient using stents of axial length 4 to 5 cm. The stents were well tolerated clinically, and all patients noted immediate relief of dyspnea. Following stent insertion, the forced vital capacity (FVC) increased from 64 +/- 21% predicted (mean +/- 1 SD) to 73 +/- 19% predicted, p less than 0.1; the forced expiratory volume in 1 s (FEV1) from 49 +/- 25% predicted to 72 +/- 26% predicted, p less than 0.02; the ratio of the FEV1/FVC from 59 +/- 16% to 78 +/- 15%, p less than 0.01; and the maximum flow at 50% expired FVC from 38 +/- 26% predicted to 72 +/- 31% predicted, p less than 0.01.

Adult↗
PubMed1990

Computed tomography and bronchoscopy in chest radiographically occult main-stem neoplasm diagnosis and Nd-YAG laser treatment in 8 patients.

We studied 8 adult patients with variable symptoms of cough, dyspnea, stridor, wheezing, or hemoptysis. Fiberoptic bronchoscopy in all showed complete or nearly complete endobronchial obstruction of a main-stem bronchus by neoplasm with a mean bronchial diameter of 1.9 mm +/- 1.6 mm (mean +/- standard deviation). In 4 patients, a lobar bronchus was also completely obstructed. No mass was visible on chest radiographs of any patient; however, computed tomography in each showed main-stem endobronchial obstruction, lobar obstruction (4 instances in 3 patients), and in 6 patients hypoperfusion of the involved lung. Computed tomographic scan showed additional abnormalities that were unsuspected on viewing chest radiographs or at bronchoscopy, including mediastinal adenopathy in 3 patients and an extraluminal tumor component in 4. After therapy with Nd-YAG laser, main-stem airway diameter increased to a mean of 9.6 mm +/- 1.0 mm (P less than .05) and pulmonary functions improved. Results suggest the complementary role of computed tomography and fiberoptic bronchoscopy in the detection and laser-treatment planning of chest radiographically occult severe neoplastic obstruction of the main-stem bronchus.

Bronchial Neoplasms↗
PubMed1989

Herpes zoster infection with trigeminal and facial nerve involvement.

In most cases, herpes zoster (shingles) infections are benign and self-limited, requiring no treatment. However, if patients are elderly or immuno-compromised, they are at increased risk of complications such as visceral dissemination, cranial and nerve palsies, ophthalmic zoster, and postherpetic neuralgia. We present a case of herpes zoster infection complicated by both motor and sensory involvement in an elderly man.

Aged↗
PubMed1988

Physiologic characteristics of malignant unilateral main-stem bronchial obstruction. Diagnosis and Nd-YAG laser treatment.

To evaluate the effects of severe, unilateral main-stem malignant bronchial obstruction on airway dynamics, we obtained maximal expiratory flow-volume (MEFV) curves in 11 patients 59 +/- 18 yr of age (mean +/- 1 SD), three with and eight without underlying emphysema, before and after laser therapy (10 patients) or lung resection (one patient). Mean main-stem bronchial diameters before and after treatment were 1.1 +/- 1.3 and 9.0 +/- 0.8 mm, respectively (p less than 0.05). In the three patients with underlying emphysema, MEFV curves showed a diffuse intrathoracic obstructive pattern before and after treatment; in the other eight patients, MEFV curves demonstrated an apparently restrictive pattern, with associated airflow obstruction in four, reversible after laser treatment in three of these four. After treatment, all patients exhibited an increase in FVC with a roughly parallel shift of the MEFV curve and little change in the slope of the descending limb of the MEFV curve: FVC improved from 54 +/- 16 to 86 +/- 13% predicted in patients without emphysema and from 54 +/- 16 to 77 +/- 8% predicted in patients with emphysema, whereas the slope of the descending limb of the MEFV curve between 45 and 55% of FVC changed minimally from 2.0 +/- 0.6 to 1.8 +/- 0.5 s-1 in patients without emphysema and from 0.8 +/- 0.3 to 0.8 +/- 0.1 s-1 in patients with emphysema.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1988

Diagnosis and Nd-YAG laser treatment of unsuspected malignant tracheal obstruction.

Thirteen adult patients underwent palliative Nd-YAG laser treatment for relief of severe dyspnea due to malignant endotracheal obstruction. Three of the 13 patients had underlying chronic airflow obstruction (CAO) due to diffuse obstructive pulmonary disease. Despite dyspnea, cough, wheezing, stridor and/or hemoptysis, the diagnosis was delayed because of a normal chest roentgenogram in eight patients and nondiagnostic pulmonary function studies (including maximal expiratory and inspiratory flow-volume loops) in all three patients with CAO and in four of ten patients without CAO. The location of the tumor was extrathoracic in two patients, including one with CAO; intrathoracic in seven patients, including two with CAO; and combined extra- and intrathoracic in four. Tracheal diameter increased from 3.5 +/- 1.0 mm before, and to 9.8 +/- 2.0 mm after single or multiple laser treatments. Increased patency of the trachea after laser surgery was associated with improvement in expiratory and/or inspiratory flow rates and with symptomatic relief in all patients which persisted for 14.1 +/- 8.7 months (range four to 48 months). These results indicate that severe symptomatic narrowing of the extra- and/or intrathoracic trachea to a diameter of 2 to 5 mm may not be detected by conventional chest radiography or even by sensitive physiologic tests, especially in patients with underlying CAO. The resultant delay in diagnosis defers possible relief of disabling symptoms with palliative therapy, including Nd-YAG laser photocoagulation.

Adult↗
PubMed1987

Neodymium-yttrium-aluminum-garnet laser in lung cancer.

Neodymium-yttrium-aluminum-garnet laser treatments were performed in 70 patients aged 62 +/- 10 (1 SD) years for incomplete malignancy-induced obstruction of the trachea or main bronchi, or both, associated with uncontrolled cough, dyspnea, atelectasis/pneumonia, and hemoptysis. Forty-three patients had been treated with surgical techniques, chemotherapy, or radiotherapy, or all three, while 27 patients were untreated before laser therapy because of acute respiratory distress. Laser treatment produced palliative improvement in 81% of the treated group (35 of 43), with survival of 4.3 +/- 3.9 months. Unsuccessfully laser-treated patients survived 0.7 +/- 0.4 month (p less than .05). Eighty-five percent of the untreated patients (23 of 27) showed postlaser improvement, with survival of 8.5 +/- 6.9 months. Unsuccessfully laser-treated patients survived 1.4 +/- 0.6 months (p less than .05). Twenty-three of the 27 previously untreated patients underwent radiation therapy after laser treatment. Laser treatments also were administered to 23 patients aged 61 +/- 13 years with complete obstruction of the main bronchi. Of this group, 17 patients had been treated and 6 had not been treated before the laser therapy. Laser treatment was successful in 47% of the treated patients (8 of 17), but there was no difference (p greater than .05) in survival between successfully and unsuccessfully treated patients (3.0 +/- 2.5 vs. 2.9 +/- 4.6 months). Similarly, laser treatment was successful in 50% of the untreated patients (3 of 6), and there was also no difference (p greater than .05) in survival between successfully and unsuccessfully treated patients (3.4 +/- 3.5 vs. 3.5 +/- 2.8 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Obstruction↗
PubMed1987

Nd-YAG laser surgery for severe tracheal stenosis physiologically and clinically masked by severe diffuse obstructive pulmonary disease.

Nd-YAG laser surgery was performed on six patients with tracheal stenosis complicating severe diffuse intrathoracic airways obstruction due to emphysema, chronic obstructive bronchitis and/or asthma. Tracheal stenosis was extrathoracic in four patients and both extrathoracic and intrathoracic in two patients. Results suggest that patients with severe chronic obstructive pulmonary disease and asthma have maximal expiratory and inspiratory flow volume patterns that may completely mask extrathoracic and intrathoracic tracheal stenosis. Following relief of tracheal obstruction with laser therapy, substantial improvement can occur both clinically and physiologically, as reflected by symptomatic relief and large increases in Vmax 50I and FVC.

Adult↗
PubMed1986

Perioral dermatitis: an uncommon condition?

To document the persistence of perioral dermatitis at dermatology clinics at University Hospital, Saskatoon, we reviewed the charts of all patients with the condition seen between January 1983 and March 1985. Patients with rosacea referred to the clinics during the same period were used as a comparison group. A total of 80 patients with perioral dermatitis and 117 patients with rosacea were seen during the study period; most were female. Those with perioral dermatitis were significantly younger and had a significantly shorter mean duration of the eruption before presentation than those with rosacea (p less than 0.001). The distribution of the lesions was different in the two groups. Sixty-eight (85%) of the patients with perioral dermatitis and 45 (38%) of those with rosacea had used topical corticosteroids, a postulated risk factor for perioral dermatitis; the use of potent topical corticosteroids was frequent in both groups. Despite continuing medical education on the dangers of chronic use of these agents for eruptions on the face, physicians continue to prescribe them.

Adrenal Cortex Hormones↗