Biomedical subjects
Publications and source records attributed to S Spier.
An 8-year-old gelding with a 3-month history of anorexia and weight loss was found to have a massive subcapsular splenic hematoma. At flank laparotomy, 36 L of fluid was removed from the hematoma. The horse's condition improved after drainage. Fifteen months later, the horse became depressed and febrile. A splenic abscess containing Bacteroides ruminicola and Clostridium sporogenes was found at necropsy.
Eight patients (aged 8 to 22 years) with the Pierre Robin syndrome underwent sleep studies. Seven demonstrated significant although minor degrees of increased sleep disturbances and apneas, and less time spent in the rapid-eye-movement (REM) stage of sleep. One patient who had previously undergone mandibular corrective surgery had major sleep abnormalities (central apnea index of 81.7 although an obstructive sleep apnea index of only 1.9). The patients had small mandibles, as demonstrated by lateral cephalometric roentgenography, and mildly increased right ventricular diastolic dimensions, as shown by M-mode echocardiography. Snoring was present in all of these patients and in 13 of 22 patients questioned from our Pierre Robin clinic. We conclude that minor abnormalities in sleep, mandibular size, and right ventricular size persist well into adolescence in the majority of patients with Pierre Robin syndrome. These appear to be clinically insignificant; however, a small percentage of such patients may continue to have major sleep disturbances.
Following the study on psychomaintenance of asthma by Kinsman, Dirks, and Jones (1977), we adapted the Battery for Asthma Illness Behavior (BAIB) to children. Thirty-four children aged 9.3 to 15.4 years were tested with this modified BAIB. They were scored simultaneously on a semistructured psychological interview. Three groups emerged out of these data: low-, medium-, and high-panic-fear personalities. Patients were also rated with regard to their pulmonary function and clinical status, including medication prescribed. The high-panic-fear personality was significantly associated with a higher intensity of prescribed medication, in particular corticosteroids. These results were independent of spirometric pulmonary measurements. We conclude that doctors may overreact to the exaggerated distress of high-panic-fear patients. Psychotherapy could be of help for this group.
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A 3-day-old foal was examined because of forelimb lameness. Brachial artery occlusion was diagnosed. The foal was euthanatized. Necropsy revealed brachial artery thrombosis and an atrial septal defect.
In 6 horses with urinary bladder neoplasms, common clinical findings included a palpable mass in the bladder, anemia, hematuria, and/or proteinuria. Squamous cell carcinoma was found in 4 horses and appears to be the most common bladder tumor in the horse. Single cases of transitional cell carcinoma and fibromatous polyp also were identified. All horses except one were over 10 years of age. In one mare, treatment with 5-fluorouracil intracystically resulted in decreased bleeding from the bladder mass and apparent stabilization of the mass size. The mare ultimately died because of abdominal metastasis. Although rare, neoplasia of the urinary bladder should be considered when evaluating horses with hematuria.
Fourteen children, aged from 2 months to 14 years, underwent surgical excision of a bronchogenic cyst in the mediastinum. Nine of these children were asymptomatic and the finding of the tumor was purely accidental. Retrotracheal and subcarinal localizations were more often symptomatic but their visualization on standard chest roentgenograms was sometimes difficult. An oesophagogram was helpful for the diagnosis in those circumstances. No postoperative complication occurred in our series.
Primary extrapleural intrathoracic tumors are extremely rare in the pediatric patient. The authors report one observation of intrathoracic subpleural lipoma in five-year-old asymptomatic girl. A thoracic CT-Scan was particularly helpful by demonstrating the homogeneous fatty nature of the mass, the density of-120 Hounsfield Units being specific. This allowed us to limit ourselves to a brief non-invasive diagnostic workup. Complete surgical excision is curative and provides histological certainty about the benign nature of the tumour. It remains the current recommended approach.
We determined the effect of nocturnal low-flow oxygen (NLFO) on arterial oxygen saturation (SaO2), transcutaneous PCO2 (TcPCO2), and sleep quality in 10 patients with cystic fibrosis (CF) and severe stable chronic obstructive pulmonary disease (COPD). The patients were studied on 2 nights, 1 with oxygen and 1 with air at 2 L/min. The NLFO had no effect upon sleep quality in our patients. The minimal SaO2 occurred during REM sleep and averaged 79.4%. With NLFO, this improved to 92.7%. The average maximal rise in TcPCO2 was 5.6 mmHg on falling asleep while breathing air; this increased a further 5.1 mmHg with NLFO. Two patients also had obstructive sleep apnea. Their SaO2 improved dramatically with NLFO, with no deterioration of ventilation. In 4 patients, ventilation was measured quantitatively. The only consistent changes during air were an increase in abdominal contribution to tidal volume and a drop in minute ventilation from Stage 3-4 to REM sleep of 26%, almost entirely caused by a drop in breathing frequency. The same changes occurred with NLFO. We conclude that NLFO is effective in alleviating the nocturnal hypoxemia of patients with CF with stable COPD and does not cause clinically important hypercapnia.
To determine what relationship might exist between gastroesophageal reflux and nocturnal asthma, we studied nine patients with asthma and seven control subjects overnight in the sleep laboratory, monitoring sleep state, esophageal pH, tidal volume (including the relative contribution of rib cage and abdomen), and oxygen saturation. There were 15 episodes of gastroesophageal reflux, in three patients with asthma and four control subjects. There were no significant differences between the two groups in the number of reflux episodes, duration of the longest episode, and the percentage of reflux time. Thirteen of the 15 episodes occurred during the awake state or after movement arousal. None of the episodes caused coughing, wheezing, or changes in oxygen saturation in any of the subjects. These patients with chronic asthma did not have an increased incidence of gastroesophageal reflux at night, and reflux did not play any role in the production of their nighttime symptoms.
The respiratory inductive plethysmograph (RIP) is used to measure ventilation from body surface movements. We have compared the accuracy of the two versions of inductance coils used with this instrument. The early version consists of rib cage and abdominal coils sewn into a one-piece jerkin, whereas the new version consists of similar coils attached to two separate bands. Following overnight studies in 12 subjects, we found that less than 50% of separate band RIP tidal volumes were accurate when compared with simultaneously measured spirometric values. The jerkin RIP, however, was accurate in 87% of the breaths measured. Therefore, we advocate the use of the jerkin RIP for prolonged studies because the separate bands appear to move more easily.
Fourteen cases of primary lung abscess in childhood were treated with antibiotics alone. The only organism discovered was Staphylococcus aureus. All the children recovered. Roentgenographic abnormalities took from six weeks to more than five years to resolve. Recently, follow-up of 11 of the 14 children was performed an average of nine years after treatment of the abscess. In all children, the clinical status, lung volumes, and expiratory flow rates were normal, except in two with asthma. A conservative approach to the management of primary lung abscess in children is recommended.
American leishmaniasis that is acquired in Panama may appear clinically as a sporotrichoid eruption. When leisons reminiscent of sporotrichosis are encountered, a careful history of the patient's travels should be made, as well as a search for the organism of leischmaniasis in tissue smears, histopathological sections, and cultured media. We report the case of an American soldier stationed in Panama who had developed an ulcer on the dorsum of his right wrist, and nodules on his right forearm that were arranged in a linear pattern. The initial clinical impression was that of sporotrichosis, but on careful study of the patient's history, and after other appropriate investigations were made, it was discovered that the patient had leishmaniasis.
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Study of the mechanical properties of the respiratory system is needed to help provide a better understanding of the pathogenesis of diseases causing respiratory failure. The nature of neonatal intensive care requires that any technique for monitoring respiratory mechanics be simple, noninvasive, and allow continued free access to the neonate. The peak airway pressure developed during volume cycled ventilation reflects the mechanical properties of the respiratory system but cannot distinguish between changes in the flow-resistive or elastic properties. Similarly, dynamic compliance combines both the flow-resistive and elastic components of the respiratory system in a single number and flow-volume loops also reflect both elements. Extracting a single time-constant from the expiratory limb of the latter assumes a single-compartment model for the respiratory system and, as such, does not provide sufficient information to describe frequency dependence of resistance and compliance. Furthermore, flow-volume loops are markedly distorted by the presence of an endotracheal tube, which must be corrected for, before calculating values of resistance and compliance. To provide the information to understand better the physiologic processes and adaptive mechanisms in diseased states causing acute respiratory failure, it is necessary to use a method that is based on a more detailed and realistic model of the respiratory system. Two such techniques that appear to warrant further investigation in ventilated infants are the interrupter technique and the forced-oscillation technique.
The scimitar syndrome, first described by Chassinat in 1836, consists aessentially of an anomalous pulmonary vein draining whole or part of the right lung into the inferior vena cava. Associated anomalies are frequent, such as hypoplasia of the right lung, dextrocardia, malformations of the right pulmonary artery and bronchial tree, and abnormal arterial supply of the right lung (the so-called sequestration). This article describes a scimitar syndrome associated with stenosis of the inferior vena cava, whose initial diagnosis was made by two-dimensional echocardiographic Doppler color flow mapping. To our knowledge this is the first description of such an unusual association.
The objective of the present document is to review the impact of new information on the recommendations made in the last (1999) Canadian Asthma Consensus Guidelines. It includes relevant published studies and observations or comments regarding what are considered to be the main issues in asthma management in children and adults in office, emergency department, hospital and clinical settings. Asthma is still insufficiently controlled in a large number of patients, and practice guidelines need to be integrated better with current care. This report re-emphasises the need for the following: objective measures of airflow obstruction to confirm the diagnosis of asthma suggested by the clinical evaluation; identification of contributing factors; and the establishment of a treatment plan to rapidly obtain and maintain optimal asthma control according to specific criteria. Recent publications support the essential role of asthma education and environmental control in asthma management. They further support the role of inhaled corticosteroids as the mainstay of anti-inflammatory therapy of asthma, and of both long acting beta2-agonists and leukotriene antagonists as effective means to improve asthma control when inhaled corticosteroids are insufficient. New developments, such as combination therapy, and recent major trials, such as the Children's Asthma Management Project (CAMP) study, are discussed.