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The comparison of respiratory resistance and occlusion pressure in alcohol dependent patients who complain or not of the respiratory system disorders.

Alcohol abusers often complain of respiratory symptoms. The aim of the study was to analyse the respiratory pattern parameters and occlusion pressure in chronic alcoholics who complained of respiratory symptoms vs. those who did not suffer from any symptoms before the admission. Also dynamics in changes of spirometry parameters and respiratory pattern parameters during controlled, absolute abstinence while hospitalisation in the Detoxification Unit of the Department of Clinical Toxicology was evaluated. There were 124 study patients: 84 ethanol dependent patients and 40 healthy subject not dependent on ethanol (control group). Ethanol dependency was diagnosed using ICD-10 criteria. The questionnaire according to Fletcher was gathered for each of the subject. The positive results of Fletcher questionnaire (chronic cough + chronic expectoration) was obtained in 43 of the ethanol abusers-group I. The rest of abusers who did not complain of any respiratory symptoms was included to the group II. Respiratory tract resistance was significant the differential factor between the patients with positive results of Fletcher questionnaire and patients who did not suffer any symptoms before admission. Significant differences in occlusion pressure values, were noted between the group of abusers with and without the respiratory symptoms both in the first and control examination.

Adult↗

[A randomized comparative study of 3 days of azithromycin treatment and 10 days of cefuroxime treatment in exacerbations in patients with chronic obstructive pulmonary disease].

BACKGROUND: The aim of this study was to prospectively evaluate the clinical and gasometric evolution and the side effects of two treatment schedules in the exacerbations of patients with chronic obstructive pulmonary disease (COPD): 500 mg/24 h of azithromycin (AZM) for three days versus 500 mg/12 h of acetyl cefuroxime (ACF) for 10 days. PATIENTS AND METHODS: Patients were randomized included into each therapeutic schedule. The patients were seen three times (days 1 and 4, and at 15-21 days) to evaluate clinical symptoms scores. Forced spirometry and arterial gasometry were performed the first and the last time the patients were seen. The number of patients requiring admission during follow up and the secondary effects of each antibiotic were quantified. RESULTS: A total de 50 patients were treated with AZM and 51 with ACF. The evolution of the symptoms was similar although with a trend to greater improvement in those treated with AZM. This improvement was significant for the characteristics of expectoration (p < 0.05). Functional and gasometric evolution was similar in the two schedules. Three patients treated with AZM required hospital admission, as did 5 treated with ACF. A greater number of secondary effects were observed in patients treated with ACF (18%) than in those receiving AZM (10%), with gastrointestinal side effects being the most commonly observed. CONCLUSIONS: Treatment with short schedule of AZM may have the same activity as longer schedule of ACF, with fewer secondary effects thereby suggesting that AZM may be an effective alternative in the treatment of exacerbations in patients with COPD.

Administration, Oral↗

The prescribing pattern of outpatient polyclinic doctors.

OBJECTIVE: This study aims to analyse the prescribing pattern of doctors working in a government outpatient polyclinic in Singapore. DESIGN: Retrospective study of 1 week of prescription scripts in 1996. MAIN OUTCOME MEASURES: Number, types and duration of drugs prescribed; combination of drugs; age distribution; bad handwriting. RESULTS: Two thousand six hundred and seventy-nine scripts were analysed. The age of patients ranged from 1 to 93 years with a mean of 43.8 years. There were 44.0% males and 56.0% females. The overall mean of 'total number of drugs prescribed' was 2.8 items. The means of 'number of drug items prescribed for more than 1 week' by age-group were: < 20 years = 0.2, 20 to < 40 years = 0.5, 40 to < 60 years = 1.3 and > 60 years = 2.4. One way analysis of variance showed significant difference between the means of each age-group. Post hoc analysis revealed that the oldest age group accounted for most of this significant result. The top 10 drugs prescribed in descending order were: antihistamines, paracetamol, throat medications (eg. lozenges, gargles, etc), nifedipine, beta-blockers, antacids, mist benadryl expectorant, Procodin cough syrup (containing codeine and promethazine), amoxycillin and vitamin B. Nifedipine and beta-blockers were the most commonly prescribed anti-hypertensives. Non-steroidal anti-inflammatory drugs were usually prescribed with antacids. One hundred and twenty (4.5%) scripts were illegible. CONCLUSION: This study provides a baseline data for monitoring future prescribing trends. There may be a need to re-evaluate the appropriateness of nifedipine as the first line anti-hypertensive drug and the usefulness of NSAID-antacid and amoxycillin-cloxacillin combinations. The prevalence of illegible handwriting was high.

Adolescent↗

[Recent progress on the therapy for chronic obstructive pulmonary disease (COPD)--usefulness and practice of the step-by-step pharmacologic therapy].

Recently, a step-by-step pharmacologic therapy for chronic obstructive pulmonary disease (COPD) has been recommended by several principal organizations. The characteristic of this therapy is that it is a stepwise approach organized according to the severity of disease and is mainly composed of bronchodilators including beta 2-agonists and anticholinergic agents, theophylline, and oral corticosteroids, and the goal of this therapy is to induce bronchodilation, decrease the inflammatory reaction, and facilitate expectoration. Since the effectiveness of one of the inhaled corticosteroids has been also indicated by the multicentre randomised trial in a few years, they may have an important role in the long-term treatment of COPD.

Administration, Inhalation↗

[Pathophysiology and management of pulmonary emphysema].

The predominant physiological abnormalities of pulmonary emphysema are chronic airway obstruction, hyperinflation of the lung, decrease of lung elastic recoil, and impaired gas exchange. Patient who still smokes must be advised and supported in an effort to stop smoking before medical treatment. The treatment goals are to induced bronchodilation, decreased the inflammatory change and promote expectoration to prevent the progressive deterioration in lung function and improves quality of life. Inhaled beta 2-agonists, anticholinergics, and oral theophylines, as bronchodilators improved exertional dyspnea and exercise tolerance. Inhaled and oral corticosteroids have an anti inflammatory effect for chronic airway inflammation. Comprehensive respiratory treatments including home oxygen therapy and rehabilitation are also successfully applied for these patients.

Adrenergic beta-Agonists↗

Usefulness of video-assisted thoracic surgery (Two Windows Method) in the treatment of lung cancer for elderly patients.

BACKGROUND: We have been performing it less invasively by making just two, small skin incisions (Two Windows Method) for lung cancer surgery. We assess the usefulness of VATS by the Two Windows Method in elderly patients. METHODS: The subjects were 32 of the 75-year-old or older patients with primary lung cancer in our department. We assessed cases in which thoracotomy was performed and the cases in which VATS by Two Windows Method was performed, and compared postoperative complications, hospital deaths, and postoperative length of stay. RESULTS: Operations by video-assisted thoracic surgery (VATS) by the Two Windows Method were completed in 20 of the 32 patients, and a conversion to thoracotomy was done in two patients (rate 9%). Ultimately, thoracotomy was performed in a total of 12 cases, including these two. In the thoracotomy patients, the most common postoperative complication was pneumonia/atelectasis (4 cases) secondary to poor sputum expectoration. There were 2 hospital deaths due to septicemia, and there was 1 due to pulmonary artery embolism. In the VATS patients, the rate of occurrence of postoperative complications was 30%, and clearly lower than the 67% among the thoracotomy patients (p<0.05). No hospital death occurred among the VATS patients. The postoperative hospital stay of the VATS patients (21 days) was shorter than that of the thoracotomy patients (31 days), (p<0.05). CONCLUSIONS: VATS by the Two Windows Method is safer than thoracotomy, and it should be considered first for lung cancer surgery in the aged.

Adenocarcinoma↗

[Proceedings: Home care in chronic respiratory insufficiency. Indications for the prescription of a home respirator, its various types and possibilities for use].

Justified doubts exist in regard to the effectiveness of a long term home care plan for patients with stable chronic obstructive lung disease (COLD), especially when intermittent positive pressure breathing (IPPB) home care is advocated. Conclusive long term studies are lacking, however. In conjunction with all other possibilities offered by a well organized home care plan, IPPB still appears to be an appropriate therapeutic adjunct in the form of regular airway cleaning 3-6 times per day. This entails repeated inhalations of an aerosol with bronchodilator and surface active humidifier, frequently repeated mobilization of mucus and expectoration, deepening of tidal volume with increase of alveolar ventilation, and consequent amelioration of the arterial blood gases and pulmonary arteriolar resistance. Two simple home care respirators may be useful in carefully selected and cooperative patients with stable COLD and chronic respiratory failure: 1. the Fluidic-Assistor, which is automated, simple to use and sterilize, and inexpensive, but noisy and difficult to adjust for pressure and flow by the patient; 2. the Monaghan 515, which is automated, fully adjustable for pressure and flow by the patient, quiet and of pleasing design but difficult to handle and expensive. A preliminary study of the Minibird 2 with apneustic flow time regulation has been performed with five stable COLD patients. A positive end-inspiratory pressure of 20 cm H2O, an inspiratory time of 3+/-0.5 sec and an apneustic flow time of 1.5+/-0.5 sec were used. An 20 mm Hg fall in blood pressure and additional arterial hypoxemia seemed to be due to a decrease in cardiac output. Also, apneustic flow time did not significantly increase the FEV1 and is therefore not recommended for home care.

Carbon Dioxide↗

Screening and noninvasive testing for pulmonary disease.

Although detection of preclinical disease using screening tests is desirable if earlier treatment improves outcome, the available data show no morbidity or mortality benefit using chest radiography, sputum analysis for Pneumocystis carinii and acid-fast bacilli, or serial measurements of single-breath carbon monoxide diffusing capacity to detect pulmonary disease in asymptomatic persons with HIV. It seems prudent to evaluate asymptomatic patients periodically with a careful history and focused physical examination and to perform only those tests that are likely to alter the plan of management such as tuberculin skin testing, CD4 lymphocyte measurement, and measurement of viral burden. Noninvasive diagnostic studies including chest radiography, arterial blood gas analysis, induced or expectorated sputum analysis, exercise testing, and nuclear scans should be performed if new pulmonary symptoms are observed. The use of these tests should be guided by the clinical presentation and followed, when necessary, by the appropriate invasive studies.

AIDS-Related Opportunistic Infections↗

[Diagnostic and therapeutic aspects of lymphatic tuberculosis: apropos of 42 cases].

We report a retrospective study of 42 cases of lymph node tuberculosis. We noted symptoms of tuberculosis impregnation in 92%, cervical localization in 71%, positive tuberculin intra-dermo-reaction in 77%, and accelerated erythrocyte sedimentation rate in 73% of the cases. Koch bacillus was detected in expectoration, urine or gastric liquid at the rate of 11% of the cases. Lymph node function was suggestive in 4 out of 12 patients, showing giant cells with or without caseum. Lymph node biopsy, performed in 32 patients, was contributive in 94% of them. Another tuberculous localization was found in 14 cases mainly pulmonary (8 cases).

Adolescent↗

The isolation results and the antimicrobial agents susceptibility analysis of Haemophilus from the sputum of the elderly suffering from respiratory tract disease.

OBJECTIVE: To inform the isolation and antibiotics susceptibility results of Haemophilus in the sputum of old men suffering from respiratory tract disease so that the epidemiological information and treatment can be available to physicians. METHODS: Two groups-group A, patients=562, group B, healthy volunteers=57 expectorated specimens of sputum were cultured with a special medium for Haemophilus. The isolates were then identified with API NH Identification plates and detected with ATB NH antibiotics susceptibility cards, finally, we got the statistics data of Haemophilus species and antibiotics susceptibility rates from Datatrac statistic system of VITEK 32. RESULTS: Haemophilus were detected in 132 specimens out of 562 (23.5%), which includes 6 strains of H. influenzae (4.5%). 122 strains of H. parainfluenzae, 4 strains of H. aphrophilus (3.1%). At the same time, 3 strains of Haemophilus were isolated from group B. Following are the susceptibility rates of sixteen antibiotics of 132 strains of Haemophilus, 73.4% to amoxicillin, 92.4% to amoxicillin and clavulanic acid, 83.3% to cefactor, 90.9% to cefotaxime, 79.5% to cefuroxime-axetil, 52.3% to kanamycin, 25.0% to gentamycin, 72.0% to spectinomycin, 79.5% to chloramphenicol, 50.0% to tetracycline, 9.1% to erythromycin, 42.4% to pristhomycin, 49.2% to rosoxacin, 62.96% to pefloxacin, 97.7% to rifampin, 33.3% to sulfonamides. CONCLUSION: There is a high isolation rate of Haemophilus in the sputum of the elderly suffering from respiratory tract diseases, The H. parainfluenzae is the main Haemophilus in our area of study, which it deserves good attention by clinical microbiological laboratory. In addition, the antibiotics susceptibility results indicate that this species is more susceptible to beta-lactams antibiotics and is less susceptible to some others such as macrolides and aminoglycosides, etc. So, the drug treatment should be based on these antibiotics susceptibility results in order to guide the specific therapy.

Aged↗

Antitussive activity of a glucuronoxylan from Rudbeckia fulgida compared to the potency of two polysaccharide complexes from the same herb.

An alkali-extracted low-molecular glucuronoxylan and two water-extractable polysaccharide complexes isolated from various parts of Rudbeckia fulgida were tested for antitussive activity on mechanically induced cough in nonanaesthetized cats. Glucuronoxylan consisted of a (1-->4)-linked beta-D-xylopyranosyl backbone with about 18% of 4-0-methyl-D-glucuronic acid attached to 0-2 of the chain xylose residues. The polysaccharide complexes differed from each the other regarding the in qualitative and quantitative composition of the sugar components. It was found that peroral administration of all the compounds led to a significant suppression of the cough reflex without negative influence on expectoration. Glucuronoxylan and the complex from the aerial parts of the herb exhibited much higher antitussive activity than the complex from the roots which did not contain any uronic acid component. Their activity (48.2% and 46.5%, respectively) highly surpassed the activity of the complex from the roots (23.5%) as well as that of the peripherally acting drugs dropropizine (28.3%) and prenoxdiazine (24.7%).

Animals↗

[Preliminay studies on polyvinyl alcohol gel and its transderman therapeutic system].

By pouring-cooling method, five kinds of hydrophilic gels (starch, agar, gelatin, CMC-Na and PVA) were prepared. The characteristics of preparation, tenacity and elasticiey were compared. Taking the PVA gel which features better characteristics as the carrier a plaster of verapamine hydrochloride and a traditional Chinese antitussive and expectorant in the form of plaster were prepared. The behavior of drug-releasing in vitro and curative effect were preliminarily studied. The results show that the PVA gel may be a fine carrier for transdermal therapeutic system.

Administration, Cutaneous↗

Histologically proven extrinsic allergic alveolitis with severe obstructive pulmonary emphysema

Anamnesis: 61-year old man with progressive shortness of breath on exercise. Cough and expectoration during the last 6 years. - Exposure: Driver of cereals, massive exposure to mouldy and pest contaminated grains. Gave up his profession in 1979 due to dyspnea with short (2-3 h) latency after exposure. Since 1980 intermittent exposure during occasional jobs; renewed symptomatology. Aspergillus fumigatus detected on agar plates inoculated with material from wet areas in bathroom and kitchen. - Clinical symptoms: Barely audible vesicular breathing, barrel-shaped thorax, inspiratory-intercostal retraction. - Bodyplethysmography: Obstructive pulmonary emphysema with FEV1 0.8 l, TLC 7.8 l, RV/TLC relation 67%. - Precipitin-detection: Significantly increased IgG against Fusarium. Other moulds including Aspergillus: negative; thermophilic actinomycetes: negative; pigeon and chicken: negative; Ouchterlony with native material from patients flat: negative. - CT including HR-CT: Bilateral-substantial emphysema, no bullae, no ground glass-opacity, no signs for interstitial lung diseases, no mediastinal enlargement of lymph nodes. - Alpha-1-Antitrypsin: 1.67 to 2.3 g/l (normal range), phenotype M1. - Histology: In resected material from right-side lung-volume-resection detection of pulmonary emphysema as well as lymphocyte infiltration and numerous epitheloid cell granulomas with Langhans'giant cells without caseation assessed as residues of an exogenous allergic alveolitis. - Conclusion: In a patient with lung volume reduction surgery due to severe emphysema histologically a persistent exogenous allergic alveolitis was detected, which might have caused the emphysema.

Journal Article↗

A clinical study of the effect of pellicle on the degradation of 10% carbamide peroxide within the first hour.

OBJECTIVE: The purpose of this study was to determine the degradation of 10% carbamide peroxide within the first hour of use and the effect of pellicle on the degradation of carbamide peroxide in vivo. METHOD AND MATERIALS: Fifteen subjects were assigned to wear nightguard trays filled with bleaching gel for 0.5, 2.5, 5.0, 10.0, 20.0, 40.0, and 60.0 minutes under 2 conditions: (1) subjects did not receive a prophylaxis before each bleaching treatment (pellicle was assumed to be present on the tooth surface); and (2) subjects received prophylaxis to remove pellicle from the tooth surface. At each evaluation time, 3 types of sample were collected: (1) a "grab sample," a sample of gel taken with a spatula from the reservoir of the tray on the maxillary right central incisor; (2) the remaining gel from the tray; and (3) the remaining gel scraped from the teeth. The collected gel samples were analyzed for the amount of peroxide using the United States Pharmacopeia-accepted method. Subjects were asked not to swallow the saliva during treatment but to expectorate into a beaker. The collected saliva was analyzed to determine the amount of peroxide. This sample represented the approximate amount of peroxide that subject would ingest during treatment. RESULTS: Pellicle did not affect the degradation of carbamide peroxide for the teeth or grab samples. The degradation of carbamide peroxide was exponential, except during the first 5 minutes, when the degradation rate was much higher. The saliva collected from subjects during use of the bleaching tray revealed an average of 2.1 mg of carbamide peroxide for 1 hour of bleaching treatment. CONCLUSION: The degradation rate is not affected by the removal of the pellicle.

Analysis of Variance↗

[Use of nebulizer in berodual treatment of patients with chronic obstructive bronchitis in exacerbation].

AIM: To study efficiency and safety of berodual in solution for inhalations delivered with the help of nebulizer in patients with exacerbation of chronic bronchitis (CB). MATERIALS AND METHODS: 12 patients with chronic bronchitis who had not responded to oral methylxantines in combination with expectorants received berodual for 10 days (1 ml 3 times a day). RESULTS: In the course of berodual treatment all the CB symptoms relieved and external respiration function improved. CONCLUSION: Berodual is effective as monotherapy of chronic obstructive bronchitis.

Administration, Inhalation↗

[Early, targeted population based screening for COPD. Preliminary study].

COPD is the fourth leading cause of death in Poland, unfortunately diagnosed not early enough. The aim of the study was to establish prevalence of COPD in chronic smokers. Therefore, using daily press and TV, smokers with at least 10 year history of smoking, over 40 years of age, were invited for a free spirometry. 263 subjects (177 M and 86 F) mean age 54 +/- 0.6 years were examined. Most of them (97.7%) were smokers with a history of 32.2 +/- 0.9 pack-years, 6 persons (2.3%) were passive smokers. 110 persons (41.8%) presented bronchial obstruction, the remaining (58.2%) had normal spirometric values. Following recommendations of the Polish Society of Physio-pneumonology bronchial obstruction was classified as mild in 25.1%,- moderate in 12.1% and severe in 4.6% subjects. Majority of examined subjects presented with COPD symptoms, cough (62.7%), expectoration (68.8%) and dyspnoea (50.2%). The presence of those symptoms did not differ among groups with different severity of bronchial obstruction. However, there were significant differences in age (p < 0.05) and years of smoking habit (p < 0.01). The great efficacy of targeted screening for COPD (40%) should be an incentive to perform routine spirometric examination in smokers with more than 20 years of smoking history.

Adult↗

Collection of buccal cell DNA using treated cards.

We devised a simple, noninvasive, cost-efficient technique for collecting buccal cell DNA for molecular epidemiology studies. Subjects (n = 52) brushed their oral mucosa and expectorated the fluid in their mouths, which was applied to "Guthrie" cards pretreated to retard bacterial growth and inhibit nuclease activity (IsoCode, Schleicher and Schuell, Keene, NH). The cards are well-suited for transport and storage because they dry quickly, need no processing, and are compact and lightweight. We stored the samples at room temperature for 5 days to mimic a field situation and then divided them into portions from which DNA was extracted either immediately or after storage for 9 months at room temperature, -20 degrees C, or -70 degrees C. The fresh samples had a median yield of 2.3 microg of human DNA (range, 0.2-53.8 microg), which was adequate for at least 550 PCR reactions. More than 90% of the samples were amplified in all three beta-globin gene fragment assays attempted. DNA extract frozen for 1 week at -20 degrees C also performed well. Stored samples had reduced DNA yields, which achieved statistical significance for room temperature and -70 degrees C, but not -20 degrees C, storage. However, because all of the stored samples tested were successfully amplified, the observed reduction may represent tighter DNA fixation to the card over time rather than loss of genetic material. We conclude that treated cards are an alternative to brushes/swabs and mouth rinses for the collection of buccal cell DNA and offer some advantages over these methods, particularly for large-scale or large-scale or long-term studies involving stored samples and studies in which samples are collected off-site and transported. Future studies that enable direct comparisons of the various buccal cell collection methods are needed.

Cell Separation↗

[Tuberculosis management unit: 7-year experience].

Between January 1992 and December 1998 we collected clinical, epidemiological and treatment data on all patients diagnosed of tuberculosis in our specialized unit. Five hundred sixty-seven patients (70% male and 30% female) were studied prospectively. The rate of new cases increased until 1995 and decreased during the last three years of study. Mean patient age was 38.8 years, with nearly 64% of patients under 45 years of age. Predisposing disease, mainly chronic alcoholism, was present in 36%. Fifteen percent belonged to a high-risk social group (6.5% were drug addicts and 6.3% lived inside secure institutions). The mean time elapsing from the appearance of symptoms until referral to our service was 80.4 days and the most common clinical picture at presentation was general unwellness with cough and expectoration (46%) followed by hemoptysis (18%). Cavitation was visible in 48.5% of x-rays, while alveolar infiltrates were seen in 33%, pleural effusion in 12% and lymph node involvement in 10%. Adult tuberculosis was diagnosed in 80% of cases, 10% were reactivations and 9% were primary. Bacteriological diagnosis was available for 85%. Therapy usually involved six months with hydrazide, rifampicin and pyrazinamide (81%). Therapy was generally well-tolerated, although analyses revealed some anomalies, such as transaminase alteration (18%) and hyperuricemia (19%). Therapy was changed because of toxicity in only 2.6%. Follow-up after therapy was strict and the rate of successful cure was 97.5%. We conclude that diagnosis was not prompt enough and believe that knowledge of epidemiological, clinical and evolutionary data, as well as monitoring of real rates of cure of treated patients justifies the existence of specialized centers for managing tuberculosis.

Adult↗