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Biomedical subjects

W M Alberts

Publications and source records attributed to W M Alberts.

At least 19 recordsLinked to original sources
PubMed1997

Pulmonary complications of cancer treatment.

Great strides have been made in the treatment of cancer. This success, however, has not come without a price. Pulmonary complications of cancer treatment have proven to be common and often result in significant morbidity. The manifestations of such complications may range from an asymptomatic patient with an abnormal chest, radiograph to one with transient dyspnea to varying degrees of chronic pulmonary insufficiency to an acute lethal event. Each of the major treatment modalities, surgery, radiation therapy, and chemotherapy, carries a significant complication rate that often limits its effectiveness. When two or more modalities are used concurrently or sequentially, the risk of complications increases further. The respiratory system, for a number of reasons, has proven to be especially vulnerable to treatment-related complications.

Antineoplastic Agents↗
PubMed1997

Delayed tension pneumothorax after laparoscopy.

Laparoscopy is a safe and useful procedure in evaluating intraabdominal disease. Serious complications have been reported but are rare. Laparoscopy related pneumothorax is one such complication that may occur during the procedure or in the immediate period thereafter. This complication is typically neither hemodynamically significant nor tension in nature. We report the unique case of a 52-year-old woman who not only developed acute respiratory compromise from a tension pneumothorax but did so 3 h after the completion of a seemingly uneventful laparoscopic procedure. Prompt recognition of this potential complication may permit immediate and effective treatment of this life-threatening complication.

Female↗
PubMed1996

Reactive airways dysfunction syndrome.

Two types of occupational asthma have been identified and are distinguished by whether they appear after a latency period. Asthma without a latency period is best illustrated by irritant-induced asthma. The reactive airways dysfunction syndrome is a subset of irritant-induced asthma. Although case reports appeared in the literature before 1985, the term reactive airways dysfunction syndrome was coined in 1985. Since that report a number of case reports of asthma-like illnesses developing as the direct consequence of massive toxic inhalation exposure have been published. Not all experts, however, are certain that reactive airways dysfunction syndrome is a real and distinct clinical entity. Most studies and reviews, although acknowledging the current gap in our knowledge of the epidemiology, pathogenesis, and pathologic findings, conclude that the available scientific evidence supports the conclusion that reactive airways dysfunction syndrome and irritant-induced asthma are valid disorders.

Air Pollutants, Occupational↗
PubMed1995

Occupational asthma. Serious consequences for workers and employers.

Patients affected by occupational asthma have respiratory symptoms that may persist for months, years, or even life. Hundreds of substances have been implicated in the disease, and the list is expected to grow. The authors discuss management of this sometimes life-threatening condition and emphasize the importance of environmental controls to prevent future cases.

Asthma↗
PubMed1994

Case report: Castleman disease in association with POEMS.

Castleman disease, or angiofollicular lymph node hyperplasia, and POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes), are associated and can lead to a clinical conundrum. The physician caring for a patient with Castleman disease should be alert to the development of multiple endocrine deficiencies, including primary hypogonadism, diabetes mellitus, hypothyroidism, and adrenal insufficiency. Avoidance of treating hypothyroidism alone when there is concomitant subclinical adrenal insufficiency is important, to avoid precipitating an adrenal crisis. A better outcome may result from earlier recognition of the endocrinopathies of this syndrome. This article describes a patient with Castleman disease in whom the features of POEMS unfolded over the ensuing years.

Adrenal Cortex Hormones↗
PubMed1994

The FEF25-75% and the clinical diagnosis of asthma.

Nonspecific bronchial provocation testing is clinically useful in the evaluation of patients with symptoms suggestive of asthma. Testing is usually reserved for those with normal or near normal baseline spirometry. Although bronchial provocation testing is safe and widely available, the protocol is time consuming and not without expense. It has been reported that a reduced FEF25-75% in the context of an otherwise normal spirogram suggests that asthma should be considered. To evaluate this suggestion, we compared the baseline FEF25-75% (expressed as percent of predicted) with the results of the subsequent methacholine bronchial provocation test in 205 consecutive patients referred for testing. The mean baseline FEF25-75% in the 112 patients with normally responsive airways (ie, a negative bronchial provocation test) was 95.4 +/- 27.5%. In the 93 patients with a positive bronchial provocation test, the mean FEF25-75% was 77.6 +/- 27.2%. The mean FEF25-75% in those with hyperresponsive airways was significantly lower (t = 4.616, P < .0001). Of those patients with a positive bronchial provocation test, there was no significant correlation, however, between the baseline FEF25-75% and the degree of bronchial hyperresponsiveness as assessed by the PC20FEV1 (r = .154, P = .141). When a significant reduction in FEF25-75% was defined as less than 60% of predicted, the sensitivity of the prediction rule was 25.8%, the specificity was 92.0%, the positive predictive value was 72.7%, and the negative predictive value was 60.0%. From these results, we conclude that the FEF25-75% derived from simple spirometry may be useful in predicting the presence or absence, but not the degree, of bronchial hyperresponsiveness.

Adolescent↗
PubMed1992

Bronchodilator testing "confidence intervals" based on the level of bronchial responsiveness.

"Confidence intervals" based upon inhalation of placebo have been proposed as criteria for defining a significant response to an inhaled bronchodilator. The published intervals were derived from a clinically heterogeneous population. We calculated the difference (delta) between spirometric data before and after placebo in 109 consecutive patients referred for methacholine bronchoprovocation challenge testing. The mean delta, expressed both as a percent change and as actual volume change for both the FVC and FEV1, was not significantly different in patients with bronchial hyperresponsiveness, as compared to subjects with a negative methacholine challenge test; however, the variance of measurements in hyperresponsive subjects was significantly greater than that of the normal population. In addition, as the category of responsiveness increased from mild to moderate to severe hyperresponsiveness, so did the variance within these groups. A negative correlation between the measured PC20FEV1 and the volume and percent change was noted. We conclude that patients with hyperresponsive airways may display increased spirometric variation before and after placebo. This general approach for establishing normal limits for defining a significant response appears to be valid, but the actual values used may vary, depending on the composition of the population tested and the goals of the study. Also, the use of the term, "confidence intervals," in this context is inappropriate; and we propose, instead, the use of percentiles and the simpler terms, upper 90th or 95th percentiles.

Adult↗
PubMed1992

Advances in occupational asthma.

Clinical and research interests in occupational asthma increased dramatically in the 1980s. Advances in our knowledge base have led to improved recognition, management, and methods for preventing this disorder. An accelerated pace of basic and clinical research is anticipated in the 1990s. These efforts will likely lead to a more complete understanding of the disease (and pay dividends in understanding asthma itself). Occupational asthma is predicted to be the preeminent occupational lung disease in the next decade.

Allergens↗
PubMed1991

Hepatic hydrothorax. Cause and management.

Significant pleural effusions are infrequently noted in patients with cirrhosis of the liver. A large effusion (hepatic hydrothorax) occasionally appears during the course of the disease. The fluid in the pleural space is believed to be derived from ascitic fluid that may accompany hepatic cirrhosis. Although the exact mechanism is somewhat controversial, it appears that the ascitic fluid is transported directly into the pleural space. A therapeutic thoracentesis, usually accompanied by a paracentesis, may be necessary to relieve acute symptoms. Long-term management, however, centers around eliminating or reducing the formation of ascites. When this is not successful, tube thoracostomy followed by chemical pleurodesis, primary repair of diaphragmatic defects with pleural sclerosis, or peritoneovenous shunting in conjunction with chemical pleurodesis may be attempted. These interventions may or may not be successful. Management of hepatic hydrothorax remains a clinical challenge.

Humans↗
PubMed1990

Effect of mild hypoxemia on bronchial responsiveness.

Nonspecific bronchial responsiveness may be influenced by a number of stimuli. A potentially important stimulus with significant clinical implications is hypoxemia. To investigate the effect of hypoxemia on baseline pulmonary function and bronchial responsiveness, 13 subjects (eight with mild asthma and five normal) were tested on two separate days within a 1-week period. Spirometry measured before and after breathing room air through the experimental circuit for ten minutes was not significantly different. Likewise, there was no difference in baseline spirometry during mild hypoxemia (arterial saturation of 90%) compared with air breathing. The eight asthmatic subjects underwent a methacholine bronchoprovocation challenge on each of the two test days. The PC20FEV1 measured on the "hypoxemic" day (3.7 +/- 4.5 mg/mL) was not significantly different from the measured on the "room air" day (2.5 +/- 2.4 mg/mL, P greater than .05). We conclude that mild hypoxemia does not significantly affect baseline spirometry nor bronchial responsiveness.

Adult↗
PubMed1989

Echocardiography in planned interruption of the inferior vena cava.

Interruption of the inferior vena cava by the transvenous placement of a filter or umbrella effectively prevents pulmonary embolism by acting primarily as a physical barrier to emboli. Such a device will be effective only if the site of thrombosis is distal to the planned placement site. We have presented two cases in which a preoperative echocardiogram revealed a right atrial embolus, thereby mandating either embolectomy, fibrinolytic therapy, or continued anticoagulation in addition to the filter placement. These cases suggest that an echocardiogram should be included in the evaluation preceding interruption of the inferior vena cava.

Aged↗
PubMed1989

Malignant pleural effusions: pleurodesis using a small-bore percutaneous catheter.

This study describes our experience using a percutaneously placed small-bore catheter for drainage of malignant pleural effusions and subsequent instillation of a sclerosing agent to obliterate the pleural space. We treated 15 consecutive patients with known metastatic cancer and a symptomatic pleural effusion. Twelve patients survived for more than four weeks after the procedure; 11 of these 12 patients had a successful objective clinical response. The procedure was well tolerated, with little or no discomfort during catheter placement and the maintenance period. No serious complications were encountered. We conclude that the use of a small-bore percutaneously placed "pneumothorax" catheter in the management of malignant pleural effusions is an effective and more comfortable alternative to large-bore closed-tube thoracostomy.

Adult↗
PubMed1989

Intrapleural streptokinase in management of parapneumonic effusions. Report of series and review of literature.

Noncommunicating locules of fluid may develop in the setting of a thoracic empyema or a complicated parapneumonic effusion. When this occurs a single chest tube may not provide adequate drainage. In an effort to promote drainage and thereby obviate the need for further procedures, instillation of streptokinase into the involved pleural space has been advocated. This communication reviews the literature and reports our experience with intrapleural streptokinase. In our retrospective review of nine patients, instillation of streptokinase resulted in an obvious increase in chest tube drainage in six. Of the nine patients, four with improved drainage required no further procedures. Two patients with improved drainage and the three with no change in drainage required an additional chest tube, a decortication procedure, or were lost to follow-up. None of the four patients with an empyema were benefitted. Intrapleural instillation of streptokinase may be a useful adjunct in the treatment of a complicated parapneumonic effusion but appears less likely to be of benefit in the management of an empyema.

Adult↗