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Biomedical subjects

J Gea

Publications and source records attributed to J Gea.

At least 37 records · Page 2Linked to original sources
PubMed1991

Ototoxic reaction to erythromycin.

We report a case of bilateral hearing loss in a patient treated with intravenous erythromycin lactobionate. The ototoxic reaction occurred despite the patient's having normal renal and hepatic function and the fact that serum erythromycin levels were within the predicted normal range. In addition to hearing loss, a marked labyrinthic hyporreflexia was also observed. Hearing loss improved after the treatment was discontinued, but labyrinthic abnormalities persisted suggesting that erythromycin had caused a permanent vestibular damage.

Erythromycin↗
PubMed1991

Mechanisms of abnormal gas exchange in patients with pneumonia.

The mechanisms of abnormal gas exchange in patients with pneumonia and the gas exchange response while breathing high inspired O2 concentrations have not been clearly elucidated. To this end, we studied 23 inpatients with pneumonia and mild to severe arterial hypoxemia and/or increased alveolar - arterial O2 difference. Ventilation-perfusion (VA/Q) distributions were obtained upon breathing room air (or maintenance inspired oxygen fraction) and 100% O2 in random order. Subjects were divided in two groups according to whether they were spontaneously breathing (SB, n = 13) or their lungs were mechanically ventilated (MV) because of acute severe respiratory failure (n = 10). The SB patients showed only small amounts of shunt (7 +/- 2%) (mean +/- standard error) and moderate VA/Q mismatching, characterized by the presence of a small percentage of blood flow to low VA/Q units (VA/Q less than 0.1) (4 +/- 1%). In contrast, patients whose lungs were MV had larger shunts (22 +/- 5%) and greater percent of perfusion to low VA/Q units (11 +/- 5%). While breathing 100% O2, shunt remained unchanged but the dispersion of the pulmonary blood flow distribution (log SDQ) (normal range, 0.3-0.6) increased in each group (from 1.04 +/- 0.10 to 1.29 +/- 0.13 in SB and from 1.40 +/- 0.11 to 1.64 +/- 0.14 in MV; P less than 0.05 each), suggesting release of hypoxic pulmonary vasoconstriction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Mechanisms of gas-exchange impairment in idiopathic pulmonary fibrosis.

To investigate the mechanisms of pulmonary gas-exchange impairment in idiopathic pulmonary fibrosis (IPF) and to evaluate their potential relationship to the CO diffusing capacity (DLCO), we studied 15 patients with IPF (mean DLCO, 52% of predicted) at rest (breathing room air and pure O2) and during exercise. We measured pulmonary hemodynamics and respiratory gas-exchange variables, and we separated the ventilation-perfusion (VAQ) mismatching and O2 diffusion limitation components of arterial hypoxemia using the multiple inert gas elimination technique. At rest VA/Q mismatching was moderate (2 to 4% of cardiac output perfusing poorly or unventilated lung units), and 19% of AaPO2 was due to O2 diffusion limitation. During exercise VA/Q mismatch did not worsen but the diffusion component of arterial hypoxemia increased markedly (40% AaPO2, p less than 0.005). We observed that those patients with higher pulmonary vascular tone (more release of hypoxic pulmonary vasoconstriction) showed less pulmonary hypertension during exercise (p less than 0.05), less VA/Q mismatching [at rest (p less than 0.005) and during exercise (p less than 0.0025)], and higher arterial PO2 during exercise (p = 0.01). We also found that DLCO corrected for alveolar volume (KCO) correlated with the mechanisms of hypoxemia during exercise [VA/Q mismatching (p less than 0.025) and O2 diffusion limitation (p less than 0.05)] and with the increase in pulmonary vascular resistance elicited by exercise (p less than 0.005). In conclusion, we showed that the abnormalities of the pulmonary vasculature are key to modulate gas exchange in IPF, especially during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Usefulness of CT scan in the diagnosis of pulmonary aspergilloma].

Early diagnosis and precise anatomical localization of aspergillomas are essential for an effective treatment of their complications. We have evaluated the usefulness of thorax CT scan in the fulfillment of these objectives. Nine consecutive patients were studied with a presumable diagnosis of pulmonary aspergilloma. A thorax CT scan was performed in all patients (sections every 5 to 10 mm) in lying position and with lateral mobilizations. This technique allowed to rule out as fibrotic lesions some of the images previously attributed to mycetomas by conventional X-ray. On the other hand it helped to identify small size aspergillomas, to precise their localization and to demonstrate the possible communication between the main cavity and bronchial tree. In three patients who died in the period immediately following the study an excellent correlation between CT scan and underlying pathological lesions was observed.

Adult↗
PubMed1990

Diagnostic value of nonfluoroscopic percutaneous lung needle aspiration in patients with pneumonia.

In forty-one patients (mean [+/- SD] age 51 +/- 19 years; range, 11 to 88 years; seven female and 34 male) with clinical signs and symptoms of pneumonia, we performed a nonfluoroscopic percutaneous lung needle (22 gauges) aspiration (PLNA) to investigate the diagnostic yield of this technique. All the patients were receiving antibiotics at the time of the study, and PLNA was performed either because of a lack of response to empiric antibiotic treatment or because of the severity of the pneumonia or the underlying condition of the patient. Eight patients were mechanically ventilated (MV) due to acute respiratory failure. The PLNA was performed at bedside and without fluoroscopic guidance. Twenty-two microorganisms were identified by means of stains and/or cultures of PLNA samples. Sensitivity of PLNA was 43 percent (18/41). We detected three false-positive cultures probably due to contamination from the skin area punctured. In the eight MV patients studied, the sensitivity of PLNA was 37.5 percent, and the microbiologic findings turned out to be crucial for the outcome of the patients. Pneumothorax developed in three patients (7 percent) after PLNA. None of these three patients developed a pleural infection but two of them required thoracostomy drainage. None of the MV patients presented complications. Our results showed that nonfluoroscopic PLNA is a technique with moderately good sensitivity and with a low rate of false-positive cultures (8 percent) to diagnose pulmonary infections in patients with unresponsiveness to empiric antibiotic treatment or with severe pneumonia. Further evaluation of its diagnostic value and complications in MV patients is needed, although our preliminary results suggest that PLNA can be an alternative technique to other methods for diagnosing pulmonary infections in patients receiving artificial ventilatory support.

Adolescent↗
PubMed1988

Lung function changes following Legionnaires' disease.

Eleven out of thirteen patients hospitalized because of severe pneumonia caused by Legionella Pneumophila were evaluated over a period of 53 months. During the acute phase, all but one patient manifested severe hypoxaemia, needing either supplementary oxygen or, in the case of three, mechanical ventilation and one died. Following recovery, two patients complained of mild shortness of breath alone. However, most of the individuals showed subclinical mild to moderate ventilatory and/or gas exchange abnormalities a few months after discharge (less than 6 months). Despite the fact that some of these functional findings in part persisted at long-term (6-33 months), a significant overall improvement in lung function was noticed. The main pulmonary functional sequelae following Legionnaires' Disease might include a restrictive ventilatory defect, a low transfer factor and hypoxaemia.

Acute Disease↗