Biomedical subjects
Publications and source records attributed to J Shahar.
We report skin findings in thirty patients with severe chronic obstructive pulmonary disease. This study illustrates that patients with chronic obstructive pulmonary disease have numerous skin manifestations and some of these cutaneous findings are specific for chronic obstructive pulmonary disease.
A case of a young girl with oligosymptomatic multiple cystic lesions of the chest is presented. The chest lesions were found on routine chest X-ray when she was admitted because of meningococcal meningitis. As the lesions increased in size, surgery was performed; the operative specimens were identified as lymphangioma. This is a rare disorder, which presents difficulties in diagnosis and treatment. Its benign nature is challenged by its tendency to recur and the need for repeated operations.
A variant of hepatorenal syndrome occurring in patients with chronic congestive heart failure following an episode of cardiogenic pulmonary edema, and in the absence of hypotension, is described. This was observed in 13 patients during an eleven-year period. The clinical picture is characterized by hepatic injury and functional renal impairment. Increase of serum glutamic oxaloacetic transaminase levels as high as 2100 IU; prolongation of prothrombin time; elevation of serum bilirubin, creatinine, blood urea nitrogen, and potassium levels; decrease in urinary sodium excretion; and a normal urinary sediment are the salient laboratory abnormalities of this entity. Treated with conventional medication, the patients' course was fatal in 4 cases. When the splanchnic vasodilator dopamine was added to the patients' management, 5 of 9 patients recovered. Cardiogenic hepatorenal syndrome is a severe but potentially reversible complication of heart failure. The apparently beneficial effect of low-dose dopamine needs further evaluation.
A patient with nodular sclerosing Hodgkin's disease had at least three episodes of lung involvement consisting of an infiltrate on one occasion and multiple cavitating nodules on the other two. The cytologic and histologic studies of the lung specimens disclosed the presence of Reed-Sternberg cells on each occasion without any evidence for infection. This represents the first time in which recurrent cavitating nodules have been reported with Hodgkin's disease.
A patient with known pelvic endometriosis suffered from recurrent episodes of retrosternal pain in the chest at the time of menstruation. Evaluation during an episode revealed subcutaneous emphysema of the neck and a pneumomediastinum without pneumothorax. This is the first report in the English literature of pneumomediastinum due to endometriosis which was probably recurrent.
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Episodes of ventricular tachycardia of the 'torsade de pointes' (VTTP) types provoked by prenylamine were observed in 7 patients: 5 females and 2 males. They all received prenylamine in a dose of 120-180 mg daily for anginal pains. Syncope or syncopal equivalents occurred in all 7 patients. Q-T intervals ranged from 0.52 to 0.64 s. Review of the literature revealed 11 patients with prenylamine-induced VTTP, of whom 8 were females. The female preponderance (72.2%), hitherto not commented upon in the literature, is highlighted. Prenylamine-indiced VTTP may appear late after initiation of therapy, consequently clinical and ECG long-term follow-up is mandatory. The drug should promptly be discontinued in symptomatic patients, and particularly in females showing prolonged Q-T.
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Exercise electrocardiograms must be interpreted with the understanding that not every positive test is indicative of coronary artery disease. Mitral valve prolapse mimics coronary heart disease clinically and often in the electrocardiographic response to exercise. Twelve patients with mitral valve prolapse in whom exercise testing was positive underwent a repeat study after beta blockade. All tracings returned to normal after adequate blockade, evidenced by 17 to 22% reduction of resting and exercise heart rates. To the best of our knowledge, this is the first such report in the English literature. The results of this study suggest that an exercise test after beta blockade should become part of the routine procedure in such patients. The elimination of false positive electrocardiographic responses by beta blockade should help improve the specificity of the exercise test. Moreover, similar responses should lead to the suspicion of mitral valve prolapse.
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Crystals were found in a pulmonary cytologic preparation in association with the aspiration of barium. This type of event has not been described previously, although rare occurrences of crystals in pulmonary cytology specimens in association with Aspergillus infection and other situations have been reported. We recommend that patients suspected of aspiration be given no oral substances for at least 12 hours before bronchoscopy.