Biomedical subjects
Publications and source records attributed to T L Lee-Chiong.
Pulmonary injury due to smoke inhalation is a significant cause of death in fire victims. Singed nasal hair and carbonaceous sputum are easily recognized warning signs, but other subtle clues should prompt thorough evaluation and aggressive treatment. Dr Lee-Chiong describes the basic mechanisms of injury and discusses how to assess and manage complications caused by smoke inhalation.
Ankylosing spondylitis is a chronic inflammatory disease that affects chiefly the joints of the axial skeleton. It is a multisystem disease. Several extra-auricular manifestations of ankylosing spondylitis have been described including ocular, cardiovascular, renal, and neurologic complications. Pulmonary involvement consists principally of upper lobe fibrocystic changes and chest wall restriction. Relapsing polychondritis, on the other hand, is a rare disorder characterized by progressive inflammation and degeneration of the cartilaginous structures and other connective tissues throughout the body. Involvement of the respiratory tract is identified in more than one-half of patients with relapsing polychondritis.
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Normally, the pleural spaces contain sterile lubricating fluid that enables smooth expansion and contraction of the lungs. But when microorganisms gain entry, directly or through contiguous spread of infection, the fluid becomes increasingly dense and viscous as purulence progresses. This article outlines clinical, radiographic, and pleural fluid features that can aid in distinguishing between pleural collections that usually respond to medical therapy and those that probably require surgical intervention.
We describe a young man who had been healthy until he developed extensive benign left pleural fibrosis. He subsequently developed disabling right pleural thickening a year later. No clear cause was discovered.
The diagnosis of hypothermia must be entertained when patients present with unexplained mental status changes or arrhythmias. Prompt recognition and aggressive treatment of complications should reduce cold-related fatalities. The choice of an appropriate rewarming method must be individualized and depends on the severity of hypothermia and the patient's degree of hemodynamic tolerance.
Infections can invade the normally sterile pleural space leading to the development of parapneumonia effusions or empyemas. Pneumonia, thoracic surgery, and trauma, together, are responsible for most cases of empyemas. Pneumococci and staphylococci remain the predominant etiologic organisms. In addition, gram-negative aerobic bacteria and anaerobes are emerging as important pathogens. Most parapneumonic pleural effusions, regardless of their underlying etiology and bacteriology, evolve through definable stages. For each stage of the disease, specific therapeutic measures, either medical or surgical, are available.
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Smoke inhalation injury affects nearly one third of all major burn victims. Significant inhalation exposures must be suspected in persons who were entrapped in a closed space or who became unconscious during a fire. Each individual fire generates a characteristic smoke depending on the type of materials burnt, temperatures reached during pyrolysis, and the availability of oxygen to sustain combustion. In addition to variable amounts of thermal loads, firesmoke may contain mixtures of carbon monoxide, hydrogen cyanide, nitrogen oxides, and other highly irritating gases. Each constituent of firesmoke may potentially create pulmonary and systemic toxicities and must be considered in every victim of smoke inhalation.
The spectrum of heat-related illnesses ranges from simple syncope to life-threatening heatstroke. Persons of all ages can be affected. Heat edema, heat cramps, heat syncope, and heat exhaustion respond readily to simple management techniques. Treatment of heatstroke must include aggressive cooling, adequate fluid and electrolyte repletion, maintenance of adequate cardiovascular performance, and prompt correction of any related or resulting complications.
A remarkably effective and efficient thermoregulatory apparatus enables humans to maintain a normal body temperature despite widely varying and changing environmental and internal thermal conditions. Nevertheless, extreme ambient cold or heat and exhaustive exercise stress can overwhelm these defenses, leading to dangerous hypothermia or hyperthermia, respectively.
One half of all cases of lung cancer occur in patients aged 65 years and older. Although adenocarcinoma is the predominant histologic subtype in the general population, squamous cell carcinoma has remained the most common type in the elderly. Although lung cancer tends to present at a less advanced stage with increasing age, the percentage of elderly patients undergoing treatment tends to decline despite the fact that they can tolerate the aggressive therapy that may enhance survival.