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Biomedical subjects

J H Austin

Publications and source records attributed to J H Austin.

At least 19 recordsLinked to original sources
PubMed1992

Missed bronchogenic carcinoma: radiographic findings in 27 patients with a potentially resectable lesion evident in retrospect.

Eighteen radiologists failed to detect 27 potentially resectable bronchogenic carcinomas revealed retrospectively on serial chest radiographs. Most of the cancers were in an upper lobe (n = 22 [81%]), especially the right upper lobe (n = 15 [56%]). More of the cancers were in women (n = 18 [67%]) than in men (n = 9 [33%]). The mean diameter of the missed lesions was 1.6 cm +/- 0.8 (range, 0.6-3.4 cm). Only two lesions (7%) were well defined around their entire extent. A lateral radiograph (available for 23 patients) revealed the missed lesion better than the posteroanterior radiograph in four patients (17%). Six consultant radiologists, who were biased by knowledge that the cases were of missed bronchogenic carcinoma, were individually shown the radiographs in 22 of the cases. Each consultant missed a mean of 26% (5.8 +/- 1.7) of the lesions. At least one of the six consultants missed the lesion in 16 (73%) of the cases. The predominant characteristics of radiographically missed and potentially resectable bronchogenic carcinomas were difficulty in radiographic detection, female gender, and location in an upper lobe, especially on the right side.

Carcinoma, Bronchogenic↗
PubMed1992

Reversible pulmonary artery obstruction in a patient with bronchogenic carcinoma. Diagnosis by two-dimensional and Doppler echocardiography.

Neoplastic invasion of the pulmonary arteries, although common, rarely results in obstruction to right ventricular outflow. We report an unusual case of severe pulmonary hypertension, right ventricular dilatation, and righ ventricular dysfunction resulting from pulmonary arterial compression by bronchogenic carcinoma. The diagnosis was made by two-dimensional and Doppler echocardiography and supported by computed tomographic findings. Echocardiography was used to follow the patient's response to therapy and documented the subsequent resolution of pulmonary arterial obstruction.

Carcinoma, Bronchogenic↗
PubMed1992

Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculoskeletal education without exercises.

A subjective sense of enhanced ease of breathing has been described after instruction in the Alexander technique of proprioceptive musculoskeletal education (awareness and voluntary inhibition of personal habitual patterns of rigid musculoskeletal constriction). We investigated the effects of AT instruction on respiratory function in healthy adult volunteers (group 1, ten subjects), who received 20 private AT lessons at weekly intervals. Spirometric tests, including maximum static mouth pressures, were assessed before and after each course of lessons. Healthy control subjects, matched for age, gender, height, and weight (group 2, ten subjects), without instruction, were tested over a similar interval. Group 1 showed significant increases in PEF (9 percent, p less than .05), MVV (6 percent, p less than .05), MIP (12 percent, p less than .02), and MEP (9 percent, p less than .005) (paired Student's t testing). Group 2 showed no significant changes. Possible mechanisms for the changes in group 1 include increased length and decreased resting tension of muscles of the torso, which in turn may increase their strength, increase thoracic compliance, and/or enhance coordination. We conclude that AT musculoskeletal education may enhance respiratory muscular function in normal adult subjects.

Adult↗
PubMed1991

Bronchial carcinoid tumors: assessment with CT of location and intratumoral calcification in 31 patients.

Bronchial carcinoid tumors (BCT) have long been regarded as predominantly central and rarely calcified. The authors retrospectively reviewed computed tomographic (CT) findings in 31 patients (thin-section CT studies in 18) who were seen at their institution with the histopathologic diagnosis of BCT (27 typical, four atypical) during the years 1978-1989. Eighteen BCT (58%) were central and 13 (42%) peripheral, with peripheral defined as located more than 2 cm distal to the origin of the appropriate segmental bronchus. CT scans revealed varied patterns of calcification in seven (39%) of the 18 central BCT and in one (8%) of the 13 peripheral BCT (P less than .1); overall, CT scans revealed calcification in eight (26%) of the BCT. The eight calcified tumors were each of the typical histopathologic type. Peripheral BCT (42%) were nearly as common as central BCT (58%), and CT detection of calcification in BCT was not uncommon (39% of central lesions; 26%, overall).

Adolescent↗
PubMed1991

Analysis of the resource-based relative value scale for Medicare reimbursements to academic and community hospital radiology departments.

The authors examined a homogeneous sample of 40 radiologists from four academic centers (ACs) and four community hospitals (CHs) to assess the prevalence, accuracy, and sources of knowledge regarding the resource-based relative value scale (RBRVS) reform of Medicare. The radiologists were also asked to estimate the relative intraservice work values of 12 of the radiologic services in the original RBRVS study, using the same definitions and the same standard service. The radiologists were found to be relatively well informed and accurate regarding the RBRVS-based Medicare reform. However, the standard errors of estimated work in the sample were much greater (from 56% to over 800%) than those reported for the nationally based RBRVS. The AC and CH radiologists also appeared to differ qualitatively in their perceptions of intraservice work. These findings suggest that the RBRVS may not represent accurately the spread of perceived relative work values among radiologists, including differences between AC and CH components in terms of site-specific radiologic work.

Health Knowledge, Attitudes, Practice↗
PubMed1991

Complications after CT-guided needle biopsy through aerated versus nonaerated lung.

Findings in patients who underwent computed tomography (CT)-guided percutaneous needle biopsy (n = 131) of lung are described. In those in whom the needle traversed aerated lung, complications developed in 51% (40 of 79). The rate of pneumothorax was 46% (36 of 79). In those in whom the needle did not traverse aerated lung (n = 52), minor hemoptysis in one patient (2%) was the only complication (P less than .0001). When a percutaneous CT-guided lung biopsy needle does not traverse aerated lung, the likelihood of complication appears to be slight.

Air↗
PubMed1991

Acute asthma. Admission chest radiography in hospitalized adult patients.

The utility of admission chest radiography has been controversial in the management of adult patients admitted to the hospital with acute asthma. We reviewed the impact of admission chest radiography on in-hospital management of 54 adult patients with acute asthma. Each patient was admitted after a failed 12-h course of bronchodilator therapy in the emergency ward. Major radiographic abnormalities were found in 20 (34 percent) of 58 occasions. These abnormalities included focal parenchymal opacities, IIM, enlarged cardiac silhouette, pulmonary vascular congestion, new solitary pulmonary nodule and pneumothorax. Subsequent antibiotic use correlated with radiographic focal opacities or IIM, even in afebrile patients, but did not correlate with elevated blood leukocyte count. Based on the evidence of in-hospital alteration of management independent of elevated blood leukocyte count and body temperature, we recommend that chest radiographs be obtained for all adult patients admitted because of acute asthma.

Acute Disease↗
PubMed1991

Cytomegalovirus pneumonitis after cardiac transplantation.

To evaluate the incidence and clinical features of cytomegalovirus (CMV) pneumonitis after cardiac transplantation, we identified 27 (16%) of 171 consecutive recipients in whom CMV pneumonitis was confirmed by strict diagnostic criteria. Cytomegalovirus pneumonitis occurred in 6 (30%) of 20 patients treated with azathioprine and prednisone, and 8 (25%) of 32 patients treated with azathioprine, cyclosporine, and prednisone, but only 13 (11%) of 119 patients treated with cyclosporine and prednisone. The incidence of CMV pneumonitis was not related to recipient preoperative CMV titers or to postoperative cardiac rejection, but there was a trend toward increased CMV pneumonitis in patients who received organs from CMV-positive donors. Mean onset of CMV pneumonitis was 2.9 +/- 1.6 (SD) months after transplantation. In the azathioprine-prednisone group, CMV was always associated with at least one other respiratory pathogen (Aspergillus, n = 5; Pneumocystis carinii, n = 2). In the two cyclosporine groups, CMV was either the sole respiratory pathogen (n = 9), or associated with P carinii (n = 11). Roentgenographically, diffuse bilateral hazy pulmonary opacities were present in 19 (70%) of 27 patients, but focal subsegmental opacity (26%), small pleural effusion (26%), and lobar consolidation (7%) were also observed. When bronchoscopy was performed, bronchoalveolar lavage was the most sensitive technique for detecting CMV (72%), whereas transbronchial biopsy (39%) and combined washings and brushings (33%) were relatively insensitive techniques. Respiratory failure and death occurred in 52% and 44%, respectively, of patients with CMV pneumonitis. In this population of immunocompromised hosts: (1) CMV pneumonitis, alone or with other respiratory pathogens, was a major cause of morbidity and mortality; (2) localized roentgenographic opacity did not exclude CMV pneumonitis; (3) bronchoalveolar lavage was the most sensitive bronchoscopic technique for detecting CMV pneumonitis.

Adolescent↗
PubMed1990

The impact of routine chest radiography on the management of patients admitted from an emergency service.

Adult patients entering a hospital usually undergo a routine admission chest radiographic examination (RACXR). Recently, this practice has been questioned. The clinical course of 188 patients admitted to an adult medical service from the emergency area of an inner city hospital was assessed prospectively. Each of these patients underwent RACXR, ie, the only indication for the examination was admission to the hospital. Four subpopulations considered to be at high risk for treatment-altering radiographic abnormalities were defined prospectively: age of 65 years or older, cigarette smokers, altered mental status, and human immunodeficiency virus (HIV) positivity. RACXR abnormalities were significantly more common in the subpopulations at high risk (104/127, 82%) than in the population at low risk (37/61, 61%) (P less than .01). Abnormalities on RACXR led to altered treatment in five (3%) of the 188 inpatients. Each of these five patients was a member of a subpopulation at high risk (5/127, 4%). Because results suggest that various clinical considerations may affect the yield of RACXR, it is proposed that a blanket recommendation to eliminate RACXR is premature.

Adult↗
PubMed1989

Nodular bleomycin toxicity.

Pulmonary interstitial fibrosis, a well-known toxic effect of bleomycin therapy, usually presents radiographically as diffuse reticularity. The authors report an unusual case of biopsy-proven bleomycin toxicity that presented as pulmonary nodules mimicking metastatic tumor. The histologic findings resembled those seen in the diffuse form of toxicity but notably also included foci of bronchiolitis obliterans.

Adult↗
PubMed1989

Pulmonary infection after cardiac transplantation: clinical and radiologic correlations.

Forty-one episodes of radiographically demonstrated pulmonary infection developed in 35 (30%) of 118 cardiac transplant recipients treated with cyclosporine. The most common pathogens were cytomegalovirus (CMV) (13 episodes), Pneumocystis carinii (12 episodes), and Aspergillus (five episodes). Appearance of CMV infection on radiographs was generalized and hazy (n = 9) or limited to one lobe (n = 4). All episodes of P carinii pneumonia, including six combined with CMV infection, appeared diffusely hazy. Aspergillus infection appeared either shaggy and nodular (n = 3) or bibasilar and hazy (n = 2). Aspergillus infection developed only early after transplantation (0.2-2.5 months), whereas CMV infection (1.1-6.1 months) and P carinii pneumonia (2.6-10.3 months) developed later (time ranges for latter two infections exclude three episodes that developed even later in two patients at risk for acquired immunodeficiency syndrome). Nine (8%) patients died of pulmonary infection, eight (7%) within 4.0 months of transplantation. Symptoms or signs were variable; none were found in four (10%) of 41 episodes. The authors recommend frequent chest radiographs in the early months after transplantation.

Adolescent↗
PubMed1988

Radiologic detection of thymoma in patients with myasthenia gravis.

From 1973 through 1986, 154 consecutive patients who had a transsternal thymectomy for myasthenia gravis had preoperative radiologic evaluation for a possible thymoma. Examinations included posteroanterior and lateral (n = 154) and shallow oblique (n = 126) chest radiography, linear tomography (n = 80), and chest CT (n = 96). At surgery, a thymoma was found in 26 patients (17%). Plain film findings, which often were subtle, correctly predicted a thymoma in 15 (58%) of 26 patients. CT findings correctly predicted a thymoma in 17 of 20 patients (sensitivity, 85.0%; specificity, 98.7%; and accuracy, 95.8%). CT findings failed to detect a thymoma in three patients because a small tumor was indistinguishable from adjacent thymus (n = 2) and respirator motion artifacts (n = 1). Four (15%) of the tumors were invasive, and three (12%) were calcified. The likelihood of a thymoma increased with increasing age (3% for 20 years old and under, 12% for 21-45 years old, and 35% for 46 years old and older). In the youngest group, the thymus is densely cellular and normally relatively large, and therefore a small thymoma may be hidden. In patients 21-45 years old, partial fatty involution leaves parenchymal islands that can mimic a thymoma or obscure a small tumor. In patients over 45 years old, fatty involution enhances recognition of even small thymic tumors. For all patients with myasthenia gravis, we recommend that the initial chest radiographic examination include posteroanterior, lateral, and shallow (20 degrees) oblique views. For those patients under 21 years old, we recommend chest CT only when local symptoms, signs, or radiographic findings suggest the presence of thymic abnormality. For those patients 21 years old and older, we recommend routine chest CT.

Adolescent↗