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Youngstown, OH, United States

Ernst A.,St Elizabeth Medical Center | Anantham D.,Singapore General Hospital
Pulmonary Medicine | Year: 2011

The application of lung volume reduction surgery in clinical practice is limited by high postoperative morbidity and stringent selection criteria. This has been the impetus for the development of bronchoscopic approaches to lung volume reduction. A range of different techniques such as endobronchial blockers, airway bypass, endobronchial valves, thermal vapor ablation, biological sealants, and airway implants have been employed on both homogeneous as well as heterogeneous emphysema. The currently available data on efficacy of bronchoscopic lung volume reduction are not conclusive and subjective benefit in dyspnoea scores is a more frequent finding than improvements on spirometry or exercise tolerance. Safety data are more promising with rare procedure-related mortality, few serious complications, and short hospital length of stay. The field of bronchoscopic lung volume reduction continues to evolve as ongoing prospective randomized trials build on earlier feasibility data to clarify the true efficacy of such techniques. © 2011 Armin Ernst and Devanand Anantham.

Smith A.M.,University of Cincinnati | Smith A.M.,Cincinnati Veterans Affairs Medical Center | Villareal M.,University of Cincinnati | Bernstein D.I.,University of Cincinnati | Swikert D.J.,St Elizabeth Medical Center
Annals of Allergy, Asthma and Immunology | Year: 2012

Background: The incidence rate of asthma has increased in all age groups in the past 40 years. Asthma in older adults is underdiagnosed and undertreated, resulting in suboptimal asthma control. Objective: The objectives of the study are to evaluate differences in host characteristics between older patients with asthma and persons who do not have asthma and how these differences impact overall quality of life. Methods: Patients older than age 60 years were recruited from the general population for this case/control and nested cohort study. A complete medical history, physical examination, skin prick testing (SPT), spirometry, and exhaled nitric oxide (ENO) measurements were performed. Quality of life was assessed through the standardized SF-36v2 questionnaire. Quality of life scores, spirometry, ENO, and aeroallergen sensitization differences were compared between older patients with asthma and control patients. Results: The mean age of the 77 patients evaluated was 68.7 ± 7.2 years, with 59 (77%) being female. A higher rate of SPT positivity was found in patients with asthma (88.9%) compared with controls (51.2%) (P =.007). The mean percent predicted forced expiratory volume in 1 second (FEV1) at baseline was lower in the asthma group (73.7 ± 21.9%) compared with controls (89.6 ± 19.1%) (P =.007). For quality of life assessed by the SF-36v2 questionnaire, the asthma group had worse general health, increased bodily pain, and worse overall physical health compared with controls (P =.02;.021;.01). Conclusion: Older adults with asthma have a higher rate of allergic sensitization, decreased lung function, and significantly worse quality of life compared with controls. © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Novak K.D.,Eye Associates of Utica | Williams S.M.,Mohawk Valley Retina | Williams S.M.,Upstate Medical Center | Kokot I.,St Elizabeth Medical Center | Schultze R.L.,Albany Medical Center
Cornea | Year: 2010

PURPOSE:: To describe the technique of Nd:YAG photodestruction of a presumed Toxocara canis corneal larval migrans and to report the unique clinical combination of a corneal nematode and diffuse unilateral subacute neuroretinitis (DUSN). METHODS:: Clinical case report. RESULTS:: A 63-year-old white male presented with idiopathic neuroretinitis treated empirically with systemic anti inflammatory therapy. Subsequently, he developed keratouveitis with an obvious corneal larva. Serology was positive for T. canis. Laser destruction of the larva combined with topical steroid and oral albendazole therapy led to initial resolution, followed by 1 episode of recurrent keratouveitis without identified ocular surface or intraocular larvae. This was cleared with topical steroids. A second empiric course of oral albendazole was also administered. The patient has shown no ocular recurrences or evidence of systemic involvement 1 year after the second course of treatment. CONCLUSIONS:: Corneal larvae can be safely and successfully destroyed by Nd:YAG photodestruction. T. canis may be one of several nematodes responsible for DUSN. A careful examination of the anterior segment is essential in the management of patients with DUSN. Copyright © 2010 by Lippincott Williams & Wilkins.

Vyshedskiy A.,Brigham and Womens Hospital | Ishikawa S.,St Elizabeth Medical Center | Murphy Jr R.L.H.,Brigham and Womens Hospital
Respiratory Care | Year: 2011

OBJECTIVE: To determine the variability of crackle pitch and crackle rate during a single automated- auscultation session with a computerized 16-channel lung-sound analyzer. METHODS: Forty- nine patients with pneumonia, 52 with congestive heart failure (CHF), and 18 with interstitial pulmonary fibrosis (IPF) performed breathing maneuvers in the following sequence: normal breathing, deep breathing, cough several times; deep breathing, vital-capacity maneuver, and deep breathing. From the auscultation recordings we measured the crackle pitch and crackle rate. RESULTS: Crackle pitch variability, expressed as a percentage of the average crackle pitch, was small in all patients and in all maneuvers: pneumonia 11%, CHF 11%, pulmonary fibrosis 7%. Crackle rate variability was also small: pneumonia 31%, CHF 32%, IPF 24%. Compared to the first deepbreathing maneuver (100%), the average crackle pitch did not significantly change following coughing (pneumonia 100%, CHF 103%, IPF 100%), the vital-capacity maneuver (pneumonia 100%, CHF 92%, IPF 104%), or during quiet breathing (pneumonia 97%, CHF 100%, IPF 104%). Similarly, the average crackle rate did not change significantly following coughing (pneumonia 105%, CHF 110%, IPF 90%) or the vital-capacity maneuver (pneumonia 102%, CHF 101%, IPF 99%). However, during normal breathing the crackle rate was significantly lower in the patients with pneumonia (74%, P <.001) and significantly higher in the patients with IPF (147%, P <.05) than it was during deep breathing. In patients with CHF the average crackle rate during normal breathing was not significantly different from that during the first deep-breathing maneuver (108%). CONCLUSIONS: Crackle pitch and rate were surprisingly stable in all 3 conditions. Neither crackle pitch nor crackle rate changed significantly from breath to breath or from one deepbreathing maneuver to another, even when the maneuvers were separated by cough or the vitalcapacity maneuver. The observation that crackle rate is a reproducible measurement during one automated-auscultation session suggests that crackle rate can be used to follow the course of cardiopulmonary illnesses such as pneumonia, IPF, and CHF. © 2011 Daedalus Enterprises.

Reddy C.,University of Utah | Ernst A.,St Elizabeth Medical Center | Lamb C.,Lahey Clinic | Feller-Kopman D.,Johns Hopkins University
Chest | Year: 2011

Background: Malignant pleural effusions (MPEs) affect > 150,000 people each year in the United States. Current palliative options include pleurodesis and placement of an indwelling catheter, each with its own associated benefits. This study was conducted to determine the safety, efficacy, and feasibility of a rapid pleurodesis protocol by combining medical thoracoscopy with talc pleurodesis and simultaneous placement of a tunneled pleural catheter (TPC) in patients with symptomatic MPE. Methods: Patients with recurrent, symptomatic MPEs underwent medical thoracoscopy with placement of a TPC and talc poudrage. The TPC was drained per protocol until the output was < 150 mL/d on two consecutive drainage attempts and then removed. Patients were followed for up to 6 months. Results: Between October 2005 and September 2009, 30 patients underwent the procedure. The median duration of hospitalization following the procedure was 1.79 days. All patients showed an improvement in dyspnea and quality of life. Pleurodesis was successful in 92% of patients, and the TPC was removed at a median of 7.54 days. Complications included fever (two patients), the need for TPC replacement (one patient), and empyema (one patient). Conclusion: Rapid pleurodesis can be achieved safely by combining medical thoracoscopy and talc poudrage with simultaneous TPC placement. Both hospital length of stay and duration of TPC use can be reduced significantly as compared with historical controls of either procedure alone. Future randomized trials are needed to confirm these results. © 2011 American College of Chest Physicians.

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