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Biomedical subjects

Z E Deeb

Publications and source records attributed to Z E Deeb.

At least 19 recordsLinked to original sources
PubMed2001

Angioedema associated with angiotensin II receptor antagonists: challenging our knowledge of angioedema and its etiology.

INTRODUCTION: Use of angiotensin converting enzyme inhibitors has long been associated with angioedema. Increased levels of bradykinin caused by the inhibition of angiotensin converting enzyme have been thought to be responsible for this side effect. Angiotensin II receptor antagonists (AT2 blockers), such as losartan potassium (Cozaar; Merck & Co., West Point, PA), are a new class of antihypertensives developed in part to eliminate cough and angioedema associated with ACE inhibitors. These agents act by selectively binding to angiotensin II receptor sites, thereby eliminating the hypertensive effects of angiotensin without affecting local and systemic bradykinin levels. We present three cases of AT2 receptor antagonist-induced angioedema, and examine its significance in the treatment of angioedema and its proposed etiology. METHODS: A retrospective chart review and review of the literature. RESULTS: Three patients taking the AT2 blocker losartan presented with mucosal swelling in the head and neck clinically consistent with angioedema. All three patients had prior episodes of angioedema while on losartan. Two patients presented with involvement of the anterior tongue and face that resolved within 12 hours of discontinuation of the losartan and a course of intravenous steroids. The third patient experienced recurring episodes of angioedema that eventually required a tracheotomy for airway compromise. After discontinuing the losartan and receiving a course of intravenous steroids, the angioedema resolved in 5 days. The patient was decannulated 10 days after onset of symptoms. CONCLUSION: Angioedema is a potentially life-threatening condition commonly associated with ACE inhibitor use. AT2 blockers bind to angiotensin II receptor sites and have no demonstrable effect on local or systemic bradykinin levels. We present three cases that demonstrate AT2 blocker-induced angioedema. They were all complicated by the fact that the inciting agent, losartan, was not discontinued after the initial episode and resulted in recurrent episodes of angioedema, one of which required surgical airway intervention. The incidence of AT2 blocker-induced angioedema brings into question prior theories on the etiology of angioedema and bradykinin's role in its pathogenesis.

Aged↗
PubMed2001

Angiotensin-converting enzyme inhibitor-induced angioedema: a multicenter review and an algorithm for airway management.

Angioedema is a nonpitting edema of which the presentation ranges from benign facial swelling to airway obstruction managed by intubation or tracheotomy. The presentation of this disease is reviewed, and a treatment algorithm based on initial signs and symptoms is proposed for proper airway management. We performed a retrospective review of 108 patients treated in 2 tertiary care centers in the Washington, DC, area over a 5-year period. Ninety-eight patients (90.7%) were African-American, and 81 (75%) were female. Seventy-four patients (68.5%) were taking angiotensin-converting enzyme inhibitors (ACEIs). A classification system was developed based on the location of the edema at initial presentation: 1) isolated facial swelling and oral cavity edema, excluding the floor of the mouth; 2) floor of mouth and/or oropharyngeal edema, and 3) oropharyngeal edema with glottic and/or supraglottic involvement. Fourteen patients (13%) needed airway intervention, 2 of whom underwent a cricothyrotomy after a failed intubation attempt. Eleven (78.6%) were taking ACEIs. The indication for each intubation was massive tongue and floor of mouth edema. The patients were extubated 48 to 72 hours later. No patient demonstrated symptom progression after medical treatment was initiated. Therapy included discontinuation of the ACEI or other inciting agent, a high-humidity face tent, an initial dose of intravenous antihistamines, and a continued course of intravenous steroids. Within 48 hours, most patients had a resolution of their edema. Only cases of significant tongue and oropharyngeal edema took longer than 48 hours to resolve. The ACEIs are a common cause of angioedema. Left untreated, angioedema may progress to involve the oropharynx and supraglottis, resulting in a life-threatening airway compromise. Marked floor of mouth and tongue edema are the indications for airway intervention. An algorithm based on the initial presentation is essential for proper airway and patient management. Once treatment has begun, angioedema is nonprogressive and often resolves within 24 to 48 hours.

Adult↗
PubMed2000

Tall cell variant: an aggressive form of papillary thyroid carcinoma.

Twenty-four cases of the tall cell variant (TCV), a subset of papillary thyroid carcinoma, were identified in a group of 624 patients with thyroid cancer. All pathology specimens were reviewed, and each patient's carcinoma was categorized according to characteristics on presentation, local recurrence, distant metastases, follow-up, and tumor-related mortality. The TCV group was compared with a historical control group (Mazzaferri and Jhiang: 1355 patients). The TCV group had a statistically higher percentage of stage 3 and 4 carcinoma, extrathyroidal invasion, and tumor size less than 1.5 cm than the control group. There was no statistical relationship between age greater than 50 years and stage in the TCV group. No relationship could be found between TCV histology and recurrence or mortality. These findings, combined with those of studies that link stage on presentation to poor outcomes, have led to our conclusion that TCV is an aggressive malignancy warranting appropriate treatment and close follow-up.

Adult↗
PubMed2000

Ultrasound-guided fine-needle aspiration and thyroid disease.

BACKGROUND: Fine-needle aspiration represents a critical diagnostic test in determining proper management of thyroid disease and the use of ultrasound-guided fine-needle aspiration (USGFNA) has increased over the years. METHODS: A retrospective chart review of patients undergoing USGFNA. Two hundred fifteen patients underwent 234 procedures with 362 nodules aspirated within a 2 (1/2)-year period. RESULTS: The mean ages of women and men were 51.9 and 57.8, respectively. The average size of nodules was 2.1 cm. A difficult to assess gland or nodule was the most common indication for USGFNA (33%). The sensitivity was 88.2%, specificity was 80.0%, the PPV was 65.2%, the negative predictive value was 94.1%, and the accuracy was 82.5%. The cancer yield, inadequacy, and complication rates were 44%, 10.5%, and 8.5%, respectively. CONCLUSIONS: USGFNA aspiration is a safe and effective diagnostic modality in the management of thyroid disease, especially for nodules that are difficult to palpate.

Biopsy, Needle↗
PubMed1999

Early diagnosis and treatment of laryngeal injuries from prolonged intubation in adults.

Prolonged endotracheal intubation can cause injuries to 1 or more regions of the larynx, making safe extubation impossible and leading to tracheostomy in many patients. Unfortunately, a considerable number of these patients do not benefit from early laryngeal evaluation, which may reveal potentially treatable soft, obstructive tissue before it undergoes irreversible fibrosis. Between July 1992 and December 1995, we performed immediate direct telelaryngoscopy on 142 adults who required tracheostomy because of failed extubation. When present, obstructive tissue was removed with microsurgical techniques. One hundred twenty-nine (90%) patients were decannulated within 3 weeks. The 2 main reasons for failure of early decannulation were intractable granulation (in patients with insulin-dependent diabetes) and coexisting tracheal stenosis. Immediate telelaryngoscopy is recommended in all patients who require tracheostomy because of failed extubation. Flexible laryngoscopy is not adequate for thorough assessment of laryngeal damage from prolonged intubation.

Adult↗
PubMed1990

Infectious adult croup.

From January 1980 to December 1987, seven patients with acute inflammatory swelling of the subglottic space were treated. Their ages ranged from 25 to 73 years. Medical history and symptomatology are similar to those characteristic of laryngotracheobronchitis (croup) in the pediatric age groups (i.e., an antecedent common cold followed by a barking cough and varying symptoms of upper airway obstruction). Physical findings before and after treatment were confirmed and documented by anteroposterior radiographs of the neck. Three patients required airway intervention but there were no deaths. To our knowledge there are no previous reports in the English literature describing this entity in adults. The purpose of this presentation was to introduce physicians, in general, and otolaryngologists, in particular, to this potentially serious infection. Our limited experience suggests that the pathogenesis and management of croup in adults are very similar to those in children.

Adult↗
PubMed1990

Atypical findings in cephalic herpes zoster polyneuritis: case reports and radiographic findings.

The purpose of this presentation is to report six patients who were seen because of multiple cranial nerve deficits occurring within a clinical picture of herpes zoster of the head and trunk. The clinical behavior, diagnostic methods, treatment, and outcome of the patients in this series are reviewed. The vagus and cochleovestibular nerves were affected in all of the patients. Three patients had radiographic evidence of a mass in the nasopharyngeal region. Malignancies were ruled out by repeated biopsies.

Adult↗
PubMed1988

Detection of antigens associated with Epstein-Barr virus replication in extracts from biopsy specimens of nasopharyngeal carcinomas.

By using monoclonal antibodies to different Epstein-Barr virus (EBV) polypeptides in combination with immunoblotting, we detected antigens associated with EBV replication in extracts from nasopharyngeal carcinoma (NPC) biopsy specimens. Major polypeptides associated with both the diffuse and the restricted components of the early antigen (EA) complex were found in extracts from nine of nine NPC biopsy specimens. Cells from an additional NPC biopsy specimen, passaged repeatedly in nude mice, were found to be positive for the major EA (restricted) polypeptide. This approach revealed that extracts from three of 14 biopsy specimens form other benign and malignant diseases also expressed these viral polypeptides. Therefore, for the first time, these results conclusively demonstrate the presence of EA polypeptides in extracts from NPC biopsy specimens. This finding provides at least a partial explanation for the reported prognostic value of antibodies to this antigen in patients with this disease.

Antibodies, Monoclonal↗
PubMed1988

A transfacial approach to the nasal-paranasal cavities and anterior skull base.

Large lesions of the nasal and paranasal cavities present a particularly difficult problem of surgical approach. The direct transnasal, Denker's, Weber-Fergusson, lateral rhinotomy, and facial degloving approaches have all been used with varying degrees of success. Nevertheless, these approaches fail to provide adequate exposure of the midfacial and interorbital spaces. In 1979, we developed a method called the transfacial approach in which two large midfacial flaps, one containing the entire external nose, are raised, exposing the maxillae, both medial orbital walls, and the nasal and paranasal cavities. Through this panoramic approach, one can easily expose the anterior skull base to the clivus and operate on this area under direct visual and manual control. The technique of this approach is described and our experience with 16 patients in whom it was applied is reviewed.

Adult↗
PubMed1987

Approach to supraglottitis.

In my experience, steroids have no use in the management of ACSOL once the airway is secured, and may actually prolong and complicate the infectious process. The main use of antibiotics is probably for preventing systemic complications such as pneumonia and meningitis. It is possible, however, that neither drug can alter the natural course of this disease and may just hasten its expected inconsequential resolution. The key to successful management of acute supraglottitis is early recognition and prompt provision of airway assistance when indicated. This potentially fatal disease occurs in adults as well as children. To my knowledge, most deaths occur after the patient arrives at the hospital, when there is hesitation and indecision about the need for airway intervention. Whenever signs of UAO appear, artificial airway should be provided promptly, regardless of the eventual diagnosis. Those physicians who try all means to avoid intubation or tracheotomy early in the process may be cautioned that complications from either procedures are just a risk, while airway obstruction in most cases of ACSOL is a certainty. Finally, the examiner assessing patients with possible obstructive laryngitis, supraglottic, or subglottic, should first and foremost decide whether an airway is needed and should defer all diagnostic guesswork and laboratory data processing until the airway is secured.

Adult↗
PubMed1985

Acute epiglottitis in the adult.

Acute epiglottitis may be fatal when diagnosis is delayed. The literature stresses data that does not help to predict impending airway obstruction in patients who present with a sore throat, the most consistent presenting symptom among patients with acute epiglottitis. In this review of 80 cases of epiglottitis in adults, almost all patients who presented within eight hours from onset of symptoms required airway intervention, while the majority of those who presented more than eight hours after onset of symptoms never developed acute upper respiratory obstruction and were treated medically or had supportive treatment only. Artificial airway was indicated in all patients who had drooling. There were no fatalities in this series, however, we recommend keeping all patients with acute epiglottitis in an intensive care unit for at least 24 hours after admission.

Acute Disease↗