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Biomedical subjects

Thomas M Roy

Publications and source records attributed to Thomas M Roy.

At least 19 recordsLinked to original sources
PubMed2006

Septic pulmonary emboli due to periodontal disease.

Septic pulmonary embolization (SPE) is a rare but serious disorder. It is a well-recognized potential problem in the settings of tricuspid valve endocarditis, septic thrombophlebitis, infected central venous catheters, and postanginal septicemia. Less well documented is the occurrence of SPE in patients with periodontal disease without suppurative thrombophlebitis of the great vessels of the neck. We report a patient with SPE in whom periodontal disease was the only identifiable nidus of infection and review the literature regarding the four other patients reported to have suffered this complication.

Humans↗
PubMed2006

Amiodarone-induced alveolar hemorrhage.

Amiodarone is increasingly prescribed for patients with ventricular and supraventricular tachyarrhythmias. Many adverse effects have been reported due to this drug and include injury to the liver, thyroid, cornea, skin, and neuromuscular system. Pulmonary toxicity is one of the more serious side effects of this anti-arrhythmic drug and is potentially fatal. Since the first case of amiodarone-induced pneumonitis was described in the early 1980s, amiodarone pneumonitis has been recognized as a distinctive and not uncommon form of drug-induced lung injury. On the other hand, amiodarone-induced pulmonary toxicity resulting in alveolar hemorrhage is rare. The authors report a patient with amiodarone-induced alveolar hemorrhage and review the literature.

Aged↗
PubMed2006

Streptococcus intermedius: an unusual cause of a primary empyema.

Despite the evolution of modern antibiotics, pleural space infection remains a common illness with significant morbidity and mortality. Every year up to 60 percent of the 1.2 million patients in the United States who present with community-acquired pneumonia develop parapneumonic pleural effusions. Few of these parapneumonic effusions progress to an empyema. Interestingly, in about 10 percent of the cases of empyema, no underlying pulmonary infection can be identified. These pleural space infections are called primary empyemas. We present a patient with a primary empyema caused by Streptococcus intermedius. Relatively few studies have investigated primary empyema caused Streptococcus intermedius. This case presentation serves as a reminder to the clinician about primary empyema caused by this micro-organism.

Anti-Bacterial Agents↗
PubMed2006

Pulmonary nocardiosis: an unusual cause of a solitary pulmonary nodule.

Nocardiosis is an infection caused by a soil-borne aerobic micro-organism. The pathogen is most commonly introduced in humans by inhalation into the respiratory tract. This infection may be transient and subclinical or may result in an acute or chronic bronchopulmonary process. Although an unusual cause of pulmonary infection in immunocompentent individuals, human nocardiosis is now documented more often in patients whose cell-mediated immunity is compromised by immunosuppression from comorbid disease or as a result of modern medical intervention. The diagnosis is often elusive unless a high index of suspicion is maintained. We present a patient with localized pulmonary nocardiosis who was immunosuppressed by virtue of a myeloproliferative disorder.

Aged↗
PubMed2005

Calciphylaxis: a rare association with alcoholic cirrhosis. Are deficiencies in protein C and S the cause?

Calciphylaxis is a rare condition of induced systemic hypersensitivity in which tissues respond to appropriate challenging agents with a sudden local calcification. It is characterized by acute calcium deposition in the medial layer of small and intermediate dermal vasculature that can lead to epidermal ischemia, ulceration, and necrosis. Calciphylaxis typically occurs in patients with end-stage renal disease who are undergoing dialysis and who have secondary hyperparathyroidism. Even in this population the incidence is less than 1%. The cause of calciphylaxis is unknown. However, it has been suggested that deficiencies of protein C and protein S may play a role in the pathophysiology of this disorder. Our patient is the fourth with cirrhosis to be reported to have developed calciphylaxis and adds further evidence that low levels of these anticoagulant factors may be an important etiologic factor for development of calciphylaxis. This report should alert the clinician that calciphylaxis occurs in patients with cirrhosis and should stimulate further research concerning the possible role of protein C and protein S deficiency in calciphylaxis.

Calciphylaxis↗
PubMed2005

Buerger's disease and pulmonary hypertension: a rare association?

Thromboangiitis obliterans (TAO), Buerger's disease, is an inflammatory thrombotic occlusive vascular disorder that typically involves small and medium-sized arteries of both the upper and lower extremities. This disease usually affects young adult males between the ages of 40 and 45 years old who smoke tobacco products. Clinically significant extrapulmonary involvement is exceptional. We describe a patient with elevated pulmonary arterial pressures associated with TAO who had no other discernible causes of secondary pulmonary hypertension.

Adult↗
PubMed2005

Post-traumatic thoracic arteriovenous fistulas.

Post-traumatic arteriovenous fistulas (AVF) between vascular structures in the thorax rarely occur. We present an unusual case of the delayed diagnosis of two post-traumatic thoracic AVF in a 70-year-old male. He had abnormal communications between an intercostal artery and an intercostal vein as well as an intercostal artery and a pulmonary vein. He has remained asymptomatic and has not developed a complication from these abnormal vascular structures in a three-year follow up.

Accidental Falls↗
PubMed2005

Phrenic nerve involvement in Charcot-Marie-Tooth disease.

Diaphragmatic weakness in Charcot-Marie-Tooth (CMT) disease may be more common than generally acknowledged. Recognizing diaphragmatic weakness in a patient with CMT is important since recognition of this process may help explain the symptoms of breathlessness and orthopnea, as well as the development of hypercarbia. Although most patients with CMT have a normal lifespan, the subset of patients with diaphragmatic weakness may be at a higher risk of pulmonary morbidity and early mortality. Elevation of one or both hemidiaphragms on chest roentgenogram should raise the suspicion of diaphragmatic dysfunction and prompt further investigation.

Age Factors↗
PubMed2004

Successful treatment of respiratory insufficiency due to adult acid maltase deficiency with noninvasive positive pressure ventilation.

Acid maltase deficiency (AMD) is a rare autosomal recessive genetic disorder that results in an accumulation of glycogen in the lysosomal storage vacuoles. It is classified as a glycogen storage disease (type II) and is also known as Pompe's disease. The prognosis of the patient with AMD is poor and the main cause of death is respiratory failure. We report a female patient whose respiratory insufficiency was documented to occur most severely during rapid eye movement sleep and who benefited clinically from the institution of nocturnal noninvasive bilevel positive airway pressure.

Female↗
PubMed2004

Myocardial injury during standard treatment of an adult with status asthmaticus.

Asthma affects 5%-10% of adults in the United States. Older adults (> 65 years) with asthma have higher rates of fatal asthma than younger adults. The occurrence of a respiratory emergency, such as status asthmaticus, would seem likely to create a situation of cardiopulmonary dysfunction conducive to myocardial ischemia. However, multiple studies of fatal or near-fatal asthma have failed to incriminate myocardial infarction as a contributing factor. We report a patient without underlying coronary artery disease who sustained myocardial injury consistent with myocardial ischemia and infarction during status asthmaticus while receiving recommended treatment without intravenous sympathomimetics or theophylline.

Adrenergic beta-Agonists↗
PubMed2004

A right-sided aortic arch misdiagnosed as asthma since childhood.

Congenital malformation of the aortic arch complex occurs in 3% of humans. These vascular aberrations result from embryonic structures that persist when there is incomplete atrophy or regression during normal development. Typically, anomalies of the aortic arch do not cause respiratory symptoms. However, in some individuals, the unusual position of the remnant vessels may compress the airway and cause airflow limitation. As might be expected, a symptomatic vascular anomaly is most often clinically apparent in childhood. We report an adult male with exertional dyspnea who had been diagnosed with asthma since childhood. After his symptoms proved refractory to newer asthmatic therapy, he was referred for further evaluation. Bronchial hyperactivity was not present with objective testing, and compression of his trachea by a right-sided aortic arch was confirmed with appropriate imaging studies. This report illustrates the need to confirm the diagnosis of asthma with objective measures of airflow and reminds the clinician that a congenital vascular aberrancy may initially elude diagnosis.

Aorta, Thoracic↗
PubMed2004

Desquamative interstitial pneumonia and hepatitis C virus infection: a rare association.

Extrahepatic manifestations of hepatitis C virus (HCV) infection are common. The authors report the unusual occurrence of desquamative interstitial pneumonia (DIP) in a patient with HCV. An immunologic response to HCV infection may have a role in the pathogenesis of DIP in patients with chronic HCV. Since DIP is treatable, HCV patients with pulmonary infiltrates should be thoroughly investigated for this disorder. In our experience, the use of steroids in HCV-associated DIP improved the patient's respiratory status without increasing the viral load.

Aged↗
PubMed2004

Severe obstructive sleep apnea in a patient with spinal muscle atrophy.

Patients with spinal muscle atrophy (SMA) who survive to adulthood experience a slow, continuous loss of motor function but typically have a normal life expectancy. These patients, however, require vigilance on the part of their health-care providers to reverse treatable disorders to maintain a satisfactory quality of life. We report on a patient with obstructive sleep apnea and type 3 SMA. The treatment of his sleep-disordered breathing resulted in the resolution of symptoms that were initially attributed to his neuromuscular disease.

Humans↗
PubMed2004

Hepatitis C and dilated cardiomyopathy.

In North America, viral infection is the most common cause of myocarditis. A number of common viral infections have been implicated. With the increased identification of patients with hepatitis C, there is recent evidence derived from myocardial molecular biology studies suggesting an association between HCV infection and the development of myocarditis. This may be followed by dilated cardiomyopathy. Primarily researchers overseas have supported the recognition of this association. We recently cared for a patient who appears to fulfill the clinical criteria of hepatitis C-induced cardiomyopathy.

Black People↗
PubMed2004

Cranial nerve VIII involvement in a patient with progressive systemic sclerosis.

Systemic sclerosis is a multisystem disorder characterized by abundant fibrosis of the skin, blood vessels, and visceral organs. Cranial nerve involvement is an uncommon feature of this connective tissue disorder, and when it occurs it is the trigeminal nerve that is primarily affected. We report an elderly woman who presented with sensorineural hearing loss and was then diagnosed with the CREST syndrome of progressive systemic sclerosis (calcinosis cutis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia). Involvement of the eighth cranial nerve with scleroderma and CREST syndrome is rare, but appears to be the cause of sensorineural hearing loss in our patient.

Aged↗