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PubMedDate not supplied

Sodium retention from mouthwashes.

Sodium intake from food and other sources must be carefully monitored in patients with hypertension and other disorders. Retention of sodium was measured during routine use of three commercially available, nonprescription mouthwashes: Cepacol, Plax, and Viadent. A test group of 17 adults rinsed with 15 ml of the three mouthwashes, and with 5% saline and distilled water as experiment controls. Sodium not recovered in the expectorate was considered to be retained for absorption by oral or other tissues. The sodium in each product (in mg/l) varied widely: Viadent, 144; Cepacol, 410; and Plax 5320. The analyzed expectorate revealed approximately 33% of the sodium in the 15 ml used for rinsing was retained, amounting to 0.7 mg for Viadent, 1.9 mg for Cepacol, and 28.3 mg for Plax. The results indicate that persons on sodium-restricted diets should be aware that some brands of mouthwash may be a potentially significant source of sodium.

Adult↗
PubMed1989

[Patients hospitalized with pulmonary tuberculosis presenting Koch's bacillus in direct sputum examination. Clinical, radiologic and bacteriologic characteristics].

To determine the influence of socio-economic, clinical and radiological factors on the detection of a Mycobacterium tuberculosis-positive direct sputum smear, we studied 531 patients hospitalized for pleuropulmonary tuberculosis over a 5 year period. M. tuberculosis positivity of the expectorate smear was found more frequently in clinically detected (43%) than in radiologically detected (26%) tuberculosis (P less than 0.001). On admission, a M. tuberculosis-positive sputum smear was more common in patients under 40 years old (P less than 0.02), blacks (P less than 0.05) and alcoholics (P = 0.001). M. tuberculosis positivity on direct sputum smears was more often associated with general (asthenia, sweating, fever greater than 38 degrees C) and functional respiratory symptoms (cough and sputum production) (P less than 0.003), bilateral diffusion of lung lesions and/or excavation on chest roentgenography (P less than 0.0001). Nevertheless, 21% of the asymptomatic radiologically detected tuberculosis patients had positive direct expectorate smears and should be considered contagious.

Adult↗
PubMed1989

[Diagnosis of mucociliary insufficiency].

The data on the diagnosis of mucociliary insufficiency (MCI) are reviewed for patients with chronic obstructive pulmonary diseases. MCI is characterized as the condition of more rapid accumulation of bronchial secretion in comparison to its evacuation, the residual secretion being the cause of the onset of the obturation syndrome. It is suggested that MCI detection be determined by expectoration time--the time of bronchial secretion evacuation following inhalation of the indicator substance. Two methods of mucociliary transport assessment are compared: the modified one and that by autologous hemoglobin. The compatibility of the results is thought evidence of a valid assessment of mucociliary transport by expectoration time.

Hemoglobins↗
PubMed1988

Invasive procedures in the diagnosis of pneumonia.

The etiology of respiratory infections can be elusive despite the recent advances in diagnostic technology. Thereby, the clinician needs a systematic approach for a definitive early diagnosis. This review presents the pros and cons of various invasive procedures in order to select the most appropriate diagnostic method. Expectorated sputum, the important initial step in community-acquired pneumonia, is unreliable in complex pneumonias, mainly because of colonization of the oropharynx. Even though blood cultures are frequently negative, they provide a precise diagnosis and should be obtained in undiagnosed pneumonias. Transtracheal needle aspiration has few false-negative results. However, its use has decreased because of the high frequency of false-positive cultures and risk of serious complications. Bronchoscopy provides direct access to both the bronchi and parenchyma for visualization and sampling. Plugged telescoping catheter brush, used safely in different clinical settings, has good sensitivity in identifying the pathogen, but the specificity varies with the underlying status of the patient. Because of upper airway contamination, bronchial washings are only slightly better than expectorated sputum. A newer technique, transbronchial needle aspiration, is, thus far, no improvement over the plugged telescoping catheter brush. In the immunosuppressed patient, bronchoalveolar lavage has excellent diagnostic accuracy for opportunistic infections. The accuracy increases with the addition of transbronchial biopsy. Transthoracic needle aspiration gives decisive information with low false-positive results. With the ultrathin needle, the complications decrease. Renewed interest in thoracoscopy-guided biopsy has demonstrated a high diagnostic accuracy with low complication rate. One procedure, a combination, or improvements of these procedures may reduce the need for open lung biopsy. Nevertheless, an open lung biopsy furnishes the best specimen for making a histological and microbiological diagnosis, although controversy exists regarding any improvement in survival rates.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Effect of mukodin on indices of mucociliary transport].

The authors report some data on the assessment of efficacy of mucodin, a modern expectorant. Its effect on the rate of mucociliary transport, rheological properties of sputum was studied in patients with infectious-allergic bronchial asthma. Administration of mucodin improves bronchial clearance promoting normalization of bronchial permeability; a positive time course of viscid-elastic indices of the sputum is noted in comparison with the control group. The drugs make no effect on the adhesive properties of sputum. Probable mechanisms of expectorant action of mucodin are discussed.

Adhesiveness↗
PubMed1987

[Significance of the presence of Candida sp. in bronchopulmonary secretions. Contribution of pulmonary biopsy].

Candida SP is often found in broncho-pulmonary secretions (expectorations, bronchial aspirations, bronchiolo-alveolar lavage...); however, its presence even in massive amounts, is difficult to interpret. Is it a sign of broncho-pulmonary candidosis or mouth-pharynx contamination? The different clinical and biological elements, in particular immunology in immunodepressed patients, bring little information. In this article, we present the retrospective study of 18 patients hospitalized in Pneumology Department of Tenon Hospital for severe extensive pneumopathy of unexplained origin. In these patients, for the most part immunodepressed, Candida sp was found in large amounts in at least a sample (expectorations [5] and/or bronchial aspirations [4] and/or bronchiolo-alveolar lavage [12]. No lesion suggestive of candidiasis was found during bronchial endoscopy carried out for these different samples. In pulmonary biopsy with diagnostic in view, these yeasts were found only in one patient. In this patient, as C. tropicalis was associated with Pneumocystis carinii and Cryptococcus neoformans, it was difficult to know the respective part of each of these agents in pulmonary symptomatology. In the other 17 cases, the direct examination and cultures were negative. The presence of Candida sp in the different broncho pulmonary secretions is not synonymous of bronchopulmonary candidiasis; likely it is, in most cases, a sign of contamination of mouth-pharynx origin.

Adolescent↗
PubMed1977

Bacterial sputum cultures. A clinician's viewpoint.

The expectorated sputum and transtracheal aspiration bacterial culture data presented by Murray and Washington were reanalyzed after removing several species unlikely to cause pneumonia in adults. After these exclusions, mean numbers of species isolated per specimen were not excessive. Those specimens with more than 25 leukocytes per field (groups 3, 4, and 5) has similar numbers of isolates per specimen (1.04, 1.05, and 1.05) compared with those with fewer than 25 leukocytes per field (groups 1, 0.57, and 2, 0.59). For this reason and others, it is recommended that expectorated sputum samples be accepted for bacterial culture if they contain more than 25 leukocytes per field.

Bacteria↗
PubMed1987

Glottic closure and high flows are not essential for productive cough.

For about 150 years, there has been emphasis on the importance of glottic closure and high flows in coughing. During voluntary coughing in normal subjects, the main expiratory flow usually begins as thoracic and abdominal pressures are rising. However, sometimes it starts at peak pressure whereas at other times flow and pressure rise together. Plateau flow in single coughs remains relatively constant in the face of large changes in pressure. In a group of coughs following a single inspiration, the fall in pressure is less during plateau flow. Consequently, for the same oral flows, it is likely that the mean linear velocity in the intrathoracic airways will be greater than in a single cough. Recordings have also been made of early morning involuntary coughing in patients with obstructive airways disease. Flow, volume and sound were recorded and sputum expectoration was noted. Sputum expectoration usually occurs after groups of coughs following single inspirations. Hence the movement of the equal pressure point peripherally may be important. These patients have very low flows and yet their coughs are productive. Sound often occurs during the whole of the low flow period immediately before the main expulsive phase. This could only occur if the glottis was open. Thus productive cough can occur without glottic closure and with low airflows.

Asthma↗
PubMed1966

An inhibitor of cholesterol biosynthesis and the alveolar macrophages.

An accumulation of lipid material was observed in the alveolar macrophages of animals treated per os with an inhibitor of cholesterol biosynthesis (trans-1, 4-bis) (2-dichlorobenzyl-aminomethyl) cyclohexane dihydrochloride: AY-9944). This lipid is probably 7-dehydro-cholesterol which is a precursor of cholesterol and accumulates in various organs, especially in the lungs. In the rats and pigs the reaction is limited to the alveolar macrophages which are expectorated or degenerate. In dogs some of the alveolar macrophages are also expectorated while others continue to collect a cholesterol-like lipid until large crystals form, which provoke the formation of giant cells and later fibrocytes, giving rise to "cholesterol granulomata".

Animals↗
PubMed1979

Elimination of test particles from the human tracheobronchial tract by voluntary coughing.

The effect of coughing on the elimination of inhaled 6 micrometer radioactively tagged teflon particles in humans was studied by external measurements of the radioactivity retained in the lungs before and after 1--2 min of voluntary coughing. In six healthy subjects coughing produced no substantial elimination of the particles. Six out of eight patients with lung disease produced expectorate and also eliminated particles from the lungs by coughing. The other two patients had no phlegm, did not produce any expectorate and did not eliminate particles by coughing. An increased amount of tracheobronchial secretion thus seems to be necessary for coughing to be effective. In the patients, the elimination of particles by coughing was fairly reproducible, suggesting that the test model may be useful for investigation of the influence of physiological and pharmacological factors on the elimination process.

Adult↗
PubMedDate not supplied

[Clinical trial of amoxycillin in chronic bronchitis and bronchial dilatations].

The therapeutic results were followed of amoxycilline after application in 57 cases of chronic bronchitis and bronchial dilatations that had been treated previously with antibiotics (including ampicillin--in 37 cases). The amount of amoxycilline was of 2 g per day, given in four 0,5 g doses. A total of 23,3 percent "very good" results were obtained (expectoration either disappeared completely or was reduced to 2--3 ml per day), and 40,4 percent "good" results (with expectoration down to less than one half of the initial amount). Thus in two-thirds of the cases the results were favourable. The cases that did not respond to ampicilline gave only 10,8 percent "very good" results but the "good" results represented 51,3 percent, indicating an increased efficiency of the new drug as compared with ampicilline. The serum levels of Amoxycilline (9,4 mg/ml after 2 hours, and 4,4 mg/ml after 4 hours), when a 0,5 g dose was given every 6 hours, assure a continuous and efficient bacteriostatic concentration. No significant adverse reaction were noted.

Amoxicillin↗
PubMedDate not supplied

[Long-term study of the evolution of chronic bronchitis detected by questionnaire 10 years earlier].

The longitudinal study carried out in a group of inhabitants from Craiova showed that 16,2% of these, classified according to previously filled questionnaires as suffering from chronic bronchitis, and 10,7% of those classified as suffering from minor forms of bronchitis (sporadic symptoms) had died, and one third of them were not found when the investigation was repeated. Re-examination of 106 adults with chronic bronchitis showed that the symptoms had disappeared in two-thirds of them, especially in those who gave up smoking; in 19,8% of them the symptoms had become more severe due to repeated attacks. Bronchial obstruction was present in 36% of the cases, and alterations in the small bronchial ducts were present in two-thirds of the patients. In 18-24% of the patients with minor forms of bronchitis the symptoms were more severe and chronic, and they can be classified as chronically ill patients. Frequently there were altered spirographic values. This study demonstrates that chronic bronchitis may evolve to: a) remission of the symptomatology (especially after suppression of smoking); b) more or less unmodified persistence of symptoms; c) increased severity of the symptoms following repeated acute attacks. Almost 25% of cases with sporadic coughing and expectoration became chronically ill over a period of 10 years. The questionnaire was demonstrated as having retrospective value for making a diagnosis of chronic bronchitis, but cough and expectoration are not sufficient for a differential assessment of the evolution, the spirographic data being of decisive importance.

Bronchitis↗
PubMed1984

Improving the ketchup bottle method with positive expiratory pressure, PEP, in cystic fibrosis.

We studied the acute effects of 4 different chest physical therapy regimens using a randomised cross-over design in 14 patients with cystic fibrosis. Treatment A consisted of postural drainage, percussion and vibration; treatment B of postural drainage and periodic application of a face mask with positive expiratory pressure (PEP); treatment C of PEP in the sitting position; treatment D of the forced expiration technique in the sitting position. In terms of sputum expectorated, treatments B and C were superior to treatment D and especially to treatment A (p less than 0.05). Skin oxygen tension, PSO2 was monitored continuously during and for 35 min after treatment. A substantial and prolonged decay in PSO2 was observed during treatment A, quite different from other patterns seen. During and even following treatment C, an increase in PSO2 was noted. PEP was well accepted by the patients, who preferred treatment C, and we suggest it is incorporated in chest physical therapy regimens if the therapeutic objective is to increase expectoration.

Adolescent↗
PubMed1983

[Changes in glycoprotein composition of the tracheal submucosal glands caused by S-carboxymethylcysteine treatment].

The mechanism for the expectorant effect of S-carboxymethylcysteine (S-CMC) was investigated histologically and histochemically using isolated canine trachea. Following S-CMC treatment, the number of total glycoprotein-containing goblet cells (GC) did not change. The numbers of acid glycoprotein (AGP)-, neutral glycoprotein (NGP)-, and sulphated glycoprotein (SGP)-containing GC were also unaltered in a concentration range of 10(-7) to 10(-4) M. On the other hand, the ratio of the acinar inner diameter of submucosal glands (SG) to the tracheal wall thickness significantly increased with 10(-5) and 10(-4) M S-CMC, and the thickness of the acini of SG significantly decreased with 10(-4) M S-CMC. Although the ratio of the numbers of AGP-to NGP-containing glandular cells and AGP content in the cells did not change, the number of SGP-containing glandular cells significantly decreased with 10(-4) M S-CMC, and SGP content in the cells significantly decreased concentration-dependently High concentrations (10(-5) and 10(-4) M) of S-CMC produced increases in total saccharide, protein and N-acetylhexosamine concentrations in the incubation fluid. These findings suggest that S-CMC has a selective secretagogic action on SG, and an action which alters the composition of AGP, a chief viscous factor, in the mucous granules of SG. The expectorant effect of this agent may, at least in part, be ascribable to these actions.

Animals↗
PubMed1984

Rheology of sputum collected by a simple technique limiting salivary contamination.

Rheological studies of sputum are often considered unreliable because expectorated secretions can be contaminated by saliva. The in vitro dilution of gel mucus by 50% of saliva results in a marked decrease in apparent viscosity and elasticity. A simple technique for collecting sputum "protected" from salivary contamination is described. It consists of using dental cotton-wool swabs placed immediately before expectoration between the cheek and the gum and under the tongue to absorb saliva. The rheological and transport properties of sputum, collected by the protected and unprotected technique in 20 patients with either recurrent or chronic bronchitis, are compared. The protected sputum samples are characterized by a significantly lower pourability (p = 0.02) and sol phase percentage (p = 0.01) and a higher apparent viscosity (p = 0.05). A marked, although not significant, increase in viscoelastic modulus is also noticed with the protected sputa. No difference is observed in the mucociliary transport velocity according to whether the sputum is protected or not. The reproducibility and reliability of the measurements are considerably improved when sputum is collected by the protected technique. The ratio of inter- to intrasample variability is twice to three times as high for the unprotected samples.

Humans↗
PubMed1983

Transtracheal aspiration in pulmonary infection in children with cystic fibrosis.

Six transtracheal aspirations (TTA) and expectorated sputum specimens were collected from four children suffering from cystic fibrosis who had pulmonary infection. Specimens obtained from both sites were cultured for aerobic bacteria and TTA aspirates were also cultured for anaerobes. Differences in bacteria isolated in TTA and sputum aspirates were present in all instances. Six isolates were recovered in both sites (three Pseudomonas aeruginosa, two Staphylococcus aureus and one Aspergillus flavus). Five aerobic isolates were recovered only in the expectorated sputum and not in TTA aspirations (two Klebsiella pneumoniae and one each of P. aeruginosa, Escherichia coli and Proteus mirabilis). Nine organisms were isolated only from the TTA (two each of Veillonella parvula and Alpha hemolytic streptococci, and one each of Bacteroides fragilis, B. melaninogenicus, Lactobacillus sp., Haemophilus influenzae and Gamma hemolytic streptococci). The recovery of anaerobic organisms from four of the six TTA specimens suggests a possible role for these organisms in the etiology of pulmonary infection in cystic fibrosis. We found TTA to be helpful in the bacterial diagnosis and management of pulmonary infections in cystic fibrosis.

Adolescent↗
PubMed1981

[Pharmacological effects of N-acetyl-L-cysteine on the respiratory tract. (I). Quantitative and qualitative changes in respiratory tract fluid and sputum (author's transl)].

The following three experiments were performed to determine the effects of N-acetyl-L-cysteine (NAC) on the quantity and quality of respiratory tract fluid (RTF) and sputum. All drugs used were administered into the stomach through a gastric tube. 1) Indirect measurement of bronchial secretion in rats, which was expressed by the amounts of dye excreted into the respiratory tract, was carried out according the the Sakuno's method, with some modification. Some expectorants of the secretomotor type, such as bromhexine and pilocarpine, significantly increased the secretion, even at low doses. On the other hand, mucolytic agents such as NAC augmented the secretion only in doses of 500 to 1500 mg/kg. 2)As a direct method of measurements, Kasé's modification of Perry and Boyd's method was used to collect RTF, quantitatively, from rabbits. The RTF of healthy rabbits was colorless and watery. The administration of NAC in doses of 500 to 1500 mg/kg augmented the output volume and RTF became slightly turbid, probably due to an increase in the viscous mucus. 3) Rabbits with subacute bronchitis were prepared by long-term exposure to air contaminated with SO2 gas and sputa were collected before and after administration of NAC, respectively, according to the Kase's method. The sputa were opalescent and viscous gel included nodular masses. The administration of NAC, 1000 and 1500 mg/kg resulted in a dose dependent decrease in the relative viscosity. The percent-decreased in viscosity with NAC was statistically correlated with that in amounts of dry matter, those in protein and polysaccharide in the sputa. From the results described above, it was concluded that NAC given into the stomach can liquefy sputum by splitting mucoprotein disulphide linkages, that is, altering the rheological characteristics of sputum to facilitate expectoration.

Acetylcysteine↗
PubMed1980

[Effects of cysteine compounds on antibiotics I. Effects of L-cysteine and its derivatives on the potency of antibiotics (author's transl)].

Various derivatives of L-cysteine obtained by conversion to an -S-S- bond in the mucoprotein by means of -SH in the chemical structure are widely used as expectorants because they show mucous dissolving action. Recently, there have been reports that L-cysteine derivatives lower the potencies of various antibiotics. Various types of antibiotics and cysteine-type expectorants are often used concomitantly for the treatment of bacterial infections in respiratory tract diseases, and any decrease in the antibiotic potency presents a major therapeutic problem. We investigated the effects of four cysteine derivatives on 12 antibiotics, ampicillin (ABPC), amoxicillin (AMPC), sulbenicillin (SBPC), cefazolin (CEZ), cephalexin (CEX), cephalothin (CET), oxytetracycline (OTC), doxycycline (DOTC), minocycline (MINO), erythromycin (EM), ribostamycin (VSM) and lincomycin (LCM), widely used clinically in vitro with the minimum inhibitory concentration (MIc) obtained by the liquid dilution method as an index. L-Cysteine, acetylcysteine, ethylcysteine and mecysteine lowered the potencies of almost all of the antibiotics at high concentrations (500 mcg/ml), but at low concentrations (12.5 mcg/ml), mecysteine lowered the potencies of only three antibiotics and L-cysteine those of only four antibiotics, while acetylcysteine decreased the potencies of six and ethylcysteine those of seven antibiotics.

Anti-Bacterial Agents↗