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Biomedical subjects

S K Goldberg

Publications and source records attributed to S K Goldberg.

At least 19 recordsLinked to original sources
PubMed1995

Bacteremic pneumococcal pneumonia. A community hospital experience.

We reviewed our experience with bacteremic pneumococcal pneumonia (BPP) over a 1-year period at a 600-bed community teaching hospital; 26 cases were identified. The mean age was 57.5 years and there were 12 male and 14 female subjects. Cough, sputum production, fever, and mental status changes were the most frequent symptoms. Risk factors included drug abuse in 10, HIV in 4, current smoking in 7, diabetes in 3, and cancer in 3. The mean PaO2/FIo2 ratio was 274. Radiographic features included a consolidation pattern in 7, bronchopneumonia in 15, combined in 1, and an initial normal film in 3. Average length of stay (LOS) was 11 days with an overall mortality of 11.5%. Four patients required mechanical ventilation, two meeting the criteria for ARDS (if this group were eliminated, LOS would be 8.4 days). Three of these survived. Four patients had organisms resistant to penicillin and all survived. We conclude that (1) BPP remains a serious but treatable infection particularly when utilizing full supportive care; (2) the bronchopneumonia x-ray film pattern was associated with all the mortality; and (3) the occurrence of penicillin resistance did not contribute to the mortality, since early recognition and the use of appropriate antibiotics saved all of these patients.

Adult↗
PubMed1993

The role of staging bronchoscopy in the preoperative assessment of a solitary pulmonary nodule.

In order to assess the role of a staging fiberoptic bronchoscopy in the preoperative assessment of an indeterminate solitary pulmonary nodule (SPN), we reviewed our experience in 33 SPNs identified among 1,269 bronchoscopies performed at the Albert Einstein Medical Center between 1985 and 1989. All lesions were less than 4 cm in greatest diameter and were not associated with symptoms of weight loss, chest pain, hemoptysis, localized wheezing, or hoarseness. A tissue diagnosis was established in 25 patients, 23 of whom had a malignant SPN. This study failed to detect a single case in which a fiberoptic bronchoscopic examination of the airway discovered a lesion that would preclude surgery and potentially curative resection. We recommend the abandonment of a staging bronchoscopy in the evaluation of a patient with an indeterminant SPN in whom history, physical examination, laboratory, and imaging studies fail to document contraindications to surgery. No additional useful information is derived and a substantial cost savings to the patient can be realized if the procedure is eliminated.

Adenocarcinoma↗
PubMed1992

Pleural effusions in right-sided endocarditis: characteristics and pathophysiology.

The incidence, characteristics, and pathogenesis of pleural effusions in patients with right-sided endocarditis (RSE) are poorly defined. We have recently observed four patients with a history of intravenous drug abuse and bacteremia due to Staphylococcus aureus who had pleural effusions during an episode of RSE. We report the pleural fluid characteristics of five effusions in these four patients and attempt to define the pathogenesis of each. We found that (1) an exudative, sterile, serosanguineous, or bloody effusion is common in RSE, (2) empyema occurred in only one patient, and (3) transudative effusions due to CHF were not observed. Possible mechanisms of pleural fluid formation in RSE include parapneumonic effusion, septic pulmonary emboli with or without infarction, and empyema. Congestive heart failure does not appear to be a common cause of pleural effusion in pure right-sided endocarditis.

Adult↗
PubMed1992

Mediastinal bronchogenic cyst. A cause of upper airway obstruction.

Although bronchogenic cysts may involve the mediastinum, they have rarely been responsible for significant upper airway obstruction. We describe a young man who had a rapidly expanding cervical mass due to the migration of a mediastinal bronchogenic cyst. Flow-volume loops confirmed the presence of a variable intrathoracic obstruction. The patient rapidly developed respiratory failure requiring urgent intubation and surgical resection.

Adult↗
PubMed1988

Utility of immediate postlobectomy fiberoptic bronchoscopy in preventing atelectasis.

In a prospective randomized trial, we examined the value of routine postlobectomy fiberoptic bronchoscopy (FOB) in preventing postoperative atelectasis. Twenty patients who underwent lobectomy were randomly assigned to either chest physical therapy alone (group 1) or immediate bronchoscopy (group 2). Both group 1 and group 2 were placed on a standard physical therapy regimen consisting of aerosol bronchodilator therapy, chest percussion, and incentive spirometry. It was concluded that routine postlobectomy bronchoscopy offers no advantage over the usual physical therapy measures in preventing the development of postoperative atelectasis.

Administration, Inhalation↗
PubMed1985

Clinical diagnosis of massive hemoptysis using the fiberoptic bronchoscope.

Pulmonary resection, when possible, is the conventional treatment of massive hemoptysis. Alternatives include bronchial artery embolization, Fogarty catheter balloon tamponade, and pharmacologic approaches. We used endotracheal intubation and flexible bronchoscopy to locate the bleeding site in three of four patients with massive hemoptysis. These cases are used to review the etiology of massive hemoptysis and the usefulness of flexible bronchoscopy to localize the source of hemorrhage.

Adult↗
PubMed1985

Usefulness of tumor markers in serum and bronchoalveolar lavage of patients undergoing fiberoptic bronchoscopy.

To evaluate the diagnostic usefulness of simultaneous determinations of 4 tumor markers (carcinoembryonic antigen, calcitonin, creatinine kinase-BB, and DNA), we studied 31 patients with lung cancer, 22 with benign lung disease, and 15 normal volunteers as control subjects. The measurements were made by radioimmunoassay in bronchoalveolar lavage (BAL) and in serum obtained on the same day. The results showed that in serum, only CEA levels were significantly higher in malignancy; in lavage fluids, all 4 markers were abnormally high in cancer patients when compared with control subjects (p less than 0.05); there was no correlation between the levels in lavage and those in the bloodstream. When the mean levels in lavage of the normal control subjects were designated as the limits for a positive test, significant association was found between malignancy and abnormally elevated marker concentration (p less than 0.01). The particular combination of CEA-BAL greater than 35 ng/mg, CEA-serum greater than 4 ng/ml, and calcitonin-BAL greater than 120 pg/mg taken together with the results of bronchoscopy (histologic and cytologic) showed the highest discriminating power between malignant and benign lung disease. The sensitivity of the bronchoscopy procedure increased from 50 to 89%, with at least 2 positive markers, and had a specificity of 71%. When both bronchoscopy and all 3 markers were negative, the results showed a negative predictive value of 100%. We conclude that tumor marker levels in lavage are a useful aid in the diagnosis of malignancy in patients undergoing bronchoscopy.

Adult↗
PubMed1985

An unusual thromboembolic complication of a Greenfield vena caval filter.

The Greenfield inferior vena caval filter is highly effective in preventing recurrent pulmonary embolism and is associated with a low incidence of complications. We have recently seen a patient with the unusual finding of recurrent pulmonary embolism due to extension of thrombus from the surface of a Greenfield filter. The proximal extension of thrombus from a partially obstructed filter is documented by venacavogram. The proposed mechanism is discussed and principles of management are reviewed.

Adult↗
PubMed1984

Hypercapnia complicating massive pulmonary embolism.

An elevated PaCO2 is distinctly unusual in pulmonary embolic disease. We report 2 patients with massive pulmonary emboli complicated by hypercapnia in the absence of underlying chronic obstructive lung disease. Profound alterations in ventilation/perfusion matching and reduced cardiac output are probable mechanisms of this gas-exchange problem.

Adolescent↗
PubMed1984

Proteinase inhibitory function in inflammatory lung disease. I. Acute bacterial pneumonia.

This study examines the bronchial alveolar lavage (BAL) samples from a group of patients with acute bacterial pneumonia (n = 13) and makes a comparison with a control group (n = 5). The proteinase inhibitory capacity was examined and found to be composed primarily of alpha 1-proteinase inhibitor (PI, alpha 1-antitrypsin) and, to a lesser extent, bronchial mucosal inhibitor. Although the average PI concentration was elevated approximately 5-fold in the pneumonia group, its inhibitory function against elastase was decreased 15-fold when compared with that in the control group. The pneumonia group showed an increased concentration of immunologically identified elastin-derived peptides. Some of the BAL fluid from patients with pneumonia showed elastolytic activity against amorphous insoluble lung elastin. The majority of the elastase appears to be of neutrophil origin. Bronchial mucosal inhibitor is shown to be a component of both normal and pneumonia BAL fluids by both immunologic quantitation and by its resistance to perchloric acid inactivation. Compared with those from control subjects, BAL samples from patients with acute bacterial pneumonia showed a decreased proteinase inhibitor function and both increased elastolytic activity and elastin-derived peptide concentration.

Acute Disease↗
PubMed1984

Is pulmonary artery catheterization necessary for the diagnosis of pulmonary edema?

The ability to differentiate cardiac from permeability edema on the basis of clinical and radiographic criteria was studied in 70 ICU patients in whom subsequent pulmonary artery catheterization (PAC) was performed. Our study demonstrated that the clinical assessment of permeability pulmonary edema was correct in 17 of 20 patients (85%). In contrast, of the 50 patients initially suspected of having cardiac edema, only 31 (62%) were predicted correctly (p less than 0.05). Complications relating to catheterization occurred in 25% of patients, with 3 deaths. We conclude that the diagnosis of cardiogenic pulmonary edema, based on clinical criteria alone, is often inaccurate in the intensive care setting. The failure of patients to respond to initial therapy should mandate pulmonary artery catheterization, despite the attendant risks. Furthermore, even though the clinical diagnosis is correct in 85% of patients with permeability pulmonary edema, PAC data may be necessary for optimal management.

Aged↗
PubMed1983

The risk factors, incidence, and prognosis of ARDS following septicemia.

Adult respiratory distress syndrome (ARDS) is frequently associated with septicemia. However, the incidence, risk factors, and prognosis are poorly defined. Therefore, during a nine-month period, 116 consecutive patients with septicemia were analyzed. ARDS occurred in 21 of 116 (18 percent) of septicemic patients. Shock preceded all cases of ARDS but occurred in only 15 percent of patients without ARDS (p less than 0.001). Thrombocytopenia was more frequent (62 percent vs 16 percent, p less than 0.001). Age, sex, compromised host status, type of septicemia, temperature, and white blood cell count were not significantly different between the two groups. It is concluded that ARDS frequently complicates all forms of septicemia. It is usually preceded by shock and thrombocytopenia and significantly worsens the prognosis.

Aged↗