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PubMedDate not supplied

Pulmonary tuberculosis presenting with cutaneous leukocytoclastic vasculitis.

This case report deals with a rare association: tuberculosis and cutaneous leukocytoclastic vasculitis. The patient was a 36-year-old man with no significant past medical problems. He presented with a palpable purpura on both legs, low-grade fever, cough and expectoration, progressive dyspnea due to a massive left pleural effusion and a symmetric swelling on his ankles and wrists. Skin biopsy yielded a histological diagnosis of leukocytoclastic vasculitis and the primary diagnosis was only achieved after performing a pleural biopsy, which unequivocally showed the presence of Mycobacterium tuberculosis. This case shares many features with the few cases already reported in the medical literature. Possible pathogenic mechanisms are reviewed and discussed in detail.

Adult↗
PubMed1993

Side reactions following ivermectin therapy in high density bancroftian microfilaraemics.

Side reactions following ivermectin treatment were evaluated in sixty males with high density bancroftian microfilaremia (GM 1388/ml). Following a single oral dose of ivermectin of different strengths (20, 50, 100 or 200 micrograms/kg), microfilariae clearance and side reactions were monitored in a double blind fashion. Microfilaria levels fell rapidly after ivermectin administration in all dosage groups and 98% of pretreatment microfilariae was cleared after 12 h of treatment. The rate of microfilaria (mf) clearance was slower with 20 micrograms/kg than with the highest dose (200 micrograms/kg) administered. Forty-six patients (77%) became amicrofilaraemic within 2 weeks of treatment. Side reactions were noted in 97% of cases. The most common reactions were fever, headache, weakness, myalgia and cough which appeared by 12 h and subsided by 72 h following treatment. The frequency and intensity of side reactions were related to pretreatment mf densities and were independent of the dose administered. Unusual side reactions were noted in a few patients with high density microfilaraemia. These included intense cough, shortness of breath, blood tinged mucoid expectoration associated with patchy pneumonitis of the lung. Itchy rashes, lymphatic nodules and raised alkaline phosphatase level were also observed in some patients. These side reactions were transient, self limiting and were not serious enough to warrant any treatment. These exaggerated unusual reactions were possibly due to allergic response of the susceptible host to rapid killing of large number of microfilariae.

Adolescent↗
PubMed1979

The role of mucociliary dysfunction in bronchial asthma.

Abnormalities of mucociliary function in the airways of patients with bronchial asthma are suggested by the clinical observation of excessive tracheobronchial secretions which are difficult to expectorate and may contribute to bronchial obstruction. Pathologic and functional studies in animals and patients have demonstrated an impairment of mucociliary transport mechanisms, but the pathogenesis of this abnormality is still poorly understood. In patients with allergic asthma, the elaboration of chemical mediators in the lung seems to depress mucociliary function. Although pharmacologic agents which increase mucous transport rates have been identified, more potent stimulators will probably be needed to produce a clinical improvement in patients with bronchial asthma.

Animals↗
PubMed1977

Anaerobic bacteriology of chronic bronchial disease. With a refined method of sampling bronchial secretions.

A refined bronchoscopic method of sampling bronchial secretions is presented. The results show that this gives higher yields of aerobic pathogens than examination of expectorated sputum and the method also avoids pharyngeal contamination in suspected cases of anaerobic lung infection. Our results indicate that anaerobic organisms do not play a major role in causing sputum purulence in patients with chronic bronchitis, bronchogenic carcinoma or with less florid degrees of bronchiectasis. Anaerobic infections did not appear to occur as often as suggested by some reports from the United States.

Anaerobiosis↗
PubMed1988

Chest physiotherapy: time for reappraisal.

Chest physiotherapy should now be updated with attention to three important features: first, its use should be limited to those patients with actual or potential sputum production and its central aim should be to increase expectoration. Second, it should incorporate the forced expiration technique with postural drainage and omit traditional elements such as percussion and vibration. Third, the additional use of inhaled adrenergic agents and possibly oral high frequency oscillation may increase sputum clearance further.

Breathing Exercises↗
PubMed1987

Relationships between the lipid content and the rheological properties of airway secretions in cystic fibrosis.

The lipid composition and rheological properties of expectorated airway secretions have been analyzed in 16 patients with cystic fibrosis (CF), separated into two groups according to whether their secretions were superinfected or not. The total lipid content was higher in the superinfected CF secretions. The content in cholesterol and GL1, GL3 and GL4 glycosphingolipid fractions were significantly higher in the superinfected in comparison to the non-superinfected group. The viscosity was two-fold higher in the CF superinfected group. A significant correlation (r = 0.72, p less than 0.01) was observed between the apparent viscosity and the total lipid content of CF secretions. Cholesterol, glycosphingolipids and sphingomyelin were the lipid components which were the most closely and positively correlated to the viscosity. On the opposite, phosphoglycerol was negatively correlated (r = -0.72, p less than 0.05) to the viscoelastic properties of CF airway secretions.

Adolescent↗
PubMed1984

Respiratory tract fluids: analysis of content and contemporary use in understanding lung diseases.

Respiratory tract fluid, produced from an enormous area spanning the mucosa of the nose to the alveolar surface, is a complex mixture of serum transudate and locally secreted proteins and glycomucoproteins and of inflammatory and immune effector cells intermingled. Its analysis is important in understanding the pathogenesis of respiratory diseases and remains essential for the clinical diagnosis of most lung disorders. Many basic facts about the formation and composition of this fluid remain unknown, and little information exists about absorptive mechanisms along the airways. Respiratory fluid is not homogeneous but has unique regional characteristics that are becoming better appreciated as more selective sampling methods are devised. Above all, it is a dynamic substance in healthy airways and diseased ones, and any specimen is just a point-in-time sample that can change in composition, often making serial analysis and comparisons necessary. Nasal fluids currently have limited diagnostic application except in allergic rhinitis. Expectorant (sputum) telescopes fluid and cells from all areas and is not from a specific locale, so the trend is to retrieve more selective and regional specimens of airways fluids. Technology largely does not exist to collect area specimens, except for bronchoalveolar lavage, which generally samples the alveolar surface. Clearly, bronchoalveolar lavage fluid analysis has been the favored way to characterize the peripheral air-spaces for the past 10 years or so, and most of this monograph has been devoted to normal data derived from lavage specimens and to a few examples of lung disease that reflect this burgeoning application. In many respects, results obtained from lavage fluid are virtually in catalogue form at present, and it remains to the future to know how some of the observations will help make diagnosis better or elucidate pathogenic mechanisms. Generally, bronchoalveolar lavage fluid analysis has led to better concepts of immunopathology of many diseases and provided new ways to monitor the evolution of certain diseases, especially the diffuse interstitial lung disorders, but development of specific criteria for diagnosis has been less rewarding. However, certain patterns of lymphocyte-predominant alveolitis, suggesting sarcoidosis or hypersensitivity diseases, recognition of specific T lymphocyte defects and opportunistic microorganisms as in AIDS, and the use of microprobe electron analysis to identify cellular particulates all point to more precision of diagnosis. Alveolar proteinosis and histiocytosis X may be detected from lavage fluid components. The prospects are truly exciting.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1985

Respiratory infections may reflect deficiencies in host defense mechanisms.

Serious respiratory tract infections are rare in the healthy individual and most of the nuisance morbidity that occurs results from nasopharyngeal viral infections that many people get once or twice a year. The economic impact from these upper respiratory tract infections is appreciable, however, in terms of absenteeism from school or work, but unfortunately there is little that can be done to ward them off in a practical way. Pneumonia is an infrequent lifetime experience for most non-smoking adults and when it occurs, unusual circumstances may pertain--a particularly virulent microorganism is in circulation, or perhaps one has been exposed to a newly recognized germ, such as has occurred with Legionella species in the past 8 years or so. What protects us the great majority of the time is a very effective network of respiratory tract host defenses. These include many mechanical and anatomical barrier mechanisms concentrated in nose and throat; mucociliary clearance, coughing and mucosal immunoglobulins in the conducting airways and in the air-exchange region of the alveolar structures, phagocytes, opsonins, complement, surfactant and many other factors combine to clear infectious agents. The ability to mount an inflammatory response in the alveoli may represent the maximal and ultimate expression of local host defense. In some way these host defenses are combating constantly the influx of micro-organisms, usually inhaled or aspirated into the airways, that try to gain a foothold on the mucosal surface and colonize it. But many general changes in overall health such as debility, poor nutrition, metabolic derangements, bone marrow suppression and perhaps aging promote abnormal microbial colonization and undermine the body's defenses that try to cope with the situation. It is a dynamic struggle. The departure from normal respiratory health may not be obvious immediately to the patient or to the physician and repeated episodes of infection or persisting symptoms of cough, expectoration and sinus or ear infections may develop before serious assessment of the situation is taken and appropriate diagnosis gotten underway. Obvious explanations for respiratory infections may be apparent and, nowadays, side effects from antineoplastic chemotherapy or immunosuppressive therapy for a variety of diseases that create an immunocompromised host are common. In a few subjects, especially young adults who present with a cumulative history of frequent but mild infections in childhood and youth, a subtle deficiency in host defenses may exist and have been partially masked because of attentive pediatric medical care and prompt use of broad spectrum antibiotics.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1987

Salivary response to esophageal acid in normal subjects and patients with reflux esophagitis.

We studied the effect of esophageal acid perfusion on salivation in patients with reflux esophagitis and in normal subjects. Serial 10-min saliva collections were obtained by expectoration during perfusion of the esophagus with water, and then 0.1 N HCl (pH 1.2) for 50 min or 0.01 N HCl (pH 2.1) for 120 min. Within 1-5 min of beginning 0.1 N HCl perfusion, all 8 patients with esophagitis developed heartburn accompanied by an increase in saliva flow. By the time the severity of heartburn required discontinuation of HCl perfusion (10-40 min), saliva flow had increased nearly fourfold. With 0.1 N HCl perfusion, 8 of 10 volunteers developed mild heartburn after 22 +/- 3 min (mean +/- SE), whereas 0.01 N HCl induced heartburn in 6 of 10 volunteers after 57 +/- 12 min of perfusion. Saliva flow increased concurrently with the onset of heartburn and doubled in those volunteers who developed heartburn. Saliva flow did not change in those volunteers who were without heartburn. We conclude that esophageal acid perfusion unaccompanied by heartburn does not affect salivation. However, saliva flow increases concurrently with the onset of heartburn, a phenomenon called "water brash" when clinically evident. The increased saliva flow that accompanies heartburn may act as an endogenous antacid that serves as a protective response to symptomatic gastroesophageal reflux.

Acids↗
PubMed1989

Late sequelae of lung contusion.

Twenty-four patients with severe lung contusion and multiple rib fractures were studied at a mean 4.9 years (range 2-9 years) after injury. All patients had been in good health before the accident. After the accident 15 (63 per cent) patients had respiratory symptoms such as dyspnoea at rest or moderate exercise (4), pain (8), cough or increased expectoration (11) and frequent bronchopulmonary infections (5). Three patients had changed their job because of respiratory disturbance. The average vital capacity, forced expiratory volume in 1 s, maximal voluntary ventilation and CO transfer factor were reduced respectively to 87, 88, 82 and 83 per cent of predicted values (P less than 0.01), while total lung capacity, residual volume and helium mixing time showed no definite changes (P greater than 0.05). Arterial blood gases at rest and at maximum exercise showed slight changes only. Maximal working capacity and ECG, as well as the ventilatory cost of moderate exercise were normal, where as the CO2 recovery time after moderate exercise was slightly increased (P less than 0.05). Overall there was a tendency towards poorer function in patients treated with artificial ventilation. Chest radiographs were normal in 10 patients (42 per cent), and moderate changes were seen in 14 patients. Diaphragmatic movements were essentially normal in all patients. Severe injury to the chest causes frequent respiratory symptoms. However, objective tests were only moderately reduced when compared with normal values. There was no unequivocal association between the subjective symptoms and the pulmonary function.

Adult↗
PubMed1982

Radioimmunoassay for the detection of virus-specific IgA antibodies in saliva.

The use of a sensitive and versatile radioimmunoassay (RIA) for detection of mumps-specific IgA and measles-specific IgA in unconcentrated saliva samples is described. The samples were obtained either by expectoration or by swabbing of the oral cavity, with or without stimulation of secretion, and were inactivated and clarified before testing. Mumps-specific IgA antibodies were detected as early as one day after onset of illness and peaked at 1-2 weeks after onset. Measles-specific salivary IgA antibodies were detected in 15-month old children 2-3 weeks after immunization. These results suggest that the RIA technique may be useful for early diagnosis of viral infections and for confirmation of response to immunization without the need for a blood sample, as well as for the study of the secretory immune response in very young and older subjects.

Acute Disease↗
PubMed1993

Congenital bronchobiliary fistula: management of the involved hepatic segment.

We present three children with congenital bronchobiliary fistula (CBBF). The first infant underwent resection of the fistula at age 3 weeks and was reported as a success. She returned 7 years later with bilious expectoration for which a second thoracotomy was performed. One year thereafter a bile collection in the right chest required open drainage. Subsequently, the left hepatic lobe was resected. The second child was initially diagnosed as suffering from gastroesophageal reflux. He underwent a fundoplication and a gastrostomy at age 9 months. Persistence of bilious sputum led to the diagnosis of CBBF at age 23 months. The fistula was excised through a right thoracotomy. The distal end was injected demonstrating an arborization involving the entire left hepatic lobe. Since there was no communication with the remaining biliary tree or the intestine, a left hepatectomy was performed. The third child was reported in a communication focusing on the diagnosis of CBBF by hepatobiliary scintigraphy. Her history is almost identical to the second patient. However, instead of a hepatectomy, she underwent a Roux-en-Y drainage of the fistula. The three children had uneventful recoveries and are well. We believe that an abnormal biliary tract should be studied by contrast injection. If no decompressing communication with the normal biliary ducts or the duodenum can be demonstrated, the involved hepatic segment should be resected or internally drained. Children who underwent simple fistula excision must have close long-term follow-up.

Anastomosis, Roux-en-Y↗
PubMed1990

An innovative method of monitoring denture hygiene.

A simple and rapid test for measuring oral hygiene was recently developed. It is based on the rate of oxygen consumption of oral expectorates of milk. This investigation modified the test to study denture hygiene. The dentures of 20 patients were immersed in 10 mL of sterile milk. After a 2-minute agitation, 3 mL of milk was added to test tubes containing methylene blue. The time required for color change at the bottom of the test tube, which is indicative of the rate of oxygen consumption, was recorded. For comparison with visual plaque accumulation, the dentures were coated with disclosing solution and the extent of plaque was scored by three examiners. A correlation was found between the plaque index scores and results of the milk test (r = -0.64; p less than 0.005). The data suggests the use of this test to monitor denture hygiene.

Aged↗
PubMed1995

Interaction of salivary flow with temporal perception of sweetness, sourness, and fruitiness.

To explore the effect of salivary flow on perception of sweetness, sourness and fruitiness, 19 subjects continuously recorded perceived intensity from ingestion, through expectoration to extinction of the sensation, for each attribute in solutions sweetened with three levels of aspartame or sucrose at three levels of citric acid. Unilateral parotid flow was collected in response to the solutions at the medium acid level and used to assign subjects to low, medium and high-flow groups. For all three attributes, although the low-flow subjects reached maximum intensity later than high-flow, no significant difference in any time-intensity parameter for any attribute was found among salivary flow groups. No difference in salivary flow was elicited by equi-sweet solutions of aspartame or sucrose. Maximum intensity of sourness and salivary flow rate decreased as the level of sweeteners was raised (at a constant acid concentration) suggesting that salivary flow is mediated by cognitively processed taste response and not only the concentration of stimuli.

Adult↗
PubMed1981

Comparison of bronchial responses to prostaglandin F2 alpha and methacholine.

We examined bronchial responsiveness to prostaglandin (PG) F2 alpha to determine its applicability in clinical practice and to compare it with bronchial responsiveness to the pharmacologically dissimilar agent, methacholine. Inhalation tests with two fold increasing concentrations of the two agents were carried out in 19 asthmatic and four normal subjects. The results were expressed as the provocation concentration causing a 20% fall in forced expiratory volume in 1 sec (PC20). The range of concentrations required to determine the PC20 was greater with PGF2 alpha (0.0001 to less than 5 mg/ml) than that with methacholine (0.07 to 30.96 mg/ml). Side effects of cough, retrosternal irritation, and expectoration of sputum were more frequent after PGF2 alpha. Repeat measurements in the same subjects showed that response to PGF2 alpha were as highly reproducible (r = 0.98, p less than 0.001) as previously reported with methacholine, and there was a cumulative dose effect (p less than 0.001). PC20PGF2 alpha correlated with PC20 methacholine (r = 0.5, p less than 0.01), but to a lesser degree than was previously demonstrated between histamine and methacholine. The poorer correlation was explained by the results of four subjects tolerant to PGF2 alpha relative to methacholine, three of whom were aspirin (ASA) intolerant; the correlation was much stronger when these subjects were excluded from analysis (r = 0.91, p less than 0.001). The results suggests that (1) PGF2 alpha is not a suitable agent to use in clinical practice to measure nonspecific bronchial responsiveness because of the wide dose range and unpleasant side effects, (2) the bronchial responsiveness of different individuals to PGF2 alpha and methacholine is usually well correlated and is thus unrelated to specific receptor activity, and (3) there is a relative reduction in responsiveness to PGF2 alpha in some asthmatics, particularly those with ASA intolerance.

Adult↗
PubMed1982

Grain fever syndrome induced by inhalation of airborne grain dust.

To study the clinical and physiologic manifestations of the grain fever syndrome and the potentially pathogenic role of complement activation, 12 subjects (six grain workers and six healthy non-grain workers) underwent inhalation provocations with airborne grain dust. The clinical response was characterized by facial warmth, headache, malaise, myalgias, feverish sensation, chilliness, throat and tracheal burning sensation, chest tightness, dyspnea, cough, and expectoration. Fever developed in four grain workers and two controls. Leukocytosis, ranging between 11,700 and 24,300 leukocytes/mm3 with left shift, developed in five grain workers and five controls. There was no evidence of complement activation by the classical or alternate pathway. None of the subjects had serum precipitins to grain dust. The pulmonary response was characterized by a decrease in FEV1, FVC, MMF, Vmax50, and Vmax75, with significant rise in pulmonary resistance and consistent change in dynamic compliance but without changes in static compliance or diffusing capacity. Hence, grain dust inhalation induced diffuse airways obstruction without detectable parenchymal reaction. The airways response to high concentrations of grain dust inhalation were unrelated to the presence of immediate skin hypersensitivity. Although we cannot exclude the etiopathogenetic role of an immunologic reaction to grain dust, our data do not support the hypothesis that the grain fever syndrome is a precipitin-mediated allergic pneumonitis. More likely, the manifestations of grain fever probably reflect the host reaction to grain dust bacterial endotoxins and/or nonallergic mediator release by grain or grain dust constituents.

Adult↗
PubMed1988

Sinusitis in adults and its relation to allergic rhinitis, asthma, and nasal polyps.

Sinusitis, an infection of the paranasal sinuses, has been linked to allergic rhinitis, asthma, and nasal polyps. Sinusitis is a common complication of allergic rhinitis, which can lead to inflammation of the sinus mucosa, obstruction of the sinus opening or ostium, and generally favorable conditions for bacterial growth. Sinusitis can trigger asthma. Stimulated nerves in an infected sinus may result in parasympathetic stimulation to the bronchial tree and in smooth muscle contraction. Sinusitis may be a cause of nasal polyps, which are common when sinusitis complicates allergic rhinitis and even more common in nonallergic rhinitis. Treatment of sinusitis strives to eliminate infection and promote drainage. Ampicillin or amoxicillin is the antibiotic of choice. All patients with sinusitis should be treated with antibiotic to encourage drainage. Fluids, expectorants, and decongestants, both oral and topical, should be used. As many as half of patients with sinusitis also have marked rhinitis (either allergic or nonallergic), nasal polyps, or swollen, edematous mucosa; these patients should also receive topical steroids, such as flunisolide. Flunisolide promotes drainage and aeration by decreasing inflammation, swelling, and the influx of white blood cells. Persistent sinusitis may need to be treated surgically.

Adult↗
PubMed1991

Respiratory mucus hypersecretion (bronchorrhea): a case discussion--possible mechanisms(s) and treatment.

The mechanism(s) underlying mucus hypersecretion (bronchorrhea) and the treatment of this condition are poorly understood. We have previously demonstrated that erythromycin inhibited mucus secretion from human airways and from secretory epithelial cells in vitro. We encountered a patient with airway obstruction marked by severe bronchorrhea, who previously had responded only to inhaled bronchodilators and high-dose prednisone. Many attempts to wean him from prednisone had failed. During the course of his disease, he had developed an IgG antibody to vasoactive intestinal peptide, had increased amounts of mucus secreted by his respiratory epithelial cells, and demonstrated hyperreactive airways as measured by methacholine challenge provocation test. Erythromycin was added to his therapy. The effect of erythromycin treatment was quite dramatic and included clinical and laboratory improvement. After a short trial of erythromycin, the patient tolerated low, every-other-day doses of prednisone. there was a significant reduction in the volume of his bronchorrhea, a major decrease in the epithelial mucins in his total expectorated mucus, complete inhibition of his airway hyperresponsiveness to inhaled methacholine, and significant reduction in the level of IgG antibody to vasoactive intestinal peptide. This response was specific for erythromycin since other antibiotics did not have any clinical, biochemical, or physiologic effects. We conclude that erythromycin may play a role in the treatment of patients with bronchorrhea and may have a steroid-sparing effect. Additional studies with larger numbers of patients are indicated.

Aged↗