A 53-year-old female with haemoptysis following breast cancer resection.
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Biopsy, Needle↗
Biomedical subjects
R S Morehead
Publications and source records attributed to R S Morehead.
Tc-99m-labeled somatostatin receptor-binding peptide imaging for a pulmonary nodule.
A 76-year-old man with chronic obstructive pulmonary disease and a smoking history had a 2-cm solitary pulmonary nodule that was likely to be malignant. He underwent Tc-99m-labeled somatostatin receptor-binding peptide SPECT. A computed tomographic-guided transthoracic needle biopsy performed before the SPECT was nondiagnostic. SPECT showed increased uptake of the tracer by the nodule, which was subsequently found to be adenocarcinoma by surgical resection. Differentiation of malignant from benign nodules by Tc-99m-labeled somatostatin imaging may be a reasonable approach in patients at high risk for cancer and concurrently at increased risk for complications from invasive diagnostic procedures or surgical resection.
Adenocarcinoma↗
Ventilator-associated pneumonia.
Ventilator-associated pneumonia is a common complication in intensive care units, occurring in 9% to 24% of patients intubated for longer than 48 hours. Because of this large disease burden and the resultant attributable morbidity and mortality, there is great interest in accurately diagnosing, treating, and preventing this complication. More severely ill patients tend to develop ventilator-associated pneumonia, and identified risk factors include prolonged mechanical ventilation, reintubation after failed extubation, and a few other clinical variables. The efficacy of diagnostic and preventive strategies is somewhat controversial. Diagnosis by invasive methods requires a considerable commitment of resources but can potentially reduce cost of care; however, mortality benefit from this approach has not been demonstrated. As such, in most institutions, ventilator-associated pneumonia is best diagnosed using traditional clinical criteria. Prompt administration of appropriate antibiotics seems to be the only intervention that alters outcome once the diagnosis is established. Several strategies seem to reduce pneumonia incidence; however, mortality and cost benefits have yet to be convincingly shown.
Anti-Bacterial Agents↗
Dermatomyositis as a presentation of pulmonary inflammatory pseudotumor (Myofibroblastic tumor).
Inflammatory pseudotumor (IPT) is a rare pulmonary tumor of uncertain etiology that usually presents as an asymptomatic radiographic finding. We describe a case of pulmonary IPT presenting as dermatomyositis with complete resolution following surgical resection.
Adult↗
Multiple left-sided vanishing tumors.
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Diagnosis, Differential↗
Delayed death from pulmonary tuberculosis: unsuspected subtherapeutic drug levels.
A patient with fulminant pulmonary tuberculosis died after 41 days of intensive care despite pansensitive organisms and no known underlying immunosuppression. Two factors leading to death in this patient were a delay in seeking medical attention and a subtherapeutic serum level of rifampin, though no obvious evidence of malabsorption existed. Malabsorption of antitubercular drugs is under-recognized and of extreme importance in the treatment of critically ill patients with active pulmonary tuberculosis. Factors associated with mortality from tuberculosis and selected aspects of critical care management are discussed.
Absorption↗
Hemoptysis and dyspnea in a 67-year-old man with a normal chest radiograph.
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Aged↗
Tuberculosis of the pleura.
BACKGROUND: Tuberculosis is a leading cause of mortality worldwide, with a growing death rate. Pleuritis remains the most common extrapulmonary site of involvement. Epidemiologic trends have altered the presentation of disease. The advent of molecular biology has allowed new insights into disease mechanisms. In this paper, I review the salient features of pleural tuberculosis, highlighting recent epidemiologic trends and advances in diagnosis. METHODS: Literature concerning pleural tuberculosis was identified by a MEDLINE search; additional sources were identified by review of the bibliographies from these papers. RESULTS: Tuberculous pleuritis is uncommon in the United States and now more commonly reflects reactivation of old infections. Patients with coexistent tuberculosis and HIV infection have a higher rate of pleural reaction than non-HIV-infected persons. CONCLUSIONS: Closed pleural biopsy remains the diagnostic procedure of choice; newer diagnostic methods do not have favorable operating characteristics in areas of low tuberculosis incidence. Recommended anti-tuberculous therapy is identical to active pulmonary disease; corticosteroids should not be routinely given.
AIDS-Related Opportunistic Infections↗
Bronchiectasis in bone marrow transplantation.
Two patients are described with clinical and radiographic bronchiectasis which occurred after allogeneic bone marrow transplantation for haematological malignancy. Both had evidence of chronic graft versus host disease in other organs. Increased immunosuppression with corticosteroids resulted in clinical response, although both patients persisted with chronic mucopurulent sputum production and one had progressive airflow obstruction. Bronchiectasis may be an under-recognised manifestation of chronic graft versus host disease of the lung.
Adult↗