PubMed Health⌕ Search

Biomedical subjects

J R Zvetina

Publications and source records attributed to J R Zvetina.

17 recordsLinked to original sources
PubMed2005

Clinical features and follow up of 302 patients with Mycobacterium kansasii pulmonary infection: a 50 year experience.

AIMS: To analyse clinical features and treatment outcomes of patients with pulmonary Mycobacterium kansasii infection treated at Hines VA Hospital between 1952 and 1995, and followed up until 2003. FINDINGS: 302 patients were confirmed to have M kansasii pulmonary infection; diagnosis was not made until death in 2%. The average age was 50 years old; 76% were white; all were men. Productive cough, dyspnoea, and chest pain were common; 16% were asymptomatic. Right sided, apical or subapical, thin walled cavitary infiltrate was the characteristic radiological feature. Heavy smoking, chronic obstructive pulmonary disease, alcoholism, peptic ulcer disease, coronary artery disease, prior tuberculosis, psychosis, prior pneumonia, and immunocompromising conditions were prevalent. Average follow up was 10 years and 2 months. PPD was positive in 58% of 179 tested. Two thirds of the patients required only first line drugs. Fourteen per cent required surgical intervention, none after 1977. Spontaneous resolution occurred in 1%. Aspergillosis developed in 4%. Bronchogenic carcinoma coexisted with M kansasii infection in 6% and followed it in 4%. Extrapulmonary malignancy coexisted with the infection in 4% and followed it in 6%; most involved head and neck. Eleven per cent of 224 deaths were attributed to M kansasii. Outcomes were affected by comorbidity, treatment compliance, rifampicin use, and extent of infection. CONCLUSIONS: Prognosis of M kansasii pulmonary infection is good if diagnosed and treated early, together with control of underlying conditions. Clinicians should be aware of atypical radiological manifestations of the disease when coexisting with other pulmonary or immunocompromising conditions.

Adult↗
PubMed1992

Mycobacterium kansasii infection following primary pulmonary malignancy.

The purpose of this study was to determine whether any of the Mycobacterium kansasii cases were the consequences of primary lung malignancy. The records and chest x-ray films of 295 patients with M kansasii pulmonary infection were reviewed. The infection was found to complicate the primary lung neoplasm in four cases. Three patients had had treatment for malignancy: one patient with small cell carcinoma received chemotherapy, steroids and radiation; one with adenocarcinoma underwent a lobectomy and radiation; and the third patient had a lobectomy and radiation for malignant fibrohistiocytoma. The fourth patient developed the infection three years after lung malignancy manifested itself, which was only a few months before the clinical evidence of distant metastasis with adenocarcinoma was detected. We suggest that this infection be considered in patients from M kansasii endemic areas, especially after they have received radiation treatment for lung malignancy. This association has never been described before.

Humans↗
PubMed1991

Direct diagnosis of tuberculosis by computer assisted pattern recognition gas chromatographic analysis of sputum.

Chemical detection of tuberculosis (TB) products in sputum was attempted by using gas chromatographic analysis in conjunction with different pattern recognition computer models. For the chromatographic separations, we used a 2 mm x 1.8 m packed column and a 0.25 mm x 30 m fused silica capillary column to analyse the methylated glycosides and fatty acid methyl ester derivatives. Three computer pattern recognition methods were applied: error score, TB score and discriminant analysis. These methods predicted the presence of active TB most often in sputa of active TB patients and less so in those from inactive, suspected and non-TB patients, in that order. Although the best true positive of 75% was obtained from the TB score method and best true negative of 98% from discriminant analysis, the accompanying false positive and false negative results (36% and 50%, respectively) were unacceptable. The use of capillary column or fatty acid methyl ester derivatives of the samples did not improve on the predictive values of chromatograms obtained from the packed column on trimethylsilylglycosidic derivatives. Additional work is needed before this method can have a direct clinical application.

Chromatography, Gas↗
PubMed1988

Identifying Mycobacterium tuberculosis cultures by gas-liquid chromatography and a computer-aided pattern recognition model.

A procedure that uses gas-liquid chromatography and a pattern recognition computer model was developed for distinguishing cultures of Mycobacterium tuberculosis from cultures of other mycobacteria, common bacteria, and fungi. In this procedure, a sample of a culture preparation is methanolyzed and trimethylsilylated sequentially and injected into a gas chromatograph equipped with a flame ionization detector. A pattern recognition procedure computes an error score by comparing the gas-liquid chromatography peak responses of a culture to those of a standard M. tuberculosis culture. Ten M. tuberculosis cultures were used in the development of the pattern recognition model. Computed error scores of 5 or less were established for identifying an M. tuberculosis culture. The method was evaluated with two sets of test samples, non-M. tuberculosis and M. tuberculosis cultures. Sample identification was correct for all 14 M. tuberculosis cultures (M. tuberculosis or non-M. tuberculosis), 45 fungal cultures, 94 bacterial cultures, and all but 1 of 18 cultures of mycobacteria other than tuberculosis (MOTT). The false prediction represented an isolate of M. fortuitum. For M. tuberculosis, fungal, bacterial, and MOTT cultures, the ranges of error scores were 1 to 5, 16 to 33, 13 to 34, and 4 to 26, respectively. Therefore, we have demonstrated that this diagnostic model can distinguish M. tuberculosis from non-M. tuberculosis cultures with a high degree of accuracy.

Bacteria↗
PubMed1985

Ten-year experience with mycetomas in patients with pulmonary tuberculosis.

We studied 33 consecutive patients with tuberculous pulmonary cavities complicated by fungus balls to evaluate their treatment. Nineteen had surgical resection for massive or recurrent bleeding or possibility of tumor. One patient died of postpneumonectomy empyema (30-day surgical mortality, 5 percent). Fourteen had no surgery. No patient died of hemoptysis. Respiratory failure contributed most often to death. Hepatic complications and other problems of alcoholism were also prominent. Good results can be obtained by resection in these severely ill patients if care is taken to preserve functioning pulmonary tissue and to avoid complications of alcoholic hepatic disease. Within these constraints, tuberculous cavities complicated by mycetomas should be resected for massive or recurrent hemoptysis.

Adult↗
PubMed1985

Pulmonary mycetoma following Mycobacterium kansasii infection. Report of seven cases.

A long-term follow-up of 263 patients with pulmonary Mycobacterium kansasii infection disclosed seven cases of mycetoma. We report the clinical manifestations of these patients. The incidence was less than that of tuberculosis. All mycetomas originated in large cavity lesions of inactive M kansasii infection. Most patients had received multiple antituberculous antibiotics, including rifampin. Five patients had died, two of underlying disease, one of invasive candidiasis following massive hemoptysis, one of surgical complication, and one of a possible invasive aspergillosis.

Aged↗
PubMed1984

Pulmonary cavitations in Mycobacterium kansasii: distinctions from M. tuberculosis.

The initial radiographs of 263 patients with pulmonary Mycobacterium kansasii infections were reviewed. Forty-nine untreated patients with active disease had unilateral lesions containing cavities less than 2 cm in diameter. The radiographs of these 49 patients were studied further and were found to have four distinct patterns: pattern 1, a circumscribed opacity containing a single cavity (39%); pattern 2, a circumscribed opacity with multiple lucencies (39%); pattern 3, multiple round or oval opacities containing lucencies (8%); and pattern 4, complex uncircumscribed opacity with lucencies (14%). Adjacent pleural thickening, "drainage area disease," and a "tail" sign were common. The initial radiographs of 27 untreated patients with solitary cavitary lesions less than 2 cm in diameter due to M. tuberculosis were studied for comparison. Only 22% had patterns 1-3 and generally showed more extensive adjacent parenchymal disease than cases with M. kansasii. A single circumscribed opacity containing one or more small cavities together with a "tail" sign, "drainage area disease," and little adjacent parenchymal disease is highly suggestive of M. kansasii infection. Since this infection usually requires more vigorous chemotherapy than tuberculosis, awareness of these findings has a practical implication.

Diagnosis, Differential↗
PubMed1982

Mycobacterium intracellulare infection of the shoulder and spine in a patient with steroid-treated systemic lupus erythematosus.

Atypical mycobacterial infections of bone are rare. A patient with systemic lupus erythematosus treated with steroids developed an M. intracellulare infection of the shoulder and spine. These infections are insidious and diagnosis is difficult. Marked involvement of one joint, large effusion, or aspirated small synovial fragments suggest an atypical tuberculous joint infection.

Adult↗
PubMed1977

Case report: miliary blastomycosis with cerebral involvement.

A patient was diagnosed as having labyrinthitis and an intracranial brain tumor. At the time a very fine nodularity to the bronchopulmonary markings was noted on the chest roentgenogram. Subsequent follow up examination revealed diffuse nodular densities throughout both lung fields having the appearance of a miliary distribution. Antituberculous therapy was begun empirically, but the patient expired within three weeks. At autopsy multiple granulomas were found in the cerebrum, cerebellum and meninges. By culture and histologic examination, these were determined to contain Blastomyces dermatitidis. The lungs contained numerous small granulomata almost to the exclusion of native pulmonary architecture. Lesions were also seen in spleen, lymph nodes and pancreas.

Blastomycosis↗