Biomedical subjects
Publications and source records attributed to M J Kryda.
A 56-year-old man with metastatic prostatic carcinoma underwent placement of a Hickman catheter. Approximately two months after the procedure, he was admitted to the hospital with hemoptysis and in respiratory distress. A contrast computed tomographic (CT) scan confirmed the diagnosis of a cava-bronchial fistula. The fistula was surgically repaired, and the patient made a satisfactory recovery.
Pulmonary embolism and venous thrombosis are ubiquitous diseases with significant morbidity and mortality and for which successful although risky treatments are available. Accurate diagnosis is therefore necessary and requires testing beyond the physical examination and history. The number of tests proposed over the years compared with the number in current use attests to the problems with the methods. The more definitive tests are also more invasive, riskier, and more expensive. Individual experience in performance and interpretation of the available tests is of great importance in achieving accurate results, and thus the best scheme for investigation of the patient varies from institution to institution. The most accepted and practiced scheme would involve contrast venography as the initial and final test for suspected venous thrombosis, and pulmonary perfusion imaging (with use of chest radiography in all instances and ventilation imaging in most instances) as the screening test for pulmonary embolism, followed by pulmonary angiography when the scan is not definitive or the clinical picture is divergent from the scan results.
A patient employed in a plant where blue cheese was manufactured developed hypersensitivity pneumonitis to Pencillium roqueforti. Symptoms of cough, dyspnea, and malaise, and findings of bibasilar crackles, reduced lung volumes, hypoxemia, and bilateral infiltrates on chest roentgenogram, resolved after she left the workplace. Bronchoalveolar lavage revealed a high percentage of lymphocytes. Antibody to P. roqueforti was demonstrated in serum and lavage fluid. To our knowledge this case represents a new occurrence of hypersensitivity lung disease in the cheese manufacturing industry in the United States.