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Biomedical subjects

L S Snyder

Publications and source records attributed to L S Snyder.

At least 19 recordsLinked to original sources
PubMed2001

Primary pulmonary coccidioidomycosis.

Coccidioidomycosis is an infection caused by the soil-inhabiting fungus Coccidioides immitis. The fungus is endemic in the desert Southwest, which is a major area for tourism and growth. Travel through this region results in many new coccidioidal pulmonary infections annually, including pneumonia, cavities, and nodules. Patients with coccidioidomycosis are therefore likely to present with pulmonary manifestations of infection when they return home to nonendemic parts of the country. This makes coccidioidomycosis a fungal infection of nationwide importance, and it is crucial that physicians everywhere have a heightened awareness of this disease to avert delays in diagnosis and treatment. This article describes primary pulmonary coccidioidomycosis and its complications for clinicians practicing both in endemic and nonendemic areas.

Coccidioidomycosis↗
PubMed1999

Airway coccidioidomycosis--report of cases and review.

Infection due to Coccidioides immitis usually begins in the lungs. Despite the initial pulmonary portal of entry, endotracheal and endobronchial coccidioidomycosis has rarely been described. Since the introduction of fiberoptic bronchoscopy and the AIDS epidemic, more C. immitis lesions of the large airways have been noted. We present data on 38 cases of coccidioidomycosis of the airways, including 6 cases detailed from our own experience and 32 from the literature. Direct infection of the airways (28 cases) is a more common mechanism of airways disease than is erosion into the airways from a lymph node (5 cases). Bronchoscopic findings vary and may show mucosal involvement or intrinsic obstruction. Endotracheal and endobronchial disease is not a self-limited disease and requires antifungal therapy. Disseminated disease in these patients is common. Coccidioidomycosis must be considered in the differential diagnosis of airway pathology.

Adult↗
PubMed1996

Tonsillectomy in children with or at risk for velopharyngeal insufficiency: effects on speech.

Recent case reports have challenged the notion that tonsillectomy is contraindicated in patients with or at risk for velopharyngeal insufficiency. The purpose of this study was to quantify the effects of tonsillectomy (with or without adenoidectomy) on perceptual speech characteristics, aerodynamic measures, and endoscopic descriptions of velopharyngeal function in a clinical population. Fifteen children 4 to 10 years of age received preoperative and postoperative evaluations. Perceptual speech characteristics improved or remained the same for most variables. There was no statistically significant difference between preoperative and postoperative ratings of hypernasality or frequency and severity of nasal emission. However, ratings of voice quality (pitch and breathiness) were significantly improved after surgery. Aerodynamic measures showed improvement or no change in velopharyngeal function for 12 of 15 children. Endoscopic assessment showed improvement or no change in velopharyngeal closure for 7 of 11 children tested. Cross-method analysis indicated that no single subject showed deterioration in velopharyngeal function in all three measures. The data from this investigation do not support the assumption that tonsillectomy is contraindicated for all children with or at risk for velopharyngeal insufficiency.

Child↗
PubMed1996

Acting to end alleged "gag" clauses in participating provider contracts.

In light of calls from various provider and consumer groups, including the American Medical Association, state and federal legislators have recently proposed legislation to eliminate the use of alleged "gag" clauses found in some managed care contracts that prohibit physicians from discussing certain matters with their patients, including treatment options not covered by the MCO and financial arrangements between physician and MCOs.

American Medical Association↗
PubMed1995

Corporate compliance programs: risk management for the future.

The Department of Justice has estimated that the government loses $100 billion annually in health care fraud. Consequently, the government's health care fraud enforcement activities with respect to all health care providers and suppliers continue to grow. Last year alone, the government collected more than $8 billion in settlements, fines, and penalties involving health care fraud. Recent settlements with the government have begun to include corporate compliance programs that require continued government oversight of the health care organization as an essential part of the settlement. The first section of this article describes the legal significance of health care companies' having corporate compliance programs. The second section provides a sample list of topics that should be included in any corporate compliance program. Finally, we describe various issues related to the creation and implementation of corporate compliance programs.

Fraud↗
PubMed1993

Cyclophosphamide-induced hepatotoxicity in a patient with Wegener's granulomatosis.

Cyclophosphamide is widely used in the treatment of many vasculitides. Hepatotoxicity associated with such therapy is uncommon but possible. Herein we describe a well-substantiated case of cyclophosphamide-induced hepatotoxicity in a patient with Wegener's granulomatosis. Physicians should be aware of this potentially serious reaction when cyclophosphamide therapy is initiated. Baseline liver function tests and periodic assessment are recommended during treatment with cyclophosphamide.

Aged↗
PubMed1991

The language-reading relationship in normal and reading-disabled children.

In this study, the word retrieval, phonological awareness, sentence completion, and narrative discourse processing skills of 93 reading-disabled and 93 normally achieving subjects from 8 to 14 years of age were compared. The subjects were matched for age, sex, and neighborhood. Results revealed that the two groups differed significantly on the time and accuracy of word retrieval, their ability to produce a syntactically appropriate structure in a sentence completion task, their retelling of stories that had been read to them, their answers to questions about the stories, and their inferences. Further analysis revealed that the variance in the younger reading-disabled children's reading comprehension scores was best accounted for by their performance on the sentence completion and word retrieval measures; the inferencing skills of the older reading-disabled children best accounted for the variance in their reading comprehension. By contrast, the younger normally achieving children's reading comprehension scores were best accounted for by their sentence completion, the proportion of the stories that they retold, and word retrieval scores. The proportion of stories retold and the phonological awareness score of the older normally achieving children best accounted for the variance in their reading scores. These findings suggest that the oral language skills of normally achieving and reading-disabled children may relate differently to their reading comprehension at different age levels.

Adolescent↗
PubMed1991

Acute lung injury. Pathogenesis of intraalveolar fibrosis.

In patients dying with acute lung injury, interstitial mesenchymal cells migrate into the airspace where they replicate and deposit connective tissue. We therefore hypothesized that peptides capable of promoting mesenchymal cell migration and replication would be present in the alveolar airspace. To examine this hypothesis, patients with severe acute diffuse lung injury (n = 26) underwent bronchoalveolar lavage. Acutely ill patients without lung injury served as controls (n = 12). Recovered effluent was examined for mesenchymal cell growth-promoting and migration-promoting activity. Lavage cell supernates from both patients and controls were devoid of bioactivity. However, substantial growth-promoting and migration-promoting activity was present in lavage fluid from nearly every patient, whereas little or none was present in fluid from controls. Characterization of the bioactivity indicated a significant proportion consisted of three peptides related to PDGF: (a) a 14-kD peptide that shared with PDGF several biophysical, biochemical, receptor-binding, and antigenic properties; (b) a 29-kD peptide that appeared identical to PDGF of platelet origin; and (c) a 38-kD peptide that was biophysically and antigenically similar to PDGF. These data indicate that peptide moieties are present in the airspace of patients after acute lung injury that can signal mesenchymal cell migration and replication.

Adolescent↗
PubMed1989

Intravascular lymphomatosis (malignant angioendotheliomatosis) presenting as pulmonary hypertension.

Intravascular lymphomatosis is a rare lymphoma characterized by proliferation of malignant cells within the lumen of small blood vessels. We describe a case of intravascular lymphomatosis resulting in pulmonary hypertension, hypoxemia, and dyspnea. This lymphoma occasionally responds to combination chemotherapy, suggesting that pulmonary hypertension secondary to intravascular lymphomatosis may be reversible. Intravascular lymphomatosis should be considered in the differential diagnosis of pulmonary hypertension.

Aged↗
PubMed1988

Evaluation of centrifugation cultures of bronchoalveolar lavage fluid for the diagnosis of cytomegalovirus pneumonitis.

Cytomegalovirus (CMV) pneumonitis is one of the most severe manifestations of CMV disease among immunocompromised patients. The diagnosis of CMV pneumonitis traditionally has required the use of invasive procedures such as lung biopsy. In this retrospective study, we evaluated a centrifugation culture method in samples of bronchoalveolar fluid for the noninvasive diagnosis of CMV pneumonitis. During a 9-mo period, 75 bronchoalveolar lavage samples were collected from 58 patients with pneumonitis. We analyzed the data from 21 patients in whom lung tissue samples were obtained within 14 days of the bronchoalveolar lavage. Centrifugation cultures of bronchoalveolar fluid were positive for CMV in 12 cases. CMV pneumonitis was confirmed in samples of lung tissue from five (42%) of the 12 patients, whereas no evidence of CMV pneumonitis was found in the remaining seven (58%) cases. Of nine patients with negative centrifugation cultures, CMV pneumonitis was confirmed in two (22%). When compared with conventional cultures, we found bronchoalveolar lavage fluid centrifugation cultures to be highly sensitive (100%) and specific (92%) for the detection of CMV infection. However, detection of CMV by centrifugation culture proved to be only moderately sensitive (71%) and nonspecific (50%) for the diagnosis of CMV pneumonitis.

Adult↗
PubMed1988

Endobronchial Richter's syndrome. A rare manifestation of chronic lymphocytic leukemia.

Endobronchial involvement in chronic lymphocytic leukemia is rare. This report describes a patient with chronic lymphocytic leukemia and Richter's syndrome in whom bronchial obstruction occurred due to massive peribronchial lymphadenopathy and endobronchial leukemic infiltrates. Endobronchial Richter's transformation has not been previously reported.

Bronchi↗
PubMed1988

Cytotoxic drug-induced lung injury.

Cytotoxic drug-induced pulmonary disease is a major cause of morbidity and mortality in immunocompromised patients. It is estimated that 20% of all patients receiving cytotoxic drugs will develop a symptomatic pulmonary reaction. Therefore, the possibility of a toxic drug reaction must be considered in all patients developing pulmonary disease during or following treatment with these agents. Clinical manifestations of lung toxicity are nonspecific and parallel the signs and symptoms of diffuse lung infection and malignant disease in the chest. For this reason, the diagnosis of cytotoxic drug-induced lung damage is one of exclusion of the various opportunistic infections that afflict this patient population. This typically requires careful microbiologic studies of bronchoalveolar lavage (BAL) samples and lung tissue. The diagnosis of cytotoxic drug-induced lung injury is often vexing. In the future, (BAL) may assume a more prominent diagnostic role and suggest insights into the pathogenesis of this entity.

Antineoplastic Agents↗