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At least 595 records · Page 33Linked to original sources
PubMed2001

Aspergillus laryngotracheobronchial infection in a 6-year-old girl following bone marrow transplantation.

Localised fungal infection of the larynx and tracheobronchial tree is extremely uncommon. We report the case of a 6-year-old girl with acute lymphocytic leukaemia, who developed symptoms of upper airways obstruction 6 months after a cord blood transplant. Bronchoscopy showed a pale plaque lesion in the larynx and tracheobronchial tree. Aspergillus fumigatus was cultured from a biopsy of the lesion. The patient was treated successfully with a prolonged course of amphotericin B and assessed with multiple surveillance bronchoscopies.

Amphotericin B↗
PubMed2003

Laryngeal sporotrichosis causing stridor in a young child.

Fungal infections of the larynx are rare entities that must be considered in the differential diagnosis of the patient who presents with laryngeal symptoms. We present an unusual case of initially recurrent and then persistent stridor in a 19-month-old girl, unresponsive to 4 months of antibiotic and steroid therapy. Upon our laryngoscopic examination, the patient was noted to have an ulcerated, granulomatous process involving the larynx. She also had an erythematous papule on the left thigh. Fungal cultures of both sites grew Sporothrix schenckii. The patient was treated with systemic antifungal medications and had complete resolution of her symptoms. We discuss the pathophysiology and possible source of this unusual form of sporotrichosis, the first such case reported in a child. We emphasize the role of empiric steroid therapy in exacerbating and eventually enabling dissemination of the infection. We also review the manifestations of sporotrichosis infections of the head and neck. This case demonstrates the vital importance of careful diagnosis and proper treatment of stridor in children.

Anti-Inflammatory Agents↗
PubMed1985

Viral respiratory diseases.

An overview of the more commonly encountered viral diseases of the dog and cat is presented. The reader is acquainted with the principles of antiviral therapy and the drugs that have been studied for use in animal viral respiratory diseases. An update on vaccination principles and guidelines is provided.

Animals↗
PubMed1985

Fatal aspiration pneumonia caused by an esophageal foreign body.

Esophageal foreign body accompanied by respiratory complications is a rare condition. A few cases have been reported, only two of them in adults. We describe the case of a 34-year-old mentally retarded patient who was hospitalized for aspiration pneumonia and died 48 hours after admission. At autopsy, the prominent finding was a 3 X 3-cm stone impacted into the upper esophagus and compressing the trachea from behind. The possibility of an esophageal foreign body should be included in the differential diagnosis of unexplained respiratory distress or aspiration pneumonia in adults.

Adult↗
PubMed1980

Advances and controversies in the management of supraglottitis and laryngotracheobronchitis.

Recent advances in pediatric airway intubation and the introduction of pharmacotherapeutic agents, active within the larynx and tracheobronchial tree, have created significant controversies in the treatment of acute obstructive inflammatory laryngeal disease. Although the etiology, pathophysiology, and clinical patterns of supraglottitis and laryngotracheobronchitis are no longer confused, decisions concerning their medical management and method of airway control remain controversial. Both inflammatory disorders are critically examined, with a reveiw of current concepts regarding the choice between endotracheal intubation and tracheotomy. Specific problems of anesthetic technique, criteria for extubation or decannulation, and the rationale for the use of corticosteroids, antibiotics, or racemic epinephrine are evaluated. If mechanical airway control is required, careful attention to initial intubation with a relatively small, cuffless polyvinyl chloride endotracheal tube and precise surgical technique when employing tracheotomy will minimize the overall morbidity. Short term intubation in acute obstructive inflammation of the larynx appears to be well tolerated. Tracheotomy is reserved for the few patients with laryngotracheobronchitis who demonstrate persistent significant subglottic edema.

Acute Disease↗
PubMed2001

Respiratory infection in the chronically critically ill patient. Ventilator-associated pneumonia and tracheobronchitis.

The long-term ventilated patient is at high risk for developing nosocomial pneumonia or tracheobronchitis. In general, the frequency of infection increases with the duration of mechanical ventilation, but the risk appears to be greatest in the first week of intubation. Although these types of infection are common and may have morbidity and mortality impact, the daily risk is less in the long-term ventilated patient than in the acutely ill intubated patient. This reduced daily risk may reflect a "survivor effect," with less healthy patients dying early in the hospital stay and not surviving long enough to undergo tracheostomy and long-term ventilation. A number of factors predispose these patients to infection, including host defense impairment and exposure to large numbers of bacteria. This exposure can occur through the airway, and proper care of respiratory therapy devices is essential to minimize the risk for infection. Most infections of the lower respiratory tract are preceded by airway colonization with EGN bacteria and, with improvement in host defenses and nutrition, infection in the face of colonization is less likely. In some patients, colonization can be eliminated. When the long-term ventilated patient does develop infection, it generally involves highly resistant gram-negative or gram-positive organisms and therapy should be prompt and appropriate. Not all such patients respond to systemic antibiotics, and the use of adjunctive aerosol therapy may have benefit for those with either tracheobronchitis or pneumonia, especially if highly resistant pathogens are present.

Anti-Bacterial Agents↗
PubMedDate not supplied

Gastroesophageal reflux in the patients with asthma.

Thirty one patients with asthma (mean age was 44.4 10.7; range 18-63) were investigated for gastroesophageal reflux (GER). The patients were separated into two groups according to presence of reflux and/or nocturnal symptoms. 13 patients had one of the reflux and/or nocturnal asthma symptoms (Group 1), whereas 18 patients had none of them (Group 2). To assess GER patients underwent to scintigraphy with Tc99m. GER was determined 4 of 13 patients in group 1 (30,7 %) and 1 of 18 patients in group 2 (5,5 %). There was significant difference between the group 1 and group 2 in that respect (p < 0,001). The patients with established GER (5 patients) were given Omeprazole (a proton pomp inhibitor) 40 mg daily for 4 weeks following a 2 week placebo period. The patients recorded their daily and nocturnal symptoms of asthma, additional salbutamol use, morning and evening peak expiratory flow rates (PEFR) measurements in a daily chart during placebo and omeprazole treatment without changing their antiasthma treatment. Their PEFR, FEV1 values, daily and nocturnal symptoms and additional beta agonist use did not changed after omeprazole treatment except one. But their reflux symptoms (heartburn and regurgitation) were improved. As a consequence, we suggested that asthmatics which have some complaints of reflux should be searched for GER. Not the respiratory functions but GER symptoms can be improved w

Adolescent↗
PubMed1985

Intubation for the membranous laryngotracheobronchitis.

A 49-year-old housewife with membranous laryngotracheobronchitis (the membranous croup) was referred to our clinic because of difficulty in breathing. Instant intubation in the emergency room did not relieve her breathing trouble, thus, following emergency tracheostomy accompanied by irrigation with mucolytic agents and antibiotics proved effective. Preceding intratracheal intubation made the patient suffocate because it induced membranous debris to detach and become lodged in the tracheal wall. In addition, dryness seemed to worsen her respiratory distress, thus high humidification was felt to be instrumental in relieving her symptoms. No pathological bacteria were found in specimens detached from the tracheal wall.

Airway Obstruction↗
PubMedDate not supplied

Role of mitogenicity in pathogenicity of mycoplasmas for murine hosts.

The mitogenicity and pathogenicity of Mycoplasma pulmonis were compared in two rat strains. Both the mitogenic and the pathologic effects induced by M. pulmonis membranes were more severe in Lewis rats than in Hooded rats, and were dependent on the mitogen doses used. It was concluded that the severity of lung lesions induced by M. pulmonis membranes correlated with the degree of mitogenic responses of the different rat strains to this organism. The roles of T- and B-cell mitogens in induction of pneumonia were studied in Hooded rats treated intranasally with either the T-cell mitogen concanavalin A or with M. neurolyticum membranes which stimulate the B-cell populations, or with both concanavalin A and M. neurolyticum. Results clearly showed that the individual B- and T-cell mitogens affected the lungs of treated animals. Nevertheless, the mitogenic co-stimulation of both B and T lymphocytes in rat lungs was necessary to obtain maximal development of interstitial lymphocytic pneumonia.

Animals↗
PubMed1991

Prospective hospital study of community acquired lower respiratory tract infection in the elderly.

A prospective study of community acquired lower respiratory tract infection in the elderly was carried out over a 15-month period. During this time 127 consecutive admissions to two acute geriatric medical wards were studied. An aetiology was established in 77 (61%) of cases. Streptococcus pneumoniae was identified in 37% of patients. Haemophilus influenzae in 18% and Branhamella catarrhalis in 10%. Infection with Mycoplasma pneumoniae was found in only one episode and no cases of Legionella pneumophilia were diagnosed. A significant number of patients had multiple bacterial pathogens isolated: 18% of all bacterial pathogens isolated were ampicillin resistant. Fourteen patients died (11%). Lower respiratory tract infection is a frequent cause of hospital admission for those aged over 65 and is often regarded as a preterminal event. Adequately treated however, mortality is no higher than in the general population. Knowledge of the likely pathogens allows early and appropriate antibiotic therapy for these patients whether at home or on admission to hospital.

Aged↗
PubMed2001

Neurophysiological effects of recurrent laryngeal and thoracic vagus nerves on mediating the neurogenic inflammation of the trachea, bronchi, and esophagus of rats.

The present study aims to investigate the neurophysiological effects of recurrent laryngeal nerve and thoracic vagus nerve on the non-cholinergic regulation of neurogenic plasma extravasation of the rat trachea, bronchi, and esophagus. Through thoracotomy, three nerve components, the right thoracic vagal trunk, thoracic vagus nerve, and recurrent laryngeal nerve, were identified. The experiment was sequentially conducted in four steps. First, the individual nerve component was electrically stimulated and the induced inflammatory responses, as quantified by the area density of India ink-labelled blood vessels in the trachea, bronchial trees and esophagus, were compared. Second, we assessed the relative importance of medial and lateral side of the right thoracic vagus nerve in inducing the inflammatory responses by alternative stimulation of one side with simultaneous severance of the other side of this nerve. Third, we examined the effects of transection of the lateral half of the right thoracic vagus nerve on the degeneration of axon fibers located at the following three sites: the nerve segment proximal to cutting site, bronchial and esophageal nerve branches. Finally, we directly observed the inflammatory histopathology of the right lower trachea after stimulation of the medial half of the right thoracic vagus nerve with transection of its lateral half. In this study, we found that the right recurrent laryngeal nerve was predominant in mediating the neurogenic inflammatory responses of upper and dorsal portions of trachea, whereas the right thoracic vagus nerve was predominant in mediating those of the right lower ventral wall of trachea, right main bronchus, and right lobar bronchial trees. The axon fibers of the right thoracic vagus nerve responsible for mediating the neurogenic inflammatory responses of the right lower ventral trachea were mainly accumulated in the medial half, whereas those innervating the right main bronchus, right lobar bronchial trees, and lower esophagus were largely in the lateral half of this nerve. Transection of the lateral half of the right thoracic vagus nerve resulted in significant degeneration of myelinated fibers in its bronchial and esophageal nerve branches. Histopathological examination of the right lower trachea after electrical stimulation of the medial half of thoracic vagus nerve demonstrated the silver-stained leaky venules with accumulations of inflammatory cells. We thus concluded that afferent C-fibers to upper and dorsal portions of trachea were mainly from recurrent laryngeal nerve. In contrast, the neurogenic inflammatory responses of the right lower trachea were predominantly mediated by the medial half of the right thoracic vagus nerve, and those of the right main bronchus, bronchial trees and lower esophagus were largely by the lateral half of this nerve.

Animals↗