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Biomedical subjects

S A Sahn

Publications and source records attributed to S A Sahn.

At least 19 recordsLinked to original sources
PubMed1992

Pulmonary hypertension and human immunodeficiency virus infection. Two reports and a review of the literature.

Pulmonary hypertension may be primary (idiopathic) or secondary. While the etiologies for secondary pulmonary hypertension are diverse, infection with the human immunodeficiency virus (HIV) has not been included. To date there have been 16 reported cases of pulmonary hypertension in the HIV-infected population. Plexogenic arteriopathy was the most common pathologic finding. We report two HIV-infected patients who were concomitantly found to have pulmonary hypertension with plexogenic arteriopathy. One patient had lymphocytic interstitial pneumonitis, an entity not previously associated with pulmonary hypertension. We review the 16 previous cases of pulmonary hypertension and HIV infection and discuss this association.

Adult↗
PubMed1992

Hamman's sign revisited. Pneumothorax or pneumomediastinum?

Louis Hamman described distinctive chest noises and emphasized their association with pneumomediastinum in 1937. However, the etiology of Hamman's sign remains incompletely defined and its association with pneumothorax underemphasized. We present a patient with pneumothorax and Hamman's sign assessed by computed chest tomography. Tomography suggested an alternate genesis of Hamman's sign; free pleural air may be cyclically channeled through a lung fissure thus creating chest sounds.

Adult↗
PubMed1992

A prospective study of amylase-rich pleural effusions with special reference to amylase isoenzyme analysis.

By analysis of pleural effusions from 200 patients, 25 cases of amylase-rich effusions were identified, for an overall incidence of 13 percent. Four of the 25 patients (16 percent) had evidence of pancreatitis. These patients had higher mean ratios of pleural fluid to serum amylase levels (18 +/- 6.3 [SEM] vs 4.8 +/- 1.3) compared to patients with nonpancreatic diseases (p = 0.003); all four exhibited a predominant pancreatic isoenzyme profile. Of the 21 patients with nonpancreatic amylase-rich effusions, lung cancer was the most commonly associated condition (8 patients). In 14 of the 21 patients in whom an isoenzyme profile was obtained, salivary-type amylase was predominant. Amylase-rich pleural effusions occur frequently, and pleural fluid isoamylase determination is specific for pancreatitis-associated effusions. The finding of a pleural effusion rich in salivary isoamylase should prompt an evaluation for carcinoma (particularly of lung primary), but may also be seen in other pleural inflammatory conditions.

Amylases↗
PubMed1992

Pleural disease in pregnancy.

Pleural effusions, pneumomediastinum, and pneumothorax are known complications of pregnancy. Although reported in small series and anecdotal case reports, the serious nature of these complications and the potential for misdiagnosis during the events of labor and delivery warrant a careful review of the available literature. In this article the incidence, clinical manifestations, and, where appropriate, therapeutic options of these disorders are discussed.

Antibodies, Antiphospholipid↗
PubMed1991

Pleural fluid analysis in malignant mesothelioma. Prognostic implications.

Pleural fluid characteristics of 26 patients diagnosed with malignant mesothelioma over an 18-year period were reviewed and compared with those of patients with effusions due to other malignancies. Survival from time of initial thoracentesis was directly correlated with pleural pH and decreased pleural fluid/serum glucose ratios but was not related to protein or LDH concentration. Decreased pleural fluid pH was statistically related to a decreased pleural fluid/serum glucose ratio. Patients with low pH (less than 7.30) pleural effusions had statistically decreased mean survival and decreased mean pleural fluid/serum glucose ratios compared with patients with normal pH (greater than or equal to 7.30). Patients with malignant mesothelioma pleural effusions had statistically decreased mean pleural fluid pH compared with patients with other malignant pleural effusions. Decreased levels of pleural fluid pH and pleural fluid/serum glucose ratios have negative prognostic significance and probably correlate with the degree of tumor bulk affecting the pleural surface.

Blood Glucose↗
PubMed1991

Miliary tuberculosis presenting as hepatic and renal failure.

A 67-year-old man developed hepatic and renal failure over a six-day period. Despite full supportive measures, he died on his 11th day of hospitalization with fulminant DIC and hepatic, renal, and respiratory failure. Postmortem examination revealed acid-fast bacilli in virtually all organ systems. Miliary tuberculosis should be considered as a potentially treatable cause of hepatic failure.

Acute Kidney Injury↗
PubMed1991

Benign thyroid hyperplasia presenting as bilateral vocal cord paralysis. Complete remission following surgery.

A 52-year-old woman developed respiratory arrest on two separate occasions that required mechanical ventilation. Fiberoptic bronchoscopy demonstrated bilateral vocal cord paralysis, and a CT scan of the neck demonstrated a right neck mass. On surgical exploration, the mass was found extending from the thyroid gland and was identified as benign thyroid tissue. Thyroid hyperplasia should be considered in the differential diagnosis of bilateral vocal cord paralysis.

Female↗
PubMed1991

Continuous lateral rotational therapy and nosocomial pneumonia.

The adverse effects of prolonged immobility are due primarily to gravitational effects on blood flow and ventilation, impairment of the normal mucociliary escalator and possibly an increase in extravascular lung water. However, CLRT theoretically should reverse these abnormalities. The sequence of events that culminate in LRTI or pneumonia is unclear; however, low tidal volumes, increased extravascular lung water and the accumulation of bronchopulmonary secretions may lead to atelectasis, a well-known precursor of pneumonia. Three prospective, randomized studies evaluating patients with acute head trauma, orthopedic injuries requiring traction and blunt chest trauma all showed a decreased incidence of LRTI or pneumonia with CLRT compared with those treated in a conventional bed and turned every 2 h by the nursing staff. In general, the methodology was sound with early randomization, use of precise criteria to define LRTI and pneumonia and appropriate observation. The fourth study performed in a medical ICU with a heterogeneous group of patients did not show a difference in incidence of nosocomial pneumonia between treatment in CLRT and a conventional bed, but did show a decreased length of ICU stay for patients with pneumonia treated with CLRT. It appears that if CLRT is to be effective, it needs to be instituted early in the patient's illness. The length of time that CLRT should be utilized is unknown; however, intuitively, as long as the patient is at risk, the therapy should be continued. It is also unclear whether CLRT should be started at full rotation immediately or begun at lesser degrees of rotation and advanced serially over several hours. Another unknown is the minimum time that CLRT should be administered per day. In the studies discussed, most patients were rotated for 10 to 16 h/day. The minimum degree of rotation necessary for an effect is also unknown; in the studies cited, rotations from 40 degrees to 62 degrees in each direction were used. Based on the current data, the early use of CLRT in comatose or otherwise immobile patients decreases the incidence of LRTI including pneumonia over the first 7 to 14 days of ICU care. The prevention of pneumonia and more rapid transfer from the ICU should offset the additional expense of a specialized bed. The data suggest that a multicenter study with accrual of a large number of patients to evaluate this form of therapy in a prospective, randomized study is necessary. If the hypothesis that CLRT decreases the incidence of nosocomial pneumonia in the ICU is proven, the impact on critical care in the 90s would be substantial.

Beds↗
PubMed1991

Management of parapneumonic pleural effusions and empyema.

Parapneumonic pleural effusions, the most common causes of exudative pleural fluid, are a frequent finding with bacterial pneumonia. Progression to empyema is related to delay in appropriate antimicrobial therapy. Once an empyema develops, therapy consists of early sterilization of the empyema space with appropriate antibiotics, early and adequate pleural space drainage, and obliteration of the empyema cavity by adequate lung expansion, surgical decortication, or enzymatic debridement.

Empyema, Pleural↗