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Biomedical subjects

J Glassroth

Publications and source records attributed to J Glassroth.

At least 19 recordsLinked to original sources
PubMed1992

Pulmonary embolism in younger adults.

To test the hypothesis that the clinical presentation and outcomes are different when pulmonary embolism occurs in younger (age 18 to 40 years) as compared to older (age greater than 40 years) adults, 40 younger patients were compared with older patients. No risk factors could be identified in 28 percent of the younger group. Normal physical examinations were more common (58 vs 28 percent, p = 0.01) among younger as compared with older adults. Hypoxemia was absent in 29 percent of the younger and 3 percent of the older group (p = 0.004); P(A-a)O2 was significantly lower among younger patients even after controlling for age. Mortality was decreased sevenfold (2.5 vs 18 percent, p = 0.03) among younger patients. These data indicate that pulmonary embolism tends to have a subtle presentation in younger adults. When diagnosed and treated, the mortality rate is substantially less among younger as compared with older patients.

Adolescent↗
PubMed1990

Why tuberculosis is not prevented.

Because of the effectiveness of isoniazid in treating tuberculosis infection, progression to tuberculosis should be largely preventable. Thus, each case of tuberculosis that occurs may be viewed as a "failure" of the prevention system. We studied the reasons for these "failures" at three centers in different geographic areas in the United States. Two hundred seventy-nine patients with bacteriologically confirmed tuberculosis were evaluated by means of a questionnaire. Our results suggest three main reasons for these missed opportunities of tuberculosis prevention. (1) Patients are out of the health care system until they develop tuberculosis. (2) Patients are in the system but are either not screened for tuberculous infection or, if screened, are not offered preventive therapy when it is appropriate. (3) Because of false negative skin test results, screening may be ineffective at the time it is applied. Advances in tuberculosis prevention will require attention to these areas.

Adolescent↗
PubMed1990

The clinical spectrum of Staphylococcus aureus pulmonary infection.

Staphylococcus aureus causes serious pulmonary infections in adults. Prior descriptions of this entity have depended on diagnosis of expectorated sputum cultures that are often contaminated. To better characterize this infection, we retrospectively reviewed the medical records of 31 adults with S aureus pulmonary infection diagnosed by culture specimens uncontaminated by the upper respiratory flora. Our results support the concept that S aureus pulmonary infections usually occur in older adults (sixth decade or older) with concomitant illnesses that are typically nosocomial. However, in contrast to previous reports, the chest roentgenograms in these patients typically showed multilobar infiltrates (60 percent), predominantly in the lower lobes (64 percent), and often bilateral (48 percent). Pleural involvement (48 percent) was more common than previously reported, and abscess formation (16 percent) occurred infrequently. Sputum cultures were found to be sensitive but nonspecific diagnostic tools. Despite antibiotic therapy, reinfection occurred in 10 percent of patients and the mortality rate was 32 percent.

Adult↗
PubMed1989

Obtaining permission for an autopsy: its importance for patients and physicians.

This paper reviews the importance, benefits, and methods of increasing autopsy percentages. Its focus is on specific procedures for obtaining autopsy consent, particularly in terms of addressing the problems that most often interfere with obtaining permission for postmortem examination. Techniques for handling various misconceptions about autopsies are discussed. These guides for postmortem-related discussions with families will lead to improvement in overall physician performance and satisfaction.

Attitude to Death↗
PubMed1989

Varied appearance of AIDS-related lymphoma in the chest.

The authors reviewed all cases of acquired immunodeficiency syndrome (AIDS)-related lymphoma (ARL) seen at their institution between January 1982 and September 1988 to determine the frequency and appearance of ARL in the chest. Of 35 patients with ARL, 11 (31%) had biopsy-proved thoracic involvement. This frequency is significantly greater than that previously reported. The radiologic appearance of the thoracic involvement varied. Pleural effusion, interstitial and alveolar lung disease, nodules, and, infrequently, hilar and mediastinal adenopathy were observed. ARL of the chest was most commonly extranodal. Pleural effusion and lung disease were the two most common manifestations of ARL on chest radiographs and computed tomographic scans. The authors recommend that clinicians treating patients with suspected or known AIDS consider ARL when a pleural effusion or a noninfective interstitial or alveolar process is present.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Mycobacterium avium complex and other nontuberculous mycobacteria in patients with HIV infection.

Nontuberculous mycobacteria (NTM) have been frequently identified as opportunistic pathogens in individuals with advanced human immunodeficiency virus (HIV) infection. The majority of these infections have been caused by members of the Mycobacterium avium-intracellulare complex (MAC). Disseminated MAC infection has generally been diagnosed late in the course of HIV infection, and it is often associated with persistent nonspecific symptoms of fever, generalized weakness, and weight loss. Abdominal pain and/or diarrhea with malabsorption may also occur in some patients. Despite frequent isolation of MAC organisms from respiratory secretions in these patients, significant pulmonary involvement has not been seen commonly with disseminated MAC infection. While MAC can be isolated from a variety of clinical specimens in infected individuals, culturing of blood is the single most useful diagnostic procedure to evaluate for MAC infection. The prognosis for disseminated MAC infection in HIV-infected patients has been poor, with a reported median survival of 7.4 months after diagnosis. The overall contribution of MAC infection to mortality in these patients has not been clearly delineated. Treatment of MAC infection in HIV-infected individuals using a variety of drug regimens has not been effective in clearing mycobacteremia or improving overall survival in the majority of patients. However, initiation of drug therapy for MAC may decrease the severity of disease symptoms in some patients. Several NTM other than MAC have also been reported as causing infection in HIV-infected patients. Many of these organisms are ubiquitous in the environment and are frequent colonizers of biologic specimens. Although many NTM are regarded as relatively avirulent, these organisms need to be recognized as potentially important pathogens in HIV-infected patients with significant immunosuppression.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The physician's role in tuberculosis prevention.

Tuberculosis is not only treatable but preventable as well. A number of options exist for reducing the transmission of tubercle bacilli. Practitioners are in a position to intervene directly on behalf of their patients and indirectly by promptly reporting infectious patients to local public health authorities. A considerable body of information supports the use of isoniazid in persons who are infected by Mycobacterium tuberculosis and who also have readily identifiable characteristics that place them at increased risk for developing tuberculosis.

Antitubercular Agents↗
PubMed1988

Residents' perceptions of their role as teachers.

Teaching by residents has long been recognized as essential to the education of interns and medical students, but how residents view their role as educators has not been examined in great detail. For this purpose a questionnaire was constructed and administered to 55 internal medicine residents at the McGaw Medical Center of Northwestern University. Responses indicate that the residents enjoyed teaching and considered it a critical component of their own experience and education. These residents' views appear unrelated to their previous teaching or academic backgrounds or to plans for an academic career. A number of variables correlated with teaching satisfaction. The teaching experience can be improved, the survey suggests, by lessening distractions and interruptions that occur during teaching sessions, freeing residents of some other obligations so that more time may be devoted to teaching, increasing faculty members' observation and guidance of teaching, and carefully structuring the content of the residents' teaching sessions.

Attitude of Health Personnel↗
PubMed1988

Amiodarone-induced pneumonitis. Assessment of risk factors and possible risk reduction.

Problems with pulmonary toxicity have emerged as a potentially limiting factor for amiodarone use. We prospectively studied 33 subjects treated with amiodarone for refractory arrhythmias. Serial clinical, radiographic and pulmonary function tests were correlated with the dose and duration of amiodarone treatment to define: a) prevalence of lung toxicity, b) subgroups of patients at particular risk for toxicity, c) potential interaction between amiodarone dose and toxicity. Considering all subjects, no significant change in lung volumes or airflow indices were noted; carbon monoxide diffusing capacity (DCO) underwent a mean reduction of 20.3 percent during treatment. Symptoms of possible pulmonary toxicity occurred in 27.3 percent of subjects. No type or degree of pretreatment cardiopulmonary dysfunction predicted lung toxicity. However, maintenance dose was correlated with toxicity; patients treated with doses of less than or equal to 400 mg per day from the start of treatment had insignificant reductions in DCO and did not develop symptoms.

Adolescent↗
PubMed1985

Pulmonary veno-occlusive disease in the middle-aged.

Pulmonary veno-occlusive disease (PVO) is an uncommon cause of pulmonary hypertension which is difficult to diagnose without histology. We report 3 cases of histologically confirmed PVO. Our patients were all middle-aged or older, and 1 had spontaneous improvement in his symptoms suggesting that PVO may occur more commonly among older adults than previously believed and that indolent forms of the disease may exist. As new therapeutic approaches to the various entities causing pulmonary hypertension are developed, it is increasingly important to determine precisely which condition is present in a given patient.

Aged↗
PubMed1985

The role of fiberoptic bronchoscopy in the evaluation of immunocompromised hosts with diffuse pulmonary infiltrates.

To define the utility of fiberoptic bronchoscopy in the evaluation of immunocompromised patients with diffuse pulmonary infiltrates, we reviewed our experience between January 1980, and January 1983, with 50 such patients with a wide variety of underlying diseases. Of these, 35 patients underwent bronchoscopy, including brushings, alveolar lavage, and transbronchial biopsy, and 15 underwent open lung biopsy; 8 patients underwent both procedures. All patients with a nondiagnostic bronchoscopy either recovered without specific antibiotic therapy or underwent an open procedure. A diagnosis was made in 29 patients (58%). An infectious process was found in 20 patients (40%). A diagnosis was made bronchoscopically in 19 patients including 18 infections. Transbronchial biopsy was rarely diagnostic of infection when brushings were negative. For all diagnoses, bronchoscopy had a sensitivity of 76.9%. For all pulmonary infections, bronchoscopy had a sensitivity of 90%. Given a negative bronchoscopy, the probability that an infection was not present (i.e., predictive value negative) was 94.4%. Unfortunately, making a specific diagnosis did not appear to greatly improve survival. We conclude that in this setting: (1) fiberoptic bronchoscopy is an extremely sensitive procedure for diagnosing pulmonary infections, (2) bronchial brushings are as useful as transbronchial biopsies for diagnosing nonfungal infections, (3) these procedures are less useful for diagnosing noninfectious conditions, and (4) in the face of a negative bronchoscopic procedure, there is a very low probability that an infectious process will be found with an open biopsy.

Adult↗
PubMed1985

Fiberoptic bronchoscopy in the evaluation of lung abscesses.

To define the results of flexible fiberoptic bronchoscopy (FFB) in patients with lung abscess and to characterize those patients most likely to have an underlying carcinoma, we retrospectively studied the records of 52 consecutive patients undergoing FFB at our institution between 1975 and 1982. Nineteen patients (36.5 percent) had an associated bronchogenic carcinoma (group 1); 33 (63.5 percent) had no malignancy (group 2). The FFB aided in diagnosing 73.7 percent of group 1 patients, but added no information in group 2 patients. Group 1 and 2 patients differed significantly with respect to prevalence of systemic symptoms (15.8 percent vs 51.5 percent, p less than 0.01); predisposition to aspiration pneumonia (26.3 percent vs 60.6 percent, p less than 0.01); mean presenting white blood cell count (10.9 vs 14.2, p less than 0.05); mean oral temperature at presentation (37.5 vs 38.3 degrees C, p less than 0.05); and the prevalence of extensive infiltrates on the initial chest roentgenogram (17.0 percent vs 83.6 percent, p less than 0.05). Based on these data, we believe that by carefully considering the available clinical information, it is possible to identify those patients whose lung abscesses are likely to be related to bronchogenic carcinoma. Such individuals should be promptly evaluated. It is not necessary, however, to routinely order bronchoscopy for all patients with lung abscess.

Adult↗