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Biomedical subjects

S M Santiago

Publications and source records attributed to S M Santiago.

At least 19 recordsLinked to original sources
PubMed2000

Hypercapnic respiratory failure in COPD patients: response to therapy.

INTRODUCTION: The clinical course of patients with acute exacerbations of underlying COPD presenting with hypercapnic respiratory failure was reviewed. METHODS: This was a retrospective review of 138 episodes of hypercapnic respiratory failure (PaCO(2) > or = 50 mm Hg and pH < or = 7.35). Patients were admitted to the West Los Angeles VAMC Medical Intensive Care Unit between 1990 and 1994. RESULTS: Of the 138 hypercapnic episodes, 74 (54%) required intubation. Comparison was made with the 64 cases in which patients responded to medical therapy. Patients requiring intubation had a greater severity of illness, with a higher APACHE II (Acute Physiology and Chronic Health Evaluation II) score (18 +/- 5 vs 16 +/- 4; p < 0.01), higher WBC, higher serum BUN, and greater acidosis (pH, 7.26 +/- 0.07 vs 7.28 +/- 0.06; p = 0.08). Those with the most severe acidosis (pH < 7.20) had the highest intubation rate (70%) and shortest time to intubation (2 +/- 2 h), and they required the longest period of time to respond to medical therapy (69 +/- 60 h). With an initial pH of < 7.25, there was a consistently higher intubation rate. Conversely, those with an initial pH of 7.31 to 7. 35 were less likely to be intubated (45%), had a longer time to intubation (13 +/- 18 h), and had a more rapid response to medical therapy (30 +/- 18 h). Of those patients requiring intubation, most (78%) were intubated within 8 h of presentation, and the vast majority (93%) by 24 h. Of those patients responding to medical therapy, half (52%) recovered within 24 h and the vast majority (92%) recovered within 72 h. CONCLUSIONS: This study provides a better characterization of the response to therapy of COPD patients with hypercapnic respiratory failure. This should be useful in limiting or omitting medical therapy in high-risk patients, thereby avoiding delays in intubation as well as providing a framework for continued therapy in those more likely to improve.

APACHE↗
PubMed1999

Characteristics of nasal airflow and the effect of a nasal dilator in normal human subjects.

Nasal resistance contributes to negative airway pressure during breathing. We sought to define normal patterns of nasal flow and the effects of mechanical dilatation and splinting of the nares on flow during forced inspiration and expiration. Maximal inspiratory and expiratory flow volume loops (FVL) were determined in 17 normal subjects. Oral FVL were obtained with nares clamped and nasal FVL through a mask with and without dilatation of nares using a plastic splint (Nozovent). Oral FVL were normal in all. Two patterns of nasal FVL were observed: one indicating 'variable' extrathoracic obstruction, the other indicating 'fixed' extrathoracic obstruction. Maximal inspiratory flow at 50% of vital capacity (FiF50) was improved by the Nozovent only in those with a 'variable' pattern (FIF50 (L/sec): 1.54 +/- 0.3 to 2.86 +/- 0.5; P < 0.05, versus 1.92 +/- 0.3 to 2.21 +/- 0.3: P = 0.5). In subjects with a fixed pattern, failure of dilatation of the nares to increase flow suggests that the site of inspiratory flow limitation is within the bony nostril.

Adult↗
PubMed1998

Pulmonary edema as a result of chronic upper airway obstruction.

This is the first case of an adult who developed recurrent pulmonary edema as a result of unrecognized chronic upper airway obstruction due to polyarticular juvenile rheumatoid arthritis. The case highlights the importance of considering upper airway involvement in the differential diagnosis of sedentary patients with arthritic joint disease and breathing difficulties.

Airway Obstruction↗
PubMed1998

Failure of physician documentation of sleep complaints in hospitalized patients.

Sleep disorders are acknowledged to be common but remain underrecognized by the medical community, often attributed to the failure to question patients about their sleep quality. We examined the prevalence of sleep complaints (insomnia or excessive daytime sleepiness) in a group of general medical patients by administering a questionnaire to hospitalized patients in a Veterans Affairs tertiary care medical center. A total of 222 consecutive adults (215 men, 60 +/- 14 years; body mass index, 24.8 +/- 5.6) completed the questionnaire. Of these, 105 patients (47%) had either insomnia, excessive daytime somnolence, or both; 63 (28%) had excessive daytime somnolence, which was severe in 27 (12%). Of 75 patients (34%) who had insomnia, a third were taking hypnotic medication. Forty patients (18%) had snoring, which was associated with excessive daytime somnolence in 36, whereas 46 patients (21%) had either restless legs or a combination of leg jerks and leg kicking or twitching during sleep, associated with a sleep complaint (insomnia in 32). The medical records were subsequently reviewed to assess the admitting physicians' recognition of these symptoms. No record included mention of any patient symptom related to sleep. We conclude that symptoms related to sleep, some of which may be clinically important, are common, and that none of these complaints appear to be recognized by the physicians of record.

Adult↗
PubMed1996

Fluorodeoxyglucose-positron emission tomography in the detection and staging of lung cancer.

Glycolysis is increased in tumor tissues. [18F]fluoro-2-deoxy-D-glucose (FDG) is a glucose analogue radiopharmaceutical used in positron emission tomography (PET) to trace glucose metabolism. We investigated the sensitivity and specificity of FDG-PET imaging in the diagnosis and staging of lung cancer. One hundred and seven patients who had abnormal chest roentgenograms underwent whole-body PET imaging using FDG. PET scan results were classified as positive or negative based on the presence or absence of increased FDG uptake in the lung and/or in the mediastinum. All 82 patients with lung cancer had increased FDG uptake in the lungs, whereas only 12 of 25 patients with nonmalignant diseases had increased FDG uptake. Sixteen lung cancer patients with mediastinal metastases had increased FDG uptake in the mediastinum, of whom three had no lymphadenopathy on computed tomography of the chest. Sixteen lung cancer patients without mediastinal nodal involvement had no FDG uptake in the mediastinum. Seven of these patients had lymphadenopathy on computed tomography. FDG-PET imaging is 100% accurate in predicting mediastinal involvement in patients with lung cancer. It is 100% sensitive and 52% specific in predicting the malignant nature of a chest radiographic abnormality.

Adenocarcinoma↗
PubMed1992

Survival in patients with superior pulmonary sulcus tumors.

We report our experience with 21 patients with superior sulcus tumors. Demographic features and survival were analyzed according to the stage of disease. Eleven patients had stage IIIA disease, 2 had stage IIIB disease and 8 had stage IV disease. Only 4 (19%) were amenable to surgery at the time of diagnosis and only 1 underwent combined preoperative radiotherapy and surgery. The majority of our patients were nonresectable at the time of diagnosis because of extensive disease or coexisting medical conditions. Overall, the probability of survival approached zero at 1 year. This poor survival is a reflection of nonresectability in the majority of our patients, which may be unique to our patient population.

Adenocarcinoma↗
PubMed1990

Sarcoidosis as a cause of left recurrent laryngeal nerve palsy.

Vocal cord paralysis is an unusual complication of sarcoidosis. Sarcoidosis may affect vocal cord function by either direct involvement of the cord or by involvement of the neural pathways, including the nucleus ambiguous, the 10th cranial nerves, and the superior and recurrent laryngeal nerves. There have been only two previous case reports of sarcoidosis with mediastinal adenopathy causing compression of the left recurrent laryngeal nerve and vocal cord paralysis. We present a third such case.

Humans↗
PubMed1987

Bronchoscopy in patients with haemoptysis and normal chest roentgenograms.

We reviewed the records of 58 patients with haemoptysis and normal chest roentgenograms who underwent fibreoptic bronchoscopy. A diagnosis of malignancy was made in six patients at bronchoscopy. Three patients had bronchogenic squamous cell carcinoma, one a carcinoid tumour and two laryngeal carcinoma. Sputum for cytology was negative for malignant cells in all six patients. Follow-up data were available for the other 52 patients for an average period of 55.7 +/- 29.6 (SD) months. Two patients had a subsequent diagnosis of bronchogenic carcinoma at 2 and 6 years after initial evaluation. Three patients died from conditions not related to pulmonary malignancy and the remaining patients followed a benign course. Our patients come from a predominantly male, elderly population of cigarette smokers. Among such patients, we conclude that bronchoscopy is indicated in the evaluation of those with haemoptysis and a normal chest roentgenogram.

Bronchoscopy↗
PubMed1986

Aspiration lung biopsy with ultrathin needles.

Aspiration lung biopsy with ultrathin needles (gauge 24-25) was performed in 232 patients. A diagnosis was established with ultrathin needles in 134 of 164 patients with malignancy. Comparison of cytologic diagnosis and histologic diagnosis was made in 49 patients. There were no false-positive results, and histologic diagnosis was similar to cytologic diagnosis in 69% of cases. Only 8 of 55 patients with non-malignant conditions had the specific diagnosis established with ultrathin needle biopsy. Our data support the safety and efficacy of the procedure in patients with malignant disease. Although the yield in non-malignant conditions was low, the relative safety of the procedure justifies its use since patients may be spared of more invasive procedures.

Biopsy, Needle↗
PubMed1981

Inhibition of methacholine-induced bronchoconstriction with reproterol, a new beta agonist-xanthine derivative.

This study compared the efficacy of single oral doses of a new beta adrenergic agonist-xanthine derivative, reproterol, with placebo by measuring the degree of induced bronchodilation and inhibition of response to methacholine challenge in patients with bronchial asthma. In comparison with placebo, 30 mg reproterol was an effective bronchodilator. Attenuation of the response, but not complete blockage of the methacholine-induced bronchoconstriction, was observed with 30 mg reproterol. Methacholine-induced bronchoconstriction is of use in assessing effect and mechanism of the action of new pharmacologic agents.

Adult↗
PubMed1981

Inhibition of antigen-induced bronchoconstriction with reproterol, a new beta agonist-xanthine derivative.

The purpose of this study was to compare the efficacy of a new bronchodilator, reproterol with standard bronchodilators terbutaline and theophylline in patients with allergic asthma. Efficacy was determined by measuring the initial bronchodilating effect and the inhibition of antigen-induced bronchoconstriction. In a double-blind, randomized, controlled study with single doses of medication, patients were given reproterol (20 mg and 30 mg), anhydrous theophylline (200 mg), terbutaline (5 mg) and placebo prior to challenge with antigen. Prior to administration of antigen both reproterol and terbutaline had measurable bronchodilating effect when compared to placebo. The bronchodilating effect of theophylline was less than placebo. In comparison to placebo both doses of reproterol and terbutaline significantly attenuated the response to antigen challenge whereas the effect of theophylline was negligible.

Adult↗